Background: Patients with a rotator cuff (RC) tear often exhibit scapular dyskinesia with increased scapularlateral rotation and decreased glenohumeral elevation with arm abduction. We hypothesized... Show moreBackground: Patients with a rotator cuff (RC) tear often exhibit scapular dyskinesia with increased scapularlateral rotation and decreased glenohumeral elevation with arm abduction. We hypothesized that inpatients with an RC tear, scapular lateral rotation, and thus glenohumeral elevation, will be restored tonormal after RC repair.Methods: Shoulder kinematics were quantitatively analyzed in 26 patients with an electromagnetic trackingdevice (Flock of Birds) before and 1 year after RC repair in this observational case series.We focusedon humeral range of motion and scapular kinematics during abduction. The asymptomatic contralateralshoulder was used as the control. Changes in scapular kinematics were associated with the gain in rangeof motion. Shoulder kinematics were analyzed using a linear mixed model.Results: Mean arm abduction and forward flexion improved after surgery by 20° (95% confidence interval[CI], 2.7°-36.5°; P = .025) and 13° (95% CI, 1.2°-36.5°; P = .044), respectively. Kinematic analysesshowed decreases in mean scapular protraction (ie, internal rotation) and lateral rotation (ie, upward rotation)during abduction by 3° (95% CI, 0.0°-5.2°; P = .046) and 4° (95% CI, 1.6°-8.4°; P = .042), respectively.Glenohumeral elevation increased by 5° (95% CI, 0.6°-9.7°; P = .028) at 80°. Humeral range of motionincreased when scapular lateral rotation decreased and posterior tilt increased.Conclusions: Scapular kinematics normalize after RC repair toward a symmetrical scapular motion patternas observed in the asymptomatic contralateral shoulder. The observed changes in scapular kinematicsare associated with an increased overall range of motion and suggest restored function of shouldermuscles. Show less
Kolk, A.; Henseler, J.F.; Witte, P.B. de; Arkel, E.R.A. van; Visser, C.P.J.; Nagels, J.; ... ; Groot, J.H. de 2016
BACKGROUND: Subacromial pain syndrome (SAPS) and scapular dyskinesis are closely associated, but the role of pain is unknown. We hypothesized that pain results in asymmetrical scapular kinematics,... Show moreBACKGROUND: Subacromial pain syndrome (SAPS) and scapular dyskinesis are closely associated, but the role of pain is unknown. We hypothesized that pain results in asymmetrical scapular kinematics, and we expected more symmetrical kinematics after infiltration of subacromial anaesthetics. OBJECTIVE: To investigate the effect of subacromial anaesthetics on scapular kinematics in patients with SAPS. DESIGN: Observational cohort study. METHODS: We evaluated shoulder kinematics in 34 patients clinically and radiologically (magnetic resonance arthrography) identified with unilateral SAPS using three-dimensional electromagnetic motion analysis (Flock of Birds). Scapular internal rotation, upward rotation and posterior tilt of the affected shoulder were compared with the kinematics of the unaffected shoulder and following subacromial anaesthetics. Additionally, the association of pain (Visual Analogue Scale, VAS) and scapular rotation was analysed. RESULTS: Compared with the contralateral healthy shoulder, 5° more (95% CI 0.4-9.7, p = 0.034) scapular internal rotation was observed in the affected shoulder at 110-120° of abduction. Following subacromial anaesthetics in the affected shoulder, internal rotation increased (2°, 95% CI 0.5-3.9, p = 0.045) and posterior tilt decreased (3°, 95% CI 1.5-5.0, p = 0.001) at 110-120° of abduction. Less scapular upward rotation was significantly associated with higher pain scores before infiltration (R = 0.45, p = 0.013). CONCLUSIONS: More scapular internal rotation was observed in affected shoulders of patients with SAPS compared with unaffected shoulders. Subacromial infiltration did not restore kinematics toward symmetrical scapular motion. These findings suggest that subacromial anaesthesia is not an effective means to instantly restore symmetry of shoulder motion. Show less
Chronic muscle diseases are highly prevalent in the elderly causing severemobility limitations, pain and frailty. The intrinsic molecular mechanisms are poorlyunderstood due to multifactorial... Show moreChronic muscle diseases are highly prevalent in the elderly causing severemobility limitations, pain and frailty. The intrinsic molecular mechanisms are poorlyunderstood due to multifactorial causes, slow progression with age and variationsbetween individuals. Understanding the underlying molecular mechanisms couldlead to new treatment options which are currently limited. Shoulder complaints arehighly common in the elderly, and therefore, muscles of the shoulder’s rotator cuffcould be considered as a model for chronic age-associated muscle degeneration.Diseased shoulder muscles were characterized by muscle atrophy and fatty infiltrationcompared with unaffected shoulder muscles. We confirmed fatty infiltration usinghistochemical analysis. Additionally, fibrosis and loss of contractile myosin expressionwere found in diseased muscles. Most cellular features, including proliferation rate,apoptosis and cell senescence, remained unchanged and genome-wide molecularsignatures were predominantly similar between diseased and intact muscles.However, we found down-regulation of a small subset of muscle function genes,and up-regulation of extracellular region genes. Myogenesis was defected in musclecell culture from diseased muscles but was restored by elevating MyoD levels. Wesuggest that impaired muscle functionality in a specific environment of thickenedextra-cellular matrix is crucial for the development of chronic age-associated muscledegeneration. Show less
Raz, Y.; Henseler, J.F.; Kolk, A.; Riaz, M.; Zwaal, P. van der; Nagels, J.; ... ; Raz, V. 2015
BACKGROUND The diagnosis of extra-pulmonary tuberculosis (EPTB) by conventional methods such as culture and microscopy has low sensitivity and requires an invasive procedure. A simple rapid... Show moreBACKGROUND The diagnosis of extra-pulmonary tuberculosis (EPTB) by conventional methods such as culture and microscopy has low sensitivity and requires an invasive procedure. A simple rapid serological test would be of great value. METHODS Six antigens (ESAT-6, Ag85A, TB10.4, Rv3881c, lipoarabinomannan (LAM) and Ara6-BSA) were tested in an ELISA to detect antigen specific IgG and IgM antibodies in sera from 54 culture and histology-confirmed tuberculous lymphadenitis (TBLN) patients, among whom four were HIV seropositive, sera from 25 smear positive pulmonary tuberculosis (PTB) patients, 15 culture and histology-negative lymphadenitis (non-TBLN) patients (n=15) and 22 healthy controls (HCs). RESULTS The sensitivities of the antigens for the detection of IgG in sera of TBLN patients ranged from 4 to 30 %. Specificities ranged from 91 to 100 % with sera from HCs. Sensitivities of the antigens for detection of IgM ranged from 0 to 15 % and specificities ranged from 91 to 100 %. LAM was the most potent antigen followed by ESAT-6 and Rv3881c for detection of IgG. However, the sensitivity for antigen specific IgG antibody detection was improved when LAM was combined with ESAT-6 and Rv3881c.The sensitivity was 54 % and the specificity 91 %. CONCLUSIONS The study suggests that the combined use of LAM, ESAT-6 and Rv3881c for the detection of IgG in sera of TBLN patients could be a supplement to microscopy of fine- needle aspirate (FNA) to diagnose EPTB. Show less
