Background: Scapular winging is a rare condition of the shoulder girdle that presents challenging treatment decisions for clinicians. To inform clinical practice, clinicians need guidance on what... Show moreBackground: Scapular winging is a rare condition of the shoulder girdle that presents challenging treatment decisions for clinicians. To inform clinical practice, clinicians need guidance on what the best treatment decision is for their patients, and such recommendations should be based on the total evidence available. Therefore, the purpose of this review was to systematically review the evidence regarding nonsurgical management and tendon transfer surgery of patients with neurologic scapular winging due to serratus anterior (SA) or trapezius (TP) palsy.Methods: PubMed, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier were searched up to April 5, 2022, for studies reporting on clinical outcomes after nonsurgical management and tendon transfer surgery of scapular winging due to weakness of the SA or TP muscle. The Integrated quality Criteria for Review Of Multiple Study (ICROMS) tool was used to classify the quality of the studies. Primary outcomes were the fraction of patients with spontaneous recovery after nonsurgical management and improvement in shoulder function, pain scores, and shoulder scores after tendon transfer surgery. Data were pooled if data on the same outcome were available for at least 3 studies, using random-effects meta-analysis.Results: Twenty-three (10 moderate-quality [MQ] and 13 low-quality) studies were included. Six studies (3 MQ; 234 shoulders) re-ported on outcomes after nonsurgical management of SA palsy, whereas 12 (6 MQ; 221 shoulders) and 6 studies (1 MQ; 80 shoulders) evaluated the outcomes of tendon transfer for SA or TP palsy (1 study addressed both). Spontaneous recovery of scapular winging with nonsurgical management varied between 21% and 78% across studies after a median follow-up of 72 months. For surgical management of SA palsy, pooling data in a meta-analysis showed that patients on average improved by 47 degrees (95% confidence interval [CI]: 34-61, P < .001) in active forward flexion, had lower visual analog scale scores for pain (mean difference [MD]: -3.0, 95% CI: -4.9 to -1.0, P = .003), and had substantial improvements in American Shoulder and Elbow Surgeons (MD: 24, 95% CI: 9-39, P = .002) and Constant Show less
Gacaferi, H.; Geurkink, T. H.; Adrichem, R. A. van; Driel, P. van; Vermeulen, H. E. M.; Nagels, J. 2022
Patiënte A, een 58-jarige vrouw met een blanco voorgeschiedenis, kwam bij de huisarts vanwege toenemende pijn en bewegingsbeperking van de linker schouder. De klachten waren ruim 3 maanden eerder... Show morePatiënte A, een 58-jarige vrouw met een blanco voorgeschiedenis, kwam bij de huisarts vanwege toenemende pijn en bewegingsbeperking van de linker schouder. De klachten waren ruim 3 maanden eerder begonnen; er was geen trauma aan voorafgegaan. De patiënte kon de arm maximaal tot schouderhoogte heffen. De klachten beperkten haar aanzienlijk bij de dagelijkse activiteiten, zoals bij aan- en uitkleden. Ook ’s nachts had zij pijn. Pijnstilling met paracetamol en NSAID’s hielp onvoldoende. Show less
There is increasing evidence for the involvement of high mobility group box 1 (HMGB1) in inflammation, angiogenesis, and tumorigenesis. However, no studies have reviewed the role of HMGB1 in... Show moreThere is increasing evidence for the involvement of high mobility group box 1 (HMGB1) in inflammation, angiogenesis, and tumorigenesis. However, no studies have reviewed the role of HMGB1 in musculoskeletal disease. This systematic review aimed to evaluate the literature regarding the potential roles of HMGB1 in musculoskeletal disease (joint, tendon, ligament, intervertebral disk, and bone). After searching PubMed, MEDLINE, and EMBASE databases up to 01-01-2020, 66 articles that measured HMGB1 expression in musculoskeletal disease were included. Immune and tissue-resident stromal cells expressed HMGB1, and both diseased human tissues and animal disease models showed increased HMGB1 expression relative to controls. Administration of recombinant HMGB1 to diseased musculoskeletal tissues induced inflammation, whereas blocking HMGB1 ameliorated histopathologic and clinical severity of disease. HMGB1 redox status was investigated in only 3% of the articles: Fully reduced HMGB1 promoted chemotaxis of leukocytes and tissue repair, whereas disulfide HMGB1 acted as a pro-inflammatory mediator. Our review highlights that while HMGB1 is an important mediator in musculoskeletal disease, its redox status remains understudied. Identification of HMGB1 redox status in musculoskeletal tissues is critical to advance understanding of the diverse biological functions of HMGB1 in musculoskeletal disease. Importantly, this will inform future therapeutic strategies to target HMGB1. Show less
Background:Physical exercises targeting proprioception are part of conservative therapy for Subacromial Pain Syndrome (SAPS). However, the effect of such exercises on proprioception itself has not... Show moreBackground:Physical exercises targeting proprioception are part of conservative therapy for Subacromial Pain Syndrome (SAPS). However, the effect of such exercises on proprioception itself has not been orderly established, hampering the advancement of treatment protocols and implementation. We summarised the evidence for a loss of proprioception in SAPS and defined the type of interventions that target and improve proprioception in SAPS. Methods:Two reviewers independently analysed 12/761 articles that evaluated joint position, kinaesthetic or force sense in patients with SAPS. Results:Patients with SAPS had reduced joint position sense during abduction. There was no evidence for a loss of kinaesthetic sense or force sense. Stretching, strengthening and stabilisation exercises improved joint position and kinaesthetic sense in SAPS. Microcurrent electrical stimulation and kinesiotaping did not improve proprioception in SAPS. Conclusions:The lack of evidence on proprioception in SAPS is striking. We found limited evidence for a loss of joint position sense in the higher ranges of abduction in SAPS. Active training programmes including strengthening and stabilisation exercises showed superiority in terms of enhancing proprioception relative to passive methods like kinesiotaping. The results of this narrative synthesis should be used as a base for providing value-based and data-driven treatment solutions to SAPS. Show less
