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Lu Y, Agarwalla A, Lavoie-Gagne O, Patel BH, Beletsky A, Nwachukwu BU, Verma NN, Cole BJ, Forsythe B. How Long Does It Take to Achieve Clinically Significant Outcomes After Isolated Biceps Tenodesis? Orthop J Sports Med 2022; 10:23259671221070857. [PMID: 35284582 PMCID: PMC8908395 DOI: 10.1177/23259671221070857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Clinically significant outcomes (CSOs) connect patient-reported outcome measures data to patient-perceived benefit. Although investigators have established threshold values for various CSOs, the timeline to achieve these outcomes after isolated biceps tenodesis (BT) has yet to be defined. Purpose: To define the time-dependent nature of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) achievement after isolated BT. Study Design: Case series; Level of evidence, 4. Methods: The American Shoulder and Elbow Surgeons score (ASES), the Single Assessment Numeric Evaluation, and the Constant-Murley score (CMS) were administered preoperatively and at 6 and 12 months postoperatively to patients undergoing isolated BT between 2014 and 2018 at our institution. Cumulative probabilities for achieving MCID, SCB, and PASS were calculated using Kaplan-Meier survival analysis. Weibull parametric regression evaluated the hazard ratios (HRs) of achieving earlier MCID, SCB, and PASS. Results: Overall cohort (N = 190) achievement rates ranged between 77.8% and 83.2% for MCID, between 42.2% and 80.2% for SCB, and between 59.7% and 62.9% for PASS. Median achievement time was 5.3 to 6.1 months for MCID, 5.9 to 6.4 months for SCB, and 6.07 to 6.1 months for PASS. Multivariate Weibull parametric regression identified older age, male sex, higher body mass index, preoperative thyroid disease, smoking history, and higher preoperative CMS as predictors of delayed CSO achievement (HR, 1.01-6.41), whereas normal tendon on arthroscopy, defined as absence of tenosynovitis or tendon tear on arthroscopy, predicted earlier CSO achievement (HR, 0.19-0.46). Location of tenodesis and worker compensation status did not significantly predict the time to achieve CSOs on multivariate analysis. Conclusion: After isolated BT, patients can expect to attain CSO by 13 months postoperatively, with most patients achieving this between 5 and 8 months. Patients tend to take longer to achieve PASS than MCID and SCB.
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Affiliation(s)
- Yining Lu
- Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Ophelie Lavoie-Gagne
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bhavik H. Patel
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Benedict U. Nwachukwu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Nikhil N. Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J. Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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TURNAOĞLU H, ALTAY F, KURAL RAHATLI F, BOZKUŞ Y, TURHAN İYİDİR Ö, HABERAL KM. Acoustic radiation force impulse elastography findings of achilles tendon in patients with hypothyroidism. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.869648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Buyuksireci DE, Tecer D, Bolayir B, Yon MEE, Akturk M, Gunendi Z, Gogus F. Ultrasonographic evaluation of shoulder tendons in patients with Hashimoto's disease. Int J Rheum Dis 2020; 23:1497-1504. [PMID: 32885607 DOI: 10.1111/1756-185x.13956] [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: 02/06/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the thickness of the shoulder tendons and the measurement of acromiohumeral distance (AHD) in patients with Hashimoto's disease (HD). MATERIAL AND METHODS Twenty-eight patients with subclinical hypothyroid HD, 40 patients with euthyroid HD, and 51 healthy subjects were included. The thicknesses of biceps brachii, subscapularis, supraspinatus, infraspinatus tendons at both shoulders were evaluated with ultrasonography. Serum levels of thyroid stimulated hormone (TSH), free tri-iodothyronine, free thyroxine (FT4), anti-thyroid peroxidase (TPO) and anti-thyroglobulin (anti-TG) antibodies levels were measured. RESULTS Height, weight, body mass index (BMI), free T3 and free T4 levels were similar between the three groups (P = .839, P = .205, P = .374, P = .430 and P = .497, respectively). Biceps brachii, supraspinatus and infraspinatus tendon thicknesses in dominant arm and biceps brachii, subscapularis and infraspinatus tendon thicknesses in non-dominant arm were significantly increased in euthyroid HD compared to healthy controls (P = .003, P = .030, P < .001; P = .035, P = .042, P < .001, respectively). Biceps brachii tendon thickness in dominant arm and subscapularis and supraspinatus tendon thicknesses in non-dominant arms were significantly increased in subclinical hypothyroid HD compared to healthy controls (P = .025; P = .046, P = .017, respectively). However there was no such difference between euthyroid HD and subclinical hypothyroid HD groups (P < .05). There was low correlation between biceps brachii tendon thickness and free T4 level in non-dominant shoulder in patients with HD (r = .272 P = .030). For the rest of the tendons, there was no correlation between TSH, anti-TPO, anti-TG levels and tendon thicknesses in patients with HD. CONCLUSIONS This study suggests that thyroid autoimmunity in HD may lead to an increase in thickness of shoulder tendons.
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Affiliation(s)
- Dilek Eker Buyuksireci
- Department of Physical Medicine and Rehabilitation, Hitit University Erol Olcok Education and Research Hospital, Corum, Turkey
| | - Duygu Tecer
- Rheumatology Clinic, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Basak Bolayir
- Endocrinology and Metabolism Clinic, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | | | - Mujde Akturk
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Zafer Gunendi
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Tran SK, Carr JB, Hall MJ, Park JS, Cooper MT. Incidence of thyroid disease in patients with forefoot deformity. Foot Ankle Surg 2020; 26:445-448. [PMID: 31186135 DOI: 10.1016/j.fas.2019.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus and lesser toe deformities are common foot disorders with substantial functional consequences. While the exact etiologies are multi-factorial, it is unknown if certain endocrine abnormalities, such as thyroid dysfunction, may be associated with these pathologies. The current study sought to investigate the prevalence of thyroid disease in patients with hallux valgus or lesser toe deformities. METHODS Every new patient who presented to our institution's foot and ankle clinic during a three-month time period was given a survey to determine the presence of a known thyroid disorder. The diagnosis for each visit was then recorded. Additionally, a national, publicly available database was queried for patients diagnosed with thyroid disease and concomitant hallux valgus or specific forefoot pathology. Odds ratios for the presence of thyroid dysfunction were then calculated for each patient group. RESULTS Three-hundred and fifty initial visit patient surveys were collected, and 74 (21.1%) patients had a known diagnosis of thyroid disease. The most common diagnoses were primary hypothyroidism (n = 61, 17.4%), secondary hypothyroidism (n = 6, 1.7%), thyroiditis (n = 4, 1.1%), and hyperthyroidism (n = 3, 0.9%). Thyroid disease was present in 16 of 26 patients (61.5%) with a diagnosis of hallux valgus (OR 7.3, CI[3.16-16.99], p < 0.0001). Lesser toe deformities, including hammertoes, mallet toes, bunionettes and crossover toes, were also significantly associated with thyroid disease (OR 5.45, CI[1.83-16.26], p < 0.002). The national database revealed 905,924 patients with a diagnosis of a specific forefoot deformity, and 321,656 of these patients (35.5%) had a concomitant diagnosis of a thyroid condition (OR 2.11, CI[2.10-2.12], p < 0.0001). CONCLUSIONS The current study suggests a significant association between forefoot pathology and thyroid dysfunction, especially hallux valgus and lesser toe deformities. Increased understanding of these correlations may offer an important opportunity in population health management, both in diagnosis and treatment. While further studies with long-term outcomes are necessary, the early diagnosis of thyroid disease may provide an opportunity to predict and potentially alter the course of forefoot pathology.
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Affiliation(s)
- Sterling K Tran
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - James B Carr
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Matthew J Hall
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Joseph S Park
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Minton T Cooper
- University of Virginia School of Medicine, Charlottesville, VA, USA.
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Tendinopathy: Pathophysiology, Therapeutic Options, and Role of Nutraceutics. A Narrative Literature Review. ACTA ACUST UNITED AC 2019; 55:medicina55080447. [PMID: 31394838 PMCID: PMC6723894 DOI: 10.3390/medicina55080447] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023]
Abstract
Tendinopathies are very common in general population and a huge number of tendon-related procedures take place annually worldwide, with significant socio-economic repercussions. Numerous treatment options are commonly used for tendon disorders. Besides pharmacological and physical therapy, nutrition could represent an additional tool for preventing and treating this complex pathology that deserve a multidisciplinary approach. In recent years, nutraceutical products are growing up in popularity since these seem to favor the prevention and the healing processes of tendon injuries. This narrative literature review aims to summarize current understanding and the areas of ongoing research about the management of tendinopathies with the help of oral supplementation.
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What is the role of systemic conditions and options for manipulation of bone formation and bone resorption in rotator cuff tendon healing and repair? TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2017; 18:113-120. [PMID: 28966557 DOI: 10.1097/bte.0000000000000121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Rotator cuff pathology is a significant cause of shoulder pain. Operative repair of rotator cuff is an established standard of care for these patient, however, failure of the procedure is common. Systemic conditions such as diabetes mellitus, hypocholesteremia, thyroid disease, and smoking significantly affect the outcomes of rotator cuff repair and have significant implications for the management of these patients. Diabetes mellitus has been proposed to damage tendons through non-enzymatic glycosylation of collagen with advanced glycation end product formation and impaired microcirculation. Hypocholesteremia may lead to fatty infiltration and subsequent pro-inflammatory degenerative enzymatic degeneration. Thyroid disease may disrupt tendon homeostasis through the alteration of collagen production and the accumulation of glycosaminoglycans. Lastly, smoking inhibits tendon healing through the induction of hypovascularity and hypoperfusion. Understanding of the implications these systemic conditions have on the outcomes is important in the management of rotator cuff disease.
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Abate M, Guelfi M, Pantalone A, Vanni D, Schiavone C, Andia I, Salini V. Therapeutic use of hormones on tendinopathies: a narrative review. Muscles Ligaments Tendons J 2016; 6:445-452. [PMID: 28217565 DOI: 10.11138/mltj/2016.6.4.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hormones can modify tendon homeostasis, some of them leading to tendon damage, while others are essentials for healing. This narrative review summarizes the current knowledge on the topic, focusing on the hormones normally secreted by endocrine glands. METHODS A search in PubMed, Web of Knowledge and EMBASE, using the terms tendinopathy or tendon, combined with estrogens, testosterone, thyroid and parathyroid hormones, glucocorticoids and growth hormone, independently, was performed. Relevant articles focusing on the correlation between hormones and tendons, and their therapeutic use in tendinopathies, were selected. RESULTS Tendon abnormalities observed in subjects with hyperparathyroidism, hypercortisolism and acromegaly are described. At present, experimental studies and preliminary observations in humans suggest that parathyroid and growth hormones, locally administered, are promising therapeutic tools in specific tendon disorders. Local injections of glucocorticoids are useful in several tendinopathies, exploiting their anti-inflammatory and anti-proliferative properties, but carry the risk of further tendon degeneration and ruptures, due to the detrimental direct effect of glucocorticoids on the tendon structure. CONCLUSION Because tendons injuries are frequent, often with long lasting sequels, it is important to improve our understanding concerning the therapeutic potential of hormones on healing. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Matteo Guelfi
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Andrea Pantalone
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Daniele Vanni
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Isabel Andia
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
| | - Vincenzo Salini
- Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti - Pescara, Chieti, Italy
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