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Maenhout A, Heijenk W, Glashouwer P, Quatacker L, Praet L, Borms D. Effect of a Novel Training Program in Patients With Chronic Shoulder Pain Based on Implicit Motor Learning: Pilot and Feasibility Study. Int J Sports Phys Ther 2024; 19:1503-1515. [PMID: 38179585 PMCID: PMC10761605 DOI: 10.26603/001c.90284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/30/2023] [Indexed: 01/06/2024] Open
Abstract
Background Implicit motor learning has been shown to be effective for learning sports-related motor skills. It facilitates automaticity of movements and thereby improves performance in multitasking and high-pressure environments. Motor learning to develop motor skills and neuroplastic capacities is not sufficiently incorporated in musculoskeletal rehabilitation. Especially in patients with chronic pain conditions like shoulder pain this approach might benefit over traditional exercise programs. Purpose/hypothesis The aim of this study was to investigate the feasibility and clinical outcome of a new implicit motor learning exercise program in a group of patients with chronic shoulder pain. Study design Pilot and feasibility cohort study. Methods Twenty-six patients with chronic shoulder pain performed a 6-week home exercise program with weekly remote follow up by a physiotherapist. The program comprised five exercises designed to challenge overall body balance, simultaneously engaging the upper limbs in a range of reaching tasks. The tasks included reaching above the head, at and below waist level, in various directions. No instructions on correct performance were provided to foster external focus. Feasibility was assessed by (1) recruitment rate, (2) follow up rate, (3) subjective experience, (4) self-reported adverse events and (5) self-reported adherence of subjects. Clinical effects of the program were assessed with (1) the Shoulder Pain and Disability Index (SPADI), (2) the Auto-Constant score, (3) the numeric rating scale (NRS) at rest and at night, (4) the patient specific functional scale (PSFS), (5) the avoidance endurance questionnaire (AEQ), (6) patient acceptable symptom state (PASS) and (7) a global rating of change (GROC). Results The study protocol was feasible in terms of follow up rate (16w for 28 patients), exercise adherence (77.1%± 29.41), and adverse events (no serious, 5 light adverse events). Statistically significant improvements were observed for SPADI (p<0.001), NRS at rest (p=0.033), at night (p=0.29), PSFS (p<0.001) and PASS (p<0.001) after only six weeks training. Conclusion This study reveals promising results of another way of looking at exercise for patients with chronic shoulder pain. Both feasibility and clinical effects of the program on pain and function was acceptable. Future studies should incorporate a control group, provide longer follow up and include objective measurements. Level of evidence 2b.
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Solheim E, Rosenlund M, Ulsaker KG, Parkar AP. Self-assessment of range of motion in patients undergoing surgery for a unilateral shoulder condition. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2023; 57:340-347. [PMID: 37755433 PMCID: PMC10837573 DOI: 10.5152/j.aott.2023.22166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE This study aimed to investigate the agreement of patient-assessed and researcher/physician-assessed measurements of the difference in range of motion between the unaffected and affected shoulders in 55 patients undergoing arthroscopic surgery for a unilateral shoulder condition. METHODS The investigation included 55 patients (17 women and 38 men; median age=53 years; range=26-74) with a symptomatic unilateral shoulder condition and a surgically treatable diagnosis. Images of a model/researcher performing active shoulder abduction, flexion, external rotation, and internal rotation were created. Each image was paired with a degree diagram or a level system (for internal rotation) on the back for the patient to accurately self-evaluate and record. Each patient was instructed to attentively examine the figures and perform the movements with the same posture as depicted. On the day of surgery, prior to the procedure, 2 independent researchers who were not involved in the patient's care used a standard goniometer to assess the same active movements that the patient had previously self-assessed. For agreement analyses, the intraclass correlation coefficient and Bland-Altman plots were calculated for continuous data (abduction, flexion, and external rotation), and Cohen's weighted kappa was calculated for ordinal categorical data (internal rotation). RESULTS The intraclass correlation coefficient for abduction, flexion, and external rotation was 0.93 (excellent) 95% CI (0.87, 0.96), 0.89 (good) 95% CI (0.81, 0.94), and 0.72 (moderate) 95% CI (0.52, 0.84), respectively. Cohen's kappa for internal rotation (measured as reaching levels on the back) was 0.63 (moderate). CONCLUSION We believe that patient-assessed measurements of abduction (intraclass correlation coefficient 0.93) and flexion (intraclass correlation coefficient 0.89) can be used as a valid substitute (for measurements by a clinician or researcher). Patient-assessed measurements for external rotation (intraclass correlation coefficient 0.72) and internal rotation (kappa 0.63) are in moderate agreement and should be used more cautiously as substitutes. LEVEL OF EVIDENCE Level II, Diagnostic Study.
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Affiliation(s)
- Eirik Solheim
- Department of Orthopedics, Aleris Nesttun Hospital, Bergen, Norway;Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway;Department of Orthopedics, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Maja Rosenlund
- Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway
| | - Karen Gjørwad Ulsaker
- Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway
| | - Anagha P Parkar
- Department of Clinical Medicine, University of Bergen, Faculty of Medicine and Dentistry, Bergen, Norway; Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway
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Zhao Y, Zhu Y, Lu Y, Li F, Jiang C. Long-term outcomes of shoulder hemiarthroplasty for acute proximal humeral fractures. INTERNATIONAL ORTHOPAEDICS 2023; 47:1517-1526. [DOI: 10.1007/s00264-023-05746-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
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Lazrek O, Karam KM, Bouché PA, Billaud A, Pourchot A, Godeneche A, Freaud O, Kany J, Métais P, Werthel JD, Bohu Y, Gerometta A, Hardy A. A new self-assessment tool following shoulder stabilization surgery, the auto-Walch and auto-Rowe questionnaires. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07290-y. [PMID: 36586000 DOI: 10.1007/s00167-022-07290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Patient-reported outcome measures (PROMS) are increasingly used for patient evaluation, as well as for scientific research. Few are used for practical purposes in the clinical setting, and few are reliable enough to allow proper feedback to physicians. Two of the most commonly used assessment tools in shoulder instability are the Walch-Duplay and the Rowe scores. The aim of this study was to evaluate the validity of self-administered versions of the Walch-Duplay and Rowe scores following shoulder stabilization procedure. METHODS Between the months of May and December 2021, all patients who were followed in one of six institutions for shoulder instability were included. Patients were required to anonymously fill a self-administered version of Walch-Duplay and Rowe score. The classic scores were measured by the surgeon. Correlations between self-assessment and physician-assessment were then recorded. RESULTS A total of 106 patients were evaluated during the study period. Using the Spearman coefficient for correlation, a strong correlation (r > 0.5) was found between the results of the self-administered questionnaire and the surgeon-measured score. The difference between surgeon- and patient-administered questionnaires was non-significant. CONCLUSION The self-administered version of the Walch-Duplay and Rowe questionnaires can reliably be used in the clinical setting for post-operative follow-up of patients undergoing shoulder stabilization procedures. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Omar Lazrek
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - Karam Mark Karam
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France.
| | | | - Anselme Billaud
- Centre de Chirurgie Orthopédique et Sportive, Mérignac, France
| | - Auriane Pourchot
- Hôpital Ambroise-Pare, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | | | | | - Jean Kany
- Clinique de l'Union-Ramsay Santé, Toulouse, France
| | - Pierre Métais
- Hopital Prive de la Châtaigneraie-ELSAN, Clermont-Ferrand, France
| | - Jean-David Werthel
- Hôpital Ambroise-Pare, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Yoann Bohu
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | | | - Alexandre Hardy
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
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Panagopoulos G, Picca G, Adamczyk A, Leonidou A, Consigliere P, Sforza G, Atoun E, Rath E, Levy O. The "purse string" technique for anterior glenohumeral instability: long-term results 7-13-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03426-5. [PMID: 36350404 DOI: 10.1007/s00590-022-03426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The "Purse-String Technique" (PST) is an arthroscopic horizontal mattress suture technique for recurrent anterior shoulder instability that uses a single double-loaded suture anchor at the 4-o' clock position, achieving a Bankart labral repair and an infero-superior capsular shift. In this study, we describe the long-term results of the PST. METHODS The study included 69 individuals (70 shoulders), with a mean age of 30 years, who had recurrent post-traumatic anteroinferior instability. A purse-string suture anchor at the 4-o'clock position was used to address the Bankart lesion and capsular laxity, recreating the anterior glenoid bumper. All patients were assessed via telephone interview at a mean of 116 months after surgery (7-13-year follow-up). RESULTS Postoperatively, the mean Constant score was 94, mean Rowe score was 93 and mean Walch-Duplay score was 89. 89% of patients resumed their preinjury sport activities, with 61% of patients achieving preinjury levels and most professional athletes returning to full activity. Seven patients had recurrent dislocation postoperatively (10% failure rate). Of these patients, three had revision arthroscopic stabilization, one patient had revision arthroscopic stabilization with remplissage, two had a Latarjet procedure, whereas one patient decided to seek no further treatment. CONCLUSION The long-term results of PST are promising, with a low failure rate, high patient satisfaction and a high rate of return to sport. LEVEL OF EVIDENCE Level IV; Case series; Treatment study.
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Affiliation(s)
- Georgios Panagopoulos
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK.
| | - Girolamo Picca
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Aleksandra Adamczyk
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Andreas Leonidou
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Paolo Consigliere
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Giuseppe Sforza
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Swallows Croft, Wensley Rd, Coley Park, Reading, Berkshire, RG1 6UZ, UK
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Orthopaedic Department, Barzilai Medical Centre, Ashkelon, Israel
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Tytherleigh-Strong G, Sabharwal S, Peryt A. Clinical Outcomes and Return to Sports After Open Reduction and Hamstring Tendon Autograft Reconstruction in Patients With Acute Traumatic First-Time Posterior Dislocation of the Sternoclavicular Joint. Am J Sports Med 2022; 50:3635-3642. [PMID: 36135350 DOI: 10.1177/03635465221124267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic posterior dislocations of the sternoclavicular joint (SCJ) are rare. Multiple case reports, case series, and systematic reviews have been published on the treatment of posterior SCJ dislocations. However, they have usually been of small numbers, described a variety of surgical techniques on a mixture of acute and chronic dislocations, and have not focused on functional recovery or return to sports. PURPOSE/HYPOTHESIS The purpose of this study was to assess the clinical outcomes and return to sports after SCJ open reduction and reconstruction using a hamstring tendon autograft in patients with an acute first-time traumatic posterior dislocation of the SCJ. We hypothesized that SCJ open reduction and reconstruction would result in high survivorship, good clinical outcomes, and a high rate of return to sports. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study included all patients who underwent SCJ open reduction and reconstruction within 14 days of sustaining a first-time traumatic posteriorly dislocated SCJ, with a minimum 3-year follow-up. Patient-reported outcomes were assessed by the following scores: short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Rockwood SCJ, modified Constant, and Single Assessment Numeric Evaluation (SANE). Survivorship was defined as no clinical failure, such as instability or recurrent dislocation, and no revision surgery. Return to sports was assessed using a customized questionnaire. RESULTS A total of 19 patients who underwent surgery were included, with a mean age of 30.8 years (range, 18-52 years). Seventeen patients were available at final follow-up at a mean 94.5 months (range, 37-155 months). At final follow-up, the mean scores were as follows: QuickDASH, 4.3 (range, 0-20.4); Rockwood, 13.9 (range, 12-15); modified Constant, 94.4 (range, 71-100); and SANE, 92.1 (range, 70-100). The construct survivorship was 96%. Of the 14 patients who participated in sports, 12 (86%) returned to their preinjury levels. CONCLUSION After an acute first-time traumatic posterior SCJ dislocation, open reduction and stabilization with a hamstring tendon autograft, undertaken within 14 days of injury, provides good clinical outcomes and high rates of survivorship and return to sports.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Sanjeeve Sabharwal
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Adam Peryt
- Division of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
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Turkish version of the patient-based Constant-Murley Score: Its cross-cultural adaptation, validity, reliability and comparison with the clinician-based version. Turk J Phys Med Rehabil 2022; 68:336-347. [DOI: 10.5606/tftrd.2022.8520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives: The aim of this study was to translate, cross-culturally adapt the patient-based Constant-Murley Score (p-CMS), assess its validity, reliability, and compare it with the clinician-based CMS (c-CMS).
Patients and methods: This cross-sectional study included a total of 51 shoulders of 46 patients (22 males, 24 females; mean age: 49±10 years; range, 29 to 70 years) with shoulder pain between December 2015 and July 2016. After translation of p-CMS, each participant was asked to complete the final Turkish version of the p-CMS. The c-CMS was assessed by a physiatrist who was blinded to the p-CMS. Retest of the p-CMS was performed in patients (n=15) who did not receive any treatment between two visits (Days 3 to 5).
Results: A total of 51 shoulders (n=5 bilateral shoulder pain) were tested. Strength, subjective, objective, and total scores were significantly different between the p-CMS and c-CMS (p<0.001). Pain scores of the c-CMS and p-CMS revealed similar results with 95% limits of agreement of -3.81 and 4.81. Weighted kappa statistics demonstrated that the levels of agreement ranged between 0.343 and 0.698 in subjective and between 0.379 and 0.515 in objective components. For test-retest reliability of the p-CMS, intraclass correlation coefficient values ranged between 0.838 and 0.995.
Conclusion: The Turkish version of the p-CMS has internal consistency and test-retest reliability to evaluate shoulder function in Turkish patients with shoulder pathologies. Considering the differences in test protocols and scoring methods of c-CMS and p-CMS, their interchangeable use is not supported.
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Evaluation of the Multiple Assessment Subjective Shoulder Score (MASSS). A pilot study. Orthop Traumatol Surg Res 2022; 108:103313. [PMID: 35537681 DOI: 10.1016/j.otsr.2022.103313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study compares an entirely patient reported modification of the Constant-Murley Score (CS) (the Multiple Assessment Subjective Shoulder Score [MASSS]), with the CS in symptomatic patients with non-instability shoulder pathology. HYPOTHESIS The hypothesis is that the sub scores and overall score of the MASSS will be well correlated and in high agreement to the corresponding scores of the CS. MATERIALS AND METHODS The MASSS, the CS and adjusted-CS (a-CS) were administered to 74 patients. The MASSS replaced the strength and ROM domains of the CS with SANE scores. Correlations, differences, agreement, test-retest reliability, and internal consistency were assessed using Pearson's R test, paired t-test, Bland-Altman method, intraclass correlations (ICC) and Cronbach's alpha. RESULTS Correlation between MASSS and CS (0.834) and a-CS (0.824) were excellent. Total MASSS (54.0) was higher than CS (41.8) (p<0.001) and a-CS (47.8) (p<0.05). MASSS strength and ROM domains were higher than those of the CS (Strength: 13.4 v 5.3 [p<0.001], ROM: 24.8 v 20.8 [p<0.001]. There was a floor effect for the strength domain of the CS (46.7% minimum score), but not the MASSS (0% minimum score). MASSS internal consistency (0.626-0.734) was better than the CS (0.401-0.643). Test re-test reliability of the total MASSS (ICC 0.93) and the strength (ICC 0.90) and ROM (ICC 0.86) domains was excellent. DISCUSSION The MASSS has several advantages over the CS. Although the correlation of the total MASSS with the CS and a-CS was high, there was poor agreement in the strength and the ROM domains and therefore the MASSS value is not interchangeable with the CS, but rather should be considered as an alternative. LEVEL OF EVIDENCE II; Prospective cohort study.
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Hallberg K, Salomonsson B. Validity, reliability, and responsiveness of the Swedish version of Western Ontario Osteoarthritis of the Shoulder index. BMC Musculoskelet Disord 2022; 23:351. [PMID: 35410269 PMCID: PMC8996484 DOI: 10.1186/s12891-022-05300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background The Western Ontario of the Shoulder index (WOOS) is a patient-reported, disease-specific instrument, designed to measure quality of life in patients with osteoarthritis of the shoulder. The Swedish Shoulder Arthroplasty Registry (SSAR) uses WOOS and EuroQoL 5-dimensions 3 levels (EQ-5D-3L) as patient reported outcome measures. The purpose of this study was to test the validity, responsiveness, and reliability of the Swedish translation of WOOS for patients with osteoarthritis of the shoulder. Methods Data was collected from three shoulder arthroplasty studies performed during 2005–2013, with 23, 21, and 19 patients respectively. Forms were collected preoperatively, and postoperatively between 12 and 24 months. WOOS and EQ-5D-3L were used in all three studies. Additionally, the Oxford Shoulder Score (OSS) (n = 23) was used in one study, and the Constant-Murley score (CMS) (n = 40) in two of the studies. Validity was analysed by calculating Pearson’s correlation coefficient (PCC). Cronbach’s alpha (CA) was used to estimate internal consistency and reliability. The responsiveness of WOOS was measured by calculating effect size and standardized response mean. To assess the performance of WOOS over time, we present repeated measures of WOOS in the registry over a 10-year period. Results The validity analysis showed excellent correlations of WOOS to CMS, OSS and EQ-5D 3L, with Pearson’s correlation coefficient of 0.72, 0.83, and 0.62 respectively (P < 0.001). There were adequate floor effects in the sport and lifestyle domains preoperatively, and adequate ceiling effects in all domains postoperatively. There were no floor effects and adequate ceiling effects for total WOOS. Analyzing reliability, Cronbach’s alpha was 0.95 for the pre- and postoperative WOOS scores combined. The analysis of responsiveness for WOOS showed an effect size of 2.52 and a standardized response mean of 1.43. The individual results measured by WOOS within the registry shows stable levels from 1 to 10 years. Conclusion The Swedish translation of WOOS is valid, reliable, and responsive for use in a clinical setting for patients with glenohumeral osteoarthritis treated with shoulder arthroplasty, and we regard it as an appropriate instrument for use in the Swedish Shoulder Arthroplasty Registry.
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Affiliation(s)
- Kristofer Hallberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden. .,Division of Orthopaedic Surgery, Danderyd hospital, Stockholm, Sweden.
| | - Björn Salomonsson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Danderyd, Sweden.,Division of Orthopaedic Surgery, Danderyd hospital, Stockholm, Sweden
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Gathen M, Cucchi D, Jansen T, Goost H, Schildberg FA, Burger C, Wirtz DC, Kabir K, Welle K. Practicability of a Virtual Consultation to Evaluate the Shoulder Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 161:195-200. [PMID: 34544165 DOI: 10.1055/a-1522-9087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the course of the corona pandemic, resource conservation and the protection of further infections have made it necessary to break new ground in the organisation of orthopaedic and trauma surgery consultations. One solution is consistent digitisation and the offer of video consultation hours. In this study, non-contact examination of patients with shoulder disorders is described and critically examined. METHODS Thirty patients who presented with pathologies of the shoulder joint in a university outpatient clinic were subjected to a physical examination in a conventional and contactless manner. The data obtained on mobility, function and provocation test of both examinations were compared to draw conclusions about the virtual feasibility. RESULTS 46% of the patients suffered from a traumatic shoulder lesion, and 54% showed degenerative lesions. The assessment of mobility showed a high correlation of 70 - 90% between the two examinations. Common tests to evaluate the supraspinatus, infraspinatus, subscapularis and the long head of the biceps could be adequately performed in a contactless version by more than three quarters of the patients, but with low-to-moderate performance values. CONCLUSION Contact-less examination is particularly disadvantageous when evaluating stability criteria. For the medical history and functional test, there were no significant differences between the classic consultation and contactless consultation. Although virtual consultation is a widespread and valuable addition in pandemic times, it cannot replace a safe assessment and indication by personal examination.
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Affiliation(s)
- Martin Gathen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Davide Cucchi
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Tom Jansen
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Hans Goost
- Department of Orthopaedics and Trauma Surgery, Krankenhaus Wermelskirchen, Germany
| | | | - Christof Burger
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | | | - Koroush Kabir
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - Kristian Welle
- Clinic for Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
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Märtens N, Heinze M, Awiszus F, Bertrand J, Lohmann CH, Berth A. Long-term survival and failure analysis of anatomical stemmed and stemless shoulder arthroplasties. Bone Joint J 2021; 103-B:1292-1300. [PMID: 34192923 DOI: 10.1302/0301-620x.103b7.bjj-2020-0915.r3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The purpose of this study was to compare clinical results, long-term survival, and complication rates of stemless shoulder prosthesis with stemmed anatomical shoulder prostheses for treatment of osteoarthritis and to analyze radiological bone changes around the implants during follow-up. METHODS A total of 161 patients treated with either a stemmed or a stemless shoulder arthroplasty for primary osteoarthritis of the shoulder were evaluated with a mean follow-up of 118 months (102 to 158). The Constant score (CS), the Disabilities of the Arm, Shoulder and Hand (DASH) score, and active range of motion (ROM) were recorded. Radiological analysis for bone adaptations was performed by plain radiographs. A Kaplan-Meier survivorship analysis was calculated and complications were noted. RESULTS The ROM (p < 0.001), CS (p < 0.001), and DASH score (p < 0.001) showed significant improvements after shoulder arthroplasty for both implants. There were no differences between the groups treated with stemmed or stemless shoulder prosthesis with respect to the mean CS (79.2 (35 to 118) vs 74.4 (31 to 99); p = 0.519) and DASH scores (11.4 (8 to 29) vs 13.2 (7 to 23); p = 0.210). The ten-year unadjusted cumulative survival rate was 95.3% for the stemmed anatomical shoulder prosthesis and 91.5% for the stemless shoulder prosthesis and did not differ between the treatment groups (p = 0.251). The radiological evaluation of the humeral components in both groups did not show loosening of the humeral implant. The main reason for revision for each type of arthroplasties were complications related to the glenoid. CONCLUSION The use of anatomical stemless shoulder prosthesis yielded good and reliable results and did not differ from anatomical stemmed shoulder prosthesis over a mean period of ten years. The differences in periprosthetic humeral bone adaptations between both implants have no clinical impact during the follow-up. Cite this article: Bone Joint J 2021;103-B(7):1292-1300.
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Affiliation(s)
- Nicole Märtens
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Maximilian Heinze
- Department of Orthopaedic Surgery, Asklepios Harzkliniken Fritz-König-Stift Bad Harzburg, Bad Harzburg, Germany
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Bardos A, Sabhrawal S, Tytherleigh-Strong G. Management of Vertical Sternal Fracture Nonunion in Elite-Level Athletes. Orthop J Sports Med 2021; 9:23259671211010804. [PMID: 34250172 PMCID: PMC8237216 DOI: 10.1177/23259671211010804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Sternal fractures are rare, and they can be treated nonoperatively. Vertical
sternal fractures have rarely been reported. Purpose: To describe the management and surgical treatment of a series of elite-level
athletes who presented with symptomatic nonunions of a vertical sternal
fracture. Study Design: Case series; Level of evidence, 4. Methods: Patients with an established symptomatic nonunion of a vertical sternal
fracture, as diagnosed by computed tomography (CT) or magnetic resonance
imaging (MRI), underwent open reduction and internal fixation using
autologous bone graft and cannulated lag screws. The patients were assessed
preoperatively and at the final follow-up using the Rockwood
sternoclavicular joint (SCJ) score; Constant score; and shortened version of
the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Bony
union was confirmed on postoperative CT scan. Results: Five patients (4 men and 1 woman) were included; all were national- or
international-level athletes (rugby, judo, show-jumping, and MotoGP). The
mean age at surgery was 23.4 years (range, 19-27 years), the mean time from
injury to referral was 13.6 months (range, 10-17 months), and the mean time
from injury to surgery was 15.8 months (range, 11-20 months). The mean
follow-up was 99.4 months (range, 25-168 months). There was a significant
improvement after surgery in the mean Rockwood SCJ score (from 12.6 to 14.8
[P < .05]), Constant score (from 84 to 96.4
[P < .05]; 80% met the minimal clinically important
difference [MCID] of 10.4 points), and QuickDASH (from 6.8 to 0.98
[P < .05]; 0% met the MCID of 15.9 points). Four of
the patients were able to return to sport at their preinjury level, and 1
patient retired for nonmedical reasons. All of the fractures had united on
the postoperative CT scan. There were no postoperative complications. Conclusion: Vertical fractures of the sternum are very rare and tend to behave clinically
like an avulsion fracture injury to the capsuloligamentous structure of the
inferior SCJ. The requirement of advanced imaging to diagnose this injury
means that the actual incidence and natural history are not known. For
high-demand athletes, early identification, surgical reduction, and fixation
are likely to achieve the best outcome.
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Affiliation(s)
- Andrea Bardos
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Sanjeeve Sabhrawal
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
| | - Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge, UK
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13
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Buchbinder R, Ramiro S, Huang H, Gagnier JJ, Jia Y, Whittle SL. Measures of Adult Shoulder Function. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:250-293. [PMID: 33091271 DOI: 10.1002/acr.24230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/14/2022]
Affiliation(s)
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, the Netherlands, and Zuyderland Medical Center, Heerlen, the Netherlands
| | | | | | - Yuanxi Jia
- Johns Hopkins University, Baltimore, Maryland
| | - Samuel L Whittle
- Monash University and Cabrini Institute, Melbourne, Victoria, Australia, and The Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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Abstract
INTRODUCTION Quantifying patient outcomes is integral in orthopaedic practice, and patient-reported outcome measures (PROMs) assist with this goal and assist clinicians in assessing subjective outcomes (pain, satisfaction, etc.). This study seeks to identify the most highly used PROMs in the shoulder literature and analyze their usage trends. METHODS PubMed was queried for all shoulder-based articles published in eight selected journals from 2007 to 2017. Articles were assessed for PROM usage, surgical approach, surgical procedure, and disease pathology. Frequency analyses identified the most used PROMs overall, and for each approach, procedure, and pathology. Last, usage trends, question number, validation, and clinician dependence of PROMs with ≥20 uses were analyzed. RESULTS In total, 1,740 of 2,462 articles (71%) used 105 unique PROMs 4,394 times during the study. PROM usage increased 18%, and the use of multiple PROMs increased by 20%. PROMs with a clinician component increased 21% slower than the baseline. Twenty-two PROMs (17%) had >20 uses, with the most used PROMs being the Constant-Murley Score (783), American Shoulder and Elbow Surgeons Shoulder Score (731), Visual Analog Scale (685), Simple Shoulder Test (372), and the University of California, Los Angeles, Shoulder Rating Scale (274). PROMs demonstrating the greatest usage increase were the EuroQol 5-Dimensions Questionnaire (1,282%), Shoulder Pain and Disability Index (638%), Western Ontario Rotator Cuff Index (632%), Western Ontario Osteoarthritis of the Shoulder Index (582%), and Oxford Shoulder Score (462%)-all without a clinician component. DISCUSSION PROM usage is increasing, often with multiple PROMs being used to evaluate patient outcomes. PROMs without a clinician component are growing at higher rates than their clinician-dependent counterparts, highlighting an emphasis on patient reporting of outcomes. This study suggests that the American Shoulder and Elbow Surgeons Shoulder Score, Oxford Shoulder Score, Visual Analog Scales-all without a mandatory clinician component and high levels of use-will be the most highly used PROMs moving forward to assess shoulder function.
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15
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Yoon SH, Lee D, Li H, Kweon H, Ahn JH. Discrimination between pain and contracture in limited passive motion patients with rotator cuff tear: A STROBE-compliant cross-sectional study. Medicine (Baltimore) 2020; 99:e21391. [PMID: 32756131 PMCID: PMC7402877 DOI: 10.1097/md.0000000000021391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Either pain or contracture may limit shoulder passive range of motion (PROM) in patients with rotator cuff disease, and an appropriate treatment may be determined according to its cause. If there is no change in PROM under general anesthesia, contracture, rather than pain, may be the underlying condition. Our goal was to devise a physical examination that would help discriminate between pain and contracture in limited PROM patients with rotator cuff tear.This is a STROBE-compliant cross-sectional study. Patients with rotator cuff tears (N = 28) were scheduled for arthroscopic repair. The main outcome measure was PROM, including flexion, external rotation (ER), and abduction obtained by a blinded examiner before and after the induction of general anesthesia, and the abduction/ER ratio was calculated. In order to perform a subgroup analysis, patients were divided into 2 groups, one where abduction difference after the general anesthesia was 8°≤ (n = 22) and the other 8°> (n = 6).Patients' average age (62.6 ± 7.2 years), symptom duration (13.0 ± 10.0 months), intensity of shoulder pain on a visual analog scale (4.8 ± 2.1), and Constant-Murley functional score (63.4 ± 8.9); the ratio of gender (male: female = 12:16); and the arthroscopic findings were recorded. According to the correlation analysis, the abduction/ER ratio before general anesthesia was correlated best with the change in PROM after general anesthesia (correlation coefficient -0.74, P < .001); the correlations for abduction and flexion were -0.69 and -0.57, respectively (P < .001 and .002, respectively). The age, gender, height, weight, duration of symptoms, trauma history, visual analog score for shoulder pain, Constant-Murley functional score, size of rotator cuff tear, and biceps pathology did not differ significantly between the 2 groups in the subgroup analysis (P > .05). The only significant difference between the 2 groups was in the synovitis status (P = .04).Patients with greater abduction/ER ratio before anesthesia exhibited fewer PROM changes after anesthesia. The abduction/ER ratio was strongly and inversely correlated with PROM changes, allowing physicians to choose an appropriate treatment for limited PROM in patients with rotator cuff tears.
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Affiliation(s)
| | | | | | | | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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16
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Lanza E, Piccoli F, Intrieri C, Muglia R, Politi LS, Borroni M, Castagna A, Sconfienza LM. US-guided percutaneous irrigation of calcific tendinopathy of the rotator cuff in patients with or without previous external shockwave therapy. Radiol Med 2020; 126:117-123. [PMID: 32451885 DOI: 10.1007/s11547-020-01229-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the outcome of US-guided percutaneous irrigation of calcific tendinopathy (US-PICT) of the rotator cuff in patients with or without previous external shockwave therapy (ESWT). METHODS We analyzed all patients treated with US-PICT from March 1, 2016, to October 1, 2019, with shoulder pain refractory to conservative management for rotator cuff calcific tendinopathy, diagnosed with ultrasound. Each patient was examined using the Constant-Murley Score (CMS) questionnaire (score 0-100) before and after treatment. We tested CMS differences using the Mann-Whitney U (Wilcoxon rank-sum) test in the two groups. US-PICT was performed placing two or multiple 14G needles, according to the calcification size, inserted under US guidance to create a circuit of irrigation in the calcified tendon. NaCl solution at 38 °C was then injected from the entry needle in a variable amount to hydrate and fragment the calcification, finally allowing for its expulsion through the exit needle. All patients also received an intrabursal steroid injection. RESULTS From 2016 to 2019, 72 US-PICT treatments were performed on 70 patients (females = 46; males = 26) with a mean age of 49.7 years (SD = 8.7. Thirty-three (47%) underwent previous ESWT, while thirty-seven (53%) had no previous treatments. No treatment-related complications were observed. Follow-up was averagely 14.4 months (median = 11.6, SD = 11.9, range 1-45); 37 patients had a follow-up shorter than 12 months (1-11.6); 35 patients were visited after more than 1 year (12.2-45.6, Table W). Before treatment, the mean CMS was 35 (SD = 21); after treatment, it reached 75.4, with an average CMS improvement of 40.3 points (SD = 23.7, p < 0.001). The comparison of improvement between the ESWT and non-ESWT group yielded no significant difference (p = 0.3). CONCLUSIONS US-PICT of the rotator cuff is an effective procedure to reduce shoulder pain and increase mobility in patients with calcific tendinopathy, both in short- and long-term time intervals. Previous unsuccessful ESWT does not affect the outcome of US-PICT.
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Affiliation(s)
- Ezio Lanza
- Radiology Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy.
| | - Francesca Piccoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Cristina Intrieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Riccardo Muglia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Letterio Salvatore Politi
- Radiology Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Mario Borroni
- Shoulder and Elbow Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Alessandro Castagna
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Shoulder and Elbow Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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17
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Forsythe B, Agarwalla A, Puzzitiello RN, Patel BH, Lu Y, Verma NN, Romeo AA, Cole BJ. Clinical Function Improves After Subacromial Injection of Local Anesthetic in Full-Thickness Rotator Cuff Tears: A Randomized Control Trial. Orthop J Sports Med 2020; 8:2325967119892331. [PMID: 31934594 PMCID: PMC6943985 DOI: 10.1177/2325967119892331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/28/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Rotator cuff pathology is the most common cause of shoulder pain in adults, accounting for nearly 70% of shoulder-related visits to clinicians. However, physical examination findings may be limited because of pain or patient inhibition. Purpose: To establish whether a relationship exists between pain, range of motion, and strength in patients with a full-thickness rotator cuff tear. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A single-blind, randomized controlled study of 40 patients undergoing rotator cuff repair for full-thickness rotator cuff tears was performed. Patients were randomized to receive either a subacromial 10-mL 2% lidocaine injection or a sham injection, with no contents being injected into the subacromial space. Before the injection, patients were assessed using a visual analog scale for pain (VAS-Pain) as well as the Constant-Murley subjective questionnaire and objective physical examination. The examination was repeated 10 minutes after injection and 6 months postoperatively. VAS-Pain after injection was not assessed. The assessment at 6 months was performed to demonstrate improvement of rotator cuff function after operative management. Statistical analysis included Student t and chi-square tests as well as multivariate binomial logistic regression analyses to identify predictors for improvement after injection. Results were considered significant if P < .05. Results: Range of motion, strength, and Constant-Murley score significantly improved after a subacromial lidocaine injection (P < .05). Range of motion, strength, Constant-Murley score, and VAS-Pain significantly improved at final follow-up compared with the preinjection assessment for both groups (P < .05); however, there was no difference (P > .05) between groups at 6 months postoperatively. Conclusion: After subacromial lidocaine injections, patients exhibited modest but significant improvements in range of motion, strength, and the Constant-Murley score. Pain may limit range of motion and strength in patients with full-thickness rotator cuff tears independent of the mechanical impact of the tear itself. Registration: NCT02693444 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Richard N Puzzitiello
- Department of Orthopedic Surgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Bhavik H Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Yining Lu
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, The Rothman Institute, New York, New York, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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18
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Moreels R, De Wilde L, Van Tongel A. Evolution of nonoperative treatment of atraumatic sternoclavicular dislocation. J Shoulder Elbow Surg 2019; 28:2350-2355. [PMID: 31350108 DOI: 10.1016/j.jse.2019.04.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Atraumatic sternoclavicular dislocation (ASCD) is an uncommon pathology that is mainly diagnosed in young adults. The aim of this study is to better describe the clinical picture of ASCD and to describe the results of a "wait-and-see" policy in these patients. METHODS All patients with ASCD who visited our department between 2011 and 2016 were retrospectively analyzed. A standardized clinical examination was used to evaluate the clinical picture. All patients were treated nonoperatively, and at latest follow-up, several parameters and standardized questionnaires (Nottingham Clavicle Score, Oxford Shoulder Score, Constant-Murley Score) were used to evaluate the outcome. RESULTS In total, 23 patients (12 male, 11 female) were evaluated. The average age at diagnosis was 18.6 years. There was a significant difference (P < .001) in angle of dislocation during forward flexion (mean = 141°) compared with abduction (mean = 101°). At latest follow-up (average 46 months, range 14-113 months; standard deviation [SD] = 27), subluxations still occurred but were less frequent and less prominent relative to presentation at initial diagnosis in 19 of 23 patients. The chance of subjective improvement increased by 27% for each year of follow-up. High outcome scores of Nottingham Clavicle Score (mean score = 80, SD = 11), Oxford Shoulder Score (mean score = 44, SD = 4), and Constant-Murley Score (mean score = 83, SD = 11) were reported. CONCLUSION In patients with ASCD, the clavicle subluxates earlier in abduction than in forward flexion. After a midterm follow-up, a "wait-and-see" policy does not resolve the subluxations. However, most patients displayed reduced frequency and severity of subluxations over their recovery period and showed excellent scores on shoulder questionnaires.
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Affiliation(s)
- Robin Moreels
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
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19
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Debeer P, Berghs B, Pouliart N, Van den Bogaert G, Verhaegen F, Nijs S. Treatment of severe glenoid deficiencies in reverse shoulder arthroplasty: the Glenius Glenoid Reconstruction System experience. J Shoulder Elbow Surg 2019; 28:1601-1608. [PMID: 30770317 DOI: 10.1016/j.jse.2018.11.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of glenoid bone deficiencies in primary or revision total shoulder arthroplasty is challenging. This retrospective study evaluated the short-term clinical and radiologic results of a new custom-made patient-specific glenoid implant. METHODS We treated 10 patients with severe glenoid deficiencies with the Glenius Glenoid Reconstruction System (Materialise NV, Leuven, Belgium). Outcome data included a patient-derived Constant-Murley score, a visual analog score (VAS), a satisfaction score, the 11-item version of the Disabilities of the Arm, Shoulder and Hand score, and the Simple Shoulder Test. We compared the postoperative position of the implant with the preoperative planned position on computed tomography scans. RESULTS At an average follow-up period of 30.5 months, the mean patient-derived Constant-Murley score was 41.3 ± 17.5 points (range, 18-76 points) with a visual analog scale of 3.3 ± 2.5 points (range, 0-7 points). The mean 11-item version of the Disabilities of the Arm, Shoulder and Hand score was 35.8 ± 18.4 (range, 2-71), and the mean Simple Shoulder Test was 47.5% ± 25.3% (range, 8%-92%). Eight patients reported the result as better (n = 3) or much better (n = 5). One patient had an elongation of the brachial plexus, and 1 patient had a period of instability. The average preoperative glenoid defect size was 9 ± 4 cm3 (range, 1-14 cm3). The mean deviation between the preoperative planned and the postoperative version and inclination was 6° ± 4° (range 1°-16°) and 4° ± 4° (range 0°-11°), respectively. CONCLUSION Early results of the Glenius Glenoid Reconstruction System are encouraging. Adequate pain relief, a reasonable functionality, and good patient satisfaction can be obtained in these difficult cases. Further follow-up will determine the bony ingrowth and subsequent longevity of this patient-specific glenoid component.
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Affiliation(s)
- Philippe Debeer
- Orthopaedics, University Hospitals Leuven, Department of Development and Regeneration, K.U. Leuven, Belgium & Institute for Orthopaedic Research and Training, Leuven, Belgium.
| | | | - Nicole Pouliart
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussels, Brussels, Belgium
| | | | - Filip Verhaegen
- Orthopaedics, University Hospitals Leuven, Department of Development and Regeneration, K.U. Leuven, Belgium & Institute for Orthopaedic Research and Training, Leuven, Belgium
| | - Stefaan Nijs
- Traumatology, University Hospitals Leuven, Department of Development and Regeneration, K Katholieke Universiteit (K.U.), Leuven, Belgium
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20
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Gómez-Blasco A, Hernández-Fernández A, Roche-Albero A, Martín-Hernández C. Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plate. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Bassens D, Decock T, Van Tongel A, De Wilde L. Long-term results of the Delta Xtend reverse shoulder prosthesis. J Shoulder Elbow Surg 2019; 28:1091-1097. [PMID: 30713067 DOI: 10.1016/j.jse.2018.11.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse shoulder arthroplasty has become the standard treatment for cuff tear arthropathy and complex fractures of the proximal humerus. The Delta Xtend prosthesis (DePuy Synthes, Warsaw, IN, USA) was launched in 2006 and has shown good short-term results. Longer-term results are not yet available. METHODS There were 126 primary Delta Xtend prostheses implanted in our center by 1 surgeon from October 2006 until December 2009. Of these, 38 patients died, 12 were lost to follow-up, and 2 needed early revision of the prosthesis. Follow-up of at least 8 years was available for 74 patients. At preoperative and postoperative visits, shoulder function and pain were evaluated using the age- and sex-adjusted Constant-Murley score (aCS). The satisfaction rate was evaluated on a visual analog scale (VAS). RESULTS The mean follow-up in our population was 113.1 months. The mean aCS was 44.6% (standard deviation [SD], 19.2) preoperatively. It increased significantly (P < .001) after surgery to 75.8% (SD, 12.5) at 3 months and 91.1% (SD, 11.8) at 5 years. At the latest follow-up, the mean aCS was only 79.9% (SD, 17.7), which was significantly lower (P = .002) than the aCS at 5 years postoperatively. An overall survival rate of more than 97% was seen at 8 years of follow-up. CONCLUSION This study confirms that the promising short-term results of the Delta Xtend prosthesis can be extended in the longer-term. However, further follow-up will be necessary to check whether the statistically significant decrease in the Constant-Murley score at latest follow-up, which was driven by a decrease in range of motion and power, continues or not.
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Affiliation(s)
- David Bassens
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Decock
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
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22
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Gómez-Blasco AM, Hernández-Fernández A, Roche-Albero A, Martín-Hernández C. Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plate. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:268-274. [PMID: 31014932 DOI: 10.1016/j.recot.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/16/2018] [Accepted: 03/10/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To evaluate the results after locking plate internal fixation of proximal humerus fractures by means of a motion capture system, and functional scales. MATERIAL AND METHOD Retrospective study of a cohort of 47 elderly patients undergoing surgery from January 2010 to December 2014. After a minimum follow-up of two years, two functional scales (Constant-Murley and Quick DASH), and a quality of life scale (EQ-5D) were used for clinical evaluation. For objective evaluation of the range of motion a kinematic marker-free analysis with cameras was performed. RESULTS The average age was 74.85 years. Average functional scores were: Constant-Murley 70.06 points, Quick DASH 35.74 points and EQ-5D 6.79 points. The average range of motion was: flexion, 111.49°; extension: 24.13°; abduction: 109.40°; adduction: 15.13°; external rotation: 38.96°, and internal rotation: 49.28°. Correlation was found between the two functional scales, between them and the EQ-5D, and between range of motion and functional scales (except for external rotation) as well as between range of motion and EQ-5D (except for flexion and external rotation). CONCLUSION Locking plate osteosynthesis in proximal humerus fragility fractures achieved good functional and quality of life scores. Motion capture systems can be a useful tool for the functional assessment of shoulder pathology allowing an objective evaluation of range of motion.
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Affiliation(s)
- A M Gómez-Blasco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España.
| | - A Hernández-Fernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España
| | - A Roche-Albero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España
| | - C Martín-Hernández
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón, Zaragoza, España; Universidad de Zaragoza, Zaragoza, España
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Agarwalla A, Gowd AK, Liu JN, Puzzitiello RN, Cole BJ, Romeo AA, Verma NN, Forsythe B. Predictive Factors and the Duration to Pre-Injury Work Status Following Biceps Tenodesis. Arthroscopy 2019; 35:1026-1033. [PMID: 30857901 DOI: 10.1016/j.arthro.2018.10.144] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/09/2018] [Accepted: 10/29/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE To determine when patients return to work after biceps tenodesis stratified by the preinjury level of work-intensity and to identify predictive measures of return to work. METHODS Patients undergoing biceps tenodesis between 2014 and 2017 were reviewed. Patients receiving concomitant rotator cuff repair or arthroplasty, revision biceps tenodesis, or unemployment before the procedure were excluded. Patient-acceptable symptom state (PASS), substantial clinical benefit, and minimal clinically important difference were calculated for the American Shoulder Elbow Society (ASES) score, subjective Constant-Murley score (CMS), and Single Assessment Numerical Evaluation (SANE) using the anchor-based and distribution-based approach. Preoperative outcome scores were analyzed to determine their predictive power of return to work using receiver operator curve area under the curve (AUC) analysis. Multivariate logistical analysis assessed predictive variables of return to work. RESULTS Seventy-nine percent of patients were able to return to work without permanent restrictions at an average of 5.4 ± 2.8 months after biceps tenodesis. Return to work status for sedentary, light, moderate, and heavy duties were 100%, 85%, 71%, and 69%, respectively. Return to work was associated with achieving PASS for the ASES and SANE questionnaires (P = .006, .003, respectively) but not for the CMS (P = .768). On multivariate analysis, there were no preoperative or intraoperative variables that were predictive of return to work in full capacity. The preoperative Short Form-12 mental component score (>59.4, AUC = 71.2%) was predictive of returning to work. CONCLUSIONS After biceps tenodesis, most patients were able to return to work at an average of 5.4 ± 2.8 months. Furthermore, there were no demographic or intraoperative variables that were predictive of return to work. Work intensity was not correlated with an increased duration of return to work. Achieving PASS on the ASES and SANE questionnaires was predictive of return to work. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Avinesh Agarwalla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Richard N Puzzitiello
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Chelli M, Levy Y, Lavoué V, Clowez G, Gonzalez JF, Boileau P. The "Auto-Constant": Can we estimate the Constant-Murley score with a self-administered questionnaire? A pilot study. Orthop Traumatol Surg Res 2019; 105:251-256. [PMID: 30876713 DOI: 10.1016/j.otsr.2018.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 11/19/2018] [Accepted: 11/28/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Constant score, allows an objective and subjective assessment of the shoulder function. It has been proven to have a poor interobserver reliability for some of its aspects and is not usable as a remote assessment tool. HYPOTHESIS The Constant-Murley functional shoulder score can be assessed with a self-administered questionnaire. METHODS We conducted a prospective continuous study in a shoulder-specialized service. For each patient seen in consultation or hospitalized for a shoulder pathology, a self-administered questionnaire was delivered, and a clinical examination was performed by a surgeon. The questionnaire, in French language, was composed of checkboxes only, with pictures preferred over text for most items. Correlations with surgeon examination were assessed with the intraclass correlation coefficients, differences with the paired t-test. RESULTS One hundred consecutive patients were analyzed. Correlation between the two scores was excellent (0.87), as were the range of motion and the pain subscores (0.85 and 0.78), good for the activity (0.69) and fair for the strength (0.57). The mean total score was 3 points lower for the self-administered questionnaire (CI95 [-5; -1]; p<0.01). Activity and pain were not significantly different (-0.4/20 and -0.3/40; p>0.05) but pain and force were slightly different (+0.8/15; -3.0/25; p<0.01). CONCLUSION The Auto-Constant questionnaire in French is an excellent estimator of the Constant score, and of its pain and mobility sub-scores. It is less accurate for the evaluation of the strength, but differences between sub-scores compensate and allow its use in daily practice. LEVEL OF PROOF II, Prospective continuous clinical series.
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Affiliation(s)
- Mikaël Chelli
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France.
| | - Yohann Levy
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Vincent Lavoué
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Gilles Clowez
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
| | - Pascal Boileau
- Institut Universitaire Locomoteur et du Sport, University Hospital of Nice, 06000 Nice, France
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Garcia GH, Liu JN, Wong AC, Gowd AK, Romeo AA, Dines JS, Gulotta LV. The Shoulder Self-Administered Motion Evaluation Has Excellent Patient Reliability and Reproducibility on Both Physician and Repeat Follow-up Testing. Orthopedics 2018; 41:e820-e826. [PMID: 30222789 DOI: 10.3928/01477447-20180912-08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/12/2018] [Indexed: 02/03/2023]
Abstract
Long-term clinical evaluation is becoming more important, yet difficulties exist because there are substantial patient costs for extended follow-up. The goal of this study was to validate whether a new shoulder motion evaluation is reproducible and reliable with physician examination. Consecutive patients were administered a shoulder motion assessment during their clinic visit. Patients completed the same evaluation 2 weeks after their visit to determine test-retest reliability. Exact and approximate (within 20° or 4 spinal levels) agreements between patient and physician measurements were calculated. A total of 112 patients (224 shoulders) with an average age of 56.7 years were evaluated. The most common diagnoses were osteoarthritis (33.0%) and rotator cuff tear (32.1%). All motion questions had greater than 50% exact patient-physician agreement and greater than 70% approximate agreement. When agreement was off, patients more often underestimated their motion. There was substantial clinician-patient agreement for all questions and almost perfect agreement for forward elevation (intraclass correlation coefficient, 0.78) and internal rotation (intraclass correlation coefficient, 0.77). On test-retest reliability testing, patient-patient agreement was substantial for external rotation at the side (intraclass correlation coefficient, 0.71). There was near perfect agreement for internal rotation (intraclass correlation coefficient, 0.83) and abduction (intraclass correlation coefficient, 0.81) testing. This shoulder assessment tool had both good agreement to physician examination and substantial agreement on correlation testing. There was substantial agreement between follow-up visits, suggesting excellent reproducibility. This motion assessment shows effectiveness with most shoulder pathologies. It is recommended as a good screening tool for both clinical and research purposes requiring long-term follow-up in which in-person clinical examinations may be costly and time consuming. [Orthopedics. 2018; 41(6):e820-e826.].
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Vrotsou K, Ávila M, Machón M, Mateo-Abad M, Pardo Y, Garin O, Zaror C, González N, Escobar A, Cuéllar R. Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res 2018; 27:2217-2226. [PMID: 29748823 PMCID: PMC6132990 DOI: 10.1007/s11136-018-1875-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study was to evaluate the psychometric properties of the Constant-Murley Score (CMS) in various shoulder pathologies, based on a systematic review and expert standardized evaluations. METHODS A systematic review was performed in MEDLINE and EMBASE databases. Titles and abstracts were reviewed and finally the included articles were grouped according to patients' pathologies. Two expert evaluators independently assessed the CMS properties of reliability, validity, responsiveness to change, interpretability and burden score in each group, using the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool. The CMS properties were assessed per attribute and overall for each considered group. Only the concept and measurement model was assessed globally. RESULTS Five individual pathologies (i.e. subacromial, fractures, arthritis, instability and frozen shoulder) and two additional groups (i.e. various pathologies and healthy subjects) were considered. Overall EMPRO scores ranged from 58.6 for subacromial to 30.6 points for instability. Responsiveness to change was the only quality to obtain at least 50 points across all groups, but for frozen shoulder. Insufficient information was obtained in relation to the concept and measurement model and great variability was seen in the other evaluated attributes. CONCLUSIONS The current evidence does not support the CMS as a gold standard in shoulder evaluation. Its use is advisable for subacromial pathology; but data are inconclusive for other shoulder conditions. Prospective studies exploring the psychometric properties of the scale, particularly for fractures, arthritis, instability and frozen shoulder are needed. LEVEL OF EVIDENCE Systematic review.
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Affiliation(s)
- Kalliopi Vrotsou
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Instituto Biodonostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
- Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain
| | - Mónica Ávila
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Mónica Machón
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Instituto Biodonostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Maider Mateo-Abad
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Instituto Biodonostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain
- Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain
| | - Yolanda Pardo
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Olatz Garin
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Zaror
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
- Faculty of Dentistry, Universidad San Sebastian, Puerto Montt, Chile
| | - Nerea González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Antonio Escobar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
- Unidad de investigación, Hospital Universitario Basurto, Bilbao, Spain
| | - Ricardo Cuéllar
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Donostia, San Sebastián, Spain
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Agreement between patient-based and clinician-based assessment of the shoulder. J Shoulder Elbow Surg 2018; 27:e59-e67. [PMID: 29128374 DOI: 10.1016/j.jse.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/02/2017] [Accepted: 09/09/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient home-based self-assessments after shoulder surgery have the potential to aid clinicians in reducing clinic time and decreasing follow-up requirements. The purpose of this systematic review was to determine the correlation between patient-based and physician-assessed outcome measures for range of motion (ROM), strength, and shoulder function. METHODS This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched. All studies comparing patient-reported and clinician-based assessments of shoulder ROM, strength, and function were eligible for inclusion. Studies that included patient or clinician assessment only, description of shoulder diseases or treatments only, and animal- or cadaveric-based studies were excluded. More than 250 abstracts were searched, and 4 studies were found eligible. RESULTS Patients assessed their shoulder ROM, strength, and function with moderate-to-high accuracy compared with clinical assessment. There was less agreement between patients and clinicians regarding the symptomatic shoulder compared with the contralateral shoulder. There was less agreement between patients and clinicians on rotation than forward elevation. Patients who were less satisfied with their shoulder had less agreement with clinicians. CONCLUSION There is moderate-to-high agreement between patients and clinicians in the assessment of the shoulder after surgery. Methods of assessment of rotation could be reviewed to create a more exact self-assessment tool.
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Barber B, Seikaly H, Ming Chan K, Beaudry R, Rychlik S, Olson J, Curran M, Dziegielewski P, Biron V, Harris J, McNeely M, O'Connell D. Intraoperative Brief Electrical Stimulation of the Spinal Accessory Nerve (BEST SPIN) for prevention of shoulder dysfunction after oncologic neck dissection: a double-blinded, randomized controlled trial. J Otolaryngol Head Neck Surg 2018; 47:7. [PMID: 29361981 PMCID: PMC5781293 DOI: 10.1186/s40463-017-0244-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 11/30/2017] [Indexed: 12/02/2022] Open
Abstract
Background Shoulder dysfunction is common after neck dissection for head and neck cancer (HNC). Brief electrical stimulation (BES) is a novel technique that has been shown to enhance neuronal regeneration after nerve injury by modulating the brain-derived neurotrophic growth factor (BDNF) pathways. The objective of this study was to evaluate the effect of BES on postoperative shoulder function following oncologic neck dissection. Methods Adult participants with a new diagnosis of HNC undergoing Level IIb +/− V neck dissection were recruited. Those in the treatment group received intraoperative BES applied to the spinal accessory nerve (SAN) after completion of neck dissection for 60 min of continuous 20 Hz stimulation at 3-5 V of 0.1 msec balanced biphasic pulses, while those in the control group received no stimulation (NS). The primary outcome measured was the Constant-Murley Shoulder (CMS) Score, comparing changes from baseline to 12 months post-neck dissection. Secondary outcomes included the change in the Neck Dissection Impairment Index (ΔNDII) score and the change in compound muscle action potential amplitude (ΔCMAP) over the same period. Results Fifty-four patients were randomized to the treatment or control group with a 1:1 allocation scheme. No differences in demographics, tumor characteristics, or neck dissection types were found between groups. Significantly lower ΔCMS scores were observed in the BES group at 12 months, indicating better preservation of shoulder function (p = 0.007). Only four in the BES group compared to 17 patients in the NS groups saw decreases greater than the minimally important clinical difference (MICD) of the CMS (p = 0.023). However, NDII scores (p = 0.089) and CMAP amplitudes (p = 0.067) between the groups did not reach statistical significance at 12 months. BES participants with Level IIb + V neck dissections had significantly better ΔCMS and ΔCMAP scores at 12 months (p = 0.048 and p = 0.025, respectively). Conclusions Application of BES to the SAN may help reduce impaired shoulder function in patients undergoing oncologic neck dissection, and may be considered a viable adjunct to functional rehabilitation therapies. Trial registration Clinicaltrials.gov (NCT02268344, October 17, 2014).
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Affiliation(s)
- Brittany Barber
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - K Ming Chan
- Department of Physical Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Rhys Beaudry
- Department of Physical Therapy, University of Texas, Arlington, Texas, USA
| | - Shannon Rychlik
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Jaret Olson
- Division of Plastic Surgery, University of Alberta, Edmonton, Canada
| | - Matthew Curran
- Division of Plastic Surgery, University of Alberta, Edmonton, Canada
| | | | - Vincent Biron
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Jeffrey Harris
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada
| | - Margaret McNeely
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Daniel O'Connell
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, Canada.
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Matsen FA, Tang A, Russ SM, Hsu JE. Relationship Between Patient-Reported Assessment of Shoulder Function and Objective Range-of-Motion Measurements. J Bone Joint Surg Am 2017; 99:417-426. [PMID: 28244913 DOI: 10.2106/jbjs.16.00556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Assessment of function is the cornerstone of clinical shoulder research. This purpose of this study was to answer 3 relevant questions: How does subjective patient assessment of shoulder function correlate with objectively measured active shoulder range of motion? What is the difference in active motion between shoulders that can and those that cannot be used to perform each of the functions of the Simple Shoulder Test (SST)? Does the relationship between subjective and objective assessment of shoulder function differ between male and female patients? METHODS We analyzed the relationship between objective range-of-motion measurements recorded by the observer-independent Kinect motion capture system and SST patient self-assessments of shoulder function of 74 male and 30 female patients with osteoarthritis. RESULTS There was poor correlation between objective measurements of active abduction and total SST scores of osteoarthritic shoulders of patients seen before shoulder surgery: the coefficients of determination (R) were 0.29 for the osteoarthritic shoulders of women and 0.25 for those of men. The relationships between active abduction and total SST score were closer for the contralateral shoulders (R = 0.54 for women and R = 0.46 for men). The difference in active abduction between the osteoarthritic shoulders that allowed and those that did not allow the patient to perform the individual SST functions was significant (p < 0.05) for only 4 of the 12 functions in the female group and 5 of 12 in the male group because of the highly variable relationship between self-assessed function and active abduction. In contrast, when the contralateral shoulders were assessed, this difference was found to be significant for 10 of the 12 functions in the female group and all 12 of the functions in the male group. The relationship between objective motion and subjective function did not differ significantly between male and female subjects. CONCLUSIONS The self-assessed function of osteoarthritic shoulders of women and men is only partially determined by the active range of abduction. Both subjective and objective measurements are important in characterizing the clinical status of shoulders. Studies of treatment outcomes should include separate assessments of these 2 complementary aspects of shoulder function. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Frederick A Matsen
- 1Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington
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Uribe B, El Bitar Y, Wolf BR, Bollier M, Kuhn JE, Hettrich CM. Agreement between patient self-assessment and physician assessment of shoulder range of motion. J Shoulder Elbow Surg 2016; 25:1649-54. [PMID: 27066961 DOI: 10.1016/j.jse.2016.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 02/01/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Shoulder outcome scores that include range of motion (ROM) and apprehension signs are limited by the need for direct involvement of the physician. Patient-reported outcome measures are patient centered and self-administered, and they can help physicians track the patient's progress between office visits and for long-term follow-up once the patient has been discharged. METHODS Thirty consecutive patients completed a form before their 6-month follow-up after surgery on the labrum or capsule as a result of instability or pain related to instability. The form included bilateral ROM, apprehension, and instability episodes. The same parameters were measured by the physician during the visit. The patient's and physician's responses were compared. The primary outcome was the percentage agreement with exact and approximate agreement. RESULTS Exact agreement was moderate for forward elevation at 56.6%; fair for abduction and external rotation at 90° at 24.5% and 34%, respectively; and poor for internal rotation at 90° and external rotation with the arm at the side at 2.6% and 12%, respectively. Approximate agreement within a range of positive or negative 20° range was very good for forward elevation (94%), abduction (92%), and external rotation at 90° (87%); moderate for external rotation with the arm at the side; and fair for internal rotation at 90°. There was 70% agreement regarding apprehension, 93% regarding subluxation events, and 100% regarding redislocation events. CONCLUSION Some measures of shoulder ROM showed a moderate to high level of agreement between patient-reported measurements and the physician's measurements. This method for short- and long-term follow-up could potentially replace routine clinic visits.
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Affiliation(s)
- Bastian Uribe
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Youssef El Bitar
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Brian R Wolf
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Matthew Bollier
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - John E Kuhn
- Vanderbilt Sports Medicine, Vanderbilt University, Nashville, TN, USA
| | - Carolyn M Hettrich
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
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Matsen FA, Lauder A, Rector K, Keeling P, Cherones AL. Measurement of active shoulder motion using the Kinect, a commercially available infrared position detection system. J Shoulder Elbow Surg 2016; 25:216-23. [PMID: 26341024 DOI: 10.1016/j.jse.2015.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/19/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The shoulder's ability to participate in sports and activities of daily living depends on its active range of motion. Clinical goniometry is of limited utility in rigorously assessing limitation of motion and the effectiveness of treatment. We sought to determine (1) whether a validated position-sensing tool, the Kinect, can enable the objective clinical measurement of shoulder motion and (2) the degree to which active range of motion correlates with patient self-assessed shoulder function. METHODS In 10 control subjects, we compared Kinect motion measurements to measurements made on standardized anteroposterior and lateral photographs taken concurrently. In 51 patients, we correlated active motion with the ability to perform the functions of the Simple Shoulder Test (SST). RESULTS In controls, Kinect measurements strongly agreed with photographic measurements. In patients, the total SST score was strongly correlated with the range of active abduction. The ability to perform each of the individual SST functions was strongly correlated with active motion. The active motion in well-functioning patient shoulders averaged 155° ± 22° abduction, 159° ± 14° flexion, 76° ± 18° external rotation in abduction, -59° ± 25° internal rotation in abduction, and -3.3 ± 3.7 inches of cross-body adduction, values similar to the control shoulders. Use of the Kinect system was practical in clinical examination rooms, requiring <5 minutes to document the 5 motions in both shoulders. DISCUSSION The Kinect provides a clinically practical method for objectively measuring active shoulder motion. Active motion was an important determinant of patient-assessed shoulder function.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
| | - Alexander Lauder
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Kyle Rector
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Peyton Keeling
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Arien L Cherones
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Van Tongel A, Piepers I, De Wilde L. The significance of the clavicle on shoulder girdle function. J Shoulder Elbow Surg 2015; 24:e255-9. [PMID: 25847517 DOI: 10.1016/j.jse.2015.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with cleidocranial dysplasia (CCD) can have a congenital partial or total absence of the clavicle. The aim of this study was to evaluate the functional shoulder score in these patients. MATERIAL AND METHODS Patients with CCD who were members of a social media group were invited to take part in an Internet-based survey. The questionnaire was composed of 3 general questions, a question concerning partial or total absence of the clavicle, and 3 patient-based shoulder scores (American Shoulder and Elbow Surgeons score; shortened Disabilities of the Arm, Shoulder, and Hand score; and patient-based Constant-Murley score). RESULTS Thirty-six patients (27 women, 9 men) with a mean age of 40 years participated in the survey; 17 patients had a bilateral absence, 16 patients had a bilateral partial absence, and 3 patients had a total absence on one side and a partial absence of the clavicle on the other side. The average patient-based Constant-Murley score was 79; shortened Disabilities of the Arm, Shoulder, and Hand score, 11; and American Shoulder and Elbow Surgeons score, 93. There was no significant difference in the scores between left and right. There was no correlation between partial and total absences and the shoulder scores. CONCLUSION Patients with self-reported CCD are subjectively normal to their peers when they are evaluated with 3 common shoulder scores. There was no correlation between partial and total absences and the shoulder scores.
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Affiliation(s)
- Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
| | - Iwein Piepers
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium
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Intraoperative brief electrical stimulation (BES) for prevention of shoulder dysfunction after oncologic neck dissection: study protocol for a randomized controlled trial. Trials 2015; 16:240. [PMID: 26021563 PMCID: PMC4453046 DOI: 10.1186/s13063-015-0745-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 05/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background Shoulder pain and dysfunction are common after oncologic neck dissection for head and neck cancer (HNC), due to traction, compression, and devascularization injuries to the spinal accessory nerve (SAN). Shoulder pain and dysfunction can hinder postoperative rehabilitation and hygiene, activities of daily living (ADLs), and return to work after treatment for HNC. Due to the rising incidence of human papillomavirus (HPV)-associated oropharyngeal cancer, patients are often diagnosed in the third or fourth decade of life, leaving many potential working years lost if shoulder dysfunction occurs. Brief electrical stimulation (BES) is a novel technique that has been shown to enhance and accelerate neuronal regeneration after injury through a brain-derived neurotrophic growth factor (BDNF)-driven molecular pathway in multiple peripheral nerves in both humans and animals. Methods/Design This is a randomized controlled trial testing the effect of intraoperative BES on postoperative shoulder pain and dysfunction. All adult participants with a new diagnosis of HNC undergoing surgery with neck dissection, including Level IIb and postoperative radiotherapy, will be enrolled. Participants will undergo intraoperative BES after completion of neck dissection for 60 min continuously at 20 Hz, 3 to 5 V, in 100-msec pulses. Postoperatively, participants will be evaluated using the Constant-Murley Shoulder Score, a scale that assesses shoulder pain, ADLs, strength, and range of motion. Secondary outcomes measured will include nerve conduction studies (NCS) and electromyographic (EMG) studies, as well as scores on the Oxford Shoulder Score (OSS), the Neck Dissection Impairment Index (NDII), and the University of Washington Quality of Life (UW-QOL) score. Primary and secondary outcomes will be assessed at 6 weeks, 3 months, 6 months, and 12 months. Discussion The objective of this study is to evaluate the effect of BES on postoperative clinical and objective shoulder functional outcomes and pain after oncologic neck dissection. BES has been shown to be successful in accelerating peripheral nerve regeneration in both animal and human participants in multiple different peripheral nerves. If successful, this technique may provide an adjunctive prevention option for shoulder pain and dysfunction in HNC patients. Trial registration NCT02268344: 17 October 2014.
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