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Fulltext Necrotizing fasciitis of the upper back presenting with left shoulder pain

Mohamad Isa MZ, Mohamed-Yassin MS, Abdul Kadir RF

Clin Pract, 2020 Mar 31;10(1):1218.
PMID: 32373307 DOI: 10.4081/cp.2020.1218

Necrotizing fasciitis is a severe and progressive infection of deep soft tissues which results in destruction of the fascia and overlying subcutaneous fat. We report a case of a 45-year-old diabetic gentleman who initially presented with left shoulder pain, which was treated symptomatically. Upon representation, he had fever and the pain extended to his left upper back. There was a warm, firm and mildly tender purplish swelling on his mid to the left upper back. Blood tests revealed significantly elevated white cell counts and C-reactive protein. A CT thorax showed extensive soft tissue gas within the deep and superficial fascial layers of his left upper back. Necrotizing fasciitis was confirmed intraoperatively. The diagnosis of this condition is often difficult as early symptoms can be mild and nonspecific. A high Laboratory Risk Indicator for NECrotizing fasciitis (LRINEC) score may be helpful to rule in this diagnosis and guide further management.

Matched MeSH terms: Shoulder Pain
Fulltext Neonatal clavicle fracture: a review of fourteen cases in east coast Peninsular Malaysia

Awang, M.S., Abdul Razak, A.H., Che Ahmad, A., Mohd Rus, R.

International Medical Journal Malaysia, 2017;16(2):79-83.
MyJurnal

Introduction: The purpose of this study is to identify the incidence of clavicle fractures in newborn
associated with fetal, maternal and process of deliveries in Kuantan General Hospital from June 2012 until
January 2014. This study is to determine epidemiological data of clavicle fractures, maternal and baby risk
factors associated with clavicle fractures of newborn and its’ outcome.

Methods: This is a prospective
study. 13 patients were identified to fulfill the inclusion criteria of the study. The data of
sociodemographic, associated fetal and maternal risk factors and the outcomes were recorded using
proforma. The statistical data analysis was done using SPSS 12.0.

Results: Out of 20,257 live births at our
centre during the study period, 13 infants were diagnosed to have clavicle fractures, giving an incidence of
0.64 per 1000 live births. There were 5 (38.5%) left, 7 (53.8%) right and one (7.7%) bilateral fracture. All
fractures located at the mid shaft of the clavicle and none have associated brachial plexus injuries. All
infants were delivered through vaginal delivery (61.5%); five through assisted delivery (instrumental); 2
(15.4%) forcep and 3 (23.1%) vacuum. Two of the babies developed shoulder dystocia. The average birth
weight was 3371 grams (SD 0.269) and mean gestational age was 38.7 weeks (SD 1.16). Five of the mothers
(38.5%) were primigravida and eight (61.5%) were multigravida in which,7 (53.8%)were healthy without
other co-morbidty, 5 (38.5%) having gestational diabetis and one (7.7%) hypertension. The average maternal
weight was 62.0 kg and height 1.58 metres with average BMI of 24.16 (3.29SD). All eventually had a
complete recovery at 6 weeks with clinical and radiological evident of fracture union.

Conclusions: In
conclusion, all patients with clavicle fractures were found following vaginal delivery. There were no
associations between neonatal clavicle fractures with maternal or baby risk factors. All fractures healed
without any complications.

Matched MeSH terms: Shoulder
Fulltext Nerve injuries in anterior shoulder dislocations

Yeap JS, Lee DJK, Fazir M, Kareem BA, Yeap JK

Med J Malaysia, 2004 Oct;59(4):450-4.
PMID: 15779576

A retrospective study was conducted to determine the incidence of nerve injuries in anterior dislocations of the shoulder and to determine if a neurological examination is routinely performed in such cases. One hundred and fifteen shoulder dislocations in 100 patients (74 males, 26 females; mean age 35+/-18 years) were reviewed. Eighty-seven patients were examined for neurological injuries prior to reduction and 8 of these patients (9.2%) were found to have sustained neurological injuries. Following reduction, neurological examination was performed in 85 patients. Three patients who were not examined initially prior to reduction were subsequently found to have nerve injuries after reduction. Seven patients (7%) were not examined for neurological injury both before and after reduction of the dislocation. Eleven patients were found to have sustained nerve injuries in the final analysis. Axillary nerve injuries were the most common, occurring in 8 patients. In conclusion, nerve injuries are common in shoulder dislocations. The importance of performing and documenting the findings of neurological examination anterior shoulder dislocations needs to be reiterated.

Matched MeSH terms: Shoulder Dislocation/complications*
Fulltext Non Secretory Multiple Myeloma With Extensive Extramedullary Plasmacytoma: A Diagnostic Dilemma

Low SF, Mohd Tap NH, Kew TY, Ngiu CS, Sridharan R

Iran J Radiol, 2015 Jul;12(3):e11760.
PMID: 26528383 DOI: 10.5812/iranjradiol.11760v2

Multiple myeloma (MM) is characterized by progressive proliferation of malignant plasma cells, usually initiating in the bone marrow. MM can affect any organ; a total of 7 - 18% of patients with MM demonstrate extramedullary involvement at diagnosis. Non-secretory multiple myeloma (NSMM) is a rare variant that accounts for 1 - 5% of all cases of multiple myeloma. The disease is characterized by the absence of monoclonal gammopathy in serum and urine electrophoresis. Our case report highlights the diagnostic challenge of a case of NSMM with extensive extramedullary involvement in a young female patient who initially presented with right shoulder pain and bilateral breasts lumps. Skeletal survey showed multiple lytic bony lesions. The initial diagnosis was primary breast carcinoma with osseous metastases. No monoclonal gammopathy was found in the serum or urine electrophoresis. Bone marrow and breast biopsies revealed marked plasmacytosis. The diagnosis was delayed for a month in view of the lack of clinical suspicion of multiple myeloma in a young patient and scant biochemical expression of non-secretory type of multiple myeloma.

Matched MeSH terms: Shoulder Pain
Osteomyelitis in childhood -the natural history documented by radiographs

Singh, H.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):74-76.
MyJurnal

It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.

Matched MeSH terms: Shoulder
Fulltext PHILOS Plate as a Fixation of Proximal Humeral Fracture: A Revisit

Mohd Shaffid Md Shariff, Hanizah Ngadiron, Firdaus Hayati, Nornazirah Azizan, Affirul Chairil Ariffin

Borneo Journal of Medical Sciences, 2019;13(2):39-43.
MyJurnal

Fracture is common after trauma. Proximal humeral fracture can occur in the elderly after fall and in youngsters after motor vehicle accidents (MVA) and sport injuries. A 37-year-old man was admitted with a fracture of his left proximal humerus following an MVA. He sustained a 3-part fracture and treated surgically using a PHILOS plate. There are few options in managing proximal humerus fracture ranging from conservative to surgical intervention based on its severity. We reminiscent the usage of PHILOS plate as a mode of treatment of such fracture.

Matched MeSH terms: Shoulder Fractures
Pain relief for reduction of acute anterior shoulder dislocations: a prospective randomized study comparing intravenous sedation with intra-articular lidocaine

Cheok CY, Mohamad JA, Ahmad TS

J Orthop Trauma, 2011 Jan;25(1):5-10.
PMID: 21164304 DOI: 10.1097/BOT.0b013e3181d3d338

The aim was to compare the effectiveness of intra-articular lidocaine (IAL) versus intravenous Demerol and Diazepam (IVS) in reduction of acute anterior shoulder dislocation.

Matched MeSH terms: Shoulder Dislocation/complications; Shoulder Dislocation/drug therapy*; Shoulder Dislocation/surgery*
Patterns of work-related musculoskeletal disorders among workers in palm plantation occupation

Henry LJ, Jafarzadeh Esfehani A, Ramli A, Ishak I, Justine M, Mohan V

Asia Pac J Public Health, 2015 Mar;27(2):NP1785-92.
PMID: 23417907 DOI: 10.1177/1010539513475657

This study investigated the patterns of ongoing work-related musculoskeletal disorders (WRMDs) and exposure risk to musculoskeletal injuries for various body regions among palm plantation workers. Standard Nordic Musculoskeletal Questionnaire (SNMQ) was used to assess the prevalence of musculoskeletal disorders symptoms. The Quick Exposure check (QEC) was used to assess the exposure risk of farmers to WRMDs. The common pattern of WRMDs was back pain (40%), followed by shoulder pain (19%). The QEC revealed high exposure risk for neck (56%), followed by back (45.6%). The results from the SNMQ showed that 58% reported pain in 1 region, followed by 2 regions (10.7%) and 3 regions (3.6%). Back pain and shoulder pain were found to be common among workers in palm plantation occupation. Nevertheless, the neck region appeared to have the highest risk of exposure to injuries.

Matched MeSH terms: Shoulder Pain/epidemiology
Fulltext Pearls and Pitfalls of Phrenic Nerve Transfer for Shoulder Reconstruction in Brachial Plexus Injury

Doi K, Sem SH, Ghanghurde B, Hattori Y, Sakamoto S

J Brachial Plex Peripher Nerve Inj, 2021 Jan;16(1):e1-e9.
PMID: 33584849 DOI: 10.1055/s-0041-1722979

Objectives The purpose of this study was to report the functional outcomes of phrenic nerve transfer (PNT) to suprascapular nerve (SSN) for shoulder reconstruction in brachial plexus injury (BPI) patients with total and C5-8 palsies, and its pulmonary complications. Methods Forty-four out of 127 BPI patients with total and C5-8 palsies who underwent PNT to SSN for shoulder reconstruction were evaluated for functional outcomes in comparison with other types of nerve transfers. Their pulmonary function was analyzed using vital capacity in the percentage of predicted value and Hugh-Jones (HJ) breathless classification. The predisposing factors to develop pulmonary complications in those patients were examined as well. Results PNT to SSN provided a better shoulder range of motion significantly as compared with nerve transfer from C5 root and contralateral C7. The results between PNT and spinal accessory nerve transfer to SSN were comparable in all directions of shoulder motions. There were no significant respiratory symptoms in majority of the patients including six patients who were classified into grade 2 HJ breathlessness grading. Two predisposing factors for poorer pulmonary performance were identified, which were age and body mass index, with cut-off values of younger than 32 years old and less than 23, respectively. Conclusions PNT to SSN can be a reliable reconstructive procedure in restoration of shoulder function in BPI patients with total or C5-8 palsy. The postoperative pulmonary complications can be prevented with vigilant patient selection.

Matched MeSH terms: Shoulder
Fulltext Pen and paper based observational method to assess postural problems: a review

Sukadarin, E.H., Deros, B.M., Nawi, N.S.M., Rambely, A.S., Bakar, S.A., Tamrin, S.B.M.

Malaysian Journal of Public Health Medicine, 2016;16(20):78-83.
MyJurnal

Posture is one of the most important factor that need to be considered in any postural analysis. Awkward, extreme,
and repetitive postures can increase the risk of musculoskeletal disorders (MSDs). As observational methods are more
widely used than instrumentation-based methods to assess postural problems, this study reviews and assesses the
scientific literature of observational methods and focused on pen and paper based specifically. In order to identify the
published methods, a list of English or Malay articles dating as far back as 1990 was compiled from PubMed, Science
Direct and Google Scholar. The keywords were ergo*, posture*, method*, observational*, postural problems*, pen and
paper*, posture analysis*, indirect* and macro-ergo*. In addition, a secondary search was also performed using
bibliography of retrieved articles so that additional papers for conducting review and evaluations can be collected. A
total of 121 articles that assessed postural problems in working activities were found. However, after intensive
screening process only 6 articles were selected to be further analyzed. Posture of upper arms/shoulder, lower arms/
elbow, wrist, neck, back/trunk and leg were highlighted in this study. The limitations and the strengths of the
published pen and paper based observational method focusing on those postures were also discussed. The finding of
this review will benefit researchers in the process of understanding unsafe posture in workplace. It could also provide
to researcher on how to improve the current pen and paper based observational method for assessing postural
problems.

Matched MeSH terms: Shoulder
Fulltext Persistent Shoulder Pain in Young Male: Osteosarcoma

Arinima P, Ishak A

Korean J Fam Med, 2018 Jul;39(4):266-269.
PMID: 29972896 DOI: 10.4082/kjfm.17.0117

A 16-year-old Malay boy presented to Kota Bharu Health Care Centre, Kelantan, with left shoulder pain after sustaining a fall. On further history taking, it was noted that the pain preceded the fall by 1 month. The early changes of osteosarcoma were visible on an X-ray during the initial presentation; however, this was missed by the primary care doctors. Three months later, the patient presented with persistent pain in the left shoulder and was diagnosed with osteosarcoma.

Matched MeSH terms: Shoulder; Shoulder Pain
Fulltext Precontoured Clavicular Locking Plate with Broad Lateral End: A Newly Designed Plate for Lateral Third Clavicle Fractures

Kapil-Mani KC, Acharya P, Arun S

Malays Orthop J, 2018 Mar;12(1):15-20.
PMID: 29725507 DOI: 10.5704/MOJ.1803.003

Introduction: Various treatment modalities are available but no consensus has been reached for optimal treatment of lateral third clavicle fractures. Precontoured locking plates with broad lateral end for multiple screws fixation is a newly designed plate for lateral third clavicle fractures. The objective of our study was to analyse the functional outcomes as well as complications of this technique in a significant number of cases with long follow-up duration. Materials and Methods: Forty-six patients with distal third clavicle fractures were treated by precontoured clavicular locking plate with broad lateral end. Functional outcomes were assessed on the basis of Constant-Murley Shoulder Outcome Score and University of California, Los Angeles (UCLA) Shoulder Rating Score, active shoulder range of motion, time for fracture union and coraco-clavicular distance. Results: The mean Constant-Murley score was 92.56±4.47 (range: 79-98) for injured side and 96.22±2.23 (range: 90-100) for normal side with p-Value 0.56. Mean coraco-clavicular distance at final follow-up was 10.52±1.13 mm (range 9.7 to 11.7 mm) in injured side and 10.25±0.98 mm (range 9.6 to 11.2 mm) in normal side. Mean UCLA Shoulder Rating Score was 32.55±2.12 (range: 27-34) for injured side and 33.46±1.88 (range: 31- 35) on normal side with p value 0.58. No major complications that necessitated revision of surgery occurred in our study. Conclusion: This newly designed plate seemed extremely useful in successful union of lateral third clavicle fractures, with reduced rate of complications like fixation failures, iatrogenic rotator cuff injury, AC joint osteoarthritis and sub-acromial bursitis, with good functional outcomes.

Matched MeSH terms: Shoulder
Fulltext Prevalence of musculoskeletal disorders and related occupational causative factors among electricity linemen: A narrative review

Padmanathan V, Joseph L, Omar B, Nawawi R

Int J Occup Med Environ Health, 2016;29(5):725-34.
PMID: 27518883 DOI: 10.13075/ijomeh.1896.00659

Occupational tasks of linemen are highly associated with the development of work related musculoskeletal disorders (WRMDs). Although linemen are prone to develop WRMDs, there is paucity of information on the prevalence of WRMDs and related occupational causative factors. Therefore, the present review was conducted to report on the prevalence of WRMDs and to outline causative risk factors within occupational tasks in the lineman profession. Literature search was conducted in various databases such as Scopus, PubMed and ScienceDirect for articles published between 1996-2013. The articles were analyzed, selected and retrieved based on predetermined objectives, inclusion criteria and Medical Subject Headings (MeSH). In the review process only articles published in English were considered. The review identified moderate to high prevalence of WRMDs among the linemen population. Back and shoulder regions were highly affected compared to the other body regions. The review also reported occupational tasks such as bar installation, insulator fixation and manual handling of tools as high risk tasks that lead to the development of WRMDs. In addition, occupational tools such as ladders, manual cutters and manual presses were also identified as a potential ergonomic hazard. In conclusion, the current review identified that WRMDs are common in the back and shoulder regions among linemen. Also, a number of occupational risk factors were identified to be associated with WRMDs among the linemen. Hence, future research on prevention and intervention studies concerning lineman profession population in order to develop a good job practice are recommended. Int J Occup Med Environ Health 2016;29(5):725-734.

Matched MeSH terms: Shoulder
Fulltext Preventing shoulder-surfing attack with the concept of concealing the password objects' information

Ho PF, Kam YH, Wee MC, Chong YN, Por LY

ScientificWorldJournal, 2014;2014:838623.
PMID: 24991649 DOI: 10.1155/2014/838623

Traditionally, picture-based password systems employ password objects (pictures/icons/symbols) as input during an authentication session, thus making them vulnerable to "shoulder-surfing" attack because the visual interface by function is easily observed by others. Recent software-based approaches attempt to minimize this threat by requiring users to enter their passwords indirectly by performing certain mental tasks to derive the indirect password, thus concealing the user's actual password. However, weaknesses in the positioning of distracter and password objects introduce usability and security issues. In this paper, a new method, which conceals information about the password objects as much as possible, is proposed. Besides concealing the password objects and the number of password objects, the proposed method allows both password and distracter objects to be used as the challenge set's input. The correctly entered password appears to be random and can only be derived with the knowledge of the full set of password objects. Therefore, it would be difficult for a shoulder-surfing adversary to identify the user's actual password. Simulation results indicate that the correct input object and its location are random for each challenge set, thus preventing frequency of occurrence analysis attack. User study results show that the proposed method is able to prevent shoulder-surfing attack.

Matched MeSH terms: Shoulder
Fulltext Primary Hemiarthroplasty following severe proximal humerus fracture dislocations with irretrievable humeral head in young patients

Khairul Nizam Siron, Lim, Chia Hua

International Medical Journal Malaysia, 2017;16(11):44-44.
MyJurnal

Neer first popularised the use of primary hemiarthroplasty to treat complex proximal
humerus fractures, especially when the humeral head is nonviable or not
reconstructable with internal fixations, and with younger patients. (Copied from article).

Matched MeSH terms: Shoulder Fractures
Fulltext Primary fixation of AO type-C fracture of the distal radius with volar locking plates. A cross-sectional study of patient rated outcomes at Hospital Tengku Ampuan Afzan

Mohd Sallehuddin H, Zamzuri Z, Ariff MS, Mohd Shukrimi A, Mohamed Azril MA, Nazri MY

International Medical Journal Malaysia, 2014;13(2):3-6.
MyJurnal

Introduction: This is a cross-sectional study of 37 patients with AO type C (complete intra-articular) fractures of the distal radius, evaluating the functional, anatomical, and patient rated outcomes one year after primary fixation with a volar locking plate.

Methods: Functional outcomes were assessed based on the grip strength, and the range of motion of forearm and wrist. Anatomical outcomes were assessed based on the radial inclination, radial height, volar tilt, and articular step or gap. Patient rated outcome was measured with a Disability of arm, shoulder and hand (DASH) questionnaire.

Results: One year after surgery, 24 (64%) patients achieved good and excellent anatomical results, and DASH scores were acceptable in 73% of patients. Most of the patients had achieved 80% of their grip strength. The mean DASH score of 12.3 was comparable with other studies. Grip strength, radial inclination and volar tilt had a significant correlation with the DASH score.

Conclusion: Volar locking plates can be used to achieve optimal reduction in all three parameters in the treatment of AO type C fractures of the distal radius. Versatile fracture fragment reduction and angular stability enable rehabilitation hence obtaining good functional outcomes.

Matched MeSH terms: Shoulder
Fulltext Profile of isokinetic rotator cuff muscle performance in adolescent state-level weightlifters

Abdul Rahim MF, Shaharudin S

J Taibah Univ Med Sci, 2018 Dec;13(6):572-575.
PMID: 31435380 DOI: 10.1016/j.jtumed.2018.08.001

Objectives: This study aimed to determine isokinetic profiles of rotator cuff muscle strength and power in adolescent state-level weightlifters.
Methods: Nineteen young state-level weightlifters performed concentric strength tests of the upper limbs using an isokinetic dynamometer. Peak torque/body weight was measured for each weightlifter in dominant and non-dominant limbs.
Results: Peak torque/body weight was significantly different in external rotation (p 0.05). Time to peak torque in external rotation was less in the dominant than in the non-dominant limb. However, opposite results were obtained in external rotation, whereby time to peak torque was longer in the dominant limb compared to the non-dominant limb. Similarly, no significant difference was found between dominant and non-dominant limbs in terms of average power (p > 0.05).
Conclusions: The findings of this study may help in establishing potential imbalance in variables of muscular contractions between dominant and non-dominant limbs of weightlifters. This may help to maximise performance and minimise potential shoulder injury.

Matched MeSH terms: Shoulder Joint; Shoulder Injuries
Prolonged writing task: comparison of electromyographic analysis of upper trapezius muscle in subjects with or without neck pain

Leonard JH, Kok KS, Ayiesha R, Das S, Roslizawati N, Vikram M, et al.

Clin Ter, 2010;161(1):29-33.
PMID: 20393675

Work related musculoskeletal disorders represent a serious public health problem as it is a leading cause for disability and absenteeism in workers. The main purpose of the present quasi-experimental study was to compare the muscle activity of the upper trapezius in subjects with neck pain and compare it to those of normal subjects.

Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)

Matched MeSH terms: Shoulder
Fulltext Prominent hardware post latarjet mimicking shoulder instability symptoms

Raymond DK Yeak, Nasir M Nizlan

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):342-344.
MyJurnal

A 29-year-old man, who was a medical intern presented with history of recurrent shoulder dislocation. Radiographs
and computed tomography imaging revealed a bony bankart lesion with glenoid bone loss of 25% with moderate
Hill- Sachs lesion. Latarjet surgery was performed. At post-operative 8 months, the patient experienced pain and
clicking in the left shoulder while performing cardiopulmonary resuscitation. At post-operative 1 year, magnetic resonance arthrography showed a united coracoid graft and intact posterior labrum. Left shoulder diagnostic arthroscopy and removal of Latarjet screws through a limited anterior deltopectoral approach were performed. The symptoms
pain, clicking and instability sense was caused by either the prominent distal screw or the remnant suture material
from the anchor which resulted in impingement of the infraspinatus muscle. We recommend the use of image intensifier to check on the position and length of the screw at the end of the surgery to avoid this complication

Matched MeSH terms: Shoulder; Shoulder Dislocation; Shoulder Joint
Fulltext Psychophysical and physiological study of asymmetric lifting and lowering task for Malaysian males

Mirta Widia, Siti Zawiah Md Dawal, NukmanYusoff

Malaysian Journal of Public Health Medicine, 2016;16(20):99-105.
MyJurnal

Extensive research has been carried out over the years to determine the maximum acceptable weight that a worker is capable of lifting in a given situation among the Occidental populations in the Europe and US. At present, there is a scarcity of studies in which lifting frequency is used as the measuring variable, especially in developing countries such as Malaysia. Therefore, the objective of this study is to determine the effects of lifting loads on the maximum acceptable frequency limit (MAFL), physiological response (muscle activity) and rating of perceived exertion (RPE) for asymmetric lifting and lowering tasks of Malaysian males.Ten male subjects are recruited in this study and they perform asymmetric lifting and lowering tasks repetitively for 30 minutes. Two lifting loads are considered (1) 1 kg and (2) 5 kg. Each of the subjects adjusts his frequency of lifting using a psychophysical approach. The subjects are instructed to perform the lifting and lowering task as fast as they could over duration of 30 minutes without exhausting themselves or becoming overheated. Electromyography (EMG) signals are recorded from four muscles (Right Erector Spinae (RES), Left Erector Spinae (LES), Right Trapezius p Descendenz (RTD) and Left Trapezius p Descendenz (LTD) and analysed in terms of the normalized MVC during asymmetric lifting and lowering tasks. The ratings of perceived exertion (RPE) for four body parts (arms, lower back, shoulders and entire body) are also collected after the subjects have completed the lifting and lowering task. The mean frequency of the lifting and lowering task obtained from the experiment is 13.41 and 9.66 times/minute for a lifting load of 1 and 5 kg, respectively. The results of the independent sample t-test show that load has a statistically significant effect on the maximum acceptable frequency limit (p < 0.05). However, it is found that even though there is an increase in muscle activity and RPE with an increase in lifting load, there is no significant difference in the overall mean muscle activity and RPE (p > 0.05). The percentage decrease in the maximum acceptable frequency for Malaysian males is higher than the Occidental populations for both of the loads investigated in this study.

Matched MeSH terms: Shoulder

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