Clinics in Shoulder and Elbow最新文献

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.

Rotator cuff repair has experience great development, transitioning from open surgical techniques to minimally invasive arthroscopic methods. This review explores its historical development, current repair techniques, biomechanical considerations, and advances in materials and biological augmentation. It also addresses strategies for managing partial-thickness and massive tears, compares single-row and double-row repairs, and highlights the importance of individualized postoperative rehabilitation. By integrating biomechanical precision with biological innovations, modern rotator cuff repair aims to improve healing rates, reduce retear risk, and optimize functional outcomes.

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.

Background: Accurate pathoanatomic diagnosis of the cause of shoulder pain cannot rely solely on clinical tests. Similarly, diagnosis based on imaging results alone is not reliable due to the high prevalence of asymptomatic pathology. This study aims to assess the diagnostic accuracy of clinical testing with lidocaine injection and ultrasonography as a screening method for detecting supraspinatus disorders compared with magnetic resonance imaging (MRI).

Methods: Patients with supraspinatus-related shoulder pain were collected from outpatient clinics. Clinical tests, ultrasonography, and subacromial lidocaine injections were performed, with tests repeated post-injection. The results were confirmed with MRI findings.

Results: Of 78 patients, the average age was 58±6 years, with 76.9% being normal weight females. Moderate shoulder pain was reported by 75.6% of participants, predominantly on the dominant right side (84.6%), with a significant correlation (P<0.05). The Hawkins-Kennedy test (0.73) and Neer sign (0.68) had the best sensitivity, while the drop arm test (0.93) showed the highest specificity for tendon pathology. For full-thickness tears, the Hawkins-Kennedy and empty can test (0.76) had the best sensitivity, and the drop arm test (0.82) had the best specificity. Lidocaine injection reduced sensitivity but increased specificity, with the drop arm test reaching 0.96. Supraspinatus ultrasonography was over 90% accurate compared with MRI, with a kappa value above 0.7.

Conclusions: Subacromial lidocaine injection reduces sensitivity but increases the specificity of clinical tests for supraspinatus tendon disorders. Ultrasonography can be used as a screening tool for supraspinatus tendon abnormalities. Level of evidence: IV.

Background: Mesenchymal stem cells (MSCs) have shown potential in regenerative medicine. In the present study the effects of MSC dosage and recipient sex on tendon regeneration were evaluated.

Methods: A full-thickness tendon defect (FTTD) was created on supraspinatus tendons (SSTs) of rats and cryoprotective solution (CPS) and MSCs (0.05, 0.1 and 0.5 million MSCs [M-MSC] for female groups and 1.0 M-MSC for both female and male groups) were applied. After 2 and 4 weeks, macroscopic and histological evaluations were performed.

Results: Total macroscopic scores were improved in all MSC groups compared with the CPS group, with no significant differences among the MSC groups. Furthermore, all MSC groups had lower total degenerative scores than the CPS group; however, only 0.1 M-MSC, 0.5 M-MSC, and 1 M-MSC groups showed significantly improved hyalinization compared with the CPS group at 4 weeks. Collagen organization and coherence were higher in all MSC groups than in the CPS group at both 2 and 4 weeks; however, 0.5 M-MSC and 1 M-MSC groups scored better than the 0.05 M-MSC group at 4 weeks. Heterotopic matrix analysis revealed smaller glycosaminoglycan (GAG)-rich areas in the 0.1 M-MSC, 0.5 M-MSC, and 1 M-MSC groups compared with the CPS group at 4 weeks. Overall, macroscopic and histological evaluations were not significantly different between female and male groups except for GAG-rich area.

Conclusions: The MSC dosage affected collagen and heterotopic matrix formation in a FTTD rat model; however, the efficacy of MSCs (1.0 M dose) in collagen regeneration was not affected based on the sex of the recipient. Level of evidence: I.

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.