Adhesive capsulitis (AC) is a disease in which the range of motion (ROM) of the shoulder joint is limited due to chronic inflammation and fibrosis of the joint capsule. It is usually manifested as thickening of the glenohumeral ligament or axillary capsule, joint capsule contracture, and reduced joint volume. The axillary capsule is the most relaxed part of the joint capsule, allowing for sliding when the shoulder joint is abducted and rotated. When chronic inflammation and fibrosis of the joint capsule cause contracture and thickening, the abduction, external rotation (ER), and internal rotation (IR) angles of the shoulder joint will also be restricted. For AC patients, the current imaging examination methods mainly include ultrasound and magnetic resonance imaging. Relevant studies have shown that the normal thickness of the axillary sac under ultrasound is approximately 1.3-2.8 mm, and the threshold for diagnosing AC is about 3.2-3.34 mm. The normal axillary sac thickness under magnetic resonance imaging is approximately 2.9 mm, and the threshold for diagnosing AC is about 4.0-5.0 mm. Ultrasound has the advantages of being non-invasive, convenient, and real-time. It can also dynamically observe the morphological changes of the axillary sac during joint movement, making it more suitable for pre-treatment assessment and post-treatment follow-up of AC. Magnetic resonance imaging (MRI) can simultaneously assess lesions in the axillary sac, rotator cuff tendons, and surrounding soft tissues, making it more suitable for preoperative evaluation. However, to date, most scholars have focused mainly on the threshold for diagnosing AC, the therapeutic effect of AC treatment, and the consistency of axillary capsule measurement by ultrasound and MRI. However, few scholars have compared ultrasound-measured axillary capsule thickness with shoulder joint ROM.

To verify the correlation between axillary capsule thickness and physical examination angle, as well as the correlation between the measurement of axillary capsule thickness by ultrasound and magnetic resonance imaging.

In this study, 30 healthy volunteers were included for ultrasound and physical examination, and 36 patients diagnosed with unilateral AC in the outpatient department of our hospital were included for ultrasound, MRI, and physical examination. Personal information, axillary sac thickness, and physical examination angles (including abduction, external rotation, and internal rotation) were collected for correlation analysis and measurement consistency analysis.

Data show that, in healthy shoulder joints, there is no statistically significant difference in parameters such as age, BMI, and axillary sac thickness between healthy volunteers and patients; however, there is a statistically significant difference in internal rotation (P=0.042). The axillary sac on the affected side was significantly negatively correlated with external rotation (r=-0.360, P=0.031) and internal rotation (r=-0.497, P=0.002), while significantly positively correlated with height (r=0.429, P=0.009) and weight (r=0.361, P=0.030). After controlling for the healthy side, the difference in axillary capsule thickness was significantly negatively correlated with the difference in external rotation (r= -0.373, P = 0.025), and the correlation improved. It was significantly negatively correlated with the difference in internal rotation (r = -0.383, P = 0.021), and the correlation was weakened. In addition, this study found that the thickness of the axillary capsule measured by ultrasound (4.39±1.19) mm was significantly lower than that measured by MRI (9.08±2.03) mm, and there was a significant positive correlation between ultrasound and MRI measurements (r=0.676, P<0.001) .

This cross-sectional study fully confirmed a significant negative correlation between axillary cyst thickness and physical examination angles (external and internal rotation). The consistency of axillary cyst measurement by ultrasound and magnetic resonance imaging was moderate, and the thickness measured by magnetic resonance imaging was significantly greater than that measured by ultrasound. Meanwhile, comparing healthy volunteers with those with limited IR revealed that limited IR might be an early warning factor for AC.

Myofascial pain syndrome (MPS) is a Myofascial strain disease characterized by myofascial trigger points (MTrPs), presenting with local pain, dysfunction, and decreased muscle strength. Epidemiological data show that the proportions of visits to basic medical care and pain clinics are 15% and 90%, respectively. The incidence rate in China ranges from 30% to 93%, and the difference is due to the non-uniform diagnostic criteria. At present, clinical diagnosis mainly relies on doctors' palpation, which is highly subjective and lacks objective detection methods. With the changing modern lifestyle (such as long-term head-down posture), MPS is showing a trend of younger onset, but public awareness and diagnostic systems remain insufficient. MTrPs, as a core pathological feature, are prone to occur in the neck, shoulders, and back. During its active period, a vicious cycle of "pain - limited movement- new trigger point" can be formed. Ultrasonic technology has become a promising diagnostic tool due to its advantages, such as real-time, non-invasive imaging, but is constrained by factors including operator experience and equipment performance. In recent years, deep learning, especially transfer learning and convolutional neural network models, has demonstrated outstanding performance in medical image analysis, capable of automatically extracting features from ultrasound images and providing objective decision support.

To explore the application effect of a musculoskeletal ultrasound image analysis based on a deep convolutional neural network (DCNN) in the intelligent diagnosis of MPS.

Five hundred patients with neck, shoulder, and back pain who visited our hospital from May 2021 to June 2025 were selected as the research subjects, and their musculoskeletal ultrasound image data were collected. After eliminating unqualified images, 1,692 ultrasound images from 481 patients were included to construct an image dataset, and three attending physicians labeled them. The dataset was split into a training set and a test set, each containing 1 383 and 309 musculoskeletal ultrasound images, respectively. Deep learning algorithms were used to construct diagnostic models (DCNN1, DCNN2, DCNN3) to assess their accuracy in identifying active and latent MTrPs. In addition, 200 musculoskeletal ultrasound images of patients with neck, shoulder, and back pain, independent of the database, were selected and evaluated by three chief ultrasound physicians. The recording took a long time and was compared with the model diagnosis results. Another 130 independent musculoskeletal ultrasound examination images of patients with neck, shoulder, and back pain were selected from the database. Six ultrasound resident physicians evaluated the images before and after model assistance, respectively, and the diagnostic results were compared.

The accuracy of the DCNN3 model in diagnosing active and latent MTrPs was 0.983 and 0.876, respectively. The model's accuracy in identifying active and latent MTrPs was comparable to the diagnostic level of three chief physicians, and the time the model took to evaluate images was significantly shorter than that of the chief physicians (P < 0.05). With the model's assistance, the accuracy of image diagnosis by resident physicians was significantly improved, and the time required to diagnose images was significantly reduced (P < 0.013) .

This intelligent assessment model has high accuracy in diagnosing active and latent MTrPs and can significantly improve diagnostic efficiency. It can effectively assist clinicians in correctly evaluating MPS in the neck, shoulders, and back.

Spinoglenoid notch cyst (SNC) is a rare type of disease in joint surgery, often presenting as non-specific shoulder joint pain. In severe cases, it may be accompanied by limited movement and limb numbness. Usually, magnetic resonance imaging (MRI) and electromyography (EMG) examinations are relied upon for a definite diagnosis. If the shoulder pain and discomfort still cannot be relieved after conservative treatment, surgical resection can be considered. In the past, conventional incision surgery was performed, which caused significant trauma, could not repair the torn labrum, and the symptoms could not be completely relieved, with a high recurrence rate of cysts. In recent years, arthroscopic SNC resection has become the mainstream surgical approach for SNC because it can simultaneously treat labral injury and the cyst wall and has a low recurrence rate.

To explore the classification, diagnosis, and treatment strategies of SNC.

A retrospective analysis was conducted on the clinical data and follow-up results of 8 patients with Spinoglenoid notch cysts who were hospitalized and underwent surgical treatment at the Third Hospital of Hebei Medical University from January 2018 to December 2024. Among them, there were 6 males and 2 females. The age ranged from 21 to 63 years, with an average of 45. There were 6 cases of right shoulder and 2 cases of left shoulder. There were 3 cases of combined suprascapular nerve injury, 3 cases of rotator cuff injury (supraspinatus muscle, subscapular muscle), and 5 cases of SLAP injury (type Ⅱ and type Ⅲ). All patients were treated with arthroscopic shoulder surgery to remove cysts. Depending on the injury of the rotator cuff and labrum, the rotator cuff and labrum were sutured if necessary.

One patient was excluded due to a follow-up of less than 12 months, and eventually, 8 patients were included. The average follow-up period was 46.1 months. The average operation time was (150.6±38.2) min, the average surgical blood loss was (53.8±16.2) ml, and the surgical incision achieved primary grade A healing. At the 1-year follow-up after the operation, MR reexamination showed no recurrence of the Spinoglenoid notch cyst. At the last follow-up, the Constant-Murley score was (90.6±5.2) points, and the American Shoulder and Elbow Surgery score was (91.0±4.2) points.

This study first proposed the classification of glenoid incision cysts. This classification is helpful for preoperative planning. The arthroscopic technique for the resection of glenoid cysts causes less trauma and has a good clinical effect.

The humeral shaft extends from the distal end of the surgical neck of the humerus to the proximal edge of the lateral epicondyle. Distal fractures are usually located at the distal one-third of the humerus. According to the national trauma database of the United States, distal humeral fractures account for 1.2% to 3.5% of all fractures in the body, with extra-articular fractures comprising 68%. Although conservative treatment can achieve a healing rate of 75%, surgical treatment can significantly shorten the recovery time and reduce the risk of malunion (OR=0.42, 95% CI: 0.28-0.63). At present, there is still controversy over the choice of surgical approach, with the focus lying in the balance between soft tissue protection and the risk of nerve injury. According to biomechanical research, when fixing humeral shaft fractures, it is usually necessary to implant four screws at each end of the fracture line (forming eight layers of cortical fixation). However, in distal humeral shaft fractures, we have almost no space to fix the distal end with conventional plates. Achieving firm fixation in distal humeral shaft fractures is more challenging. The posterior part of the humerus is flat, and the plate can be used without shaping and can be placed at the farthest end of the humerus to ensure the fixation strength and working length of the plate. Therefore, the posterior approach is a commonly used approach for treating distal humeral fractures. However, the posterior approach may carry the risk of damaging the radial nerve. The commonly used access routes at the rear can be divided into two types: one is the modified posterior approach to the distal humerus. Another one is the Triceps Splitting Approach to the Distal Humerus. Both approaches have distinct advantages and limitations.

To compare the clinical efficacy of the modified posterior approach and the triceps brachii splitting approach in the treatment of distal humeral fractures.

A retrospective analysis was conducted on 46 patients with distal humeral fractures admitted from December 2020 to December 2023. They were divided into the modified posterior approach group (24 cases) and the triceps brachii splitting group (22 cases) according to the surgical approach. The operation time, intraoperative blood loss, hospital stay, fracture healing time, elbow joint function (Mayo score), radial nerve injury, and incidence of incision complications were compared between the two groups.

Both groups of fractures healed, and there was no statistically significant difference in healing time (P>0.05). The amount of bleeding in the modified lateral group (100.27±23.39) mL was significantly less than that in the splitting group (209.38±25.78) mL, P=0.034, but the rate of radial nerve injury (8.33% vs 0%, P=0.036) was significantly higher. The incidence of incision complications in the splitting group (9.09%) was higher than that in the modified group (0%, P=0.041). One year after the operation, there was no statistically significant difference in the excellent and good rate of elbow joint function between the two groups (83.33% vs 77.27%, P=0.399) .

The modified posterior approach can reduce intraoperative bleeding, but the risk of radial nerve injury is relatively high. The triceps brachii splitting approach offers more comprehensive nerve protection, but it has a higher rate of incision complications.

Proximal humeral fractures account for approximately 6% of all fractures and are one of the most common fracture types in elderly patients, with about 20% requiring surgical treatment. Locking plates offer advantages such as anatomical-morphology matching, built-in suture holes, and angular stability. In recent years, they have been widely used in the internal fixation treatment of proximal humeral fractures and have achieved good clinical efficacy. However, for proximal humeral fractures with comminuted medial calcar, since the Philos locking plate placed on the lateral side cannot directly perform anatomical reduction on the comminuted medial calcar to provide sufficient support, postoperative complications such as varus deformity, internal fixation failure, and non-union are often prone to occur. In light of this, various methods have been adopted in clinical practice to support and stabilize humeral fractures. The Philos locking plate, placed on the lateral side of the humerus, with its spacing screws, can directly support the crushed medial column of the humerus. However, for petite patients (such as short women), its applicability is often limited. Fibula bone graft support can provide biomechanical strength and shows good mechanical stability. However, once conditions such as humeral head necrosis or obvious greater tuberosity absorption occur, surgical revision becomes significantly more difficult. The double-plate fixation treatment technology of outer PHILOS locking plates combined with auxiliary micro-plates has been widely applied recently. It significantly enhances stability and has a clear therapeutic effect. In addition, as one of the commonly used fixation methods for proximal humeral fractures, intramedullary nail fixation can preserve the blood supply to the humeral head through minimally invasive surgical procedures. Its load-dispersion design and the way the humeral center is fixed give it significant biomechanical advantages in stabilizing medial-compression fractures of the proximal humerus. Although double-plate fixation and intramedullary nail fixation are currently used for proximal humeral fractures with medial calcar comminution, direct comparative evidence remains limited.

To evaluate and compare the imaging and clinical effects of double plate and intramedullary nail fixation in the treatment of comminuted proximal humeral fractures with medial calcar of the humerus.

A retrospective analysis was conducted on 46 patients with proximal humeral fractures accompanied by fragmentation of the medial humeral calcar who underwent surgical treatment at the trauma center of our hospital from January 2017 to July 2024. Patients underwent double-plate fixation (n = 24) or intramedullary nails fixation (n = 22). According to the Neer classification, there were 16 cases of two-part fractures and 30 cases of three-part fractures. The causes of injury were as follows: 21 cases of traffic injuries, 17 cases of falls, and 8 cases of falls from heights. During outpatient follow-up at 1, 3, 6, and 12 months after the operation, shoulder joint X-ray imaging and clinical efficacy evaluation were performed for the above patients, and postoperative complications were also evaluated at the same time. Functional assessment indicators include: Shoulder joint range of motion (ROM), the American shoulder and elbow surgeons (ASES) score, and the Constant-Murley score to evaluate shoulder joint function.

Except for one patient whose fracture healed 5 months after the operation, the fractures of the remaining patients all healed 3 months after the operation. In the double-plate group, 2 cases had screw penetration and underwent revision surgery. One patient in each group experienced proximal screw loosening, but no reoperation was required. Ischemic necrosis of the humeral head was not found in either group. In imaging examinations of the two groups of patients before the operation and 12 months after, there was no significant difference in the neck-shaft angle. The shoulder joint range of motion, average ASES score, and Constant-Murley score in the double plate group were all better than those in the locked intramedullary nail group. Still, there was no statistically significant difference at the 12-month follow-up after the operation.

Double plate and intramedullary nail fixation treatment with comminuted proximal humeral fractures of the medial calcar of the humerus can all achieve satisfactory therapeutic effects. There were no significant differences between the two in terms of joint ROM, ASES, and Constant-Murley scores. Intramedullary nail treatment carries the risk of iatrogenic rotator cuff injury, while patients with double plate fixation have better recovery of shoulder joint function after surgery.