Shoulder arthroscopy is the standard surgical procedure for rotator cuff injury treatment. Compared with open shoulder joint surgery, it has the advantages of safety, minimal invasiveness, and ease of operation, and has been widely used in clinical practice. Nerve block is an ideal anesthetic technique for shoulder joint surgery. Moreover, with ultrasound-guided block, the operation is visualized, which is of great significance in improving the success rate of anesthesia block and reducing the incidence of postoperative complications. However, clinical practice has also shown that nerve block can cause diaphragmatic paralysis, and the incidence of diaphragmatic paralysis varies among different nerve block approaches. Diaphragm activity is affected in patients with neuromuscular system diseases. To ensure the safety of extubation after surgery, it is necessary to assess the diaphragm in patients before anesthesia and after surgery. At present, there are relatively few research reports on the application of ultrasound-guided superior trunk block (STB) anesthesia in rotator cuff repair.

To investigate the effect of ultrasound-guided brachial plexus STB anesthesia on the incidence and muscle strength of unilateral diaphragmatic paralysis in patients undergoing arthroscopic rotator cuff repair.

A total of 92 patients who underwent elective shoulder joint surgery at Sichuan Orthopedic Hospital from March 2023 to March 2024 were selected and randomly divided into a control group and an observation group, with 46 cases in each group. The control group was given intravenous general anesthesia combined with brachial plexus nerve block via the supraclavicular approach, while the observation group was given intravenous general anesthesia combined with STB. The diaphragmatic mobility and diaphragmatic paralysis rate of the two groups were compared before the block and 30 minutes after the block. The blood gas indices were recorded before nerve block (T0) and 30 minutes after surgery (T1). The blocking effect and muscle strength of the patients were recorded, and the safety of anesthesia was evaluated.

Thirty minutes after block, the diaphragmatic mobility during deep breathing and calm breathing in the observation group was less than that in the control group (P < 0.05), and the incidence of diaphragmatic paralysis in the observation group was lower than that in the control group (P < 0.05). The duration of motor block in the observation group was shorter than that in the control group (P < 0.05). There was no statistically significant difference in blood gas parameters between the two groups at any time point (P > 0.05). The elbow flexion and wrist flexion muscle strength of the observation group at 12, 24, and 48 hours after the operation were all higher than those of the control group (P < 0.05). There was no statistically significant difference in adverse reactions between the two groups (P > 0.05) .

Ultrasound-guided STB has a relatively mild impact on the flexion muscle strength of the upper limb, elbow, and wrist in patients undergoing arthroscopic rotator cuff repair of the shoulder. Moreover, it plays a more prominent role in protecting the diaphragm and reducing the incidence of diaphragmatic paralysis, which is worthy of clinical application.

The treatment of massive and irreparable rotator cuff tears has long been a complex problem for shoulder joint surgeons. Due to muscle fat infiltration and tendon retraction, surgical repair of these tears is challenging, and some chronic, massive rotator cuff tears cannot be completely repaired. At present, there are many surgical treatment options available, including debridement and subacromial decompression, partial rotator cuff repair, allogeneic or autologous transplantation (patches, fascia, or dermis, etc.), tendon transposition (latissimus dorsi, pectoralis major, or pectoralis minor, etc.), balloon technique, and reverse total shoulder arthroplasty. For relatively younger patients, joint preservation surgery involving clearance and partial repair, patch enhancement, or tendon transfer remains the preferred option. If a complete repair cannot be achieved, a partial repair may still improve shoulder pain and function, but the risk of retearing after partial repair is as high as 52%. Compared with partial repair, arthroscopic patch augmentation has better clinical efficacy but offers no significant benefit to patients with high steatosis and has a relatively high nonunion rate. Tendon transposition of the latissimus dorsi and other muscles is also a good choice for clinical treatment. However, this surgical method is a non-anatomical transposition, and a large number of anchors need to be implanted during the operation, which causes significant trauma, a long recovery time for patients, and a high incidence of complications. Reverse shoulder arthroplasty is mainly suitable for elderly patients and can effectively improve pain and shoulder joint function in patients with advanced rotator cuff tear disease and/or painful pseudopalsy. However, the prosthesis has a limited lifespan, and complications such as postoperative infection, prosthesis loosening, and pad wear after replacement can occur, and it is expensive. The long head tendon of the biceps brachii is used as an autologous graft to reconstruct the upper joint capsule, exerting its tension-reducing scaffold function, enhancing the mechanical strength of the anterior tissue of the rotator cuff and exerting the anterior upper blocking effect, reducing the tissue tension of the repaired rotator cuff to promote the tendon-bone healing of the rotator cuff and prevent retear of the rotator cuff. Moreover, it has few complications, low cost, and a relatively simple surgical procedure, which are among its advantages.

To explore the efficacy of arthroscopic transposition and reinforcement of the long head tendon of the biceps brachii (LHBT) combined with partial rotator cuff repair in the treatment of massive and irreparable rotator cuff tears, and to compare the results with the one-year follow-up of arthroscopic partial rotator cuff repair (APR) alone.

A retrospective analysis was conducted on a total of 36 patients who underwent arthroscopic repair of massive and irreparable rotator cuff tears at Jiangsu Provincial Hospital of Chinese Medicine from August 2019 to June 2023. There were 20 cases in the partial repair group and 16 cases in the LHBT translocation combined with the partial repair group. The inclusion criteria were irreparable rotator cuff tears in which the tendon could not reach its original footprint, and the postoperative follow-up was 1 year. The active range of motion of the shoulder joint, visual analogue scale (VAS) for pain, UCLA score, American society of shoulder and elbow surgeons (ASES) score, and Constant-Murley score after surgery were compared between the two groups to assess postoperative complications. MRI was reexamined, and the Sugaya healing classification was used to assess the integrity of the reconstructed tissue.

There were no statistically significant differences in VAS and functional scores (UCLA, ASES, and Constant-Murley) for resting pain and motor pain at 1 month and at 3, 6, and 12 months after surgery between the two groups (P>0.05). Six months after the operation, there was no significant difference in the range of motion of forward flexion and upward lift between the two groups (P>0.05), but the range of motion of external rotation in the LHBT combined group was better than that in the APR group (P<0.05). MRI at 3, 6, and 12 months after the operation showed that the tendon-bone healing grades (Sugaya classification) and retear rates of the two groups were comparable (P>0.05) .

LHBT transposition enhancement combined with partial repair can more significantly improve postoperative active external rotation function in patients with massive, irreparable rotator cuff tears than APR alone. However, the efficacy of both is comparable in terms of forward flexion and elevation range of motion, pain relief, functional score, tendon-bone healing, and retreater rate.

Cervical spondylosis is a syndrome characterized by degenerative changes in the cervical intervertebral disc tissue and its accessory structures, which subsequently cause compression or stimulation of adjacent nerve roots, spinal cords, or blood vessels, and the appearance of corresponding clinical symptoms. Cervical radiculopathy (CSR) is the most common type of cervical spondylosis in clinical practice, mainly manifested as sensory, motor, and reflex disorders consistent with the distribution area of spinal nerve roots. The symptoms are mainly characterized by severe neck pain and limited neck movement. The pain radiates to the shoulders, arms, forearms, and fingers, and may be accompanied by weakness in the upper limbs and numbness in the fingers. The nerve roots of C5, C6, and C7 are most commonly involved. Brachial plexus neuritis (BPN), also known as neuralgic amyotrophy (NA), is a common peripheral nerve disease that can lead to motor and sensory dysfunction of the affected limb, severely affecting patients' lives and work. The cause of BPN remains unclear. It is speculated to be caused by viruses and immune factors, and may also be related to genetic factors. BPN attacks often start with severe pain around the shoulder and deep within the clavicle, which is generally ineffective with painkillers. Three to ten days later, muscle weakness in one upper limb occurs, followed by rapid muscle atrophy, and the pain tends to ease. Early identification, active diagnosis and treatment, and rehabilitation are conducive to the patient's recovery. Because the two share similar symptoms, such as neck and shoulder pain, abnormal sensations, or reduced muscle strength, BPN is often misdiagnosed as cervical spondylosis of the nerve root type in clinical practice. Especially when cervical spondylosis and BPN coexist, it is more likely to be misdiagnosed and mistreated.

To explore the clinical characteristics, diagnostic key points, and treatment methods of patients with cervical spondylosis complicated with brachial plexus neuritis.

The data of 22 patients diagnosed with cervical spondylosis complicated with brachial plexus neuritis who visited Fuxing Hospital Affiliated to Capital Medical University and Tsinghua Changgung Hospital of Tsinghua University in Beijing from August 2016 to January 2025 were collected. Their onset characteristics, symptoms and signs, imaging (cervical MRI, brachial plexus nerve ultrasound/MRN), and neuroelectrophysiological features were summarized. Moreover, follow up on its comprehensive therapeutic effect.

Among the 22 patients, 16 were male, and 6 were female, aged 43 to 87 years, with disease courses ranging from 10 days to 7 months. All 22 patients presented with acute exacerbation of pain and movement disorders based on chronic neck discomfort, and most of them were accompanied by evident proximal muscle atrophy of the upper limbs. Electromyography confirmed neurogenic damage, mainly due to brachial plexus injury, with a pattern characterized by injury to common motor nerves such as the suprascapular, axillary, and musculocutaneous nerves. After comprehensive treatment, the pain of all patients was significantly relieved. At the 6-month follow-up, 21 patients achieved clinical cure.

Cervical spondylosis and brachial plexus neuritis can coexist. For patients with complex shoulder and arm pain, this should be considered. A detailed electrophysiological examination is key to a precise diagnosis. Comprehensive conservative treatment for such diseases is an important means to improve prognosis.

Proximal humeral fractures (PHFs) refer to fractures involving the area from the humeral head to 2 to 3 cm away from the surgical neck of the humerus. They usually involve the surgical neck, large and small nodules, the anatomical neck, or the humeral head. Some patients also experience humeral head dislocation, and a few cases are accompanied by brachial plexus nerve injury. Epidemiological studies have shown that its incidence accounts for 4% to 10% of all fractures. Among elderly patients, its incidence rate is second only to hip fractures and distal radius fractures, and it is the seventh most common type of fracture in adults. With age, the phenomenon of osteoporosis, driven by physiological and pathological changes such as negative calcium balance and the degeneration of bone tissue microstructure, becomes increasingly evident. At the same time, the elderly often have geriatric syndromes such as ataxia and muscle strength decline, which can lead to PHFs when they suffer from low-energy injuries (such as falls, etc.). For stable fractures without obvious displacement, satisfactory therapeutic effects can be achieved through non-surgical methods such as suspension fixation and early functional exercise. However, for complex fractures with significant displacement, surgical treatment is usually adopted. There are numerous fixation techniques for PHFs. Dimakopoulos et al. believe that the bone suture fixation technique balances efficacy and cost-effectiveness. The Picker-needle fixation technique can prevent further damage to soft tissues and blood supply to the humeral head, but its success depends on satisfactory closed reduction, sufficient bone strength, minimal fragmentation, and good patient compliance. Intramedullary nail technique has good clinical efficacy and can provide more stable internal fixation, but discontinuous lateral cortical fragmentation is one of its major contraindications. Plate screw internal fixation is now one of the most commonly used surgical treatment methods for PHFs in clinical practice, with both traditional and locking plates available for selection. Locking plate internal fixation offers good angular stability and axial support and has gradually become the mainstream surgical treatment method for PHFs in recent years. Precise reduction of fracture fragments can be achieved through open reduction and internal fixation. However, the biomechanical stability of this technique significantly depends on sufficient bone mass support at the proximal end. For elderly patients with severe bone mass deficiency and poor blood supply at the fracture end, the locking plate internal fixation is very likely to fail, and the incidence of surgical complications has remained high. The main reasons for the failure of PHFs internal fixation include loosening of internal fixators, nonunion of fractures, necrosis of the humeral head, and secondary shoulder joint dysfunction. The management strategies for failed PHFs internal fixation and the selection of revision surgery plans have become important challenges in the current field of orthopedic and joint surgery. Reverse total shoulder arthroplasty (RTSA) has gradually become a treatment for cuff tear arthropathy since Grammont completed the biomechanical improvement. Effective methods for shoulder joint diseases, such as CTA and end-stage shoulder osteoarthritis, are still being developed, and current clinical research on the application of RTSA in revision after PHF internal fixation failure remains limited. Most existing studies are limited to small-sample, single-center retrospective analyses and lack support from high-quality multicenter randomized controlled trials (RCTs). In addition, the incidence and risk factors for complications after RTSA revision surgery remain unclear.

To explore the efficacy of reverse shoulder joint replacement surgery as a revision procedure in the treatment of failed internal fixation of proximal humeral fractures.

A retrospective analysis was conducted on 9 patients with failed plate internal fixation of proximal humeral fractures who were admitted from April 2018 to November 2023, including 2 males and 7 females. Age: 51 to 76 years old. All 9 cases underwent reverse shoulder joint replacement and revision surgery. Preoperative and postoperative systematic assessment of pain visual analogue scale (VAS), American shoulder and elbow surgeons' form (ASES) score, Constant-Murley shoulder score scale, University of California at Los Angeles UCLA score, disabilities of the arm, shoulder, and hand (DASH), shoulder pain and disability index Key indicators such as SPADI and joint range of motion were analyzed, and surgical complications were also analyzed.

All 9 cases were followed up. At the last follow-up, compared with that before the operation, the Angle of flexion and elevation increased from (53.89±19.65) ° to (107.78±25.26) °. The external rotation Angle increased from (3.33±9.68) ° to (31.67±6.61) °. The internal rotation Angle increased from (25.00±13.23) ° to (57.22±9.05) °. The abduction Angle increased from (48.33±16.95) ° to (95.00±15.00) °. The UCLA score increased from (9.33±3.60) points to (22.78±6.39) points. The Constant-Murley shoulder joint score increased from (23.44±5.70) points to (61.56±18.75) points. The ASES score increased from (34.11±9.66) points to (74.44±18.80) points. The DASH score decreased from (65.55±9.13) points to (31.73±11.05) points. The SPADI score decreased from (57.34±14.05) points to (23.77±16.35) points. The VAS score decreased from (5.00±1.73) points to (1.11±2.26) points. Furthermore, the differences in each score were statistically significant (P < 0.05). One case presented with aggravated postoperative pain. One case had a humeral shaft fracture during the operation.

Reverse shoulder joint replacement, as a revision for failed internal fixation of proximal humeral fractures, has reliable efficacy and good clinical application value.

The ossification center of the medial epicondyle of the humerus appears at the age of 5 to 7. The time when the epiphyses close varies by gender, approximately 15 years for females and 18 years for males. Medial epicondylar fractures of the humerus are common elbow fractures in children, accounting for approximately 12% of all elbow fractures in children. Their incidence rate is second only to supracondylar fractures and lateral epicondylar fractures of the humerus. This type of fracture is prone to occur in children and adolescents with unclosed epiphyses, with a high incidence at an age of 8 to 12 years old. The incidence rate in boys is three times that in girls, and about half of children with elbow dislocation are boys. In terms of diagnosis, since the epiphysis is not visible on X-rays before ossification, it is easy to miss a diagnosis based solely on plain X-ray films. In addition, anterior-lateral X-ray films often underestimate the actual displacement of the fracture fragment, whereas axial films or CT and MRI examinations can more accurately assess the displacement. Therefore, for children who are clinically suspected of having medial epicondylar fractures of the humerus or whose X-ray plain films show unclear displacement, it is recommended to perform axial X-ray, CT, or MRI examinations to confirm the diagnosis. At present, there is still controversy over the treatment plan for this injury, but the consensus is that conservative treatment can be adopted for fractures without apparent displacement. For those with significant displacement or accompanied by elbow dislocation, surgical treatment is required. At present, open reduction is mainly used in surgical treatment. For older children with nearly closed epiphyses, screw fixation can be chosen, whereas for younger children with unclosed epiphyses, Christie's needle fixation is more commonly selected. In recent years, ultrasound-guided reduction has been a research hotspot in the minimally invasive treatment of fractures. Due to its advantages, such as minimal trauma, dynamic monitoring, and reduced radiation exposure, it has been used to treat elbow fractures in some children. However, its application value in the treatment of medial epicondylar fractures of the humerus in children remains to be explored. Medial epicondyle fractures are common elbow injuries in children, ranking as the third most frequent among pediatric elbow fractures. For fractures with significant displacement, surgery is the preferred treatment to restore joint stability. Among surgical options, open reduction and internal fixation with Kirschner wires is a widely used technique that enables anatomical reduction and reliable fixation. In recent years, ultrasound-guided techniques have gained attention as a focus of minimally invasive fracture management in children, owing to their advantages, including the absence of ionizing radiation and dynamic monitoring. However, the application value of ultrasound in the treatment of medial epicondyle fractures remains to be validated.

To explore the differences in clinical efficacy between ultrasound-guided closed reduction (UGCR) Kirschner wire fixation and open reduction Kirschner wirefixation in the treatment of medial epicondyle fractures of the humerus in children.

A retrospective cohort study design was adopted to analyze the clinical data of 45 children with medial epicondylar fractures of the humerus admitted to Anhui Children's Hospital from August 2022 to August 2024, including 26 boys and 19 girls. The age ranged from 3 to 14 years old, with an average age of (9.07±2.93) years old. There were 17 cases on the left and 28 cases on the right. According to the surgical methods, they were divided into the open reduction Kirschner wirefixation group (24 cases) and the closed reduction Kirschner wirefixation group under ultrasound guidance (21 cases). The operation time, fluoroscopy frequency, elbow joint range of motion, and recovery speed were compared between the two groups. The last follow-up time was 6 months after the operation. The Mayo elbow score and the incidence of complications were recorded and compared.

There was no statistically significant difference in baseline data, such as age, gender, and fracture side, between the two groups of patients (P > 0.05). The operation time of the closed reduction Kirschner wirefixation group under ultrasound guidance (47.29±11.02) min was shorter than that of the open reduction Kirschner wirefixation group (63.46±20.10) min (P < 0.05). The number of fluoroscopy (2.86±0.74) times was less than that of the open reduction Kirschner needle fixation group (5.87±2.03) times (P < 0.05). The elbow joint motion angles of the ultrasound-guided closed reduction Kirschner wirefixation group and the open reduction Kirschner wirefixation group at 1.5 months, 3 months, 4.5 months, and 6 months after surgery were recorded, respectively. Repeated measurement data analysis showed that the recovery speed of the ultrasound-guided closed reduction Kirschner wirefixation group was better than that of the open reduction Kirschner wirefixation group (P < 0.05). At the 6-month follow-up after the operation, the flexion Angle (139.57±3.17) ° and the extension Angle (1.20±9.58) ° of the elbow joint in the closed reduction Kirschmann needle fixation group under ultrasound guidance were both better than those in the open reduction Kirschmann needle fixation group (136.00±4.22) ° and the extension Angle (9.26±15.02) ° (P < 0.05). At the 6-month follow-up after the operation, there was no statistically significant difference in the Mayo elbow score between the two groups (P > 0.05). During follow-up, no complications, such as loosening, withdrawal, neurotendon injury, or nonunion, occurred in either group of children. However, two cases in the open reduction group developed incisional infections, which resolved with dressing changes in the outpatient department and oral antibiotics. No infection occurred in the closed reduction Kirschner wire fixation group under ultrasound guidance.

This retrospective study preliminarily indicates that ultrasound-guided closed reduction with Kirschner wirefixation may have potential advantages, such as shorter operation time, less radiation exposure, faster recovery of elbow joint function, and fewer complications in the treatment of medial epicondyle fractures of the humerus in children. This treatment method has promising clinical application prospects and warrants further research and verification.

Proximal humeral fractures are the third most common osteoporotic fractures in the elderly population, which can lead to severe shoulder pain, functional impairment, and a decline in quality of life. The incidence rate is significantly related to age. With the increase in age, bone mass decreases and osteoporosis develops, and its incidence rate gradually increases. The prevalence of rotator cuff tears in the general population also increases with age. Therefore, there may be a significant overlap between the two patient groups. The recovery of shoulder joint function in patients with proximal humeral fractures is significantly correlated with rotator cuff injury, and rotator cuff tears affect the selection of treatment plans for patients with proximal humeral fractures. Undetected rotator cuff tears in patients with proximal humeral fractures may be an important reason for poor therapeutic effect. Not only full-thickness tears, but also simple partial rotator cuff tears have a significant impact on functional prognosis. Compared with patients without rotator cuff injury, even the functional prognosis of patients with partially torn proximal humeral fractures at one-year follow-up is impaired.

To investigate the prevalence of rotator cuff tears in proximal humerus fractures via Meta-analysis.

Meta-analysis was used to summarize and statistically analyze the previously published literature on proximal humeral fractures combined with rotator cuff tears. The search period is from the establishment of the database to March 1, 2025. The data in the literature were extracted, summarized, and analyzed using Stata 17.0 software.

A total of 15 studies were included. A total of 1 787 samples of the population with proximal humeral fractures were extracted, involving 1 791 cases of proximal humeral fractures. The incidence of rotator cuff tears was 26.7% (95% CI: 20.1-33.2), among which the incidence was 22.6% in males and 27.4% in females (comparison between males and females, P> 0.05). Based on the Neer classification of proximal humeral fractures, the incidence of rotator cuff tears in patients with Neer 2 partial fractures was 21.4%, 34.8%, and 9.1%. The incidence of supraspinatus tendon tears and (supraspinatus + infraspinatus) tendon tears was analyzed based on the tendon sites involved in rotator cuff tears. The incidence of patients with proximal humeral fractures combined with supraspinatus tendon tears was 9.4%, and the incidence of patients with (supraspinatus + infraspinatus) tendon tears was 3.7% (P< 0.05 for comparison between the two). Taking every 10 years as one age group, it is divided into five age groups. The overall trend shows that after the age of 50, the incidence of proximal humeral fractures combined with rotator cuff tears increases with age.

Rotator cuff tears are relatively common in patients with proximal humeral fractures. There is no significant gender difference in patients with rotator cuff tears. Patients with Neer's three-part fractures are more prone to rotator cuff tears. Supraspinatus tendons are more likely to tear in patients with rotator cuff tears. The incidence of proximal humeral fractures combined with rotator cuff tears in patients over 50 years old increases with age.