alireza rouhani

 Frozen shoulder syndrome is a pathological condition associated with pain and restricted glenohumeral joint movement. It is divided into two types: idiopathic and secondary. The present study aimed to compare pain, as well as the condition of the cervical and dorsal spine, in patients with idiopathic and secondary frozen shoulder syndrome.

This analytical observational study was conducted on 25 women with idiopathic frozen shoulder and 30 women with secondary frozen shoulder, referring to clinics of Tabriz, who were purposively selected. The pain level was measured using a visual analog scale, the posture of the cervical spine was measured using a photograph, and the posture of the thoracic spine was measured using a flexible ruler. An independent t-test was performed to compare the mean values of the variables. The data were analyzed using SPSS software at a significance level of 0.05.

The obtained results demonstrated that there was a significant difference in the comparison of pain between patients with idiopathic and secondary frozen shoulder (P=0.001). Nonetheless, the comparison of the posture of the cervical spine revealed no significant difference between the two groups (P=0.057). However, the thoracic spine arch was significantly higher in patients with idiopathic frozen shoulders than in the secondary group (P=0.002).

Pain and thoracic spine arch were more common in idiopathic frozen shoulder patients than in secondary patients. Although the difference in the condition of the cervical spine in the two groups was not significant, it is generally necessary to evaluate the posture of the spine to treat the pain of patients with frozen shoulders, especially idiopathic patients.

 Radial head resection has been necessary in cases of radial fragmentation. We assessed the results of radial head resection in patients with the terrible triad. Thirteen patients with terrible triads who had undergone radial head resection and lateral collateral ligament (LCL) repair by a single surgeon from 2004 to late 2020 were studied. Patients were followed for one year and evaluated in terms of the range of motion (ROM), the efficiency of the relevant organ, and radiological factors in patients who could not visit in person; the evaluations were performed using the software. Movements were evaluated with a metal goniometer, and the efficiency was measured using the disability of the arm, shoulder, and hand (DASH), the Mayo elbow performance (MEPS), and the visual analog scale (VAS) scores. The patient's radiography was evaluated for the elbow joint's instability and degree of osteoarthritis.  The mean duration of injury to surgery was 7.30 ± 2.15 days, and the mean follow-up period was 35.19 ± 2.85 months; the mean ROM (Pas, Act) rate was equal to 126.33 ± 10.49 degrees. None of the patients met the criteria for joint instability; of 13 patients, seven were completely satisfied with the surgery, and two returned to their previous jobs. The mean total pain score according to the VAS criteria was 2.6. Radial head resection and LCL repair in the terrible triad of the elbow led to the individual's improved performance and the patient's reduced pain severity and satisfaction.

Ligamentous laxity is a condition that leads to joints’ hypermobility beyond their average and normal range of motion. It can cause musculoskeletal and joint injuries. This national multi-centered study investigated the epidemiology of generalized ligamentous laxity and its relationship with musculoskeletal disorders among Iranian adults with different ethnic backgrounds. A total of 1,488 people (age range: 17-40 years) were selected from eight cities and six different ethnicities of Iran and included in this cross-sectional study. The presence of ligamentous laxity with clinical examinations was searched according to Beighton score criteria. They were also examined for any kind of musculoskeletal disorders that might accompany ligamentous laxity. The Chi-square test was used to compare the frequency of ligamentous laxity based on gender and ethnicity; moreover, the t-test was utilized to compare the frequency of ligamentous laxity based on age. In total, 280 (18.8%) participants had generalized ligamentous laxity, and it was more prevalent in women (22.7%), compared to men (14.4%). Regarding ethnicity, the highest and lowest prevalence rates were in Gilak (37.9%) and Persian-Arab (6%) ethnicities, respectively (P<0.001). Ligamentous laxity showed a significant relationship with sports injury, joint complaint, joint dislocation, ligament sprain, sciatica and back pain, Baker’s cyst, and varicose veins (P<0.001). Most participants with generalized ligamentous laxity (93.6%) had no knowledge of their problem and its importance in choosing an appropriate sports activity.  The prevalence of generalized ligamentous laxity seems to be relatively high among the 17-40-year-old population of Iran, especially in women. It seems to be significantly related to ethnicity. It is strongly recommended that examinations, screening, and information be provided at an early age in schools or at least in areas with a high prevalence as national programs. Level of evidence: I

The aim of this study was to compare the therapeutic effects of four methods of ultrasound (US) alone or in combination with low-level laser therapy (LLLT) (L/US), intra (InCI), and extra (ExCI) sheath US-guided corticosteroid injection in the treatment of long head of the biceps (LHB) tendonitis. In a randomized clinical trial, patients with LHB tendonitis were enrolled in four groups (US, L/US, InCI, and ExCI). Pain using visual analogue scale (VAS) and shoulder performance according to Constant-Murley score (CMS) were evaluated at five visits of before, one week, one month, three months, and one year after treatment. VAS and CMS scores were improved after treatment in all four groups and at all visits in comparison with before treatment. The VAS score in the one-week visit was lower in the InCI group than in all other groups, but it became similar to the score of the ExCI group after this visit and was significantly lower than the score of the US group one year after treatment. CMS was similar at all visits between InCI and ExCI. At one-week and one-month visits, significant differences were seen between the injection groups and the two other non-injection groups, but at the last visit, CMS of the InCI group was only significantly different from that of the US group. Although intrasheath corticosteroid injection under US guidance is an effective method for the treatment of LHB tendonitis, especially in the 1st week after treatment, extra sheath injection also has acceptable results. Using L/US as a less invasive treatment could be as effective as using corticosteroid injection in long-term.

Pediatric forearm fracture is one of the most common upper extremity fractures in young sters. The treatment is often non-surgical. In patients, who need surgical intervention, intramedullary nails are used. Growth disturbances in long bones of the lower extremity occur in youngsters however. Longitudinal overgrowth is very rare in the upper extremity.

This report presents a five-year-old child, who had radius and ulna shaft fracture in the distal one third of his forearm. This child was treated with radius fracture fixation by flexible intramedullary nails. After six months, the child had wrist pain and limitation in range of motion. On the radiography, 4 mm increase in radius was observed.

Overgrowth of long bones after application of intramedullary nails is known in the lower extremity however it is uncommon in the upper extremity and the exact mechanism of this phenomenon has not yet been determined and needs further investigation.

Distal radius fractures are the most common fractures of upper limbs in adults and their treatment in older patients is difficult. There are different therapeutic methods. In this study we aim to compare the therapeutic outcome of distal radius fractures treated with pin-in plaster and percutaneous pinning in older patients.

In this randomized clinical trial, 60 old patients including 40 female and 20 male between 60-85 years old with distal radius fractures were evaluated in two groups of pin-in plaster (n=30) and percutaneous pinning (n=30) for treatment outcome, radiographic changes, functional outcome and pain during 6 month after surgery.

Pin-in plaster group compared to percutaneous pinning had significantly better radiologic findings at the end of 6 month. Excellent functional results after 6 weeks were observed in 30% and 23.3% of pin-in plaster and percutaneous pinning groups, respectively (p=0.84), six months after surgery, excellent functional outcome were significantly higher in pin-in plaster group (83.3% vs. 50%, p=0.006). Being painless has no significant difference between groups after 6 weeks (43.3% vs. 56.7%, p=0.54), however it was significantly higher in pin-plaster group after 6 months (93.3% vs. 50%, p=0.002).

Pin-in plaster method compared to percutaneous pinning had acceptable radiologic and functional outcome in old patients over 60 years old. Using this method as a simple method with high efficacy in treatment of distal radius fractures is recommended.

Acromioclavicular dislocation is one of the most common shoulder injuries among athletes, and appropriate treatment of acromioclavicular joint dislocation is controversial. Acromioclavicular ligament (AC) and Coracoclavicular(CC) are the most important joint stabilizers. In joint dislocation the ligaments are torn, therefore the repair of these ligaments play an important role in increasing the joint stabilization after surgical treatment. The purpose of this study was to compare treatment results of Acromioclavicular dislocation with Coracoclavicular(CC) ligament repair and without it.

In a descriptive analytical study, 40 patients with acute acromioclavicular dislocation required operative treatment were studied. In the target group in addition to an open reduction and fixation with screws, Coracoclavicular(CC) ligament repair with non-absorbable suture was done. Two groups were compared in terms of clinical outcome and functional ability and complications.

In this study, 40 patients were studied, including 39 males (97.1%) and 1 female (2.6%) were studied. The mean age was 31.6 ± 8.1 years. Comparisons of patient’s performance according to Constant Score showed a significant difference between two groups. So that has been in the ligament repaired was 8.7 ± 1.7 and in other group was 10.1 ± 2.1. Also according to the Constant on ligament repair was higher points score 90% excellent and 10% good, the other group rated was 70% excellent and 30% good. Coracoclavicular (CC) distance in patients undergoing CC ligament repair was significantly reduced and was equally to the healthy side While in the cases without ligament repair was not diminished coracoclavicular(CC) distance. No complications were observed in the groups.

Coracoclavicular(CC) ligament repair lead to better functional ability in patients with acute acromioclavicular dislocation and not associated with any symptoms.

Backgrounds and Adhesive capsulitis, characterized by pain and progressive stiffness of the glenohumeral joint, is a common cause of shoulder pain in patients referred to the outpatient clinic. Calcitonin is a thyroid hormone that provides analgesic effects in painful conditions including complex regional pain syndrome, trauma, vertebral metastasis fractures and etc. Intranasal calcitonin would lead to significant improvement in the treatment of shoulder adhesive capsulitis.
In a prospective, double blind, randomized, placebo controlled clinical trial study, 64 patients with adhesive capsulitis were divided into 2 groups. The active group received intranasal Calcitonin spray (200 u/day for 6 weeks) and placebo group received placebo spray. Patients of two groups were evaluated before and after intervention, with assessment of shoulder pain, shoulder range of motion and ability in performing daily activities.
At 6 weeks, there was greater improvement in shoulder pain, shoulder range of motion and ability in performing daily activities in the calcitonin group than placebo group. In intervention group, 22 (68%) patients experienced improvement while 10 (32%) patients did not experience improvement in their shoulder function. In placebo group, 9 (28%) and 23 (72%) of patients of the placebo group experienced and did not experience improvement of shoulder function.
A 6 week course of 200 u/day intranasal calcitonin spray has a significant benefit in shoulder adhesive capsulitis. Considering the noninvasive nature and lack of any significant complications of this treatment, intranasal calcitonin spray associated with physiotherapy and anti-inflammation medicines are recommended for the treatment of shoulder adhesive capsulitis.

Supracondylar humerus fracture is the most common elbow fracture in children and accounts for about 16% of pediatric fractures. To maintain stability in the reduced segment in medial and lateral columns is an important treatment concept. The aim of this study was to compare two methods of proximal distal lateral pinning with medial and lateral cross pinning.
In a cross-sectional study, 140 children (63 boys, 77 girls) with supracondylar humerus fracture were evaluated in a training center in Tabriz, Iran. The mean age was 5.04 years. The cases were divided into two groups (each 70 patients), matched for age, sex and type of fracture and were treated with two above methods. Complications and outcomes were copmpared.
Ulnar nerve lesion in the medial and lateral cross technique was 4.3%, and none in the group done by all lateral pin technique. The need for further surgery and loss of stability was 2.9% and 1.4% respectively with no statistical difference. Pin site infection around the pins was 4.3% and 12.9% percent respectivly. Cubius varus deformity rate was 2.9% in lateral cross pinning and 4/1% in medial lateral cross pinning.
Proximal distal cross pinning technique for suprocondylar humerus fracture is comparable to medial and lateral cross pinning in terms of stability in maintaining a good reduction. The possibility of ulnar injury is negated in cross-lateral technique.

Osteoid osteoma is a benign bone tumor that when located on the base of the coracoids process of the scapula is very rare and diagnosis and treatment is often delayed because of its rarity. Almost any bone can be involved, but half of cases involve the femur or tibia. The radiologic features of osteoid osteoma are well known, but these tumors may present with unusual features and be easily misdiagnosed. In this report, we present a case of osteoid osteoma of the neck of the left scapula that took almost 27 months to be diagnosed accurately.

Pain is one of the most important factors adversely affecting clinical outcomes of operated patients. The present study aims at evaluating effects of preoperative COX2 non-steroidal anti-inflammatory inhibitors on pain mitigation and performance of patients with shoulder rotator cuff tear. This case-control study was conducted on 60 patients suffering from rotator cuff injury candidate for arthroscopic repair. The patients were classified in two parallel and matched groups. One group (case group) was treated using Celecoxib (200mg/12h) started 48 hours before surgery and continued for 10 days after operation. In the control group, the placebo was prescribed in the same way. Postoperative pain, side effects, sleep disturbance, and short-term outcomes were compared between two groups using DASH questionnaire. Postoperative pain in the Celecoxib group significantly decreased in comparison with the control one. The difference was statistically meaningful (P<0.001). Well motion ability was seen in 80% of patients of the Celecoxib group. It was 26.6% in the placebo group since pain inhibited them from exercising more motions. In this regard, there was a statistically meaningful difference between these two groups (P=0.02). Sleep disturbance was meaningfully at higher levels in the placebo group (P=0.001). Following up the patients for three months, it was made clear that performance of the Celecoxib group was better than that of the placebo one. COX2 inhibitors are well efficient in patients’ pain management after arthroscopic rotator cuff repair surgery. It results in less life complications, less sleep disturbances, improvement of patients’ short-term clinical outcome, and more quick recovery.

Although the majority of soft tissue masses are benign, it is important to consider malignancy in differential diagnoses. Because most soft tissue sarcomas present as a painless mass, clinicians must watch for signs suggestive of malignancy, including large size, rapid growth, and site deep into the deep fascia.The purpose of this study was to determine the relative prevalence according to sex and age, site of tumor, skeletal distribution, and treatment (surgery, chemotherapy and radiotherapy) before and after surgery, and ascertain the relative frequency of these tumors in specific anatomic sites and age groups based on pathological studies. A total of 308 patients, with a musculoskeletal tumor were evaluated retrospectively. All of the patients enrolled into this study were referred to the Beirouni Hospital of Damascus University with a proven diagnosis of alignant soft tissue tumors from the beginning of January 2008 until the end of 2010. The prevalence of the malignant soft tissue tumors in these patients was analyzed. For purposes of analysis, all lesions were placed in 1 of 9 categories: hand and wrist, forearm, humorous (arm), proximal limb girdle (axilla and shoulder), foot and ankle, thigh, hip and buttocks region, trunk, and other lesions. Age and sex also were recorded. Malignant tumors consisted of seven diagnostic categories: malignant fibrous histiocytoma (23%), liposarcoma (22%), rhabdomyosarcoma (9%), leiomyosarcoma (8%), malignant schwannoma (5%), dermatofibrosarcoma protuberans (5%), synovial sarcoma (10%), fibrosarcoma (13%), extraskeletal chondrosarcoma (1%), and extraskeletal Ewing sarcoma (4%). Despite the multitude of pathologic possibilities, most malignant soft-tissue tumors are classified into a small number of diagnoses. These may be further defined when the site of the lesion and the age of the patient are considered. Knowledge of tumor prevalence will assist radiologists in establishing a suitably ordered differential diagnosis when a soft-tissue tumor has a nonspecific radiologic appearance.

Avulsion injury of the flexor digitorum profundus (FDP) with concomitant fracture of the distal phalanx dorsal base is uncommon. Simultaneous avulsion fractures of the insertion of this tendon associated with rupture of the tendon from the bony fragment and combination with dorsal base fracture is very rare and also complicated. A 36- year- old man fell and injured his right little finger. FDP avulsion with simultaneous dorsal base fracture (containing extensor Tendon insertion) was detected. Our surgical repair by a single midlateral incision the avulsed fragment was replaced on the palmar base of the distal phalanx and successfully immobilized with 1.5 mm screw. After three months, patient had 20 degree range of motion in DIP joint. The digit was pain free and also relatively functional. It seems that FDP avulsion classification need to be extended and include this uncommon type as described in this case report for better management of these uncommon type.

The Forearm fractures are common among children and usually managed differently comparing with other similar injuries in adults. The aim of this study was to identify the risk factors of forearm fractures in children. In this clinical trial study، 86 patients randomly were divided into two groups: group A (treated with a long arm cast method) and group B (treated with Sugar-Tong splint method). The risk factors of distal radial fractures were evaluated. Eighty six children less than 15 years with the mean age of 12. 24±2. 24 years old were studied. The compared with a true transverse fracture، the 10°،20°، and 30° of obliquity increased the likelihood of redisplacement 3. 23، 5. 82، 12. 14 times، respectively. The complete initial displacements of the fracture and increases obliquity of the fracture line are the most important risk factors for redisplacement.

Malunion is the most common complication following distal radius fractures. Aim of this study was to evaluate the results of distal radius corrective osteotomy and plate fixation by dorsal approach in the malunion. In this retrospective study, 14 patients with neglected distal radius malunion from 2005 to 2011 were studied. All patients were treated with an opening wedge osteotomy with a dorsal plate and cancellous bone grafting. Radiological and clinical measurements were performed pre and postoperatively. All patients were followed at least for two years. Fourteen patients with a mean age of 42.5±10.2 years including 2 females (14.2%) and 12 males (85.8%) were studied. Radiological healing was achieved in all osteotomies at a mean of 11.5 (range: 11 to 14) weeks. There were significant differences between wrist function and radiological findings before and after treatment. Following the operation, all patients were relieved of pain. There were not any complications. Based on our findings, dorsal approach for osteotomy and plate insertion is an effective approach with good final results and no major complication for the treatment of distal radius malunion.

Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair. Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group). The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day). The range of motion improvement rate of the involved fingers and the patients’ performance after their follow-up period were compared. There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03). According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01). There was not any case of re-tear or need to re-operate in the intervention and control groups. Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury.

Femoral neck fractures are urgent injuries that require precise reduction and stable fixation. In some cases, however, early treatment is not possible.

The present study aimed to evaluate long-term results of delayed fixation of femoral neck fractures using cannulated screws.

This retrospective descriptive-analytical study was conducted on 26 patients with femoral neck fractures. The patients were treated through a closed reduction and fixation method using cannulated screws. Patients were followed up for at least five years and the rate of complications was determined.

In this study, 26 patients with mean age of 34.3 years were assessed. Average time interval from injury to surgery was 46.4 ± 12.2 hours; 18 patients (69%) were operated on with more than 36 hours of delay. Incidence of AVN and nonunion was reported in 10 (38.4%) and 3 (11.5%) patients, respectively.

Time plays an important role in treatment results of femoral neck fractures. To treat the fractures, closed reduction and fixation using cannulated screws may still be the best option.

Lower limb amputation has different etiologies and it varies with socioeconomic issues and incidence of some diseases such as diabetes and vascular diseases. The aim of this study was to evaluate causes of the amputation, the amputation level and the incidence of amputation among male and female patients of different ages. In a retrospective and descriptive study between 2002 and 2007 in Tabriz Shohada hospital, the ttiology, level and type of amputations were assessed and results were analyzed. One hundred forty six medical files with diagnosis of the lower limp amputation were selected. Trauma was the most common cause of amputation (46%), followed by the vascular diseases (42%) and infection (12%). One hundred seventeen patients (80%) were male and 20% were female. This investigation showed that trauma is the major cause of amputation in our region and vascular problems are of second significance.

Osteoid osteoma is a small benign bone tumor usually affects adolescents and young adults. Although this tumor mainly affects the shafts of long bones there have been several reports of subperiosteal and intramedullary involvement. Complete surgical excision is the classic treatment of choice for patients with osteoid osteoma. Despite the small size of the tumor, the operative procedure for its removal can be extensive. The surgeon may have to excise a significant piece of bone to be sure the lesion is removed. There is a risk of fracture if a large amount of bone is removed and therefore internal fixation, bone grafting, or both may be required. In recent years several techniques of minimally invasive treatment of osteoid osteoma have been proposed. We introduce intramedullary reaming as a minimally invasive procedure for the treatment of intramedullary osteoid osteoma in long bones.