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Sibanda V, Anazor FC, Bhadresha A, Altaf K, De C, Relwani J. The impact of the post- COVID 19 pandemic elective waiting list delays on patient reported symptoms and intention to proceed with planned upper limb surgeries-A prospective cohort study. Musculoskeletal Care 2023; 21:453-461. [PMID: 36420684 DOI: 10.1002/msc.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate patient reported outcome measures using the EQ5D-5L and EQ5D-5L visual analogue scale (VAS) following elective shoulder and elbow orthopaedic list delays. This was further correlated with patients' intention to proceed with the planned surgery. METHODS Patients on the waiting list for more than 26 weeks were included in the study. Telephone interviews were conducted utilising the EQ5D-5L and the EQ5D-5L VAS at the time of addition to the waiting list and presently. RESULTS 75 out of 324 screened patients were eligible. 62 (82.7%) patients still wanted to proceed with their planned procedure while 13 (17.3%) patients in the other group no longer wanted to proceed. There was no statistically significant difference in the mean age, gender, initial trial of conservative treatment and limb laterality between these groups (p < 0.05). There was a statistically significant difference in the mean duration of being on the waiting list between these groups (40.4 ± 19 vs. 62.9 ± 17.5 weeks respectively). Furthermore, statistically significant differences (p < 0.05) in the current EQ5D-5L VAS scores were observed between these groups (52.4 vs. 65.8 respectively). CONCLUSION This study has shown that majority of patients on elective shoulder and elbow orthopaedic lists with prolonged waiting list delays and improved EQ5D-5L scores are likely to decline the planned procedure and vice versa. Nevertheless, the unplanned 'watchful waiting' caused by the COVID-19 pandemic and leading to patients deciding to decline surgery, is not a substitute for timely planned surgery to alleviate patients' suffering.
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Affiliation(s)
- Vusumuzi Sibanda
- Trauma and Orthopaedics Department, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Fitzgerald Chukwuemeka Anazor
- Trauma and Orthopaedics Department, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Ashwin Bhadresha
- Trauma and Orthopaedics Department, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Kalsoom Altaf
- Trauma and Orthopaedics Department, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Chiranjit De
- Trauma and Orthopaedics Department, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
| | - Jai Relwani
- Trauma and Orthopaedics Department, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, UK
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Aimprasittichai S, Suphakitchanusan W, Pakmanee N, Suvithayasiri S, Thanindratarn P. Subdeltoid Lipoma Associated With Subscapularis Tear Successfully Treated With Arthroscopic Resection and Cuff Repair: A Case Report. Cureus 2023; 15:e38176. [PMID: 37252457 PMCID: PMC10220325 DOI: 10.7759/cureus.38176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
A 61-year-old male patient presented with left shoulder pain and an associated lump. Magnetic resonance imaging revealed a subscapularis tear, and subdeltoid lipoma obliterated its insertion. He was successfully treated with arthroscopic subscapularis repair and resection of mass simultaneously.To the authors' knowledge, this will be the first documented case of lipoma occurring under the deltoid muscle associated with the subscapularis tear. The reported arthroscopic approach for resection of the subdeltoid lipoma provides a complete removal, minimal muscle dissection, limited surgical scar, and satisfying functional outcomes. Therefore, it may be considered an option for benign tumor resection in this area.
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Affiliation(s)
| | | | - Nithi Pakmanee
- Department of Orthopedics, Chulabhorn Hospital, Bangkok, THA
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Ayasrah M, Qtaish I. Quality assessment of shoulder MRI according to practice parameters of American College of Radiology: A multi-center study in Jordan. J Med Life 2023; 16:412-418. [PMID: 37168307 PMCID: PMC10165529 DOI: 10.25122/jml-2022-0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/01/2023] [Indexed: 05/13/2023] Open
Abstract
Magnetic resonance imaging (MRI) is essential for assessing shoulder conditions. This study aimed to evaluate current shoulder MRI practices in Jordan, including technical parameter patterns, and determine if they adhere to the American College of Radiology (ACR) guidelines. The retrospective analysis included data from 48 eligible participants from 13 MRI centers in March 2021. Descriptive and correlation data analysis were performed using IBM SPSS statistics version_20 and Excel 2013. Most MRI centers (50%) were private outpatient clinics with closed MRI machines above 1 Tesla. Most participants (62.5%) were male, and shoulder pain (47.9%) was the main clinical indication. Most shoulder orientations (68.7%, 33/48) were right shoulders, and the coronal MRI planes (43%, 121/280) were the most common. The alignment percentage for the axial plane was 100%, but MRI artifacts of the shoulder were present in 8.2% of cases (23/280). Dark fluid T1-W coronal sequence was not conducted in 25% of the cases. The percentage of the field view (FOV) within ACR recommendations was 45% (126/281), and slice thickness parameters were 96% (269/281). The recommended pixel area for all sequences was 47.9% (134/280), encompassing all axial, sagittal oblique, and coronal planes. However, crucial parameters, such as FOV and slice thickness, were inadequate and did not meet the ACR guidelines, resulting in suboptimal image quality of shoulder MRI. To improve MRI image quality, it is recommended that MRI technologists receive ongoing education and training on appropriate MRI image parameters.
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Affiliation(s)
- Mohammad Ayasrah
- Department of Allied Medical Sciences, Jordan University of Science and Technology, Ramtha, Jordan
- Corresponding Author: Mohammad Ayasrah, Department of Allied Medical Sciences, Jordan University of Science and Technology, Ramtha, Jordan. E-mail:
| | - Izzeddin Qtaish
- Radiology and Interventional Radiology Department, Faculty of Medicine, Jordan University of Science and Technology, Ramtha, Jordan
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Overbeek CL, Geurkink TH, de Groot FA, Klop I, Nagels J, Nelissen RGHH, de Groot JH. Shoulder movement complexity in the aging shoulder: A cross-sectional analysis and reliability assessment. J Orthop Res 2021; 39:2217-2225. [PMID: 33251589 PMCID: PMC8518861 DOI: 10.1002/jor.24932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Healthy individuals perform a task such as hitting the head of a nail with an infinite coordination spectrum. This motor redundancy is healthy and allows for learning through exploration and uniform load distribution across muscles. Assessing movement complexity within repetitive movement trajectories may provide insight into the available motor redundancy during aging. We quantified complexity of repetitive arm elevation trajectories in the aging shoulder and assessed test-retest reliability of this quantification. In a cross-sectional study using 3D-electromagnetic tracking, 120 asymptomatic subjects, aged between 18 and 70 years performed repetitive abduction and forward/anteflexion movements. Movement complexity was calculated using the Approximate Entropy (ApEn-value): [0,2], where lower values indicate reduced complexity. Thirty-three participants performed the protocol twice, to determine reliability (intraclass correlation coefficient [ICC]). The association between age and ApEn was corrected for task characteristics (e.g., sample length) with multiple linear regression analysis. Reproducibility was determined using scatter plots and ICC's. Higher age was associated with lower ApEn-values during abduction (unstandardized estimate: -0.003/year; 95% confidence interval: [-0.005; -0.002]; p < .001). ICC's revealed poor to good reliability depending on differences in sample length between repeated measurements. The results may imply more stereotype movement during abduction in the ageing shoulder, making this movement prone to the development of shoulder complaints. Future studies may investigate the pathophysiology and clinical course of shoulder complaints by assessment of movement complexity. To this end, the ApEn-value calculated over repetitive movement trajectories may be used, although biasing factors such as sample length should be taken into account.
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Affiliation(s)
- Celeste L. Overbeek
- Department of OrthopaedicsLeiden University Medical CenterLeidenThe Netherlands,Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Timon H. Geurkink
- Department of OrthopaedicsLeiden University Medical CenterLeidenThe Netherlands,Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Fleur A. de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Ilse Klop
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
| | - Jochem Nagels
- Department of OrthopaedicsLeiden University Medical CenterLeidenThe Netherlands
| | | | - Jurriaan H. de Groot
- Laboratory for Kinematics and Neuromechanics, Department of Orthopaedics and RehabilitationLeiden University Medical CenterLeidenThe Netherlands
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Abstract
The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.
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Affiliation(s)
- Patrick Goetti
- Division of Orthopaedics and Trauma Surgery, Centre Hospitalier |Universitaire Vaudois, Lausanne, Switzerland
| | - Patrick J. Denard
- Denard Department of Orthopaedic & Rehabilitation, Oregon Health & Science University, Portland, Oregon, United States
| | - Philippe Collin
- Collin Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Mohamed Ibrahim
- Mohamed Ibrahim, Department of Orthopaedics and Trauma Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Adrien Mazzolari
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Khan AM, Assiotis A, Ibrahim MS, Sankey AR. Shoulder examination: a systematic approach. Br J Hosp Med (Lond) 2021; 82:1-15. [PMID: 34338008 DOI: 10.12968/hmed.2020.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The shoulder is a complex joint with static and dynamic stabilising structures working synchronously. These allow a full range of movement while preserving stability of the joint. Patients may present with pain, stiffness, weakness, deformity or instability. The authors suggest a systematic examination sequence to ensure that important pathology is not overlooked. Adopting this approach allows common pathologies, including tears of the rotator cuff, impingement and tendinopathy, to be easily identified. This shoulder examination sequence may be used by all healthcare professionals and can also act as a revision aid for those undergoing exams in this field, at different levels of training.
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Affiliation(s)
- Akib M Khan
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Angelos Assiotis
- Department of Trauma and Orthopaedics, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Mazin S Ibrahim
- Department of Trauma and Orthopaedics, The Whittington Health/University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew R Sankey
- Department of Trauma and Orthopaedics, Chelsea and Westminster NHS Foundation Trust, London, UK
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Ostrowski JL, Beaumont A, Dochterman E. Diagnostic Accuracy of Musculoskeletal Ultrasound on Long Head Biceps Tendon Pathologies. J Sport Rehabil 2021;:1-4. [PMID: 34006667 DOI: 10.1123/jsr.2020-0511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/12/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear. Clinical Question: In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies? Summary of Key Findings: Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP. Clinical Bottom Line: There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology. Strength of Recommendation: There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis.
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Lädermann A, Bothorel H, Collin P, Elhassan B, Favard L, Bernal N, Raiss P, Athwal GS. Could Subtle Obstetrical Brachial Plexus Palsy Be Related to Unilateral B Glenoid Osteoarthritis? J Clin Med 2021; 10:1196. [PMID: 33809287 DOI: 10.3390/jcm10061196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
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Charousset C, Lefebvre Y, Bonnevialle N, Joudet T, Audebert S, Berhouet J, Michelet A, Geais L, Godenèche A. Prevalence of metal hypersensitivity in patients with shoulder pathologies. J Shoulder Elbow Surg 2020; 29:1789-1795. [PMID: 32371039 DOI: 10.1016/j.jse.2020.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND To date, medical history and dedicated questionnaires are the fastest and easiest way to assess risks of joint metal hypersensitivity. No published studies determined the overall prevalence of hypersensitivity to metals in patients with shoulder pathologies. The purpose of this study was therefore to estimate the prevalence of metal hypersensitivity reported by patients with shoulder pathologies, and to identify patients at risk of joint metal hypersensitivity based on a dedicated questionnaire. METHODS The authors prospectively asked all adult patients consulting for shoulder pathologies between September 2018 and February 2019 at 10 centers to fill in a form. The main outcome was "reported hypersensitivity to metals," comprising belt buckles, coins, earrings, fancy jewelry, keys, leather, metallic buttons, piercings, spectacles, watch bracelets, or zips. RESULTS A total of 3217 patients agreed to fill in the survey, aged 55 ± 16 (range, 18-101) with equal proportions of men (51%) and women (49%), and a majority of patients consulting for cuff pathology (55%). A total of 891 (28%) patients had professions considered at risk for metal hypersensitivity. The most frequently reported metal hypersensitivities were fancy jewelry (15%), earrings (13%), and watch bracelets (9%). A total of 629 (20%) patients, of which the vast majority were women, reported hypersensitivity to 1 or more metals. CONCLUSIONS This survey of 3217 patients identified 20% who reported metal hypersensitivities, though only 2.2% had done patch tests. Matching profiles of those with positive patch tests to those with no patch tests revealed that 9.4% of the total cohort had similar sex and self-reported metal hypersensitivities. Factors associated with a positive patch test were female sex, self-reported cutaneous allergy, and self-reported metal hypersensitivity. The clinical applicability of these estimates remains uncertain as there is insufficient evidence that allergy to metal implants can be predicted by questionnaires or patch tests.
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Affiliation(s)
| | - Yves Lefebvre
- Institut de l'Epaule de Strasbourg 16, allée de la Robertsau, Strasbourg, France
| | - Nicolas Bonnevialle
- Département de chirurgie orthopédique, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Thierry Joudet
- Department of Orthopaedic Surgery, Clinique chirurgicale du Libournais, Libourne, France
| | - Stephane Audebert
- Department of Orthopaedic Surgery, Clinique du Cambresis, Cambrai, France
| | - Julien Berhouet
- Service d'Orthopédie 1C, Centre Hospitalier Universitaire de Tours, Tours, France
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- Shoulder Friends Institute, Paris, France
| | | | | | - Arnaud Godenèche
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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Takeno K, Glaviano NR, Norte GE, Ingersoll CD. Therapeutic Interventions for Scapular Kinematics and Disability in Patients With Subacromial Impingement: A Systematic Review. J Athl Train 2019; 54:283-295. [PMID: 30829536 DOI: 10.4085/1062-6050-309-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Impaired scapular kinematics are commonly reported in patients with subacromial impingement syndrome (SIS). Various therapeutic interventions designed to improve scapular kinematics and minimize pain and disability have been described in the literature. However, the short- and long-term benefits of these interventions are unclear. OBJECTIVE To determine the effects of specific short- and long-term therapeutic interventions on scapular kinematics and disability in patients with SIS. DATA SOURCES We searched PubMed, CINAHL, and SPORTDiscus databases from their origins to January 2018 using a combination of the key words scapular kinematics AND (shoulder dysfunction OR subacromial impingement) and conducted a manual search by reviewing the references of the identified papers. STUDY SELECTION Studies were included if (1) preintervention and postintervention measures were available; (2) patient-reported outcomes were reported; (3) scapular kinematics measures at 90° of ascending limb elevation in the scapular plane were included; (4) SIS was diagnosed in participants or participants self-reported symptoms of SIS; (5) they were original clinical studies published in English; and (6) the sample sizes, means, and measure of variability for each group were reported. DATA EXTRACTION Seven studies were found. Sample sizes, means, and standard deviations of scapular upward rotation, posterior tilt, and internal rotation at 90° of ascending limb elevation on the scapular plane and the Disabilities of the Arm, Shoulder and Hand scores were extracted. DATA SYNTHESIS Standardized mean differences between preintervention and postintervention measures with 95% confidence intervals (CIs) were calculated. We observed that the Disabilities of the Arm, Shoulder and Hand scores improved (mean difference = 0.85; 95% CI = 0.54, 1.16) but did not observe changes in scapular upward rotation (mean difference = -0.04; 95% CI = -0.31, 0.22), posterior tilt (mean difference = -0.09; 95% CI = -0.32, 0.15), or internal rotation (mean difference = 0.06; 95% CI = -0.19, 0.31). CONCLUSIONS The short- and long-term therapeutic interventions for SIS improved patient-reported outcomes but not scapular kinematics. The identified improvements in shoulder pain and function were not likely explained by changes in scapular kinematics.
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Affiliation(s)
- Katsumi Takeno
- College of Health and Human Services, University of Toledo, OH
| | - Neal R Glaviano
- College of Health and Human Services, University of Toledo, OH
| | - Grant E Norte
- College of Health and Human Services, University of Toledo, OH
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Razmjou H, Dwyer T, Holtby R. Impact of symptom bilaterality and hand dominance on patient-reported disability outcomes. SAGE Open Med 2018; 6:2050312118797566. [PMID: 30181877 PMCID: PMC6111396 DOI: 10.1177/2050312118797566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives: It is not clear if using patients with bilateral symptoms would impact the
level of disability reported in orthopaedic research. The purposes of this
study were to (1) examine the prevalence of bilateral shoulder symptoms
(significant pain, stiffness or weakness affecting function) in patients
with rotator cuff impingement syndrome, rotator cuff tear and osteoarthritis
of the glenohumeral joint, (2) explore risk factors associated with
bilateral shoulder symptoms, and (3) examine the impact of symptom
bilaterality and hand dominance on pre- and post-operative patient-oriented
disability outcomes. Methods: This study involved secondary analysis of prospectively collected data of
patients who had undergone shoulder surgery and had returned for their
1-year follow-up. Two outcome measures were collected prior to surgery and
at 1-year following surgery: the American Shoulder and Elbow Surgeons and
the Constant–Murley Score. Results: Data of 772 patients, 376 (49%) females, 396 males (51%); 288 (impingement
syndrome), 332 (rotator cuff tear), and 152 (osteoarthritis) were included
in the analysis. There was a statistically significant difference in the
prevalence of bilateral symptoms being 44%, 28%, and 22% in the
osteoarthritis, impingement syndrome, and rotator cuff tear groups,
respectively (p < 0.0001). The prevalence of dominant side involvement
was 71%, 67%, and 53% in the rotator cuff tear, impingement syndrome, and
osteoarthritis groups (p < 0.0001). Older age and female sex were risk
factors for development of bilateral symptoms only in patients with rotator
cuff tear. Neither symptom bilaterality nor dominant arm involvement had a
negative impact on patient-oriented disability outcome measures prior to or
after surgery (p > 0.05). Conclusion: This study shows that patients with osteoarthritis of the glenohumeral joint
have the highest prevalence of bilateral shoulder complaints. The older age
and the female sex increased the risk of having bilateral symptoms in
patients with rotator cuff tear. Having bilateral shoulder symptoms or
dominant side involvement was not associated with higher level of disability
prior or after surgery.
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Affiliation(s)
- Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic & Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Physical therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tim Dwyer
- Division of Orthopaedic Surgery, Department of Surgery, Women's College and Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Holtby
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Orthopaedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Abstract
OBJECTIVE A new closed reduction technique for anterior glenohumeral dislocations and tuberosity fracture dislocations is introduced. METHODS Forty-one consecutive patients with an acute anterior glenohumeral dislocation or tuberosity fracture dislocation underwent closed reduction by an orthopaedic surgeon employing this new method. RESULTS Closed reduction was successful in 88% of patients using the reduction maneuver. Associated fracture with glenohumeral dislocation did not influence the success rate of the reduction maneuver. An assistant was needed in 15% of cases. No complications related to the reduction maneuver were noted amongst the cohort. CONCLUSION This novel reduction technique is safe demonstrating excellent success rates both for anterior shoulder dislocations and tuberosity fracture-dislocations.
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Affiliation(s)
- Mark J Gage
- a Department of Orthopaedic Surgery , NYU Hospital for Joint Diseases , New York , NY , USA
| | - Brian K Park
- a Department of Orthopaedic Surgery , NYU Hospital for Joint Diseases , New York , NY , USA
| | - Eric J Strauss
- a Department of Orthopaedic Surgery , NYU Hospital for Joint Diseases , New York , NY , USA
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Abstract
PURPOSE With increased sports participation and medical community awareness, there appears to be an increase in pediatric musculoskeletal injuries. Our purpose was to identify the intra-articular injury pattern seen within the pediatric shoulder. METHODS A retrospective review was performed at two tertiary-care children's hospitals between 2008 and 2011 on all patients who underwent magnetic resonance imaging (MRI) and subsequent shoulder arthroscopy. Exclusion criteria included: girls >14 years old and boys >16 years old. Demographics, MRI and arthroscopic findings were recorded. Labral pathology was grouped: Zone I (Bankart lesions, 3-6 o'clock for right shoulder), Zone II (posterior labral lesions, 6-11 o'clock), Zone III (SLAP lesions, 11-1 o'clock), and Zone IV (anatomic variants, 1-3 o'clock). RESULTS One hundred and fifteen children met criteria, mean age 14.4 years (range 8-16). There were 24 girls and 91 boys, with 70 right shoulders. Of 108 children, labral pathology involved: 72 Zone I (16 isolated anterior), 56 Zone II (15 isolated posterior), 38 Zone III (four isolated superior), and three had an isolated Buford complex. Seventy had more than one labral zone injured, and 31 (30 %) had more than two zones injured. Non-labral pathology included partial rotator cuff tears and humeral avulsions of the glenohumeral ligament. CONCLUSION With 94 % of intra-articular pathology being labral tears, the distribution of proportion in children differs from adults; moreover, 23 % involved only the posterior or posterosuperior labrum. Treating surgeons should be prepared to find anterior tears extending beyond the zone of a classic Bankart lesion and an association with C rotator cuff tears.
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Kuye IO, Jain NB, Warner L, Herndon JH, Warner JJP. Economic evaluations in shoulder pathologies: a systematic review of the literature. J Shoulder Elbow Surg 2012; 21:367-75. [PMID: 21865060 PMCID: PMC3783003 DOI: 10.1016/j.jse.2011.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 05/24/2011] [Accepted: 05/27/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Economic evaluations provide decision makers with a tool for reducing health care costs because they assess both the costs and consequences of health care interventions. This study reviewed the quality of published economic evaluations for shoulder pathologies. MATERIALS AND METHOD A MEDLINE search was conducted to identify articles published from 1980 to 2010 that contained "cost" or "economic" combined with terms for several shoulder disorders and treatments. We selected studies that fit the definition of 1 of the 4 routinely performed economic evaluations: cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analyses. Study quality was determined by measuring adherence to 6 established health economic principles, as described in the literature. RESULTS The search retrieved 942 studies. Of these, 32 were determined to be economic evaluations, and 53% of the economic evaluations were published from 2005 to 2010. Only 8 of the 32 studies (25%) adhered to all 6 health economic principles. Publication in a nonsurgical journal (P < .05) or in more recent years (P < .01) was significantly associated with higher quality. CONCLUSION Future health care resource allocation will likely be based on the economic feasibility of treatments. Although the number and quality of economic evaluations of shoulder disorders have risen in recent years, the current state of the literature is poor. Given that availability of such data may factor in private and public reimbursement decisions, there is a clear demand for more rigorous economic evaluations.
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Affiliation(s)
- Ifedayo O Kuye
- Harvard Shoulder Service, Department of Orthopedics, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
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