Clinics in Shoulder and Elbow最新文献

As the incidence of reverse total shoulder arthroplasty (RSA) continues to increase with its expanding indications, a growing number of patients are being considered for bilateral RSA. This review aims to explore the functional outcomes of patients with bilateral RSA and examine the effect of risk factors and implant positioning on internal rotation. Multiple studies have reported favorable results in bilateral RSA patients, with significantly improved patient-reported and clinical outcomes bilaterally. Although challenges remain in achieving reliable improvements in internal rotation following RSA, several studies to date have demonstrated that bilateral RSA patients are able to retain independence in personal hygiene and activities of daily living, with difficulty experienced primarily only in extreme internal rotation tasks, such as washing the back or securing a bra. Nevertheless, compensatory strategies can enable patients to manage these limitations effectively. Patients who have undergone bilateral RSA demonstrate functional outcomes and perform internal rotation tasks at a level comparable to that of patients who have undergone bilateral anatomic total shoulder arthroplasty or a combination of total shoulder arthroplasty and RSA. Risk factors for internal rotation deficits after RSA include poor preoperative functional internal rotation, increased body mass index, preoperative opioid use, and preoperative diagnosis of a massive irreparable rotator cuff tear. Lateralization and inferior positioning of the glenoid component as well as humeral component retroversion can increase functional internal rotation, while repairing the subscapularis does not appear to offer any clinically significant benefit. Although some patient and surgical factors have been associated with internal rotation deficits after RSA, further investigation is necessary to better characterize the underlying causes of this issue.

Background: Augmenting subscapularis peel repairs with the long head of the biceps tendon (LHBT) may provide increased strength to the repaired construct. We aimed to report on the early outcomes of anatomic total shoulder arthroplasty (aTSA) in patients whose subscapularis peel repairs were augmented with LHBT autografts.

Methods: All patients who underwent aTSA with augmentation of subscapularis peel repair using LHBT were reviewed. Patients were included if they had a minimum 1-year follow-up. Preoperative demographics and intraoperative information were recorded. Primary outcomes were American Shoulder and Elbow Surgeon (ASES) scores and visual analog scale (VAS) pain scores, which were assessed at 3, 6, and 12 months, as well as changes in range of motion values.

Results: Sixteen patients with a mean age of 63.3 years and a mean follow-up of 12.4 months were included in the study. Six patients were female and 10 were male. Average LHBT length was 7.3 cm (range, 6.5-9.0 cm). Two patients were converted to reverse shoulder arthroplasty (12.5%). For the remaining 14 patients, there were statistically significant improvements exceeding the minimal clinically important difference in both ASES (34.1-92.1, P<0.001) and VAS (6.3-0.9, P<0.001) scores. Patients exhibited a mean improvement of 47.7° in forward elevation (P<0.001), 30.8° in abduction (P<0.001), 21.4° in external rotation (P<0.001), and a 3-level improvement for internal rotation.

Conclusions: At 1-year minimum follow-up, patients who underwent aTSA with augmentation of the subscapularis peel repair with the LHBT demonstrated favorable outcomes. Level of evidence: IV.

Acute postoperative parotitis, also known as anesthesia mumps, involves transient inflammation and enlargement of the parotid gland after general anesthesia. No case reports of acute postoperative parotitis after arthroscopic shoulder surgery have been reported to date. Therefore, we share our experience with a recent case of acute postoperative parotitis as a rare complication of arthroscopic rotator cuff repair in lateral decubitus position. Symptoms can be unilateral or bilateral, painless, and often resolve spontaneously within hours or days; in rare cases, such as upper airway obstruction, the condition can be fatal. Treatment options for parotitis vary from conservative to surgical depending on severity, and outcomes also vary. Therefore, orthopedic surgeons should be aware that this rare complication can occur after surgery, and patients should be warned before surgery.

Reverse total shoulder arthroplasty (RSA) has emerged as a promising treatment option for rotator cuff tear arthropathy. However, concerns persist regarding horizontal rotational dysfunction after RSA. While many studies focus on improving external rotation after RSA, limited attention has been paid to internal rotation. In this technical note, we describe how to perform secondary pectoralis major transfer in a patient with residual internal rotation dysfunction after RSA.

Background: This study sought to evaluate the effectiveness of a combined treatment approach for septic shoulder arthritis involving arthroscopic synovectomy and use of antibiotic-impregnated polymethylmethacrylate (PMMA) beads for localized antibiotic delivery.

Methods: This retrospective study included 22 patients with septic shoulder arthritis treated at our institution between 2017 and 2023. The treatment involved arthroscopic lavage, debridement, and insertion of antibiotic-impregnated PMMA beads. Patients were evaluated preoperatively and postoperatively based on laboratory tests, imaging, joint fluid analysis, and physical examination. Treatment efficacy was assessed based on normalization of C-reactive protein (CRP) levels, pain reduction as measured using a visual analog scale (VAS), and improvement in shoulder function according to Constant-Murley score.

Results: All 22 patients demonstrated successful resolution of infection, with only one case of recurrence, leading to a notably low recurrence rate of 5%. Recurrence was determined based on clinical signs (aggravated pain, swelling, and fever) and laboratory markers (elevated CRP and white blood cell count). Mean follow-up duration was 20.2 months. Significant reductions in pain (average VAS score reduction from 8.1 to 2.4, P<0.001) were observed, and mean Constant-Murley score at final follow-up was 60.7, reflecting improved shoulder function.

Conclusions: Arthroscopic debridement combined with localized antibiotic delivery using PMMA beads is an effective and safe treatment for septic shoulder arthritis. This method offers substantial advantages over traditional treatments, as evidenced by the very low recurrence rate. Level of evidence: IV.

Background: Lateral epicondylitis, colloquially known as tennis elbow, is a common cause of elbow pain and daily task disability. Caused by repetitive movement, it is typically a degenerative rather than inflammatory event and affects mostly middle-aged patients. Despite its good prognostic nature, its economic burden on the healthcare system encourages research on the efficacity of non-operative injection treatments. This article aims to compare the clinical effectiveness of platelet-rich plasma (PRP) and corticosteroid (CS) injections in managing lateral epicondylitis.

Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up to March 2024. Only randomized controlled trials were included. The clinical outcomes evaluated were the visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results: Twenty-six randomized controlled trials with 1.877 patients were included in this meta-analysis. In terms of VAS scores, short-term results (<2 months) favored CS over PRP (P=0.03; mean difference [MD], 0.67; 95% CI, 0.05 to 1.28), whereas long-term results (>6 months) favored PRP (P<0.001; MD, -1.60; 95% CI, -2.01 to -1.20]). Intermediate-term results (2-6 months) showed no significant difference between injection treatments. In terms of DASH scores, short- and intermediate-term results showed no significant difference, whereas long-term results favored PRP (P<0.001; MD, -4.87; 95% CI, -7.69 to -2.06).

Conclusions: CS provides significantly better short-term pain relief, while PRP provides better long-term functional improvement and clinical long-term pain relief. However, future studies should focus on other injection protocols or addition of other non-invasive modalities. Level of evidence: I.

Background: This study compared the clinical and radiological outcomes of chronic retracted rotator cuff tears where complete footprint coverage cannot be achieved, using two treatments: footprint medialization with bone marrow stimulation and conventional incomplete repair.

Methods: This retrospective study included 87 patients who underwent arthroscopic rotator cuff repair with incomplete footprint coverage. The included patients were divided into group 1 (54 patients with footprint medialization and bone marrow stimulation) and group 2 (33 patients with conventional repair). Medialization and bone marrow stimulation were performed if the tendon did not cover a footprint of ≥1 cm2. Clinical outcomes, including a visual analog scale for pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and patient satisfaction, were evaluated preoperatively and at follow-up. Radiological healing was assessed using magnetic resonance imaging or computed tomography arthrography at 6 months and ultrasound at 2 years.

Results: Both groups showed significant improvements in clinical outcomes from preoperative levels. Group 1 demonstrated better outcomes in all measures at the final follow-up than group 2. Active range of motion improved significantly in both groups, with no significant postoperative differences. At 2 years postoperatively, group 1 had a significantly lower retear rate (14.8%) than group 2 (36.4%) (P=0.020).

Conclusions: In this study, the group that underwent footprint medialization and bone marrow stimulation for chronic retracted rotator cuff tears, in which complete footprint coverage was not possible, exhibited a lower retear rate and better clinical outcomes than the group that underwent conventional incomplete repair, with a minimum follow-up period of 2 years. Level of evidence: III.

Background: Although functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures are satisfactory, there is a high rate of complications. This study aims to characterize the 30-day complications, readmissions, and mortality of patients with TEA for distal humerus fractures in a large registry database.

Methods: Patients who underwent TEA for a distal humerus fracture were identified from the 2015 to 2020 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database. Baseline demographics, clinical characteristics, and complications including deep vein thrombosis/pulmonary embolus, infection, mortality, readmissions, and reoperations were recorded. Overall, 134 patients (mean age, 73.6 years; mean body mass index, 28.9 kg/m2 ; 88.8% females) were included.

Results: The total complication rate was 21.6% (n=29). The most common complications were unplanned readmission (6.0%), postoperative transfusion (5.2%), unplanned reoperation (3.0%), wound disruption (2.2%), and urinary tract infection (1.5%). The composite infection rate was 3.7%. There were no 30-day events of mortality, sepsis, or cerebral vascular accident. Patients 80 years or older had higher but not significant rates of unplanned readmission (10.2% vs. 3.5%, P=0.116) and reoperation (6.1% vs. 1.2%, P=0.105).

Conclusions: TEA for distal humerus fracture analyzed over 5 years had high rates of 30-day postoperative complications (21.6%), with unplanned readmission, reoperation, and infection being the most common. Level of evidence: IV.

Background: Reverse total shoulder arthroplasty (RTSA) has become increasingly popular in recent years, and this trend is expected to continue. However, differences in outcomes of RTSA for fractures compared with other indications are poorly understood. This study aimed to identify the compare the incidences of adverse events during RTSA to treat cuff tear arthropathy (CTA) versus RTSA to treat fractures, as well as identify risk factors for any adverse event.

Methods: Patients who underwent RTSA from 2010 to 2020 in the National Surgical Quality Improvement Program database were included. Matched cohorts were created using nearest-neighbor matching. Independent sample t-tests and chi-square tests were used to determine differences between groups, and binary logistic regression was performed to determine odds ratios and 95% CIs.

Results: In total, 27,607 CTA patients (94.5%) and 1,537 fracture patients (5.3%) underwent RTSA. Adverse events occurred in 1,088 CTA patients (3.9%) and 192 fracture patients (12.4%). Incidences of adverse events, postoperative transfusions, and returns to an operating room were all significantly higher in the fracture cohort compared with CTA patients.

Conclusions: Following surgery, higher rates of adverse events were observed in the CTA patients compared with those in the fracture cohort. These findings improve our understanding of the effectiveness of an increasingly popular surgical intervention due to the use of a large database analysis to identify short-term complications and risk factors. Level of evidence: III.