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Kocyigit BF, Kızıldağ B. Neuropathic arthropathy of the shoulder secondary to operated syringomyelia: a case-based review. Rheumatol Int 2023; 43:777-790. [PMID: 36271191 DOI: 10.1007/s00296-022-05234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022]
Abstract
Neuropathic arthropathy (NA) is a long-term progressive disorder that causes joint destruction in the existence of a neurologic deficit. Minor injuries and fractures are commonly overlooked until the visible joint deterioration becomes persistent. Syringomyelia is one of the important causes of NA. The appearance of clinical signs in syringomyelia is caused by longitudinal cysts formed in the cervical and cervicothoracic regions of the spinal cord. Depending on the existence of the underlying disorder, the number and localization of the syrinxes, a range of symptoms, involving pain, sensation deficit, loss of motor function, and deep tendon reflex abnormality, emerge. The case is here described of a 68-year-old female patient with shoulder NA following syringomyelia, who partially responded to the rehabilitation program. Furthermore, the available case reports were comprehensively reviewed on Web of Science, Scopus, and PubMed/Medline. Furthermore, the available case reports were comprehensively evaluated on Web of Science, Scopus, and PubMed/Medline. Thus, we aimed to present the demographic characteristics, symptoms, physical examination signs, treatment, and follow-up parameters of syringomyelia-related shoulder NA cases.
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Affiliation(s)
- Burhan Fatih Kocyigit
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Betül Kızıldağ
- Department of Radiology, Faculty of Medicine, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey
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2
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Skedros JG, Cronin JT, Finlinson ED, Langston TD, Adondakis MG. Manual wheelchair use leads to a series of failed shoulder replacements: A case report and literature review. Clin Case Rep 2022; 10:e06374. [PMID: 36188047 PMCID: PMC9508804 DOI: 10.1002/ccr3.6374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- John G. Skedros
- Department of Orthopaedic Surgery The University of Utah Salt Lake City Utah USA
- Utah Orthopaedic Specialists Salt Lake City Utah USA
- Intermountain Medical Center Salt Lake City Utah USA
| | | | | | - Tanner D. Langston
- Department of Radiology West Virginia University Morgantown West Virginia USA
| | - Micheal G. Adondakis
- Department of Radiology Beth Israel Deaconess Medical Center Boston Massachusetts USA
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Chiche L, Teissier J, Gelis A, Chammas M, Laffont I, Coulet B. Arthroplasty for weight-bearing shoulders. Orthop Traumatol Surg Res 2022; 108:103145. [PMID: 34780996 DOI: 10.1016/j.otsr.2021.103145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population. MATERIALS AND METHODS This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User's Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients' autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder. RESULTS The 11 patients had a mean age of 64±19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8±3 preoperatively to 4±2 postoperatively (p=0.003). The mean Constant score increased 90% from 22±11 preoperatively to 42±23 postoperatively (p=0.008). The WUSPI score decreased by 73% from 80±30 to 21±15 (p=0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change. DISCUSSION Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Léo Chiche
- Unité de chirurgie de la main et du membre supérieur, Hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France.
| | - Jacques Teissier
- Unité de chirurgie du membre supérieur, Centre OrthoSud, 15, avenue du Pr Grasset, 34090 Montpellier, France
| | - Anthony Gelis
- Centre de rééducation Propara, 263, rue du Caducée, 34000 Montpellier, France
| | - Michel Chammas
- Unité de chirurgie de la main et du membre supérieur, Hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France
| | - Isabelle Laffont
- Service de médecine physique et rééducation hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France
| | - Bertrand Coulet
- Unité de chirurgie de la main et du membre supérieur, Hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France
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Wawrzyniak A, Lubiatowski P, Kordasiewicz B, Brzóska R, Laprus H. Shoulder arthropathy secondary to syringomyelia: case series of 10 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1275-1281. [PMID: 34430987 DOI: 10.1007/s00590-021-03102-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/16/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Neuroarthropathy is a progressive joint degeneration secondary to neurological diseases. In the upper extremity, the shoulder is the most exposed, and it is mainly caused by syringomyelia. This condition is rare; therefore, the literature has documented only a few case reports or case series of small groups of patients. METHODS We collected data about patients with shoulder arthropathy due to syringomyelia who were treated in our two institutes and collected among members of the Polish Shoulder and Elbow Society. Our analysis was based on epidemiological data, symptoms, and clinical examinations. We also examined the results of diagnostic tests, including-spinal cord MRI and shoulder X-ray, and treatment methods and their effectiveness. RESULTS The examined group included 10 women with an average age of 63 years. Of these, nine patients reported pain, seven reported-swelling, and nine reported-weakness. In every patient, diagnosis was confirmed by X-ray of the shoulder with joint degeneration and MRI of the spinal cord with syrinx. Two patients were operated with reverse shoulder arthroplasty; the first one had excellent result-significant active range of motion improvement and reduction of symptoms, and the second one had a good result-pain relief and moderate range of motion improvement. Other patients were conservatively treated, resulting in total or partial symptoms relief but without significant range of motion improvement. CONCLUSION Charcot shoulder secondary to syringomyelia was mainly manifested by range of motion limitation, swelling, and pain. Both conservative and surgical treatments could be a good solution. However, if reverse arthroplasty is technically possible, it seems to be the most promising treatment for recovering function.
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Affiliation(s)
| | - Przemysław Lubiatowski
- Rehasport Clinic, Poznań, Poland
- Sport Traumatology and Biomechanics Unit, Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Science, Poznań, Poland
| | - Bartosz Kordasiewicz
- Trauma and Orthopedics Department, Centre of Postgraduate Medical Education, SPSK Im. A. Grucy, Otwock, Warsaw, Poland
- Idea Ortopedia, Warsaw, Poland
| | - Roman Brzóska
- Department of Orthopedics, St Luke's Hospital, Bielsko-Biała, Poland
| | - Hubert Laprus
- Department of Orthopedics, St Luke's Hospital, Bielsko-Biała, Poland
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Yamaguchi T, Urita A, Endo T, Ota M, Iwasaki N. Charcot Arthropathy of the Shoulder Joint in a Patient with Guillain-Barré Syndrome: A Case Report. JBJS Case Connect 2020; 10:e0530. [PMID: 32224650 DOI: 10.2106/jbjs.cc.19.00530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A 53-year-old woman presented with Charcot arthropathy of the shoulder joint secondary to residual sensory neuropathy of Guillain-Barré syndrome, which was accompanied by swollen shoulder and restricted range of motion of the right shoulder. We performed a reverse shoulder arthroplasty (RSA). The range of motion had improved 15 months postoperatively, and there was no postoperative complication after RSA. CONCLUSION Clinicians should be aware that Guillain-Barré syndrome can cause Charcot arthropathy of the shoulder joint. RSA is regarded as a useful treatment, although careful follow-up is needed.
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Affiliation(s)
- Tetsuya Yamaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Takeshi Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Mitsutoshi Ota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan
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Rickert MM, Cannon JG, Kirkpatrick JS. Neuropathic Arthropathy of the Shoulder: A Systematic Review of Classifications and Treatments. JBJS Rev 2019; 7:e1. [PMID: 31663919 DOI: 10.2106/jbjs.rvw.18.00155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Neuropathic arthropathy of the shoulder is a chronic progressive process characterized by joint destruction in the presence of a neurosensory deficit. Causes include syringomyelia, syphilis, diabetes, chronic alcoholism, and leprosy, with syringomyelia accounting for the vast majority of upper-extremity Charcot joints. Early presentation of this rare condition includes nonspecific symptoms such as swelling, erythema, sensory symptoms, and decreased functionality, making diagnosis challenging. METHODS We systematically reviewed 32 case reports published between 1924 and 2016. A total of 59 shoulders from 56 patients are included in this analysis. Variables include patient demographic characteristics, presentation, etiology, diagnostic techniques, treatment, outcome, and follow-up of Charcot shoulder. RESULTS We compiled a total of 25 right shoulders (42%), 24 left shoulders (41%), and 10 shoulders (17%) with unspecified laterality. The mean patient age (and standard deviation) was 49 ± 11 years, and the median age was 47 years. There was a higher prevalence in men (37 shoulders [63%]) compared with women (22 shoulders [37%]). Presenting symptoms included reduced range of motion (53 shoulders [90%]), paresthesia or hypoesthesia (45 [76%]), swelling (44 [75%]), weakness (40 [68%]), pain (31 [53%]), and reduction in deep tendon reflexes (22 [37%]). Shoulder radiographs were made in all cases. The presence of a syrinx was detected in 45 shoulders (76%) with magnetic resonance imaging, myelography, or clinical diagnosis. Sixteen shoulders (27%) reported exposure to trauma, with a 69% decrease in time from presentation to diagnosis compared with non-traumatic cases. Treatment was categorized as solely nonoperative management (14 [24%]), operative management (13 [22%]), combined therapy (20 [34%]), and no treatment listed (10 [17%]). Two surgical cases (3%) were excluded from our treatment group analysis as they were treated for unrelated or misdiagnosed conditions. CONCLUSIONS Our study increases awareness and understanding of this complex, progressive disease to reduce delay and misdiagnosis and to contribute to the standard-of-care recommendations. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mariel M Rickert
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - John S Kirkpatrick
- University of Central Florida College of Medicine, Orlando, Florida
- Orlando Veterans Affairs Medical Center, Orlando, Florida
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Jordan RW, Sloan R, Saithna A. Should we avoid shoulder surgery in wheelchair users? A systematic review of outcomes and complications. Orthop Traumatol Surg Res 2018; 104:839-846. [PMID: 29705081 DOI: 10.1016/j.otsr.2018.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/22/2018] [Accepted: 03/20/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The prevalence of shoulder pathology in wheelchair dependent patients is high. The shoulder joint is critical for maintaining independence but traditionally there has been reluctance to offer surgical intervention in view of perceived poor outcomes. The aim of this study was to provide patients and surgeons with a realistic overview of outcomes following surgical intervention for shoulder pathology in wheelchair dependent patients. METHODS A systematic review of the online databases Medline and Embase was performed in September 2017. Studies reporting functional outcomes, complications or rate of revision surgery after shoulder surgery in patients' dependent on wheelchair for mobility were included. A narrative synthesis of the studies and appraisal using the MINORS tool was performed. RESULTS The search strategy identified 11 eligible studies; 7 assessed rotator cuff repair and 4-shoulder arthroplasty. Six of the seven studies reporting on rotator cuff repairs demonstrated improvement in pain, range of motion and functional outcomes with a retear rate between 12 and 39%. Although total shoulder arthroplasty and hemiarthroplasty reportedly improved pain and function, the subsequent risk of rotator cuff failure was reported up to 100%. The two studies assessing reverse arthroplasty demonstrated significant improvement in function and pain with the largest series reporting a 15.8% failure rate. CONCLUSION Rotator cuff repairs and reverse shoulder arthroplasties performed in wheelchair users are associated with significant functional improvement and a slightly higher complication profile to those performed in ambulatory patients. This review provides a resource to aid surgeons and patients in holding realistic expectations following shoulder surgery in wheelchair users.
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Affiliation(s)
- Robert W Jordan
- University Hospitals Coventry & Warwickshire, Clifford Bridge Road, CV2 2DX Coventry, UK.
| | - Roger Sloan
- Warwick Hospital, South Warwickshire Foundation Trust, CV34 5BW Warwick, UK
| | - Adnan Saithna
- Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, NG11 8NS Nottingham, UK; Renacres Hospital, Halsall, L39 8SE Lancashire, UK
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8
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Letter to the Editor: The Weight-Bearing Shoulder. J Am Acad Orthop Surg 2018; 26:e258-e259. [PMID: 29781822 DOI: 10.5435/jaaos-d-18-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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9
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Reply to the Letter to the Editor: The Weight-Bearing Shoulder. J Am Acad Orthop Surg 2018; 26:e259-e260. [PMID: 29781823 DOI: 10.5435/jaaos-d-18-00242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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10
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Alentorn-Geli E, Wanderman NR, Assenmacher AT, Sánchez-Sotelo J, Cofield RH, Sperling JW. Reverse Shoulder Arthroplasty in Weight-Bearing Shoulders of Wheelchair-Dependent Patients: Outcomes and Complications at 2 to 5 years. PM R 2017; 10:607-615. [PMID: 29111467 DOI: 10.1016/j.pmrj.2017.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/06/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Wheelchair-dependent patients rely on their upper extremities for mobility and transfers. This entails the heavy use of upper extremities as weight-bearing joints, leading to shoulder overuse with increased prevalence of rotator cuff-related disorders and ultimately to challenging cases for shoulder surgeons when a joint replacement is needed. OBJECTIVE To report the outcomes of reverse shoulder arthroplasty (RSA) in wheelchair-dependent patients with arthritis and rotator cuff tears. DESIGN Retrospective case series/cross-sectional study. SETTING Tertiary university hospital. PATIENT (PARTICIPANTS) All wheelchair-dependent patients undergoing RSA between 2004 and 2013. METHODS/INTERVENTIONS Of the 22 wheelchair-dependent patients undergoing RSA, 18 of them had a minimum follow-up of 2 years. There were 9 men and 9 women, with a mean (standard deviation) age and length of follow-up of 68 (8.5) years and 36 (24-63) months. A retrospective chart review and cross-sectional phone calls were conducted to obtain all data. OUTCOMES Pain, range of motion, functional scores (Neer scale, simple shoulder test, and American Shoulder and Elbow Society), satisfaction, complications/reoperations, radiographic loosening, and 90-day mortality/morbidity. RESULTS RSA resulted in a significant improvement in pain (P = .02) and nonsignificant improvements in forward flexion (P = .3) and external rotation (P = .07). There were 3 (16%) excellent, 12 (63%) satisfactory, and 4 (21%) unsatisfactory results. The mean (standard deviation) postoperative American Shoulder and Elbow Society score was 56.5 (16.5). All patients stated that they would undergo RSA again. There were no surgically related complications or reoperations. The 90-day mortality and morbidity rates were 0% and 26%, respectively. CONCLUSIONS RSA is a safe and effective procedure in wheelchair-dependent patients who use their shoulders for weight-bearing purposes. Although functional scores are not optimal and medical complications are not uncommon, 79% of patients had an excellent or satisfactory result. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Eduard Alentorn-Geli
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Nathan R Wanderman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Andrew T Assenmacher
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Joaquín Sánchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.,Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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11
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Levy O, Walecka J, Arealis G, Tsvieli O, Della Rotonda G, Abraham R, Polyzois I, Jurkowski Z, Atoun E. Bilateral reverse total shoulder arthroplasty-functional outcome and activities of daily living. J Shoulder Elbow Surg 2017; 26:e85-e96. [PMID: 27856265 DOI: 10.1016/j.jse.2016.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 08/07/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years, providing good shoulder elevation, yet less predictable rotations. Good rotations are crucial for performance of activities of daily living (ADLs), including personal hygiene. Concerns remain regarding bilateral rTSA over lack of rotations bilaterally and resultant difficulties with ADLs. This study examined the outcome of patients with bilateral rTSA in restoration of function and ADLs. METHODS Data were prospectively collected for 19 patients (15 women, 4 men; 38 shoulders), with a mean age of 74.5 years, who underwent staged bilateral rTSA between 2007 and 2013. Mean follow-up was 48.4 months (range, 24-75 months). Patients were evaluated clinically using the Constant score, patient's satisfaction, Subjective Shoulder Value, and the Activities of Daily Living External and Internal Rotations (ADLEIR) score. Video clips were also recorded for documentation at all visits. RESULTS Mean duration between staged operations was 18.2 months (range, 3-46 months). The Constant score improved from 18.7 to 65.1 points (age- and sex-adjusted, 100.2). Elevation improved from 57.5° to 143°, internal rotation (IR) from 9° to 81° (30 shoulders could reach above the sacroiliac joint), and external rotation (ER) from 20° to 32° (35 shoulders had >20° ER in adduction, 31 shoulders had full ER in elevation). The Subjective Shoulder Value improved from 2.1 of 10 to 9.2 of 10. Mean ADLEIR score was 33 of 36 (P < .001 for all). Most patients resumed their leisure and sport activities (gardening, golf, swimming, bowling). CONCLUSION Bilateral rTSA results in marked and predictable improvement in all movements, pain relief, and functional outcomes, with high patient satisfaction and high ADLEIR score. All patients were able to perform perineal hygiene after their rTSA. Most patients had no limitation in ADLs and their leisure activities.
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Affiliation(s)
- Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK.
| | - Joanna Walecka
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - George Arealis
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Oren Tsvieli
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Giuseppe Della Rotonda
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ruben Abraham
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ioannis Polyzois
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Zac Jurkowski
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
| | - Ehud Atoun
- Reading Shoulder Unit, Royal Berkshire Hospital and Berkshire Independent Hospital, Reading, UK
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Snoddy MC, Lee DH, Kuhn JE. Charcot shoulder and elbow: a review of the literature and update on treatment. J Shoulder Elbow Surg 2017; 26:544-552. [PMID: 28111181 DOI: 10.1016/j.jse.2016.10.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/28/2016] [Accepted: 10/26/2016] [Indexed: 02/01/2023]
Abstract
Charcot arthropathy of the shoulder and elbow is a rare disease process initially described in the 1700s; however, it was not until the 19th century that physicians understood its association with other disease processes such as cervical spine pathology and diabetes. A primary complaint is painful or painless joint dysfunction, meaning the orthopedic surgeon is regularly the first physician to evaluate the patient. Frequently, the condition of these patients is misdiagnosed. Although the pathogenesis of the disease is controversial, the etiology is commonly due to syringomyelia. The key to successful management is a thorough history and examination along with a workup including specific laboratory testing and imaging to rule out other disease processes. Most neuropathic shoulders and elbows have historically been managed conservatively because of poor outcomes with operative interventions. Newer data have emerged hinting that early neurosurgical intervention can stabilize this degenerative process. If clinical and radiographic stabilization occurs, recent studies have outlined surgical indications that can provide surgeons with a guide as to patients in whom successful operative outcomes can be achieved in the face of failed conservative management.
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Affiliation(s)
- Mark C Snoddy
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Donald H Lee
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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13
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Schoch B, Werthel JD, Sperling JW, Cofield RH, Sanchez-Sotelo J. Is shoulder arthroplasty an option for charcot arthropathy? INTERNATIONAL ORTHOPAEDICS 2016; 40:2589-2595. [PMID: 27743013 DOI: 10.1007/s00264-016-3309-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/26/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Charcot arthropathy is a rare cause of debilitating joint destruction. Shoulder arthroplasty for Charcot arthropathy is challenging secondary to local bone and soft tissue loss, lack of protective sensation, and altered muscle control. The purpose of this study is to review the outcomes, complications, and survivorship of shoulder arthroplasty for Charcot arthropathy. METHODS Between January 2000 and December 2011, ten shoulders with Charcot arthropathy were treated with shoulder arthroplasty at our Institution (six hemiarthroplasty, one total shoulder arthroplasty, three reverse shoulder arthroplasty). Shoulders were followed for a minimum of two years or until re-operation. Outcomes measures included pain, range of motion, complications, and reoperation. RESULTS Shoulder arthroplasty improved pain to a mean score of 2.6 at follow up. However, gains in range of motion were not as substantial, with mean elevation of only 105°. External rotation improved from 20 to 43°. Subjectively, six of the ten patients rated the result as much better or better. Two shoulders underwent revision surgery at an average of five months after index arthroplasty. CONCLUSION Shoulder arthroplasty for the treatment of the sequelae of a Charcot joint is a reasonable treatment option to provide substantial pain relief and improved motion. The relative indications of hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty for this particular condition continue to evolve.
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Affiliation(s)
- Bradley Schoch
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | | | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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14
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Kemp AL, King JJ, Farmer KW, Wright TW. Reverse total shoulder arthroplasty in wheelchair-dependent patients. J Shoulder Elbow Surg 2016; 25:1138-45. [PMID: 26895599 DOI: 10.1016/j.jse.2015.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/25/2015] [Accepted: 11/10/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wheelchair-dependent patients have a high incidence of shoulder pathology, often causing severe impairment. This study reports outcomes of wheelchair-dependent lower extremity-impaired patients with symptomatic shoulder arthritis or severe rotator cuff pathology treated with reverse total shoulder arthroplasty (RTSA). METHODS Data for 19 wheelchair-dependent patients who had an RTSA for symptomatic arthritis or rotator cuff pathology, or both, were obtained from the University of Florida Shoulder Arthroplasty Database. Included were 16 of 19 shoulders with adequate follow-up averaging 40 months. Functional outcome scores included the Simple Shoulder Test, University of California Los Angeles Shoulder Rating Scale, Shoulder Pain and Disability Index, American Shoulder and Elbow Surgeons score, Constant score, and 12-item Short Form (SF-12) health survey. Objective measures were active elevation, external rotation, and internal rotation. Radiographs were evaluated for lucent lines, notching, and prosthetic loosening. RESULTS All measured parameters, except the SF-12, significantly improved at the final follow-up. Functional outcome scores included Shoulder Pain and Disability Index, 45; Simple Shoulder Test, 7; American Shoulder and Elbow Surgeons, 73; University of California Los Angeles Shoulder Rating Scale, 30; Constant, 70; and SF-12, 33. Active elevation was 112°, and active external rotation was 29°. Most patients (83%) were satisfied. The complication rate was 25%; baseplate failure and dislocation occurred early, and periprosthetic humeral fracture secondary to infection occurred late. The notching rate was 42%. CONCLUSIONS Shoulder pain and dysfunction due to arthritis and rotator cuff pathology can result in the loss of independence in wheelchair-dependent patients. We investigated whether RTSA can sustain the increased loads placed by these patients during transfers. Wheelchair-dependent patients can benefit from an RTSA for shoulder pain and dysfunction but must accept worsened impairment during the immediate postoperative period and a higher complication rate than the general population treated with an RTSA.
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Affiliation(s)
- Adam L Kemp
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin W Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
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Phelps KD, Hamid N. Spontaneous Ruptures of the Distal Biceps and Rotator Cuff Tendons Secondary to Syringomyelia: A Case Report. JBJS Case Connect 2015; 5:e115. [PMID: 29252821 DOI: 10.2106/jbjs.cc.n.00239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We present a case of ipsilateral spontaneous ruptures of the distal biceps and rotator cuff tendons secondary to syringomyelia of the cervical spine. The distal biceps tendon ruptured first and underwent successful repair. Six months postoperatively, the patient was found to have an ipsilateral massive acute-on-chronic rotator cuff tear following minimal trauma, with a well-maintained glenohumeral joint space. He was subsequently diagnosed with a syrinx and underwent neurosurgical decompression. Five months later, a successful lower trapezius transfer was performed. CONCLUSION Orthopaedic surgeons should maintain a high index of suspicion for a neurologic etiology in the setting of relatively atraumatic tendon ruptures in otherwise healthy young patients.
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Affiliation(s)
- Kevin D Phelps
- Department of Orthopaedic Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204
| | - Nady Hamid
- Shoulder and Elbow Center, OrthoCarolina, 1915 Randolph Road, Charlotte, NC 28207
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16
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Triplet JJ, Everding NG, Levy JC, Moor MA. Functional internal rotation after shoulder arthroplasty: a comparison of anatomic and reverse shoulder arthroplasty. J Shoulder Elbow Surg 2015; 24:867-74. [PMID: 25487902 DOI: 10.1016/j.jse.2014.10.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recovery of functional internal rotation after primary shoulder arthroplasty is essential to perform many important activities of daily living. Functional internal rotation is typically reported as it relates to clinical examination findings of motion (posterior reach) and lift-off or belly-press tests. A more detailed evaluation of functional recovery of internal rotation after primary anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) is needed. METHODS A retrospective review of patients treated with primary TSA (n = 132) and RSA (n = 91) with a minimum 2-year follow-up was performed. Subanalysis of revision RSA (n = 24) and primary RSA was performed. Active range of motion, subjective internal rotation motion, manual internal rotation strength, and specific questions related to internal rotation function isolated from the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) functional questionnaires were reviewed. RESULTS Compared with RSA, TSA patients could more likely reach the small of the back (SST) and wash the back/fasten bra (ASES). Active internal rotation motion, SST score, ASES score, and subjective internal rotation were greater after TSA. No significant difference was observed with respect to managing toileting between cohorts. Revision RSA patients were less likely to be able to wash the back/fasten bra (ASES) and easily manage toileting (ASES) compared with primary RSA patients. CONCLUSION Primary anatomic shoulder arthroplasty yields greater functional internal rotation than does primary RSA, with either procedure being effective at managing toileting. Patient education regarding activities of daily living related to internal rotation can be predicted.
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Affiliation(s)
- Jacob J Triplet
- Nova Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, FL, USA.
| | | | | | - Molly A Moor
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
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17
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Morris BJ, Haigler RE, O'Connor DP, Elkousy HA, Gartsman GM, Edwards TB. Outcomes of staged bilateral reverse shoulder arthroplasties for rotator cuff tear arthropathy. J Shoulder Elbow Surg 2015; 24:474-81. [PMID: 25441561 DOI: 10.1016/j.jse.2014.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/28/2014] [Accepted: 08/13/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate outcomes in patients with rotator cuff tear arthropathy after staged bilateral reverse shoulder arthroplasties (RSAs) and to compare them with an age-, gender-, and diagnosis-matched control group with a unilateral RSA. METHODS We identified 11 patients with bilateral RSAs for rotator cuff tear arthropathy with a minimum of 2-year follow-up in a prospective shoulder arthroplasty registry. The bilateral group was matched to a control group of 19 patients with a unilateral RSA. Shoulder function scores, mobility, patient satisfaction, and activities of daily living were assessed preoperatively and at final follow-up. RESULTS There was no statistical difference between the first RSA or second RSA and the control group regarding age, gender, or follow-up. No group differences were noted preoperatively for shoulder function scores or mobility (P > .10). All groups significantly improved on all shoulder function scores (Constant score, American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder index, Single Assessment Numeric Evaluation score) and mobility at final follow-up (all P < .01). There were no significant differences in shoulder function scores or mobility between the first and second RSA in the bilateral group or between either shoulder in the bilateral group and the unilateral group (all P > .10). Patient satisfaction improved and patients were successfully able to perform many important activities of daily living after bilateral RSAs. CONCLUSIONS Patients with bilateral rotator cuff tear arthropathy can be advised that staged bilateral RSAs can be successful when indicated. Improvements in shoulder function scores, patient satisfaction, and mobility are possible for both the first RSA and the second RSA.
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Affiliation(s)
- Brent J Morris
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA.
| | - Richard E Haigler
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Daniel P O'Connor
- Laboratory of Integrated Physiology, University of Houston, Houston, TX, USA
| | - Hussein A Elkousy
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | - Gary M Gartsman
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
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18
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Stevens CG, Struk AM, Wright TW. The functional impact of bilateral reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2014; 23:1341-8. [PMID: 24581874 DOI: 10.1016/j.jse.2013.12.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of reverse total shoulder arthroplasty (RTSA) has been increasing. However, many recommend against bilateral RTSA because of concerns over lack of internal rotation (IR) and the resultant difficulties with activities of daily living (ADLs). METHODS Data on 15 consecutive patients who underwent staged bilateral primary RTSA for cuff tear arthropathy (CTA) were retrospectively reviewed. All operations were performed by a single surgeon. The mean follow-up was 33.4 months from the second RTSA. The mean age of the patients at the time of the first operation was 72.9 years. The mean duration between arthroplasties was 21.6 months. Patients were evaluated preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and yearly with standardized clinical examinations and outcome measures questionnaires. RESULTS On both operative sides, elevation showed significant improvement from preoperative values; however, external rotation, abduction, and IR did not show significant improvement at an average follow-up of 33.4 months. Functional outcome scores of both RTSA shoulders showed significant improvement from preoperative values; however, the 12-Item Short-Form Health Survey scores on either shoulder did not show significant improvement. Evaluation of the outcome measures questionnaire revealed that all patients were able to perform perineal hygiene after their RTSAs. CONCLUSION Bilateral RTSA results in marked improvement in forward elevation, pain, and functional outcomes, and carries a high rate of satisfaction in subjective patient assessment. Common ADLs that require significant IR, such as perineal care, were not problematic in the cohort.
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Affiliation(s)
- Christopher G Stevens
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Aimee M Struk
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.
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19
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Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2011; 20:146-57. [PMID: 21134666 DOI: 10.1016/j.jse.2010.08.001] [Citation(s) in RCA: 522] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 07/28/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Matthias A Zumstein
- Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet II, University of Nice Sophia-Antipolis, Nice, France
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20
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Castoldi F, Lollino N, Caranzano F, Assom M. Importance of neurological evaluation before reverse shoulder arthroplasty in patients with previous poliomyelitis. Prosthet Orthot Int 2009; 33:167-72. [PMID: 19367520 DOI: 10.1080/03093640802425459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We present a case report of a patient, affected by post-polio syndrome and cuff tear arthropathy of his right shoulder, who underwent reverse shoulder arthroplasty. A previous radial deficiency was unmasked in the post-operative follow-up, with passive elbow bending when the forearm was put in an antigravitational position. A precise preoperative neurological evaluation is mandatory in shoulder replacement in order to estimate the functional outcome after surgery.
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Affiliation(s)
- Filippo Castoldi
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
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