Background. Frozen shoulder (FS) is associated with pain, reduced range of motion (ROM), and shoulder function. The condition occurs in 2–5% of the population, and it is especially common around the age of 50 years. FS symptoms will recover after 1–4 years. Many patients turn to acupuncture in order to alleviate the FS symptoms. Objective. In this review, we will investigate the efficiency of acupuncture as a FS treatment. Methods. A literature search of acupuncture and FS-related keywords was performed in the following databases: PubMed, Cochrane Library, Embase, and Web of Science. Thirteen publications were included for a systematic review, and a meta-analysis was done using the following measurements: visual analogue scale (VAS) for pain, Constant-Murley Shoulder Outcome Score (CMS) for shoulder function, and active shoulder ROM including flexion, abduction, and external rotation. The Cochrane Collaboration’s risk of bias tool and quality of evidence GRADE recommendations and STRICTA 2010 were used to grade the included publications. Results. A meta-analysis on VAS pain score showed significant pain reduction, restoring CMS shoulder function, and flexion ROM in favor of acupuncture versus the control. In external rotation and abduction ROM, a meta-analysis was not significant. The most used acupoints are Jian Yu (LI15) and Jian Liao (TB14). Conclusions. The results indicate that acupuncture could be safe and effective for pain reduction, restoring shoulder function, and restoring flexion ROM for FS patients in the short term and midterm. However, the level of evidence was very low. More high-quality and longer studies are needed in order to robust the evidence.

Malnourishment is prevalent in patients suffering from head and neck cancer. The postoperative period is crucial in terms of nutritional support, especially after composite resection and reconstruction surgery. These patients present with a number of risk factors that aggravate feeding intolerance, including postoperative status, prolonged immobility, decreased head elevation, mechanical ventilation, and applied sedative agents. Routine management protocols for feeding intolerance include prokinetic drug use and post-pyloric tube insertion, which could be both limited and accompanied by detrimental adverse events. This single-blind clinical trial aimed to investigate the effects of acupuncture in postoperative feeding intolerance in critically ill oral and hypopharyngeal cancer patients. Twenty-eight patients were randomized into two groups: Intervention group and Control group. Interventions were administered daily over three consecutive postoperative days. The primary outcome revealed that the intervention group reached 70% and 80% of target energy expenditure (EE) significantly earlier than the control group (4.00 ± 1.22 versus 6.69 ± 3.50 days, p = 0.012), accompanied by higher total calorie intake within the first postoperative week (10263.62 ± 1086.11 kcals versus 8384.69 ± 2120.05 kcals, p = 0.004). Furthermore, the intervention group also needed less of the prokinetic drug (Metoclopramide, 20.77 ± 48.73 mg versus 68.46 ± 66.56 mg, p = 0.010). In conclusion, digestion-specific acupuncture facilitated reduced postoperative feeding intolerance in oral and hypopharyngeal cancer patients.

Partial foot amputations have become increasingly prevalent among long-lived diabetic patients. These patients have lower extremity neuropathy and are prone to ulceration at their amputation site. These ulcers are difficult to heal, and they place a significant financial and resource burden on the healthcare system. We examined the efficacy of total-contact casts (TCC) in diabetic amputees with nonhealing partial foot amputation site neuropathic ulcers. Data were collected retrospectively on all patients with amputations who were treated with a total-contact cast between December 2000 and December 2003. Seventeen patients (13 men, 4 women) with amputation site ulceration were identified. All patients were diagnosed with neuropathy secondary to diabetes and none had wound healing compromised by ischemia. The initial ulcer averaged 1,169 mm(2) with a depth of 2.77 mm. Patients were treated with an average of 7.9 cast applications over 8.4 weeks; 47% (8/17) of ulcers healed, but 29% (5/17) of patients were unable to complete their recommended treatment course secondary to complications from the TCC. Of the patients who were able to complete their treatment course, the healing rate was 66.7% (8/12). The recurrence rate for healed ulcers was 63% (5/8). Partial foot amputations with neuropathic ulcers present a very difficult problem to the vascular surgeon. Patient compliance and underlying medical comorbidities limit the success rate. In patients who can complete a TCC treatment course, good short term results can be expected. However, recurrence rates are high following discontinuation of mechanical TCC off-loading.

A 52 year old man was brought to the Bellevue Trauma Center after a single stab wound to the upper back. The patient arrived hemodynamically normal with a Glasgow Coma Scale score of 15. He denied any chest pain or shortness of breath.Physical examination revealed mildly decreased breath sounds on the left and a sharp kitchen knife impaled in his upper back ( Fig. 1). Pulse exams were equal in both upper extremities. Secondary survey was otherwise normal. FAST examination revealed no pericardial effusion or free intraperitoneal fluid.A chest radiograph revealed the foreign object as well as an asymmetric lucency at the left costophrenic angle consistent with a small pneumothorax (Fig. 2). A left-sided thoracostomy tube was placed with air and minimal blood return.Given his hemodynamic stability, the patient was brought for a CT scan of the chest with IV contrast to better delineate the knife blade tract (Fig. 3). The computed tomography (CT) demonstrated the knife blade entering the left lower lobe and terminating 8 mm from the descending thoracic aorta with no evidence for aortic or esophageal injury. The knife was withdrawn under controlled conditions in the operating room with the patient prepped and draped. His vital signs remained normal after a period of observation. The chest tube was removed after 2 days. The patient was subsequently discharged and doing well on follow-up.Evaluation of patients with impaled foreign bodies has evolved with the expansion and accessibility of diagnostic modalities such as CT scanning. The anatomic information acquired by CT, in conjunction with reliable and repeated clinical examination, allows for non-operative management of injuries that once mandated a more aggressive surgical approach. Fig. 1. Victim with impaled knife.Fig. 2. Prone PA chest radiograph revealing knife and small pneumothorax.Fig. 3. CT chest in prone position revealing the location of the knife blade in relation to the mediastinal structures.