Rotator Cuff Tear

The purpose of this study is to compare a novel double row technique with suture bridge double row technique in the arthroscopic repair of massive-large rotator cuff tears clinically. The study is designed as a randomized controlled trial. A total of 52 participants with large - massive rotator cuff tears will be prospectively enrolled and randomly divided into 2 groups according to the applied repairing technique: novel double row technique group and suture bridge double row technique group. The investigators prospectively enrolled participants who met the following inclusion criteria: preoperative magnetic resonance imaging (MRI) diagnosis of a large - massive sized rotator cuff tear (\>3cm), which was confirmed during operation; chronic tear; older than 17 years and younger than 75 years; without surgical contraindications and willing to participate. The investigators excluded patients with poor quality rotator cuff and irreparable tear; severe glenohumeral arthritis; previous shoulder surgery; accompanied by dislocation or fracture of shoulder; refusal to participate. Each participant, assigned using a randomization table, was assessed by a clinical researcher, who was blinded to the grouping, at the following time points: preoperatively; 3, 6, 12 and 24 months postoperatively. The visual analog scale (VAS) for pain, active and passive ROM, and functional scores were assessed at each time point. The functional scores including the Constant score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles shoulder score (UCLA). Anatomic healing was evaluated using MRI at 3, 6, 12 and 24 months postoperatively. An experienced musculoskeletal radiologist interpreted the MRI and determined the healing failure rate. On the basis of the MRI findings, type IV or V of the Sugaya classification was regarded as healing failure. Based on the previous study, the retear rate of large to massive rotator cuff tears treated with suture bridge double row technique was assumed to be 28.3%. Based on the investigators' previous clinical data on large to massive rotator cuff tears, it is assumed that the retear rate of large to massive rotator cuff tears treated with novel double row technique is 1.0%. Differences in primary end points between the two groups were analyzed using chi-square tests. Set α=0.05, power is 0.80, the sample ratio of the two groups was 1:1. The sample size was estimated with PASS 15.0. A total of 46 patients, with 23 in each group, had sufficient power to detect statistical differences between groups. In consideration of the uncertainty of the effect and the possible loss of follow-up, the design effect was assumed to 10%. Therefore, the total sample size of this study should be more than 46÷90%≈51. To facilitate randomization, the sample size was determined to be 52 patients, with 26 patients in each group. Variables such as age, sex, tear size, and functional scores were analyzed, and their mean values were obtained. Continuous data were presented as the mean ± SD, and were analyzed using the independent t test. The retear rates between the two groups were analyzed using chi-square tests. Differences in values between the 2 groups were set at P \< .05 to be statistically significant. All statistical analyses were performed using SPSS version 15.0

Rotator cuff tear is one of the most common shoulder diseases and conservative treatment is commonly used for tears involving ≤50% of tendon thickness. Since conventional conservative treatments are not fundamental to repair tendon tissue, there is a growing need of new therapy to improve structural outcome. This study assesses the safety and efficacy of allogeneic fibroblasts on partial-thickness rotator cuff tear. The primary outcome is change in Constant Score (CS) at 24 weeks after TPX-115 injection. Secondary outcomes include changes from baseline in CS, Visual Analogue Score (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH), Simple Shoulder Test (SST), and functional evaluations including Range of Motion (ROM) at 4, 12, 24 and 52 weeks after administration and structural evaluation using MRI at 24 and 52 weeks after injection.

The use of biologic acellular matrices for the surgical augmentation of rotator cuff lesions has greatly expanded inrecent years. The study team patented a method for removing cells from human dermis (Acellular Dermal Matrix), maintaining unaltered biological and structural integrity. Acellular Dermal Matrix has been succesfully used for rotator cuff surgical repair augmentation beside in a limited number of patients. The aim of the project is to demonstrate the therapeutical efficacy of this strategy in patients affected by rotator cuff massive tears. Acellular Dermal Matrix will be also combined with autologous orthobiologics.

Previous studies have shown that even when following standard sterilization protocols, the positive culture rate of Cutibacterium acnes can still be as high as 30%. In recent years, several studies have reported that preoperative skin preparation of the shoulder, such as applying benzoyl peroxide (BPO) to the skin, can effectively reduce the cutaneous bacterial load of C. acnes and even decrease its incidence in the shoulder joint or surgical sutures after surgery. However, most of the existing studies have focused on arthroplasty, and robust evidence regarding contamination in rotator cuff surgery remains lacking. Therefore, this study aims to investigate whether preoperative skin preparation with a 10% BPO acne cleanser can effectively reduce contamination in rotator cuff surgery. The findings will help guide future clinical practice in preoperative preparation. This study will adopt a prospective randomized design. Patients will be randomly assigned (using a random number table) into two groups: the control group and the BPO cleanser group. All patients will receive instructions on preoperative skin cleansing. Patients in the control group will follow the current routine practice in our institution, cleansing the surgical site (shoulder) with soap or body wash. Patients in the BPO group, in addition to routine preoperative instructions, will receive specific guidance on cleansing the shoulder and surrounding skin. They will be provided with a 10% BPO acne cleanser and instructed to use it on the shoulder and surrounding area during bathing the day before surgery. After surgical disinfection, skin samples will be collected for bacterial culture. In addition, a segment of surgical suture will be obtained postoperatively for bacterial culture.

Objectives, "The purpose of the study is to evaluate whether acupuncture, a technique recognized in the literature for its analgesic, anti-inflammatory and immunomodulatory effect, can affect: acute pain control and chronic pain prevention, functional outcome and subjective patient satisfaction. In particular, the investigators propose to define, through clinical evaluation and blood dosage of inflammation mediators, the anti-inflammatory effect of acupuncture, whether this affects the trend of inflammatory biomarkers and whether it can influence the functional result and the establishment of post-operative joint stiffness. Primary endpoint: to evaluate the efficacy of acupuncture on post-operative pain control at 36-48 hours after surgery, when moderate-severe pain occurs, due to the resolution of peripheral blocks. This role will be evaluated in relation to: total opioid consumption and the onset of side effects (nausea/vomiting, constipation, sedation), time out-of-bed and effect on the rehabilitation pathway, patient satisfaction. The medium/long-term functional outcome will be analyzed at one, three, six and twelve months after surgery. Secondary endpoint: to evaluate the effect of acupuncture on the modulation of systemic inflammatory response through the analysis of specific serum biomarkers and to evaluate their correlation with functional outcome and the onset of chronic pain." Inclusion/exclusion criteria Inclusion criteria: patients undergoing total knee replacement for primary osteoarthritic degeneration, elective monolateral surgery, patients capable of informed consent. Exclusion criteria: age \< 18 years, total knee replacement for causes other than primary osteoarthritis (e.g. post-traumatic arthritis), revision surgery, contraindications to loco-regional anesthesia, contraindications to therapy with NSAIDs, cortisones and paracetamol, chronic assumption of opiates, use of corticosteroids in the six months prior to surgery, periarticular infiltration in the three months prior to surgery, patients with rheumatoid arthritis or autoimmune disorders, patients on therapy with biological drugs, ASA class \> 3, pregnant women, active infection in antibiotic treatment. Methods: Patients candidates for elective, monolateral, total knee replacement will be enrolled. The following data will be collected: demographic characteristics; comorbidities and psychological status (SF-12 score); pre-operative severity score (WOMAC Score); pre-operative pain assessment (NRS scale). For all patients, the anesthesiological treatment will be the one routinely used in the investigators' UOC : mild sedation with midazolam 1-2mg ev LRA subarachnoid with Levobupivacaine 0.5% 10-12mg tranexamic acid 1g ev. dexamethasone 4mg ev pre-operative analgesic block of the saphenous nerve with L-bupivacaine 0.5% 15ml, ultrasound-guided technique: pre-operative iPACK Block (Interspace between the Popliteal Artery and Capsule of the Knee) with L-bupivacaine 0.375% 20ml, ultrasound-guided technique; intraoperative analgesic therapy: Ketorolac 15mg + Paracetamol 1000mg ev post-operative analgesic therapy: paracetamol 1000mg ev every 8 hours; ibuprofen 400mg cp every 8 hours; tapentadol 50mg cp every 12 hours; rescue therapy (to be administered in case of NRS \> 4): Oxycodone + Paracetamol 5/325mg, 1cp every 30 minutes, for a maximum of 4cp/day. Patients will be divided into two groups: Acu vs Standard. In the Standard group, the treatment will be the one described above. In the Acu group, acupuncture and auriculotherapy will be added to the standard treatment: patients will undergo three/four sessions of manual acupuncture lasting 20 minutes, the first in the immediate pre-operative period and the subsequent ones at a distance of 24, 48, 72 hours from surgery. The treatment includes manual acupuncture applied to specific points: LI4, LV3 and ST36 bilaterally and monolaterally SP6 and GB34, ipsilateral to the knee to be prostheticized. Furthermore, auricolar needles will be positioned, before surgery, for self-stimulation of the auriculotherapy points corresponding to Shen Men bilaterally and the knee point ipsilateral to the surgical side. The patient will be instructed on how to self-stimulate these auricular points during hospitalization. Patients will be evaluated at 24, 48, 72, 96 hours after surgery; post-operative parameters: evaluation of dynamic and resting pain (NRS scale), assumption of rescue analgesics; trend of vital parameters (HR, NIBP, RR, SpO2); incidence of adverse events and complications; functional outcomes: post-operative joint mobility parameters (ROM, Range of Motion, active and passive), time out-of-bed, resumption of ambulation, length of hospital stay (surgery-end of rehabilitation); patient-reported outcomes and related measures: Patient-Reported Outcome Measures (PROMs) and, specifically, Knee Injury and Osteoarthritis Outcome Score (KOOS); satisfaction questionnaire. In addition to biomarkers such as CRP and N/L ratio, routinely measured in the post-operative period, blood dosages of specific inflammation mediators (IL2 IL6 IL8 IL10 IFNy TNFa) will be performed in three moments: pre-operative, 48 hours and one month after surgery. The medium/long-term re-evaluation of enrolled patients will coincide with the outpatient checks normally prescribed, at a distance of one, three, six and twelve months post-TKA, and will include: evaluation of dynamic and resting pain (NRS scale); need for analgesic assumption; post-operative joint mobility parameters (ROM, Range of Motion, active and passive), patient-reported outcomes and related measures: Patient-Reported Outcome Measures (PROMs) and, specifically, Knee Injury and Osteoarthritis Outcome Score (KOOS); satisfaction questionnaire. In case the patient is unable to go to UOC for the checks scheduled after three months from surgery, the evaluation will take place by telephone.

OBJECTIVES: The objectives of this study are: 1. To determine the additional effects of kinesio taping in combination with physical therapy on ROM of upper limb shoulder, elbow and wrist joint in subacute stroke patients 2. To determine the additional effects of kinesio taping in combination with physical therapy on upper limb spasticity in subacute stroke patients 3. To determine the effects of kinesio taping on upper limb function in subacute stroke patients. HYPOTHESIS: Alternate Hypothesis: There is a statistically significant difference between kinesio taping combined with physical therapy on ROM, spacticity and function of upper limb Shoulder, elbow and wrist joints in patients with subacute stroke compared to conventional physical therapy. Null Hypothesis: There is no statistically significant difference between kinesio taping combined with physical therapy on ROM, spacticity and function of upper limb Shoulder, elbow and wrist joints in patients with subacute stroke compared to conventional physical therapy. Research Design: Experimental study. Randomized Control Trial Clinical setting: Rehabilitation department, Fauji Foundation Hospital , leading edge physical therapy and rehabilitation islamabad. Study duration: 6 months. Selection Criteria: Inclusion Criteria * Age group: 40-65 years onwards * Both males and females * Patients with history of diagnosed stroke and lie within subacute stage of stroke * MAS scale score of 1\_2 Exclusion Criteria * Any congenital deformities * cognitive deficits * Fractures * Upper limb surgery Sampling technique: Convenience sampling Outcome Measures: Data will be collected on Demographics and general information Goniometer will be used to assess the range of motion of shoulder, elbow and wrist joint Modified Ashworth scale will be used to determine the level of spasticity in the participants. Wolf motor function test scale for upper limb will be used to assess upper limb function. Experimental Group (A) = This group will receive kinesio taping every alternate day for six weeks combined with conservational physical therapy which includes AROMs, PROMs, PNF D1 flexion and extension, resistance raining using resistance band of medium resistane. and their outcomes will be measured at baseline and at 3rd week and at the end of 6th week treatment. Control group (B) =this group will not receieve kinesio taping , only conservationall Physical therapy will be given and their outcomes will be observed at the baseline, at third week and then after treatment of 06 weeks. Data analysis techniques: The data will be analyzed through SPSS 21 and Data would be analyzed based on the study design chosen that is random control experimental study. A printed questionnaire will be provided to the participents after obtaining written consent and providing adequate explanation regarding the study, after which the data will be presented in the form of graphs or tables. Significance of the study: This study will add data to the literature. Providing evidence-based data and aiding healthcare providers to incorporate kinesio taping as an adjunct intervention. This study will also provide a feasible and cost-effective treatment to the patient diagnosed with subacute stroke. Kinesio taping is easy to apply, potentially beneficial treatment options for patients with subacute stroke upper limb dysfunction.

The purpose of this study is to determine the effects of mobilization with movement with upper quadrant core strengthening in rotator cuff related shoulder pain on A. Pain B. Range of motion C. Propioception D. Kinesiophobia Data collection procedure: Participants of interest would be approached and explained about the research. Informed written consent will be taken. Recruited participants will be allocated to either of the groups through a sealed opaque envelope method.

Major surgeries of the shoulder constitute some of the most commonly performed orthopedic procedures. They often result in moderate to severe postoperative pain thereby requiring a multimodal analgesic approach centered around peripheral nerve blocks. Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Interscalene blocks (ISB) are well-studied and established means of providing analgesia following shoulder surgery and are considered the gold standard mode of regional anesthesia and post-operative pain management in shoulder surgeries. A novel technique: pericapsular nerve group (PENG) block can be effectively and safely applied under ultrasound guidance in shoulder surgery cases for postoperative analgesia. In addition, PENG block targets articular branches with less motor effect compared with interscalene brachial plexus block providing anesthetic and analgesic effect with less complication and better and sooner ambulation.

Intravenous analgesia (Paracetamol, NSAIDs, opioids) is preferred for patients during the treatment and reduction stages of anterior shoulder dislocation. Additionally, patients may receive regional anesthesia and analgesia (lidocaine, bupivacaine). The route and dosage of analgesic administration are chosen by the attending physician managing the patient. In this study, investigators plan to observationally evaluate the analgesic management of patients without intervening in the method and dosage chosen by the primary treating physician. Patients receiving analgesia will be chosen according to preffered treatment at emergency department. The study population will consist of patients presenting to the emergency department with shoulder dislocation who receive analgesia and fall into the following 4 treatment groups. These 4 group will consist in: 1. ketamine group 2. interscalene nerve block group 3. suprascapular nerve block group 4. intraarticular lidocaine injection group. The study will compare these 4 treatment methods in terms of analgesia management, reduction time, comfort, and length of hospital stay for patients presenting to the emergency department with shoulder dislocation and receiving analgesia. The researcher will not interfere with the treatment decision made by the responsible physician or the treatment process

A single-center randomized controlled clinical trial was conducted to compare the effect of ESWT combined with conventional rehabilitation training on patients with rotator cuff tear. To explore the effect of ESWT on the clinical efficacy of patients with rotator cuff tear, and to explore the application of shockwave technology in the conservative treatment of rotator cuff tear. It provides a new treatment idea for patients with rotator cuff tear who choose conservative treatment, promotes tendon healing for patients with partial rotator cuff tear, improves shoulder joint function, and provides a new treatment plan for patients to accelerate their return to life and exercise, and provides a theoretical basis for the clinical application of ESWT.