Postoperative Pain and Paresthesia in Labral Repairs of the Shoulder: Location Does Matter

Background:

Favorable outcomes have been reported regarding postoperative shoulder pain and function after repair of anteroinferior (Bankart) glenohumeral labral tears. However, the outcomes of patients after repair of isolated superior labral anterior-posterior (SLAP) tears are a contentious topic. The authors have also anecdotally noted that patients evaluated with labral tears complained of numbness and tingling in their ipsilateral hand.

Purpose:

To determine if there is a difference in the temporal outcomes of shoulder pain and hand paresthesia in patients with SLAP tears versus Bankart tears after arthroscopic repair.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Included were 66 consecutive patients who underwent arthroscopic labral repair at a single institution between August 2018 and February 2021. The prevalence and magnitude of shoulder pain as well as numbness and tingling of the hand were assessed using questions from the L’Insalata Shoulder Questionnaire and the Boston Carpal Tunnel Questionnaire preoperatively and at 1 week, 6 weeks, 12 weeks, and 6 months after surgery.

Results:

Preoperatively, patients with SLAP lesions reported a higher prevalence of shoulder pain during sleep compared with those with Bankart tears (P < .05). Postoperatively, patients who underwent SLAP repair reported a larger proportion and more severe magnitude of shoulder pain during rest, overhead activities, and sleep compared with those who underwent Bankart repair (P < .05). Only patients who underwent Bankart repair reported improvements in the prevalence and magnitude of their shoulder pain during rest, overhead activities, and sleep by 6 months postoperatively compared with preoperative levels (P < .05). Preoperatively, 30% of patients with Bankart repairs and 40% of patients with SLAP repairs reported hand tingling, while 35% and 50%, respectively, reported hand numbness. The prevalence and magnitude of hand tingling and numbness were not significantly different between groups at any time point.

Conclusion:

Study results indicated that patients who underwent SLAP repair experienced worse shoulder pain outcomes compared with those who underwent Bankart repair using the same anchor and surgical technique. Only patients who underwent Bankart repair reported improvements in their hand numbness after surgery. Therefore, labral tear location does matter with respect to shoulder pain and hand numbness.

Reliability of shear wave elastography ultrasound to assess the supraspinatus tendon: An intra and inter-rater in vivo study

INTRODUCTION

Shear wave elastography ultrasound is a relatively new technique that evaluates the tissue elasticity by applying an acoustic radiation force impulse. It is undetermined how reliable this modality is in assessing rotator cuff tendons. The aim of this study, therefore, was to evaluate the reliability of shear wave elastography ultrasound to assess the stiffness of normal and tendinopathic supraspinatus tendons.

METHODS

An inter- and intra-rater reliability trial was carried out using shear wave elastography to assess the supraspinatus tendon at its distal insertion, by measuring shear wave velocity and elasticity. Twenty participants with a mean age of 37 (21-69) years old were evaluated. Ten subjects with normal supraspinatus tendon and 10 subjects with tendinopathic tendon were selected. The Virtual Touch Imaging Quantification program was used to generate the acoustic radiation force impulse and to obtain the elastography data. Three raters with different experience in conventional ultrasound were used for the inter-rater trial in normal tendons and the most experienced rater examined all subjects for the intra-rater reliability evaluation. Each rater obtained three readings in three different examinations per subject over a one-week period.

RESULTS

The mean (±SEM) shear wave velocity for the normal supraspinatus tendon was 9.96 ± 0.02 m/s (=297 kPa), while in the tendinopathic supraspinatus tendon was 8.3 ± 0.2 m/s (=207 kPa) (p < 0.001). The intra-rater trial agreement was excellent, with an intraclass correlation coefficient = 0.96. In the inter-rater testing, the mean shear wave velocity in normal tendons was 9.90 ± 0.07 m/s (=294 kPa), with intraclass correlation coefficient = 0.45.

CONCLUSION

Shear wave elastography ultrasound was able to show that tendinopathic tendons were less stiff than normal tendons. It was a reliable imaging technique to assess the supraspinatus tendon, especially when used by a single experienced musculoskeletal sonographer.

A comparison of the minimum data sets for primary shoulder arthroplasty between national shoulder arthroplasty registries. Is international harmonization feasible?

The aims of this study were to identify the common components of the Minimum Data Set (MDS) of current national shoulder arthroplasty registries that could be pooled for analysis; and to determine whether further harmonisation of data collection across these registries would be feasible. Copies of primary shoulder arthroplasty MDS forms, annual reports, and other publications from national shoulder arthroplasty registries were identified using internet search engines up to November 2016. Data relating to local or regional registries was excluded. There were nine national shoulder arthroplasty registries reporting a total of 97,388 primary shoulder replacements. All minimum data sets included patient identifiers, date of surgery, implant identification, laterality of surgery, indication and mode of implant fixation. At least 6 registries had common options within the categories of indication, implant fixation and previous operations. Most discrepancies were seen in categories for additional interventions, outcome measures, and intra-operative complications. As numbers within individual registries are relatively small, international collaboration would harness the global strength of knowledge and experience in shoulder replacement. Several similarities were identified between the current national registries that could become unified with only minor changes by a few registries, highlighting the potential feasibility of MDS harmonisat.