Frozen shoulder, also known as periarthritis of shoulder, fifty shoulder, etc., is aseptic inflammation of soft tissue around shoulder joint caused by degenerative changes of shoulder joint, with shoulder pain and mobility disorders as the main symptoms, seriously affecting the quality of life. Frozen shoulder is more common in patients of 40-70 years old, and the prevalence rate is 2%-5%. At present, the pathogenesis of frozen shoulder is still not completely clear, and the main treatment purpose is to relieve pain and restore function. Currently, non-steroidal anti-inflammatory drugs are mainly used to relieve pain in clinical practice, but the efficacy is limited. Surgical release is effective in reducing adhesion and restoring joint activity, but it is easy to relapse and the cost is high. It is of great significance to find long-term effective, economical and convenient therapeutic drugs to improve patients’ life quality. Cheezheng Xiaotong Plaster is a traditional Tibetan medicine prescription, with the effect of promoting blood circulation, removing blood stasis, reducing swelling and relieving pain, which is widely used in acute and chronic torsion and contusion, stiff neck, periarthritis of shoulder, lumbar muscle strain and other diseases.

To compare the effect of Cheezheng Xiaotong Plaster and local drug injection in the treatment of frozen shoulder, and evaluate the advantages of Cheezheng Xiaotong Plaster in relieving pain of frozen shoulder patients and increasing the recovery of shoulder function.

A multicenter randomized controlled trial was developed, and a total of 280 subjects with frozen shoulder, from 8 domestic centers were divided into treatment group or control group with random digital table, 140 cases in each group. The treatment group was treated with Cheezheng Xiaotong Plaster of 1 post for 8 hours every day from the first week to the second week, and 1 post every other day from the third week to the fourth week. The control group was given sodium hyaluronate + 1% lidocaine 1 ml by subacromial injection once. The visual analogue scale (VAS) score of pain, Oxford shoulder function score (OSS) and shoulder range of motion of the two groups were recorded at the time of initial diagnosis, 14 days, 28 days and 90 days after treatment. In this study, the VAS score reduction rate after 28 days of medication was taken as the main efficacy index, and reduction rate > 30% was regarded as effective. Vital signs, laboratory data and adverse events were recorded.

The effective rate was 91.3% in the treatment group and 84.1% in the control group conforming to the protocol population set, with no significant difference between the two groups (P>0.05) . After 14 days of treatment, there was a significant difference in VAS score reduction rate between the two groups (P<0.01) , which was 70.5% and 42.7% respectively in the treatment group and the control group. The effective rates of the treatment group and the control group were 95.3% and 90.3%, respectively after 90 days of treatment (P>0.05) . After 14 days, 28 days and 90 days of treatment, OSS in the two groups declined, and decline in the treatment group was more significant (P<0.05) . Compared with the baseline period, the VAS scores of two groups both declined after 14 days, 28 days and 90 days of treatment, and the decline of the treatment group was more significant (P<0.01) . The range of motion of two groups both improved after 14 days, 28 days and 90 days of treatment. The improvement of abduction and external rotation in the treatment group was more significant (P< 0.05) .

Cheezheng Xiaotong Plaster has good curative effect on frozen shoulder, and its curative effect is not inferior to sodium hyaluronate + lidocaine injection. Cheezheng Xiaotong Plaster has significant effect in relieving pain and improving shoulder dysfunction, which could improve the range of motion of shoulder joint. Cheezheng Xiaotong Plaster are safe in clinical practice with no serious adverse events occurred.

Acromioclavicular instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations are suggested to be managed by various surgical procedures that utilize different grafts to achieve healing with a pain-free shoulder. Currently, the two modern techniques widely used are hook plate fixation and coracoclavicular ligament fixation using a suspensory loop device.

To investigate the causes and preventive strategies for specific complications after coracoclavicular suture button fixation.

A retrospective study was conducted to analyze the clinical data of 113 patients with acromioclavicular dislocations or distal clavicle fractures admitted to Changshu No.2 People's Hospital from September 2011 to July 2020. Seventy-six patients who suffered acromioclavicular dislocations were categorized as Tossy classification type Ⅲ, while 37 who suffered distal clavicle fractures were classified as Cho classification typeⅡ. There were 42 males and 71 females with an average age of (54.3±9.6) years (23 to 78 years ) . All patients were operated on after an average of 4.2 days from the initial injury. The anteroposterior radiographs of the affected shoulder were performed to evaluate the position of the implants and the reduction. The Karlsson degree system was used to assess the functional recovery of the affected shoulder. Specific complications related to the hardware or the surgical technique were recorded to explore the causes and related preventions.

The mean follow-up period was 39.1 months ( 16 to 120 months) . In the distal clavicle fracture group, one case suffered transient brachial plexus injury when a guide pin was drilled through the base of the coracoid process and recovered immediately with no dysfunction. In the acromioclavicular dislocation group, one case received unanticipated hook plate fixation as a coracoid process fracture was found during the procedure. Another coracoid process fracture and loss of reduction on radiographs were detected one day after the initial operation, and the patient received clavicular bandage immobilization for four weeks. One patient underwent revision surgery with informed consent as the button migrated inferior to the subclavian area, and the complete loss of reduction alignment was found on the immediate radiographs. Seven cases of subluxations on the radiographs were observed one day after the operation, which was attributable to the surgical procedure. The patients received clavicular bandage immobilization for four weeks. One delayed postoperative infection was diagnosed four months after the initial operation and treated with sensitive antibiotics and implant removal. Eleven cases of redislocations were identified during the 1 to 7 months follow-ups. By Karlsson degree system of 12 months after the operations, excellent results were obtained in 55 patients ( 72.4% ) and good in 13 patients ( 17.1%) in the acromioclavicular dislocation group. In contrast, excellent results were obtained in 29 patients (78.4%) and good in 5 patients (13.5% ) in the distal clavicle fracture group.

More attention should be paid to coracoclavicular suture button fixation even though it is maneuverable. It is crucial to create tunnels in the correct position and ideal direction.

The superior labrum anterior and posterior (SLAP) lesion is a common reason for shoulder pain and snapping or popping and severely affects exercise performance. According to the pathological structure, SLAP injury is classified into four sub-types, and type II is the most common injury. The treatment of SLAP lesion is based on the type of SLAP injury, the patient's age, and the need for shoulder movement, etc. However, the surgical method for SLAP-II injury remains controversial, and there is a lack of high-level evidence-based support. Though with a sound effect for SLAP repair, it is reported that the patient satisfaction and return rates are not high among elderly or overhead athletes, and there is a possibility of prolonged recovery time and surgery failure. Tenotomy or tenodesis has gradually become the alternative option for primary SLAP injury.

To explore the decisive factors influencing the clinical decision for the surgery of SLAP injuries.

A total of 163 patients with SLAP injuries who had undergone surgery in our hospital from January 2018 to January 2021 was retrospectively analyzed, and the correlation between the surgical methods and the critical factors, including age, history of shoulder trauma, history of conservative treatment, duration, combined injuries and classification, etc. were investigated. The Logistics regression equation was used to construct the regression model.

Among the 163 patients, 4 cases were type I, 132 cases were type II, 13 cases were type III, and 14 cases were type IV. There was no correlation between the surgery method and the SLAP classification (P>0.05) . In type II SLAP injury, there were no significant correlative factors related to SLAP repair (P>0.05) . The average age of patients who underwent SLAP repair was 18.84 years younger than those who did not. The average age of patients who underwent tenotomy were 13.01 years younger than those who did not (P<0.01) . Compared to tenotomy, there is a negative correlation between simple tenodesis or insertion downward tenodesis with LHBT tear (OR=0.169, 95% CI: 0.039-0.736; OR=0.275, 95% CI: 0.086-0.878) . However, compared to tenotomy or insertion downward tenodesis, there is a positive correlation between tenodesis with the history of conservative treatment (OR=26.979, 95% CI: 2.622-277.635; OR=8.827, 95% CI: 1.007-77.358) .

SLAP repair is widely used for all types of SLAP lesions. For type II SLAP injuries, SLAP repair is preferred for young patients, while elderly patients and those with LHBT tear were more likely to undergo tenotomy. In addition, the simple tenodesis is preferred for patients with a history of conservative treatment.

Massive rotator cuff tear was defined as a complete tear of at least two tendons or a tear size of over 5 cm. Massive irreparable rotator cuff tears often lead to shoulder dysfunction that can significantly affect daily activities. In chronic cases, rotator cuff tears are accompanied by retraction and atrophy of muscles and tendons, followed by muscle fat infiltration, making the rotator cuff irreparable. Rotator cuff tears are considered non-repairable and usually result in structural healing. Various surgical approaches have been used to treat massive irreparable rotator cuff tears, including arthroscopic combined biceps long head tendon fixation, rotator cuff partial repair, tendon transposition, and patch enhancement. However, none of these methods is the best treatment for massive irreparable rotator cuff tears. Their clinical results are not very reliable, and the incidence of postoperative complications increases over time. In patients with glenohumeral arthritis, arthroscopic repair or tendon transposition may be associated with residual pain and dysfunction. RTSA is an option for patients with or without \irreparable rotator cuff tear when the deltoid muscle is functioning well. RTSA was initially designed to improve upper limb elevation and relieve pain in patients with rotator cuff defects combined with glenohumeral arthritis. Since the development of RTSA, many clinical studies have demonstrated that RTSA is an effective treatment for rotator cuff arthropathy. Indications for RTSA have gradually expanded to other shoulder disorders, including irreparable rotator cuff tears that were previously treated differently. Currently, RTSA is the preferred treatment for elderly patients with massive irreparable rotator cuff tears. RTSA can relieve pain and improve shoulder function, thereby improving quality of life, but the prostheses' high complication rate and longevity are of concern. The implementation of RTSA in China is late, and the RTSA for irreparable massive rotator cuff tears is less experienced.

To investigate the clinical efficacy of reverse total shoulder arthroplasty in treating irreparable massive rotator cuff tear.

From May 2018 to January 2020, 13 irreparable massive rotator cuff tear cases were treated in the Affiliated Hospital of Nanjing University of Chinese. The angles of anteflexion, abduction, external rotation, and the scores of ASES (American shoulder and elbow surgeons) and UCLA (University of California at Los Angeles) were recorded before surgery and at the final follow-ups to evaluate the shoulder joint function, and the complications and imaging results were documented as well. Preoperative MR was conducted to assess the degree of rotator cuff fat infiltration, CT was undertaken to evaluate the condition and defect of scapular glenoid bone, and postoperative radiographs were used to assess the status of the prosthesis.

All patients were followed up for at least 12 months. The angles of anteflexion, abduction, and external rotation and the scores of ASES and UCLA after operation were remarkably improved compared to those before the procedure. There was a significant statistical difference (P<0.01) . During the follow-up period, 1 of the 13 patients underwent hematoma removal and drainage one week after surgery due to local hematoma, and all patients had good functional recovery.

RTSA has an excellent clinical effect on irreparable massive rotator cuff tears.

Distal clavicular fracture is a common traumatic injury. Given the high rates of non-union after non-operative treatment, it is recommended that clavicular fractures of Neer type II are treated surgically due to their unstable nature. The clavicular hook plate is one of the recommended devices for treating distal clavicular fractures. The clavicle hook plate works according to the principle of leverage, where the distal part is designed as a hook that is placed beneath the acromion, and the proximal portion is designed as a plate. Although it is easy to manipulate the hook plate during surgery, which is associated with excellent functional outcomes for the shoulders, the high complication rate of 40.7% is problematic. The complications caused by the hook under the acromion are common and include acromial osteolysis, acromioclavicular joint arthrosis, subacromial impingement, and rotator cuff injury. Many authors have discussed these complications, and some of them are considered to be associated with highly concentrated subacromial stress. However, clavicular midshaft fractures on another stress concentration point are rarely reported or investigated due to their lower incidence.

To identify and analyze the potential risk factors of clavicular midshaft fractures after hook plate fixation to treat Neer type II clavicular fractures.

From March 2009 to July 2019, 294 patients treated with hook plates for distal clavicular fractures met the inclusion criteria during the period. The study sample comprised 279 patients without clavicular midshaft fractures (control group) and 15 patients with clavicular midshaft fractures (complication group) . Data collection included gender, age, affected side, body mass index, smoking status, type of medial screw used, whether the surgery was performed by a resident, whether the hook plate was bent during the surgery, number of holes in the plate, depth of the hook, and the time and causes of this complication. The Chi-square test was used to compare all potential risk factors between the two groups. Only a statistically significant predictive variable was included in the final logistic regression.

Older patients with distal clavicular fracture treated with hook plate are more likely to develop clavicular midshaft fractures (OR= 3.478; 95% CI : 1.719-15.407; P= 0.003) .

The risk of clavicular midshaft fracture after hook plate fixation could be significantly increased by advanced age.

Rotator cuff injury is the most common clinical shoulder joint disease, accounting for 50%-85% of all shoulder joint diseases. At present, arthroscopic rotator cuff repair has replaced the traditional surgical plan of incision and suture, becoming the first choice of surgeons. Its effectiveness and safety have been recognized in the industry. However, there are also occasional cases with poor postoperative effects and insufficient pain relief.

To analyze the prognostic factors of arthroscopy rotator cuff repair.

From February 2019 to February 2020, the primary data of 117 patients who received arthroscopic rotator cuff repair in the department of orthopedics of tenth people's hospital of Tongji university were retrospectively analyzed, and the surgical efficacy was followed up for one year after surgery.

There were 95 patients with a good prognosis, accounting for 81.20%. Multivariate analysis showed that age, preoperative course of the disease, degree of tear, and the use of platelet-rich plasma (PRP) were independent factors affecting prognosis.

The age, preoperative course of the disease, rotator cuff tear degree, use of PRP during operation are important factors affecting the prognosis of arthroscopy rotator cuff repair.