Clinics in Shoulder and Elbow最新文献

Lower trapezius tendon transfer has emerged as an effective treatment option with promising clinical outcomes for patients with posterior superior irreparable rotator cuff tears (PSIRCTs). This technique has gained considerable attention for PSIRCTs, with various modifications proposed by different authors. In this report, we present an arthroscopic-assisted approach to lower trapezius tendon transfer in patients with PSIRCT using an Achilles tendon allograft that is reinforced with an acellular dermal matrix graft. The procedure is conducted with the patient in the lateral decubitus position.

Background: Reverse shoulder arthroplasty (RSA) is an alternative to anatomic total shoulder arthroplasty (TSA) for treating glenohumeral osteoarthritis (OA), particularly in elderly patients. This study evaluates 90-day postoperative complication rates and identifies risk factors for adverse outcomes in RSA and TSA patients.

Methods: A retrospective cohort study was conducted using the TriNetX Research NLP Network to identify patients aged 65-90 years who underwent RSA or TSA for OA from 2006 to 2024. 1:1 propensity score matching controlled for demographics and comorbidities. Orthopedic and infectious complications were compared using multivariate logistic regression.

Results: The final matched cohort included 4,117 RSA and TSA patients. RSA was associated with significantly higher odds of orthopedic complications compared to TSA. Significant risk factors for orthopedic complications in RSA included nicotine dependence (OR, 1.592; P=0.001) and hypertension (OR, 1.545; P=0.001). In TSA, risk factors included male sex (OR, 0.702; P=0.005), chronic obstructive pulmonary disease (OR, 1.650; P=0.016), and obesity (OR, 1.776; P<0.001). For infections, RSA risk factors were male sex (odds ratio [OR], 1.698; P=0.005), heart failure (OR, 2.396; P<0.001), and diabetes (OR, 1.525; P=0.039). Diabetes was the only significant risk factor in TSA (OR, 2.453; P=0.003).

Conclusions: RSA carries a higher risk of orthopedic complications and infection than TSA within 90 days. Distinct risk factors for each procedure highlight the need for patient-specific risk stratification to optimize preoperative assessment and surgical decision-making. Level of evidence: III.

Background: The purpose of this study was to identify risk factors of pain while lying on the operative shoulder following primary reverse total shoulder arthroplasty (rTSA).

Methods: Patients who underwent primary rTSA with available (1-year) follow-up data were retrospectively identified. Demographics, diagnosis, comorbidities, implant configuration, surgical information, and pain scores (including preoperative, postoperative and improvement in pain) were assessed while lying on the operated shoulder. To categorize preoperative pain while lying on the operative shoulder, cohorts were defined based on above or below the average pain level. Postoperative pain and improvement in pain were defined based on the following thresholds: patient acceptable symptomatic state (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB). The PASS was defined as the 75th percentile of pain scores in patients with high satisfaction ratings after rTSA, while MCID and SCB were calculated as the difference in average pain improvement in patients with high versus low satisfaction rates postoperatively. Univariate and multivariate logistic regression analyses were conducted.

Results: A total of 4,235 patients who underwent rTSA were included. Previous shoulder surgery, tobacco use, and preoperative pain lying on the operative shoulder failed to achieve threshold values. Subscapularis repair was associated with an improved ability to achieve the thresholds.

Conclusions: Tobacco use, higher preoperative pain levels, and previous shoulder surgery were negatively associated with satisfactory improvement in pain while lying on the postoperative shoulder. In contrast, subscapularis repair was associated with clinically significant improvements. Given that postoperative pain when lying on the operative side is a frequent preoperative question, understanding these influencing factors is useful when counseling patients on postoperative expectations. Level of evidence: III.

Intramuscular hemangiomas are rare in musculoskeletal pain differentials, especially in the upper extremities. We report a case of a 56-year-old male with an intramuscular hemangioma and abscess in the biceps brachii, presenting with pain, swelling, and limited elbow movement. High C-reactive protein (25.43 mg/dL) and visual analog scale score of 10 were noted. Radiograph showed 3 phleboliths. MRI revealed an enhancing lesion (2.5×2.7×9.8 cm) and abscess. We performed surgery for excision of the intramuscular hemangioma and drainage of the abscess in the biceps muscle. By 5 weeks post-surgery, all functional limitations had resolved, and no recurrence was observed at the 5-month follow-up.

The terrible triad of the shoulder (STT) is an injury involving anterior shoulder dislocation, rotator cuff tear, and nerve injury. The optimal timing for rotator cuff repair (RCR) remains controversial, with some favoring early intervention and others recommending delaying surgery until nerve recovery. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, exploring STT treatment and RCR timing using PubMed, Embase, and Web of Science. The inclusion criteria were studies published in English and involving human subjects. Exclusion criteria included non-English articles, review papers, cadaveric studies, and studies on unrelated conditions. Time to surgery and outcomes related to shoulder and nerve function, such as range of motion, muscle strength, and sensation were analyzed qualitatively. Of 671 articles identified, 28 met inclusion criteria. Most patients underwent surgical RCR and demonstrated excellent functional and neurologic outcomes, with many achieving 150°+ flexion, 110°+ abduction, 4+/5 strength, and resolution of nerve hypoesthesia. RCR timing ranged from 10 days to 6 months, with comparable outcomes regardless of timing. Prompt RCR in STT may be beneficial for maximizing shoulder outcomes, while coexisting nerve injuries should be managed conservatively with watchful waiting, as most recover spontaneously.

Background: The introduction of patient-specific instrumentation (PSI) in total shoulder arthroplasty (TSA) has improved implant positioning accuracy. However, whether PSI yields additional clinical benefit compared to standard instrumentation (SI) in the setting of primary TSA (anatomic and reverse) remains unclear.

Methods: PubMed, Cochrane, Embase, and Google Scholar were queried through August 2024. Inclusion criteria consisted of studies that compared PSI to SI in TSA (anatomic and reverse). Key outcomes analyzed included adverse events, patient-reported outcomes, and discrepancies between planned and achieved implant positioning.

Results: Five retrospective studies, three randomized controlled trials, and one prospective study met the inclusion criteria. There was no difference in complications (odds ratio [OR], 1.00; 95% CI, 0.16 to 6.10; P=1.00), reoperation (OR, 1.35; 95% CI, 0.37 to 4.91; P=0.65), American Shoulder and Elbow Surgeons score (mean difference [MD], 1.61; 95% CI, -4.08 to 7.30; P=0.58), Constant-Murley Score (MD, 3.06; 95% CI, -3.68 to 9.81; P=0.37), version error (MD, -0.76; 95% CI, -2.51 to 0.99; P=0.40), and inclination error (MD, -2.89; 95% CI, -5.82 to 0.05; P=0.05) between the two groups.

Conclusions: This study found no significant differences in patient-reported outcomes, complication rates, or implant positioning accuracy between PSI and SI in primary TSA. Future randomized controlled trials comparing these two types of instrumentation would be useful to assess whether a benefit exists for PSI in the setting of primary TSA. Level of evidence: III.

Background: Lateral epicondylitis (LE), commonly known as tennis elbow, is a condition involving inflammation of the extensor carpi radialis brevis tendon at its attachment to the lateral epicondyle of the humerus. In recent years, platelet-rich plasma (PRP) therapy, an ortho-biologic treatment, has emerged as a promising option for the treatment of LE. Despite promising results in clinical trials, variability in PRP preparation and administration is a barrier to consistent outcomes. To address this, the Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were created in 2017 to establish a standardized approach for reporting findings in PRP-based studies. The objective of this study was to analyze and compare the rate of adherence of the MIBO guidelines in the use of PRP in treating LE.

Methods: This systematic review evaluates the adherence of studies on PRP for LE to MIBO guidelines using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Adherence was determined by calculating the total percentage of checklist items that each study adequately and clearly reported from the 46-point checklist.

Results: A total of 26 studies (954 patients) were included. Overall, only 52.2% of the 46-point MIBO checklist was reported per article on average with 0 articles displaying adherence rates of 100%. There was no significant difference in the mean adherence rates between studies prior to publication of the MIBO guidelines (45.2%) and after (53.7%).

Conclusions: This review demonstrated that studies evaluating the outcomes and procedures of the use of PRP in the setting of LE have poor adherence to MIBO guidelines. There was no difference in the adherence rates in studies published before and after the creation of MIBO guidelines in 2017. Level of evidence: II.

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.