Clinics in Shoulder and Elbow最新文献

Background: Little is known about the potential negative or positive effects of peritendinous infiltration with corticosteroids in the non-surgical treatment of partial distal biceps tendon tears. Peritendinous fluid, synovitis, and bursitis often accompany partial tears and can be a source of persistent pain. We hypothesize that peritendinous corticosteroid infiltration is a safe non-surgical treatment option for complaints related to a partial distal biceps tendon rupture.

Methods: A single-center retrospective analysis was performed on a cohort of 52 patients with partial distal biceps tears (<50% of the footprint involved), as confirmed by magnetic resonance imaging. All patients received an ultrasound-guided intrabursal peritendinous infiltration with 1 mL of triamcinolone acetonide (10 mg/mL) and 4 mL of 2% lidocaine HCl. Patient files were reviewed for demographic information, date of injury, injury mechanism, treatment modality (operative or nonoperative), clinical follow-up (2011-2021), and complications, including progression to a complete rupture.

Results: The median duration of follow-up after infiltration was 15 months (1.2-45 months). No infiltration-related complications were observed following infiltration therapy. Surgical reconstruction was ultimately performed in 65% of the patients with a partial tear. One patient sustained a trauma to the elbow in the weeks following infiltration, resulting in a complete tear.

Conclusions: Infiltration with corticosteroids is a safe treatment option for patients with a partial tear of the distal biceps who failed progressive exercise therapy. Surgical reconstruction was avoided in 35% of patients following infiltration treatment. Level of evidence: IV.

Midshaft clavicular fractures account for approximately 80% of all clavicle fractures in pediatric and adolescent populations and represent up to 15% of all fractures in adolescents. These injuries commonly result from falls, sports-related trauma, or motor vehicle accidents, with adolescent males experiencing fractures at rates up to three times higher than females. This review examines the diagnosis, classification, and management of these fractures, highlighting the nuances between pediatric and adult treatment approaches. Historically, nonoperative management has been favored, leveraging the adolescent clavicle's remodeling capacity. Recent trends reflect increasing operative interventions, driven by adult studies demonstrating faster recovery and improved functional outcomes in displaced fractures. While nonoperative treatment, using slings or figure-of-8 braces, remains effective for most cases, operative fixation, including open reduction and internal fixation or elastic stable intramedullary nailing, is indicated for open fractures, neurovascular injury, or significant displacement. Studies demonstrate high union rates with both methods, but operative treatment offers quicker return to activity, albeit with higher risks of hardware- related complications. The Function after Adolescent Clavicle Trauma and Surgery study notably supports nonoperative management, showing similar long-term functional outcomes compared to operative treatment. Future research should focus on refining patient-reported outcome measures specific to adolescents and identifying subsets of patients who may benefit from surgery. Shared decision-making remains crucial for optimal patient-centered care.

Background: Patient-related outcomes are increasingly emphasized in anatomic (ATSA) or reverse total shoulder arthroplasty (RTSA). Identifying patients at risk of adverse outcomes is key to mitigating complications. Comorbidity indices such as the American Society of Anesthesiologists Physical Status (ASA), classification, modified Charlson Comorbidity Index (mCCI), Elixhauser Comorbidity Measure (ECM), and 5-Factor Modified Frailty Index (mFI-5) can predict postoperative complications but were developed primarily for inpatient populations. Whereas studies have assessed these indices for total joint arthroplasty, few have assessed their performance for complications following TSA. This study compared their prognostic values for 30-day adverse outcomes after TSA.

Methods: Using the National Surgical Quality Improvement Program database, 39,810 patients who underwent ATSA or RTSA (2011- 2022) were analyzed. Logistic regression evaluated six outcomes: non-home discharge, length of stay greater than 1 day, major or minor complications, readmission, and mortality. Predictive performance was assessed using the concordance statistic (C statistic), where values greater than 0.7 indicate good discrimination and those greater than 0.8 indicate excellent discrimination.

Results: Of all the indices, only the mCCI was a good predictor of non-home discharge (C statistic, 0.713; 95% CI, 0.705-0.722). The ASA, ECM, and mFI-5 demonstrated limited predictive value for all outcomes.

Conclusions: Among the indices analyzed, only the mCCI demonstrated acceptable predictive accuracy and only for discharge destination. None of the indices effectively identified patients at risk for adverse outcomes, underscoring the need for a TSA-specific scoring system. Level of evidence: III.

Brachial plexus paralysis is a rare but serious complication following clavicle fractures that is often linked to neurovascular compression, with an incidence of 0.5% to 9.0%. This report presents a case of brachial plexus paralysis in a 61-year-old woman after surgical fixation of a deformed mid-clavicle fracture with a metal plate. Revision surgery was performed to address the paralysis, involving removal of the metal plate, arcuate osteoplasty to create a smooth arch beneath the clavicle, and re-fixation of the plate with adjusted superior angularity. We used this approach to relieve neurovascular compression and restore thoracic outlet space. Over a period of 1 year, significant recovery and successful fracture union were achieved. This case demonstrates that managing brachial plexus paralysis with revision surgery and osteoplasty can effectively restore both neurological function and bone healing.

Degenerative rotator cuff disease (RCD) is a common musculoskeletal condition that disproportionately affects individuals with diabetes mellitus, leading to pain, functional impairment, and a reduced quality of life. Emerging evidence suggests that sodium-glucose co-transporter 2 inhibitors (SGLT2is), which are widely used for glycemic control in type 2 diabetes, offer additional musculoskeletal benefits beyond their metabolic effects. This review explores the potential protective role of SGLT2is in diabetic RCD by examining the epidemiological link between diabetes and tendon degeneration and evaluating the biological mechanisms through which SGLT2 is influence tendon health. These potential benefits include reducing inflammation, altering metabolism to a more tendon-friendly state, combating oxidative stress with ketones, encouraging a healing environment through macrophage modulation, and improving overall health via weight and blood sugar management. Preclinical and observational studies provide preliminary support for therapeutic benefits, although high-quality randomized clinical trials are lacking. Understanding the multifaceted role of SGLT2is in tendon biology will open new avenues for prevention and management of RCD, particularly in patients with metabolic disorders.

Background: Allograft prosthetic composite (APC) and megaprosthesis (MP) have both been used to reconstruct the proximal humerus after its resection due to primary or secondary tumors. However, varied results have been reported in the literature with no consensus on which reconstruction has better overall outcomes.

Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were queried through September 2024. The compared outcomes consisted of adverse events, patient-reported outcomes measures, and range of motion. Ten studies and 400 patients were included, with 115 in the APC group and 285 in the MP group.

Results: The APC group had a higher rate of reoperations (odds ratio, 2.50; 95% CI, 1.40-4.45; P=0.002) than did the MP group over an average follow-up of 7.0 years. However, better postoperative flexion (mean difference, 10.11; 95% CI, 5.33-14.90; P<0.001) and Musculoskeletal Tumor Society scores (mean difference, 3.73; 95% CI, 1.37- 6.08; P=0.002) were seen in the APC group.

Conclusions: The present study shows a lower rate of revision with the use of MP but better functional outcomes and forward flexion with APC as the surgical option for proximal humerus reconstruction. Level of evidence: III.

Background: Accurate measurement of glenoid version is essential for optimal implant positioning in shoulder arthroplasty. This study compared the accuracy and reliability of unformatted two-dimensional computed tomography (2D-CT), formatted 2D-CT, and three-dimensional CT (3D-CT) reconstructions in measuring glenoid version.

Methods: Shoulder CT scans for arthroplasty were analyzed retrospectively. Glenoid version was measured at the estimated glenoid midpoint using unformatted and formatted 2D-CT in the scapular plane. Measurements from 3D-CT reconstructions using the Corrected Friedman Method were used as the control. Inter- and intra-observer reliability was calculated as well as minimally detectable difference.

Results: Sixty-five CT scans were analyzed (mean age, 61.7 years). Mean glenoid version was -3.48° (standard deviation [SD], 8.7°) on unformatted 2D-CT, -3.27° (SD, 8.15°) on formatted 2D-CT, and -4.25° (SD, 7.92°) on 3D-CT. Although no significant difference in mean values was observed (analysis of variance, P=0.245), formatted 2D-CT measurements were within 6° of 3D-CT in 95.4% of cases versus 83.1% for unformatted 2D-CT (P=0.023). Directional error occurred in 27.7% of unformatted scans and 16.9% of formatted scans. Inter-observer reliability was highest for 3D-CT (intraclass correlation coefficient [ICC]=0.83; 95% CI, 0.74-0.89), and intra-observer agreement was strongest for 3D-CT (ICC=0.91; 95% CI, 0.86-0.94), followed by formatted 2D-CT (ICC=0.83; 95% CI, 0.73-0.89) and unformatted 2D-CT (ICC=0.77; 95% CI, 0.65-0.85).

Conclusions: 3D-CT reconstructions are widely considered the most accurate and reproducible method for glenoid version assessment, supported by multiple comparative imaging studies. Formatted 2D-CT provides a reliable alternative when 3D-CT is unavailable, significantly outperforming unformatted 2D-CT in both agreement with the 3D reference and intra- and inter-observer reliability. Level of evidence: IV.

Background: YouTube is a widely accessible platform that facilitates the rapid dissemination of both evidence-based and potentially misleading health-related information. This study assesses the educational quality, reliability, and comprehensiveness of the most-viewed YouTube videos about scapular dyskinesis.

Methods: A systematic search was conducted on YouTube using the keywords "scapular dyskinesia" and "scapular dyskinesis." The top 100 videos for each keyword were screened for inclusion, and the metrics, sources, and content of the included videos were analyzed. Video quality and reliability were assessed using the Global Quality Scale and the modified DISCERN scale, respectively. In addition, a newly developed, non-validated tool, Scapular Dyskinesis Specific Scoring, was used to provide a condition-specific content assessment.

Results: The analysis revealed that 48.1% of the videos were low quality, and 62.0% lacked reliability. Videos produced by health-related websites exhibited superior quality. Content focusing on treatment and diagnostic approaches demonstrated significantly higher quality than other content categories (P<0.001). A correlation analysis indicated that the Video Power Index did not correlate significantly with reliability, quality, or comprehensiveness scores. Additionally, a simple regression analysis revealed that the video upload time negatively affected the quality, reliability, and comprehensiveness metrics.

Conclusions: Most YouTube videos on scapular dyskinesis were of low quality, lacked reliability, and failed to provide comprehensive and accurate information. Furthermore, high-quality and reliable content tended to receive relatively low engagement and user preference scores. These findings underscore the urgent need for well-structured, evidence-based, and regularly updated YouTube content about scapular dyskinesis. Level of evidence: IV.