Adhesive capsulitis (AC) is a common cause of chronic shoulder pain for which transcatheter arterial embolization (TAE) is emerging as a minimally invasive therapy. This intervention targets neovascularization associated with chronic inflammation in AC. This review aims to summarize the vascular anatomy of the shoulder relevant to embolization. We report on data from cadaveric, diagnostic imaging, and embolization studies evaluating axillary artery branches, their variants, and angiographic blush patterns in AC embolization. The shoulder's arterial supply arises primarily from the axillary artery and thyrocervical trunk, which form extensive anastomoses. Angiographic studies of patients undergoing TAE demonstrate a hyper vascular blush in symptomatic regions and include characterization of the arterial branches perfusing these regions. Detailed knowledge of the vascular anatomy of the shoulder and its variants is valuable to understand, so as to perform TAE in a safe and effective manner.

Adhesive capsulitis or frozen shoulder is an idiopathic condition causing progressive shoulder pain and restriction of glenohumeral motion. Conventional management includes physical therapy, intra-articular injections, and surgery for refractory cases. In recent years, adhesive capsulitis embolization (ACE) has emerged as a minimally invasive endovascular treatment targeting pathological neovascularization associated with chronic inflammation. This article reviews the clinical background, pathophysiology, imaging findings, patient selection, technical aspects, and outcomes of ACE, with a focus on practical considerations for interventional radiologists.

Acute nontraumatic mediastinitis is a rare and potentially life-threatening condition. In children, management strategies remain poorly standardized. Here, we describe four pediatric cases: two originating from cervical infections (descending necrotizing mediastinitis [DNM]) and two with indeterminate source. The first two patients presented with febrile otorhinolaryngologic symptoms, one complicated by secondary respiratory failure and the other by possibly toxin-related symptoms. The third presented with varicella and scarlet fever-like rash, complicated by multiorgan involvement secondary to a probable toxic shock syndrome. The fourth case presented with fever without focus and shoulder pain. Three patients developed secondary pleural effusions. In three cases, diagnosis was confirmed by computed tomography (CT) scan and in one case by MRI. None had necessitated surgical drainage. All patients were managed conservatively with prolonged antibiotic therapy and achieved complete recovery without sequelae. These cases suggest that, in selected pediatric patients, a conservative, antibiotic-based approach can be both safe and effective.

BackgroundAdhesive capsulitis (AC) is a common shoulder disorder. Ultrasound-guided intra-articular injection (IAI) and suprascapular nerve block (SSNB) are frequently used interventions for AC treatment; however, their comparative effectiveness remains unclear.ObjectiveTo compare the effects of SSNB and IAI on pain, functional status, and shoulder range of motion in patients with AC.MethodsIn this prospective, randomized, controlled, assessor-blinded trial, patients with AC were assigned to either ultrasound-guided IAI or SSNB. Both groups received the same injectable and a home-based exercise program. Outcome measures included the Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), and passive shoulder ROM. Assessments were performed at baseline, on the 10th day, and at the 3rd month after treatment. ClinicalTrials.gov NCT05909462.ResultsBoth groups showed significant improvements in pain, functional status, and shoulder range of motion over time (all p < 0.001). Compared with the IAI group, SSNB resulted in significantly greater improvements in SPADI Total and SPADI Disability scores, movement-related pain, shoulder flexion, and abduction at both the 10-day and 3-month follow-up assessments (all p < 0.05). In contrast, improvements in resting pain, shoulder extension, internal rotation, and external rotation were comparable between the groups.ConclusionBoth ultrasound-guided IAI and SSNB were effective in the management of adhesive capsulitis. However, SSNB was associated with greater improvements in movement-related pain, shoulder function, and shoulder flexion and abduction, with these benefits maintained at both the early and mid-term follow-up assessments.

BackgroundSmartphones have become essential tools in modern daily life, with usage intensifying in the post-pandemic era. Prolonged and addictive smartphone use has been increasingly associated with Musculoskeletal disorders (MSD) in the upper extremity. Beyond usage duration, device characteristics may also influence musculoskeletal strain.ObjectivesThis study examined the relationships between smartphone usage patterns, addiction levels, device dimensions, pain severity, and the 12-month prevalence of MSD in the upper extremityMaterials and MethodsA cross-sectional study was conducted among 262 adults aged 19-44 years with at least 12 months of smartphone use. Data were collected using a structured questionnaire incorporating demographic variables, smartphone usage habits, device specifications, the SNMQ, the SAS-SV and the NPRS.ResultsThe 12-month prevalence of neck, shoulder, elbow, and wrist/hand MSDs was 52.7%, 39.3%, 34%, and 51.1%, respectively. Smartphone addiction was present in 60.3% of participants and was significantly associated with shoulder, elbow, and wrist/hand MSDs. Gender showed a small but significant association with shoulder symptoms. Correlation analyses revealed small positive associations between smartphone width and neck pain, and between phone length/width and right wrist and right thumb pain. Logistic regression models identified that phone width predicted neck MSD, daily usage duration and overall body position contributed to shoulder MSD, age predicted elbow MSD, and both smartphone addiction and age predicted wrist/hand MSD.ConclusionSmartphone addiction, specific device dimensions, and behavioral factors contribute to MSD. These findings underscore the need for ergonomic device design and informed usage practices to reduce musculoskeletal strain among young adults.

BackgroundDespite its economic benefits, the tobacco processing industry poses health risks to workers due to occupational hazards. Body mapping can help gather evidence about the work effects on the body.ObjectiveTo assess the occupational health of tobacco processing workers by body mapping.MethodsBody mapping data were collected from one hundred private industry tobacco processing workers in November, 2024. The other data were collected by health professional workers (body temperature, heart rate, blood pressure, random blood glucose, height, and weight).ResultsA survey of one hundred employees revealed that many workers reported experiencing pain in the areas of the left (35%) and right shoulder (36%) and the waist (26%). Additionally, wound complaints were predominantly noted in the left (9%) and right finger (8%) areas, while bruising was less prevalent among the sample. Complaints of itching or redness were most frequently reported in the left (7%) and right forearm (10%) areas. The other general health of the workers mostly showed a normal result. Statistical analysis on 4 major pain locations showed significant results in body mass index (BMI) for each left and right shoulder, in duration and type of work for the back, but none for the buttocks.ConclusionsBased on this study, we can divide three groups of possible causes of workers' complaints, i.e., ergonomic problems, contact dermatitis, and injury by sharp objects. Several risk factors were the BMI, the type and duration of work. Further investigation is required to ascertain other causes and to determine appropriate countermeasures.

BackgroundFocused shock wave therapy (FSWT) and radial pressure wave therapy (RPWT) are commonly used noninvasive modalities for managing musculoskeletal disorders (MSKDs), yet their distinct physical properties and inconsistent evidence make it unclear which modality provides better outcomes.ObjectiveTo compare the FSWT with the RPWT in terms of pain, function, strength, and range of motion (ROM) in patients with MSKDs.MethodsWe searched PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus, MEDLINE, the Physiotherapy Evidence Database, and Google Scholar from inception to October 5, 2025. The risk of bias was assessed via the RoB 2.0 tool, and meta-analyses were conducted via RevMan 5.4. Sensitivity analysis was used to examine the effect of excluding studies at high risk of bias. The certainty of evidence was evaluated via the GRADE approach.ResultsTwenty-one randomized controlled trials (RCTs) (16 RCTs and 5 pilot RCTs) were included (n = 1030). Meta-analyses revealed that neither modality for pain nor function was favored across short-, medium-, or long-term follow-ups. For short-term grip strength, low-certainty evidence favored the FSWT (MD = 3.09; 95% CI: 0.31-5.88), whereas the RPWT was superior for improving medium-term wrist extensor strength (MD = -2.39; 95% CI: -4.34-0.44) in patients with lateral epicondylitis. For shoulder ROM, no significant difference was observed in the short term (P > 0.05). Excluding studies with a high risk of bias in the sensitivity analysis did not change the pooled effect estimates.ConclusionVery low- to low-certainty evidence suggests no significant difference between FSWT and RPWT for pain, function, or ROM. Low-certainty evidence suggests a potential short-term advantage of FSWT for grip strength and a potential medium-term advantage of RPWT for wrist extensor strength in patients with lateral epicondylitis. However, these findings should be considered exploratory because they are based on a limited number of studies with small sample sizes and require confirmation in adequately powered, high-quality randomized controlled trials before informing clinical recommendations.

PurposeTo describe a hybrid fixation technique combining a superior distal clavicle locking plate with coracoclavicular (CC) augmentation through cannulated locking screws and to report its radiological and clinical outcomes.MethodsWe retrospectively reviewed a consecutive surgical cohort treated between March 2022 and March 2025. Of 26 patients who underwent the procedure, 4 were excluded because of follow-up of less than 12 months or loss to follow-up, leaving 22 patients for analysis. Two 2.4-mm × 8.5-mm suture anchors were placed at the conoid and trapezoid footprints of the coracoid base, and the sutures were shuttled from the anteroinferior aspect of the clavicle through cannulated locking screw lumens. Outcomes included union, maintenance of reduction, complications, pain, function, and shoulder motion.ResultsAll 22 fractures united at a mean of 12.8 ± 2.5 weeks. The final CC distance ratio was 1.05 ± 0.10. The mean visual analogue scale and QuickDASH scores were 0.6 ± 0.8 and 5.4 ± 2.1, respectively. No coracoid cortical breach, neurovascular injury, implant failure, loss of reduction, or implant removal occurred. Three patients developed transient supraclavicular nerve irritation, which resolved spontaneously.ConclusionThis technique provided reliable union, maintained reduction, and favorable short-term clinical outcomes. It may provide an anatomically oriented option for supplementary CC stabilization, although comparative and biomechanical studies are required.

Anatomical variations of the axillary artery and its branches are clinically relevant as they may complicate surgeries in the axilla and shoulder. Accessory heads of the biceps brachii can compress key neurovascular structures. The present report describes these variations observed on the left upper limb of a 79-year-old male cadaver during cadaveric dissection. We observed that the usual branches of the 3[rd] part of the axillary artery as well as the profunda brachii artery originated from the 2[nd] part of the axillary artery via a common trunk in the left axilla. In addition to that, a small accessory head of the biceps brachii was observed on the left arm originating from the shaft of the humerus. Knowledge about variant branches of the axillary artery is surgically important for establishment of collateral circulation around the scapula following shoulder surgeries. The accessory head of biceps brachii may cause nerve entrapment neuropathy leading to mysterious pain syndrome in the upper limb.