The authors assessed the effects of forearm rotation on the proximity of the radial nerve and medial collateral ligament (MCL) to a proximal and a more distal arthroscopic anterior elbow ...capsulectomy. Arthroscopy was performed on 10 cadaveric specimens. Sutures were passed lateral to medial at the level of the radiocapitellar joint and at the proximal edge of the annular ligament. Dissection measured the distance to the radial nerve from the lateral starting point and to the MCL from the medial exit point in varying degrees of forearm rotation. The extent of brachialis muscle coverage of the radial nerve was documented. The distance from the starting point to the radial nerve increased in pronation at both levels. The medial extent of the capsulectomy remained a safe distance from the MCL. Brachialis muscle covered the radial nerve at both levels. Pronation increases the capsulectomy safe zone, including more distally, before encountering the radial nerve; the MCL is not at risk. Orthopedics. 2020;43(5):e399-e403..
Objective
Patients with supraspinatus high-grade partial-thickness tear or full-thickness tear are potential candidates for rotator cuff repair surgery. We sought (1) to compare supraspinatus ...intramuscular fatty infiltration between these groups by Goutallier grade, fuzzy C-means and an orthopaedic surgeon visible percentage estimate, (2) and to determine the reliability of each method.
Materials and methods
We performed a retrospective cross-sectional study of supraspinatus intramuscular fatty infiltration on T1-weighted MR images for 93 shoulders with either supraspinatus partial-thickness tear > 50% tendon thickness or full-thickness tear by Goutallier grade, fuzzy C-means and an orthopaedic surgeon visible percentage estimate, by two observers for each method. Descriptive statistics were performed to compare groups. Inter- and intra-observer reliability was determined. Correlative analysis among the three methods was performed.
Results
Significant differences of mean supraspinatus intramuscular fatty infiltration were present when comparing supraspinatus high-grade partial-thickness tear versus full-thickness tears by Goutallier grade (
p
= 0.004), fuzzy C-means (
p
= 0.002) and orthopaedic surgeon visible percentage estimate (
p
= 0.001). There was no significant difference for age (55.0 ± 11.1 years versus 56.1 ± 9.6 years) or sex (35.4% male versus 47.8% male) for supraspinatus high-grade partial-thickness tear and full-thickness tear, respectively. A significant difference existed among the subgroup of full-thickness tears stratified by tear size by all three methods (
p
< 0.020). Inter- and intra-observer reliability was Goutallier grade 0.590 and 0.624, fuzzy C-means 0.768 and 0.925 and orthopaedic surgeon visible percentage estimate 0.858 and 0.686, respectively. For shoulders with mean Goutallier grade ≥ 2.0, inter-observer reliability was 0.878 and 0.802 for fuzzy C-means and orthopaedic surgeon visible percentage estimate, respectively. A strong correlation was present among the three methods of supraspinatus FI analysis (rho ≥ 0.72).
Conclusion
Supraspinatus full-thickness tears have higher amounts of intramuscular fatty infiltration compared to high-grade partial-thickness tear. Quantitative fuzzy C-means shows excellent inter-observer reliability for estimating supraspinatus intramuscular fat. Experienced orthopaedic surgeons’ semi-quantitative estimation of supraspinatus visible intramuscular fat may offer improved reliability as compared to semi-quantitative Goutallier grade.
Background:
Perioperative education and socioeconomic factors influence patient behavior. Recent evidence has suggested that sling compliance is associated with improved outcomes after shoulder ...surgery; it is important to investigate factors that influence sling compliance.
Purpose:
To determine the associations between postoperative sling wear and patients’ understanding of sling necessity, postoperative home assistance, and social deprivation.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
A total of 66 patients were prospectively enrolled from 2018 to 2020 if they were ≥18 years of age and undergoing shoulder surgery requiring a sling for at least 1 month postoperatively. Sling wear was measured using a temperature-sensing device. At 6 weeks postoperatively, patients’ understanding for sling necessity was determined by their response to a question on the Medical Adherence Measure questionnaire, “Why did you have to wear a shoulder sling?” The Patient Understanding Grading Scale (PUGS) was developed to quantify patient responses. PUGS was graded 1 to 3, with grade 1 corresponding to the least technical knowledge. Patient characteristics, social deprivation (Area Deprivation Index ADI), and home assistance were additionally analyzed.
Results:
There were no significant differences in baseline characteristics between patients when stratified by PUGS grade. Multivariable linear regression analysis for total hours of sling wear per week showed that patients with PUGS grade 2 (β, 48.2 hours; P = .007) and grade 3 (β, 59.5 hours; P = .003) wore their slings significantly more than grade 1 patients. Patients with home assistance had significantly greater day hours (73.5 ± 33.0 vs 44.0 ± 24.5 hours; P = .037) of sling wear per week, but there was no difference in night sling hours. Patients older than 60 years wore their slings significantly more, while men and those with a higher body mass index (BMI) wore their slings significantly less. ADI was not significantly associated with sling wear.
Conclusion:
This study demonstrates that patients with greater understanding for sling necessity, those with home assistance, and patients >60 years have greater sling wear, while male patients and those with a higher BMI have lower sling compliance. ADI was not a significant contributor.
Symptomatic, Unstable Os Acromiale Hasan, S Ashfaq; Shiu, Brian; Jauregui, Julio J
Journal of the American Academy of Orthopaedic Surgeons,
2018-November-15, Volume:
26, Issue:
22
Journal Article
Peer reviewed
Management of a persistently symptomatic, unstable os acromiale remains controversial. An unstable os acromiale is an easy diagnosis to miss and should be specifically evaluated for in patients with ...shoulder pain and a high degree of clinical suspicion. Surgical options include open or arthroscopic excision and open reduction and internal fixation. Open excision of large fragments has had poor results. Arthroscopic treatment is commonly used for small fragments (preacromion), and the technique has also been used in larger fragments (meso-os), but concerns persist over postoperative weakness secondary to shortening of the deltoid lever arm. Open reduction and internal fixation through a transacromial approach has been shown to have predictable union rates but can be complicated by symptomatic implant. Recent biomechanical studies have expanded our understanding of optimal fixation constructs, which may also decrease implant-related issues. Ultimately, the choice of which procedure to use will be dictated by patient factors such as age, activity level, and the nature of rotator cuff pathology.
LEVEL OF EVIDENCE:Level V
SDG3includes the all-important Target 3.3 that explicitly mentions TB. ...once again a new plan has been laid out-the World Health Organization's (WHO's) End-TB Strategy 2016-2035-a costed, scalable ...blueprint for a world free of TB-zero deaths, zero disease and suffering due to TB2. The re-evaluation of India's TB demographics for the period 2000-2015 was based on household surveys, a single state-wide TB prevalence survey from the Western state of Gujarat (which was extrapolated to the rest of the country) sales of anti-TB drugs in pharmacies, and from India's new web-based notification system, the NIKSHAY. Contrasting India's increasing TB burden with the plummeting TB epidemic in China (which once had a TB population surpassing India's), in an article evocatively titled "The Dragon and the Tiger," the differences in the programmatic reforms between the two countries have been highlighted by Bhatter and colleagues from the Foundation for Medical Research, Mumbai4. ...CDCs exist in 28 other Chinese provinces, monitoring the changing dynamics of important diseases, and enabling the necessary policy changes based on the surveillance data. Health and health issues are a subject of the state, and from past experience (such as in the case of the effete Malaria Control Program) state governments do...
The risks and complication profile of reverse total shoulder arthroplasty (RSA) in rheumatoid arthritis (RA) patients has yet to be clearly defined as most studies have small cohorts. Using a large ...inpatient database, the purpose on our study was to determine the overall demographics, hospitalization characteristics, and early complication rates in rheumatoid patients and compared these to rotator-cuff arthropathy patients without RA undergoing RSA. Utilizing United States Nationwide Inpatient Sample from 2010 to 2013, we evaluated a total of 919 RA RSA and compared them to 8097 patients without RA undergoing RSA. The outcomes included demographic characteristics like age, race, sex, Deyo comorbidity score, perioperative complications, and mean length-of-stay. The RA cohort had 81% females versus 60% in the comparison cohort. This cohort was younger (
p
= 0.006) and had longer hospitalization time (
p
= 0.001), but the total inpatient costs were not significantly different (
p
= 0.15). In regards to Deyo index, rheumatoid patients had significantly higher scores (
p
< 0.001). The inpatient complication rates for infection (
p
= 0.9), nerve injury (
p
= 0.9), and instability (
p
= 0.19) were similar, but the RA cohort had more prosthetic-related (
p
= 0.001) and greater tuberosity-related (
p
= 0.008) complications. The mortality rates were also similar (
p
= 0.625). In RSA for RA patients, surgeons should be mindful of preoperative risk factors and demographic characteristics that may influence their outcomes. Caution should specifically be paid to the possibility of longer hospitalization time and increased incidence of certain complications, including intraoperative fracture, when compared to non-rheumatoid patients. Close collaboration between rheumatologists, surgeons, and primary care physicians is a must for optimizing and managing these patients.
Shoulder arthroplasty is performed with increasing frequency, and osteoarthritis is the most common indication for this procedure. However, the glenoid side of the joint is widely recognized as a ...limiting factor in the long-term durability of shoulder replacement, and osteoarthritis leads to characteristic bony changes at the glenoid which can exacerbate this challenge by reducing the already limited glenoid bone stock, by altering biomechanics, and by interfering with operative exposure. This article reviews the Walch classification system for glenoid morphology. Several typical findings of osteoarthritis at the glenoid are discussed including central bone loss, posterior bone loss, retroversion, biconcavity, inclination, osteophyte formation, subchondral bone quality, and bone density. The three primary types of shoulder arthroplasty are reviewed, along with several techniques for addressing glenoid deformity, including eccentric reaming, bone grafting, and the use of augmented glenoid components. Ultimately, a primary objective at shoulder arthroplasty is to correct glenoid deformity while preserving bone stock, which depends critically on characterizing the glenoid at pre-operative imaging. Understanding the surgical techniques and the implications of glenoid morphology on surgical decision-making enables the radiologist to provide the morphologic information needed by the surgeon.
Purpose
The primary aims of this study were to (1) assess the preoperative expectations of patients undergoing shoulder surgery, and (2) determine the relationship between preoperative patient ...demographics, PROs, and preoperative patient expectations. It was hypothesized that younger patients with worse function and worse health status had higher expectations of shoulder surgery.
Methods
Data from a total of 319 patients (319 shoulders) from 2015–2018 were analyzed. Patients completed a series of questionnaires covering demographics and patient-reported outcome measures. Expectations of treatment were evaluated using the Musculoskeletal Outcomes Data Evaluation and Management System. Bivariate analyses were performed to determine the significance of identified associations.
Results
The study population consisted of 186 males and 133 females. The mean age was 46.9 (± 17.2), and the mean BMI was 30.1 (± 6.8). Overall, patients had high expectations of shoulder surgery, with a mean score of 84.7 (± 19.3). The most commonly performed procedure in the study population was arthroscopic rotator cuff repair. There was a significant association between pre-treatment expectations and ethnicity, previous shoulder surgery, employment status, income level, tobacco use, preoperative opioid use, depression, and ASA score.
Conclusion
The findings suggest that patients undergoing shoulder surgery have high overall preoperative expectations, which were significantly associated with ethnicity, surgical history, opioid use, and employment status, and with multiple patient-reported outcome measures including physical function, pain interference, fatigue, and depression. Nevertheless, by discussing expectations preoperatively, orthopaedic surgeons can help patients develop high but realistic expectations to improve outcomes and satisfaction.
Level of evidence
IV.
Compared to a large scale assault upon an army of invading bacilli, where for instance, the liver might cause the blood C-reactive protein (CRP) to go up a thousand-fold; in chronic inflammation, ...elevations in CRP are rather more modest.
Hypothesis The purpose of this study was to accurately map the insertional footprint of the distal biceps tendon and to test our hypothesis that a superior anatomic repair can be achieved by a ...2-incision technique when compared with a 1-incision technique. Methods We randomly assigned 20 cadaveric arms to 1 of 2 groups: 1 incision (group I) or 2 incision (group II). The bicipital tuberosity was exposed through either a single anterior incision (group I) or a posterolateral approach (group II). A guide pin was placed into the tuberosity to mark the axis for creating a virtual bone tunnel. Each radius was harvested with the biceps insertion intact. The length, width, and area of the insertion footprint for each tendon were determined with a 3-dimensional computerized digitizer. A 7.5 mm-diameter virtual bone tunnel was centered over the drill hole created by the guidewire. The percentage of the virtual tunnel within the original footprint was determined. Results The percentage of the virtual tunnel (repair site) within the original tendon footprint was 73.4% for the posterolateral approach and only 9.7% for the anterior approach. There was a statistically significant difference ( P ≤ .001) in the median values of footprint covered when the 2 types of repair were compared. Discussion and conclusion The 2-incision technique results in a significantly improved anatomic repair of the biceps tendon to the original insertion site. Prospective clinical studies directly comparing the 2 techniques with regard to the strength of supination after repair may be helpful.
PDF
