The neuropeptide oxytocin (OXT) can enhance the impact of positive social cues but may reduce that of negative ones by inhibiting amygdala activation, although it is unclear whether the latter causes blunted emotional and mnemonic responses. In two independent double-blind placebo-controlled experiments, each involving over 70 healthy male subjects, we investigated whether OXT affects modulation of startle reactivity by aversive social stimuli as well as subsequent memory for them. Intranasal OXT potentiated acoustic startle responses to negative stimuli, without affecting behavioral valence or arousal judgments, and biased subsequent memory toward negative rather than neutral items. A functional MRI analysis of this mnemonic effect revealed that, whereas OXT inhibited amygdala responses to negative stimuli, it facilitated left insula responses for subsequently remembered items and increased functional coupling between the left amygdala, left anterior insula, and left inferior frontal gyrus. Our results therefore show that OXT can potentiate the protective and mnemonic impact of aversive social information despite reducing amygdala activity, and suggest that the insula may play a role in emotional modulation of memory. (5), social recognition (6-8) and related memory (9-11), social reinforcement learning and emotional empathy (12), and social judgments (13)(14)(15).This prosocial perspective on OXT is challenged, however, by evidence that OXT also enhances envy and schadenfreude (gloating) (16), ethno-centrism (including prejudice, xenophobia, and racial bias) (4), and outgroup derogation (17). Moreover, OXT hinders trust and cooperation when social information about interaction partners is lacking (18). Furthermore, OXT appears to negatively bias recollections of maternal care and closeness and to diminish trust and cooperation in insecurely or anxiously attached individuals (19,20).In an attempt to reconcile this controversial evidence, it has been proposed that the social effects of OXT could be mediated by reduced anxiety or by an increased perceptual salience of social cues (21). The anxiolytic action of OXT has been confirmed by showing reduced amygdala responses to aversive social stimuli in healthy people (22-25; but see also refs. 26 and 27), and subjects with social phobia (28). It is compatible with decreased endocrine and subjective responses to social stress (29), as well as reduced negative cognitive self-appraisal in individuals scoring high in traitanxiety (30). In contrast, the social salience hypothesis has gained substantial support from studies demonstrating increased eye contact (31) and improved mind-reading from facial expressions (32) as a result of OXT treatment. Whether these mechanisms quintessentially yield positive or negative social outcomes may vary depending on contextual or person-specific characteristics (21). An alternative view holds that emotional valence may be the key in guiding the social effects of OXT, with it facilitating social approach to positive cues and inhibiting...

Restoration of subscapularis function is essential for long-term maintenance of good clinical results for both traumatic and nontraumatic rotator cuff tears. The anatomic repair of partially and completely torn tendons from the footprint at the lesser tuberosity is the goal of surgical repair. The described technique, with a combination of an interlocking stitch and additional mattress sutures using a double-loaded suture anchor, provides reduction of the retracted tendon, sufficient pullout strength, and compression of the tendon to the footprint to facilitate healing.

Introduction Rotator cuff tears are one of the most common reasons for shoulder pain, and patients often present initially to general practitioners. However, subscapularis tears are especially difficult to diagnose and hence adequate therapy is often delayed. General practitioners or non-specialist orthopedic surgeons need reliable MRI findings to allow timely referral of patients to shoulder specialists. The purpose of this study was to determine the validity of the written MRI report of patients with arthroscopically proven subscapularis tendon tears. Method In this retrospective study, 97 patients (mean age 62.4 ± 10 years, 63 men) who underwent arthroscopic subscapularis repair between April 2013 and January 2015 by two experienced shoulder surgeons and who underwent a preoperative 1.5 T MRI study were included. All of these patients had high-field strength (i. e., ≥ 1.5 T) standard MRI scans performed within 4–164 (mean 57.4 ± 38.4) days before their arthroscopic procedures. Results and Conclusion Subscapularis tendon tears, verified by arthroscopy, were correctly identified in only 37 of 97 cases in the written report of the preoperative MRI. This resulted in an overall low sensitivity of 38.1 %. Correctly predicted lesions were as follows: Fox and Romeo I 29.4 % (5/17 patients), Fox and Romeo II 20 % (7/35 patients), Fox and Romeo III 46.7 % (14/30 patients) and Fox and Romeo IV 73.3 % (11/15 patients). In contrast, concurrent supraspinatus tendon tears were identified correctly in 88.2 % of patients (60/68 cases, sensitivity 88.2 %, specificity 96.5 %). Preoperative written radiology reports provided by a heterogeneous group of 39 presumably non-MSK-specialized radiologic centers do not reliably detect subscapularis tendon tears and are not sufficient for guiding patients to specialist centers. Compared to other rotator cuff injuries, this study shows difficulties in the correct diagnosis of subscapular tendon injuries. However, this is necessary to provide patients with timely therapy. It can be assumed that MRI review by musculoskeletal-specialized radiologists would more often than not lead to the correct diagnosis. Key Points:  Citation Format

PurposeThe objective of this study is to assess tendon integrity, shoulder function and subscapularis (SCP) power in comparison to the contralateral normal shoulder after arthroscopic SCP repair using the SICK stitch technique.MethodsThis study assessed 32 patients with arthroscopically repaired SCP lesions. The mean age was 63.3years. All patients were assessed with a clinical examination and ultrasound pre and postoperatively. Shoulder function was evaluated using specific clinical tests and established scoring systems. The muscular strength was measured using an Isoforce Control EVO2 device in two positions for SCP (standing and sitting).ResultsAt a mean follow up of 18 months n=30 patients showed significantly improved range of motion and clinical scores (pre, post), Constant score (39.2, 66.7), subjective shoulder test (3.5, 92.32), subjective shoulder value (46.6, 88.2) and disabilities of arm, shoulder and hand score (69.3, 34). All tendons showed full integration in ultrasound and there was no significant difference for lesion size or additional SSP lesion. In comparison to the contralateral side a good restoration of power was observed.ConclusionsAfter arthroscopic repair of the subscapularis tendon using the SICK-stich technique, patients show a good restoration of shoulder function and power accompanied by good patient satisfaction. Additionally treated lesions did not significantly affect the surgical outcome.