Arthroscopic capsular release is more effective in pain relief than conservative treatment in patients with frozen shoulder

BACKGROUND

Frozen shoulder is a common medical condition, but the ideal therapeutic method is yet to be determined. Our aim was to analyze the pain-relieving effect of different treatment options used for the management of this disease.

METHODS

Medical records of 59 patients (22 male, 37 female, average age: 55.5 years ±9.9) with early stage primary frozen shoulder were evaluated, their demographic data, physical examination, concomitant diseases and treatment specific data were registered. Life quality and the level of pain were assessed using the Oxford Shoulder Score (OSS) and Numeric Rating Scale (NRS). Different treatment modalities and their effect on pain relief were recorded. Any existing correlation between life quality, pain and demographic data, concomitant diseases or the therapeutic method used was investigated.

RESULTS

The level of pain measured on NRS improved from 7.9 ± 1.6 to 1.9 ± 2.2. The most effective therapeutic method in terms of pain relief was surgery, followed by physiotherapy and intraarticular steroid injection (NRS score after treatment: 2 - p < 0.0001; 3.3 - p < 0.0001; 4.9 - p < 0.0001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs) did not reduce pain significantly. OSS improved from 24 to 43.6 and was not affected by the investigated variables, time to recovery was not influenced by the demographic data, the type of treatment or concomitant diseases.

CONCLUSIONS

Arthroscopic capsular release, physiotherapy and intraarticular steroid injection outperformed physical therapy and NSAID treatment in terms of pain relief. Despite of slight but persistent post-therapeutic pain found in half of the cases, treatment was considered satisfactory by the patients. Nor patient specific neither therapy specific data had a significant effect on the course of the disease.

[Scapula dyskinesis in medium size full-thickness supraspinatus muscle tears]

INTRODUCTION

Scapular motion abnormality in rotator cuff tears is a well-known symptom, but its significance is not clear. Some authors consider it as a cause of rotator cuff tear, others as a consequence of the disease.

OBJECTIVE

The aim of our study was to assess the changes in scapular motion in medium size full-thickness rotator cuff tear of degenerative origin compared to a healthy control group.

MATERIAL AND METHOD

10 healthy (control group) and 9 subjects with a medium size (1-3 cm), complaining rotator cuff tear (study group) were included in our study, in whom we analyzed the movements of the shoulder girdle, including the scapula, during sagittal and scapular plane flexion using a VICON 3D motion capture system and U.L.E.M.A. motion analysis software. A two-sample t-test was used to test whether significant differences in scapular posterior tilting, upward rotation and protraction values were observed between the two groups for each humeral flexion angular position.

RESULTS

In the study group, a significant increase in scapular protraction was demonstrated in sagittal arm elevations at 40 and 50 degrees of arm elevation compared to the control group (p<0.05), whereas no significant difference in scapular upward rotation and posterior tilting was demonstrated. During scapular plane flexion, no significant difference in scapular movements was demonstrated compared to the control group.

CONCLUSION

Scapular dyskinesis is already present in cases of medium size rotator cuff tears. In scapular dyskinesis, a significant difference in protraction is first observed, which may affect scapular upward rotation and tilting as the tear continues to grow. Orv Hetil. 2023; 164(31): 1213-1221.

Negative association of L-arginine methylation products with oocyte numbers

BACKGROUND

The aim of this study was to determine the concentrations of L-arginine and methylarginines in follicular fluid obtained from women participating in our IVF program and to find clinical correlates of these biochemical parameters.

METHODS

Follicular fluid was obtained from 108 women by ultrasonography guided transvaginal puncture following controlled ovarian hyperstimulation. Follicular fluid L-arginine, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and monomethylarginine (MMA) concentrations were determined with liquid chromatography-tandem mass spectrometry. The integrated index of arginine methylation (arg-MI) was calculated according to the formula: arg-MI = (ADMA + SDMA)/MMA.

RESULTS

There were significant inverse relationships between IVF embryo number and follicular fluid L-arginine (r = -0.507, P < 0.001), ADMA (r = -0.356, P < 0.024), SDMA (r = -0.347, P < 0.028), MMA (r = -0.449, P < 0.004) and to L-arginine/ADMA ratio (r = -0.328, P < 0.031). By contrast, arg-MI was directly related to IVF embryo number (r = 0.426, P < 0.006). Moreover, the number of IVF oocytes was also inversely related to ADMA (r = -0.202, P < 0.037) and MMA (r = -0.384, P < 0.012) and positively to arg-MI (r = 0.450, P < 0.03).

CONCLUSIONS

The elevated levels of follicular fluid l-arginine and methylarginines appear to have an adverse influence on the reproductive processes as reflected by a reduction in the number of oocytes and embryos conceived. In contrast, the integrated methylation index proved to be positively correlated to the above parameters of fertilization.

Visual temporal window of integration as revealed by the visual mismatch negativity event-related potential to stimulus omissions

We studied whether, similarly to the auditory modality, short-period temporal integration processes occur in vision. Event-related potentials (ERP) were recorded for occasional stimulus omissions from sequences of patterned visual stimuli. A posterior negative component emerged only when the constant stimulus onset asynchrony (SOA) was shorter than 150 ms. This upper limit is comparable with the duration of the temporal window of integration observed in the auditory modality (including experiments studying the effects of stimulus omissions). Parameters of the posterior negativity were highly similar irrespective of whether the stimuli were task-relevant or not (Experiment 1). Thus, we identified this potential as the visual mismatch negativity (vMMN) component, which reflects task-independent detection of violating regularities of the stimulation. vMMN was followed by an anterior positivity (the P3a), indicating attentional shifts induced by the stimulus omissions. In Experiment 2, a posterior negativity similar to that observed in Experiment 1 emerged after the termination of short trains of stimuli, again only when the SOA was shorter than 150 ms. These results support the notion of a temporal integration window in the visual modality, the duration of which is between 150 and 180 ms.