Spinal Accessory Nerve Duplication – A Rare Anatomical Consternation During Neck Dissectio

Prevention of the spinal accessory nerve (SAN) is an indispensable aspect of the functional neck dissection surgery to avoid highly disabling shoulder syndrome postoperatively. This requires comprehensive knowledge of the anatomy of SAN and its variations. Rare anatomical variations like SAN duplication can result in an inadvertant injury to the SAN. We report a case of duplication of SAN, which was encountered while doing a functional neck dissection surgery for oral squamous cell carcinoma. No iatrogenic injury occurred during the surgery and neither there was any SAN dysfunction post-operatively. Meticulous dissection and consistent identification of SAN, along with vast anatomical knowledge is the key to the preservation of the nerve during the surgery. This report aims to broaden our anatomical knowledge of SAN and also discuss the clinical implications and literature pertaining to the duplication of SAN.

The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015–2020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017–2020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials.

A Study of Association Between Acromion Types and Shoulder Pathology

Background and aim: Shoulder impingement and rotator cuff tear are commonly seen shoulder pathology. Pathological changes in soft tissue around shoulder can be due to intrinsic degenerative in tendons or extrinsic mechanical compression due to Acromion types. Arthroscopic acromioplasty is still standard procedure done for shoulder impingement pathology and during rotator cuff repair. Our primary objective was to determine acromion types, its prevalence rate with shoulder pathology.Methods: Total 85 patients who met inclusion criteria were included in the study. Acromion types were classified according to Bigliani et al type I acromion has flat undersurface, type II acromion has curved undersurface, type III acromion has hooked undersurface on Supraspinatous outlet view radiographs. Types of Acromion were co-related with shoulder pathology and age group.Results: Out of 85 patients with shoulder pathology 43 patients had impingement shoulder syndrome and 42 patients had rotator cuff tear. Mean age group for impingement shoulder syndrome group was 39.6 years and for rotator cuff tear group was 58.6 years. Overall right shoulder is affected more compared to left shoulder. Type 2 acromion was seen in 64.7% study population and type 1 is seen in 23.5% and type 3 is seen in 11.8%.Conclusions: In our study type 2 acromion is more frequently seen in shoulder pathology involving rotator cuff tear and impingement syndrome. Acromion morphology does not vary with age.

STUDY OF RESULT OF FROZEN SHOULDER SYNDROME TREATED WITH INTRAARTICULAR STEROIDS

OBJECTIVE: Adhesive capsulitis or frozen shoulder is a common condition that presents with pain and progressive limitation of both active and passive shoulder movements. In this study, we investigate the efcacy of intraarticular steroid injection in case of frozen shoulder. Material & Methods: Study is done on 32 patients of frozen shoulder attended Orthopedic OPD at Jhalawar Medical college, Jhalawar from July 2018 to June 2019. Intra-articular injection of steroid (methyl prednisolone acetate 80 mg) given & results analyzed. RESULTS: Patient follow up done every 2 weeks after giving Intraarticular steroid & advised to exercise of shoulder. Improvement in shoulder pain & movement of shoulder analyzed & recorded up to 12 – 24 weeks. CONCLUSION: Intraarticular injection for frozen shoulder is good, safe & efcient method. For better result corticosteroid injection is given in the early stages when pain is the predominant presentation.

PREVALENCE AND MANAGEMENT OF THE DIABETIC FROZEN SHOULDER

The term frozen shoulder was first introduced by Codman in 1934. He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty sleeping on the affected side. Codman also identified the marked reduction in forward elevation and external rotation that are the hallmarks of the disease. Long before Codman, in 1872, the same condition had already been labelled periarthritis by Duplay. In 1945, Naviesar coined the term adhesive capsulitis. [2] The pathophysiology of idiopathic adhesive capsulitis (frozen shoulder) is poorly understood. Most authors have reported various degrees of inflammatory changes in the synovial membrane. Adhesions between the shoulder capsule and the humeral head have been noted by some, but not all, authors. [4] The aetiology of periarthritis of the shoulder, however, is not clearly understood. Amongst the factors suggested are trauma myocardial infarction hemiplegia, pulmonary tuberculosis, thyrotoxicosis, cerebral tumour, and epilepsy. [7] Subjects with Frozen Shoulder Syndrome group A treated with ERM and MWM and group B treated with MRM. The duration of each treatment was 3 weeks. There was an improvement in mobility and functional ability at 12 weeks in subjects treated with the 3 mobilization techniques. Comparing the effectiveness of the 3 treatment strategies in subjects with unilateral Frozen Shoulder Syndrome, ERM and MWM were more effective than MRM in increasing mobility and functional ability. [22].

Subscapularis Trigger Points as a Predictor for Frozen Shoulder Syndrome: Correlation Study

Trigger points in the shoulder region muscles restrict movement of shoulder and create pain on movement and at rest. The key muscle that must be examined is the subscapularis muscle. The aim of this study is to investigate the relationship between subscapularis trigger with shoulder pain, shoulder abduction and shoulder external rotation. 50 patients diagnosed with frozen shoulder. Data obtained regarding pressure pain threshold (PPT) using pressure algometry, shoulder pain and disability index (SPADI)using questionnaire, shoulder abduction and external rotation ROM using digital inclinometer were statistically analysed and compared. Strong negative significant correlation between PPT with SPADI, strong positive significant correlation between PPT with shoulder abduction and external rotation. Subscapularis trigger points in patients with frozen shoulder affect shoulder pain, shoulder abduction, and external rotation.

The use of dry needling to treat painful shoulder syndrome – a case report

Background. Painful shoulder syndrome is a common condition in society. Most patients experience pain and reduced mobility of the affected limb, which can have an impact on the quality of life. This report presents a case of a patient with pain and reduced range of motion in the left shoulder. Aim of the study. The study aim was to evaluate the efficacy of dry needling in the treatment of painful shoulder syndrome, based on functional measures of pain, disability and range of motion. Case report. A 42-year old patient reported pain in her left shoulder. A series of 6 dry needling sessions were performed, twice a week, for a period of 3 weeks. Prior to, and immediately after, the therapy a subjective pain assessment using the VAS pain rating scale and an assessment of the degree of disability using the Modified Laitinen Pain Questionnaire were performed. The range of motion within the shoulder girdle was also measured with a goniometer. Conclusion. Following the dry needling therapy, a reduction in pain and improved shoulder girdle mobility was observed.