Pub Date : 2024-04-16DOI: 10.1177/17585732241246718
L. Rusimov, A. Baltov, D. Enchev, B. Gueorguiev, Krasimira Prodanova, M. Hadzhinikolova, Vladimir Rusimov, M. Rashkov
This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft. Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant–Murley Score (CSabs), Relative Constant–Murley Score (CSrel), and Individual Relative Constant–Murley Score (CSindiv). Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 ± 16.2/29.6 ± 17.6 months and 60.5 ± 13.7/66.3 ± 11.7 years. CSabs, CSrel, and CSindiv were 57.3 ± 21.2/52.4 ± 18.9, 73 ± 24.1/73.9 ± 23.4, and 69.6 ± 24.8/64 ± 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.409. DASH was 14.8 ± 12.5/18.7 ± 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 ± 9.4/8.2 ± 15.6° and 0.6 ± 5.5/1.4 ± 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.380. Surgical time was 165.8 ± 77.6/84.7 ± 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, p < 0.001. Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.
{"title":"Open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with locking plate and intramedullary allograft: A retrospective study","authors":"L. Rusimov, A. Baltov, D. Enchev, B. Gueorguiev, Krasimira Prodanova, M. Hadzhinikolova, Vladimir Rusimov, M. Rashkov","doi":"10.1177/17585732241246718","DOIUrl":"https://doi.org/10.1177/17585732241246718","url":null,"abstract":"This retrospective clinical study aims to compare the functional and radiological outcomes after open reduction and internal fixation versus minimally invasive plate osteosynthesis of unstable proximal humerus fractures treated with both locking plate and intramedullary graft. Forty-seven patients with proximal humerus fractures were treated with either open reduction and internal fixation (25 cases) or minimally invasive plate osteosynthesis (22 cases) and evaluated retrospectively with a minimum follow-up of 12 months. Thirty-one fresh-frozen fibulae and 16 lyophilized tibia allografts were used for augmentation. Change of both neck-shaft angle and humeral head height were evaluated radiologically. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand Score (DASH), Absolute Constant–Murley Score (CSabs), Relative Constant–Murley Score (CSrel), and Individual Relative Constant–Murley Score (CSindiv). Follow-up period and age for open reduction and internal fixation/minimally invasive plate osteosynthesis were 27.4 ± 16.2/29.6 ± 17.6 months and 60.5 ± 13.7/66.3 ± 11.7 years. CSabs, CSrel, and CSindiv were 57.3 ± 21.2/52.4 ± 18.9, 73 ± 24.1/73.9 ± 23.4, and 69.6 ± 24.8/64 ± 25.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.409. DASH was 14.8 ± 12.5/18.7 ± 14.5 for open reduction and internal fixation/minimally invasive plate osteosynthesis, p = 0.324. Decrease of neck-shaft angle and humeral head height was 7.8 ± 9.4/8.2 ± 15.6° and 0.6 ± 5.5/1.4 ± 2.6 mm for open reduction and internal fixation/minimally invasive plate osteosynthesis, p ≥ 0.380. Surgical time was 165.8 ± 77.6/84.7 ± 38.1 min for open reduction and internal fixation/minimally invasive plate osteosynthesis, p < 0.001. Locked plating with intramedullary graft augmentation of unstable proximal humerus fractures demonstrates similar functional and radiological outcomes when comparing open reduction and internal fixation with minimally invasive plate osteosynthesis. However, minimally invasive plate osteosynthesis is related to significantly shorter surgical time versus open reduction and internal fixation.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140696536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1177/17585732241246756
J. Heifner, Peter A. Falgiano, Thomas O Yergler, Ty A Davis, N. Hoekzema, Jorge L Orbay
Compared to total elbow arthroplasty, elbow hemiarthroplasty (EHA) does not have an ulnar component or a hinge/link which eliminates complication risk due to polyethylene wear and ulnar loosening. There are notable gaps in the existing EHA literature. Patient age is often identified as an important determinant when deciding to treat with EHA; however, there is limited age-based evidence. Our systematic review objectives were (a) to compare EHA outcomes between younger and older adults, and (b) to stratify outcomes for EHA by prosthesis. In compliance with PRISMA guidelines, databases were searched for EHA studies and 65 years was used to delineate younger and older adults. Older adults (N = 159) had a significantly higher elbow arc of motion compared to younger adults (N = 121) at a mean follow-up of 51 months. There was a significantly increased risk for a MEPS below 75 in younger compared to older adults. Mean Disabilities of the Arm, Shoulder, and Hand scores and rates of revision/removal were comparable between age groups. The current findings suggest that although elbow range of motion may be limited in younger adults following EHA, function is satisfactory and comparable to the function in older adults. Additionally, the risk of revision/removal surgery is similar between younger and older adults across short to mid-terms of follow-up.
{"title":"The age specific performance of elbow hemiarthroplasty: A systematic review","authors":"J. Heifner, Peter A. Falgiano, Thomas O Yergler, Ty A Davis, N. Hoekzema, Jorge L Orbay","doi":"10.1177/17585732241246756","DOIUrl":"https://doi.org/10.1177/17585732241246756","url":null,"abstract":"Compared to total elbow arthroplasty, elbow hemiarthroplasty (EHA) does not have an ulnar component or a hinge/link which eliminates complication risk due to polyethylene wear and ulnar loosening. There are notable gaps in the existing EHA literature. Patient age is often identified as an important determinant when deciding to treat with EHA; however, there is limited age-based evidence. Our systematic review objectives were (a) to compare EHA outcomes between younger and older adults, and (b) to stratify outcomes for EHA by prosthesis. In compliance with PRISMA guidelines, databases were searched for EHA studies and 65 years was used to delineate younger and older adults. Older adults (N = 159) had a significantly higher elbow arc of motion compared to younger adults (N = 121) at a mean follow-up of 51 months. There was a significantly increased risk for a MEPS below 75 in younger compared to older adults. Mean Disabilities of the Arm, Shoulder, and Hand scores and rates of revision/removal were comparable between age groups. The current findings suggest that although elbow range of motion may be limited in younger adults following EHA, function is satisfactory and comparable to the function in older adults. Additionally, the risk of revision/removal surgery is similar between younger and older adults across short to mid-terms of follow-up.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140697627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-04DOI: 10.1177/17585732241245377
Ralph Alberto, Apoorva H Mehta, Puneet Gupta, Emily Arciero, Kunj G Patel, David P. Trofa
There has been an increase in the number of total shoulder arthroplasty (TSA) revisions performed as the number of primary surgeries increases rapidly. Revision procedures have a higher failure rate and there is a lack of understanding of patient risk factors for needing another repeat surgery following revision TSA. Revision patients were separated into two cohorts: those needing an unplanned reoperation and those that did not within 30 days following revision TSA. Multivariate logistic regression was performed to identify independent risk factors for an unplanned reoperation. 1909 revision TSA patients were included in the final analysis. Sixty-nine of these patients underwent an unplanned reoperation within 30 days and 1840 did not. Multivariate logistic regression analyses found an ASA class of III or IV, male sex, congestive heart failure, and inpatient setting to be independent risk factors. 3.6% of revision TSA patients require an unplanned reoperation within 30 days postoperatively. An ASA class of III or IV, male sex, congestive heart failure, and inpatient setting were found to be independent risk factors for early reoperation. Surgeons should be aware of these risks to improve preoperative patient optimization and guide shared decision making with patients considering revision.
随着初次手术数量的快速增长，全肩关节置换术（TSA）翻修手术的数量也在增加。翻修手术的失败率较高，而且人们对翻修 TSA 后需要再次手术的患者风险因素缺乏了解。我们将翻修患者分为两组：翻修 TSA 术后 30 天内需要意外再次手术的患者和不需要再次手术的患者。通过多变量逻辑回归来确定意外再次手术的独立风险因素。最终分析共纳入了 1909 名翻修 TSA 患者。其中 69 名患者在 30 天内接受了意外再手术，1840 名患者没有。多变量逻辑回归分析发现，ASA III 级或 IV 级、男性、充血性心力衰竭和住院环境是独立的风险因素。3.6%的TSA翻修患者在术后30天内需要进行计划外再次手术。ASA分级为III级或IV级、男性、充血性心力衰竭和住院环境是早期再次手术的独立风险因素。外科医生应该意识到这些风险，以改善患者的术前优化，并指导考虑翻修的患者共同做出决定。
{"title":"Patient-related risk factors for early unplanned reoperation following revision total shoulder arthroplasty","authors":"Ralph Alberto, Apoorva H Mehta, Puneet Gupta, Emily Arciero, Kunj G Patel, David P. Trofa","doi":"10.1177/17585732241245377","DOIUrl":"https://doi.org/10.1177/17585732241245377","url":null,"abstract":"There has been an increase in the number of total shoulder arthroplasty (TSA) revisions performed as the number of primary surgeries increases rapidly. Revision procedures have a higher failure rate and there is a lack of understanding of patient risk factors for needing another repeat surgery following revision TSA. Revision patients were separated into two cohorts: those needing an unplanned reoperation and those that did not within 30 days following revision TSA. Multivariate logistic regression was performed to identify independent risk factors for an unplanned reoperation. 1909 revision TSA patients were included in the final analysis. Sixty-nine of these patients underwent an unplanned reoperation within 30 days and 1840 did not. Multivariate logistic regression analyses found an ASA class of III or IV, male sex, congestive heart failure, and inpatient setting to be independent risk factors. 3.6% of revision TSA patients require an unplanned reoperation within 30 days postoperatively. An ASA class of III or IV, male sex, congestive heart failure, and inpatient setting were found to be independent risk factors for early reoperation. Surgeons should be aware of these risks to improve preoperative patient optimization and guide shared decision making with patients considering revision.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-02DOI: 10.1177/17585732241244515
Federico Guido, Davide Venturin, Andrea De Santis, G. Giovannico, F. Brindisino
The main goal of this scoping review is to highlight the clinical features of subjects with rotator cuff calcific tendinopathy (RCCT), in order to identify and map this condition clinical criteria, and thus to be able to hypothesize such pathology before imaging investigations. Four databases were consulted up to January 2023. The obtained results were reported following the PRISMA-ScR and the Joanna Briggs Institute reviewer's manual was used as guideline for conducting the review. No time and geographical restrictions were applied. A total of 851 records have been identified, with 50 studies meeting the inclusion criteria. Subjects with RCCT mostly reported nightly, acute and severe pain with spontaneous onset. Symptoms were mostly unilateral. Subjects were mostly women aged between 30 and 60. Deficit in active and passive range of motion was reported, mainly during abduction and forward flexion. Endocrine and metabolic disorders were described as comorbidity, in particular diabetes and thyroid disorders. In this scoping review, the most relevant RCCT clinical features were detected. These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path. III.
{"title":"Clinical features in rotator cuff calcific tendinopathy: A scoping review","authors":"Federico Guido, Davide Venturin, Andrea De Santis, G. Giovannico, F. Brindisino","doi":"10.1177/17585732241244515","DOIUrl":"https://doi.org/10.1177/17585732241244515","url":null,"abstract":"The main goal of this scoping review is to highlight the clinical features of subjects with rotator cuff calcific tendinopathy (RCCT), in order to identify and map this condition clinical criteria, and thus to be able to hypothesize such pathology before imaging investigations. Four databases were consulted up to January 2023. The obtained results were reported following the PRISMA-ScR and the Joanna Briggs Institute reviewer's manual was used as guideline for conducting the review. No time and geographical restrictions were applied. A total of 851 records have been identified, with 50 studies meeting the inclusion criteria. Subjects with RCCT mostly reported nightly, acute and severe pain with spontaneous onset. Symptoms were mostly unilateral. Subjects were mostly women aged between 30 and 60. Deficit in active and passive range of motion was reported, mainly during abduction and forward flexion. Endocrine and metabolic disorders were described as comorbidity, in particular diabetes and thyroid disorders. In this scoping review, the most relevant RCCT clinical features were detected. These clinical criteria, predictive for shoulder RCCT, can be crucial to help all clinicians suspect this musculoskeletal disease early and with certainty, thus allowing for an appropriate and prompt diagnosis path. III.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140755444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/17585732241245054
Simon BM MacLean, P. Caekebeke, J. Phadnis, R. V. van Riet, Gregory I Bain
Partial distal biceps tendon tears encompass a spectrum of disease. They can be either traumatic or degenerative in nature. Traumatic tears usually involve the short head. Degenerative tears can involve either or both short and long head components with the tear affecting the lateral fibres first. Chronic tears may be associated with a narrow radioulnar space, distinct head insertions and radial tuberosity hypertrophy. Patient history and clinical examination findings suggestive of partial tearing of the distal biceps tendon should be confirmed with advanced imaging. Magnetic resonance imaging allows assessment of the tear size, morphology and associated pathologies. Non-surgical management, including physiotherapy and injections, is appropriate in selected cases. Surgical management can involve either endoscopic or open techniques. In small tears or low demand patients, a simple debridement of the bursa, tuberosity and tendon may be indicated. In larger tears in higher functioning patients, release of the remaining fibres, debridement and an anatomical repair is indicated. In this review paper, the authors present current concepts on the pathogenesis and management of partial distal biceps tendon tears.
{"title":"Current concepts in the aetiology, assessment and management of partial distal biceps tendon tears","authors":"Simon BM MacLean, P. Caekebeke, J. Phadnis, R. V. van Riet, Gregory I Bain","doi":"10.1177/17585732241245054","DOIUrl":"https://doi.org/10.1177/17585732241245054","url":null,"abstract":"Partial distal biceps tendon tears encompass a spectrum of disease. They can be either traumatic or degenerative in nature. Traumatic tears usually involve the short head. Degenerative tears can involve either or both short and long head components with the tear affecting the lateral fibres first. Chronic tears may be associated with a narrow radioulnar space, distinct head insertions and radial tuberosity hypertrophy. Patient history and clinical examination findings suggestive of partial tearing of the distal biceps tendon should be confirmed with advanced imaging. Magnetic resonance imaging allows assessment of the tear size, morphology and associated pathologies. Non-surgical management, including physiotherapy and injections, is appropriate in selected cases. Surgical management can involve either endoscopic or open techniques. In small tears or low demand patients, a simple debridement of the bursa, tuberosity and tendon may be indicated. In larger tears in higher functioning patients, release of the remaining fibres, debridement and an anatomical repair is indicated. In this review paper, the authors present current concepts on the pathogenesis and management of partial distal biceps tendon tears.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140780756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1177/17585732241239031
Tim Philips, J. Duerinckx, Laurens Van Melkebeke, R. V. van Riet, P. Caekebeke
Forearm rotation is essential for daily activities and functional dexterity, involving both pronation and supination. Forearm rotation limitations can result from various pathologies, often linked to trauma, structural changes in radio-ulnar joints, and interosseous membrane alterations. Soft tissue contracture, such as post-burn scarring or specific neurological conditions, can also restrict forearm rotation. We present two cases of painless restricted passive and active supination, devoid of bony, neurovascular, soft tissue, or congenital abnormalities. We describe a surgical technique to improve forearm rotation in these patients.
{"title":"The pronator contracture syndrome: A new entity in supination restriction","authors":"Tim Philips, J. Duerinckx, Laurens Van Melkebeke, R. V. van Riet, P. Caekebeke","doi":"10.1177/17585732241239031","DOIUrl":"https://doi.org/10.1177/17585732241239031","url":null,"abstract":"Forearm rotation is essential for daily activities and functional dexterity, involving both pronation and supination. Forearm rotation limitations can result from various pathologies, often linked to trauma, structural changes in radio-ulnar joints, and interosseous membrane alterations. Soft tissue contracture, such as post-burn scarring or specific neurological conditions, can also restrict forearm rotation. We present two cases of painless restricted passive and active supination, devoid of bony, neurovascular, soft tissue, or congenital abnormalities. We describe a surgical technique to improve forearm rotation in these patients.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140218503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.1177/17585732241239030
Joan Tomàs Gebellí-Jové, Antonio Buñuel-Viñau, Marta Canela-Capdevila, Jordi Camps, Fàtima Sabench, Petrea Iftimie-Iftimie
This study aimed to compare hydrodilatation with or without corticosteroid administration on the outcomes of patients with shoulder adhesive capsulitis. This was a prospective, randomized, blinded study of 82 patients with adhesive capsulitis treated with hydrodilatation with corticosteroids (HDC) or without corticosteroids (HDA). Assessments were performed at 48 h and 1, 3, 6, and 12 months. Pain in HDC patients was significantly lower after 48 h of treatment than that of HDA, and the functional scales were better after the first month. These differences were maintained after 1 year. (visual analog scale: 0.8 vs. 1.6, p = 0.018; shoulder pain and disability index: 4.8 vs. 9.8, p = 0.003; simple shoulder test: 11.4 vs. 8.7, p = 0.008; subjective shoulder value: 96.6 vs. 90.1, p = 0.024). We found that hydrodilatation with corticosteroids improved pain levels, shoulder function, and subjective perception of shoulder status compared to hydrodilatation without corticosteroids.
本研究旨在比较水动力扩张术加皮质类固醇或不加皮质类固醇对肩关节粘连性囊炎患者疗效的影响。这是一项前瞻性、随机、盲法研究，82 名粘连性肩关节囊炎患者接受了含皮质类固醇（HDC）或不含皮质类固醇（HDA）的水动力扩张术治疗。在 48 小时、1、3、6 和 12 个月时进行评估。治疗 48 小时后，HDC 患者的疼痛明显低于 HDA 患者，第一个月后的功能量表也更好。这些差异在 1 年后得以保持。(视觉模拟量表0.8 vs. 1.6，p = 0.018；肩痛和残疾指数：4.8 vs. 9.8，p = 0.018）：4.8 vs. 9.8，p = 0.003；简单肩关节测试：11.4 vs. 8.7，p = 0.003）：11.4 vs. 8.7，p = 0.008；肩部主观值：96.6 vs. 90.1，p = 0.024）。我们发现，与不使用皮质类固醇的水动力扩张术相比，使用皮质类固醇的水动力扩张术可改善疼痛程度、肩关节功能和肩关节的主观感觉。
{"title":"A prospective, randomized, blinded study on the efficacy of using corticosteroids in hydrodilatation as a treatment for adhesive capsulitis of the shoulder","authors":"Joan Tomàs Gebellí-Jové, Antonio Buñuel-Viñau, Marta Canela-Capdevila, Jordi Camps, Fàtima Sabench, Petrea Iftimie-Iftimie","doi":"10.1177/17585732241239030","DOIUrl":"https://doi.org/10.1177/17585732241239030","url":null,"abstract":"This study aimed to compare hydrodilatation with or without corticosteroid administration on the outcomes of patients with shoulder adhesive capsulitis. This was a prospective, randomized, blinded study of 82 patients with adhesive capsulitis treated with hydrodilatation with corticosteroids (HDC) or without corticosteroids (HDA). Assessments were performed at 48 h and 1, 3, 6, and 12 months. Pain in HDC patients was significantly lower after 48 h of treatment than that of HDA, and the functional scales were better after the first month. These differences were maintained after 1 year. (visual analog scale: 0.8 vs. 1.6, p = 0.018; shoulder pain and disability index: 4.8 vs. 9.8, p = 0.003; simple shoulder test: 11.4 vs. 8.7, p = 0.008; subjective shoulder value: 96.6 vs. 90.1, p = 0.024). We found that hydrodilatation with corticosteroids improved pain levels, shoulder function, and subjective perception of shoulder status compared to hydrodilatation without corticosteroids.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140227546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1177/17585732241239011
H. Tunnicliffe, P. Divall, Seth O’Neill, Harvinder Singh, David Wright
Conservative management of displaced proximal humerus fractures involves a period of rest in a sling followed by physiotherapy. The aim of this review is to provide a narrative synthesis of how long immobilisation is used, types of slings, when and how exercises are introduced, and if complications may be associated with these components. A systematic search of the literature was undertaken. Two researchers screened relevant articles using Covidence software, with a third reviewer consulted for consensus. Data was extracted and a narrative synthesis is presented. Thirty-nine studies were included (3059 studies screened, 159 full-text reviews). This included a cohort of 2664 patients with a mean age of 70.9. Time immobilised in sling ranged from 1 to 6 weeks. Sling types were variable and were grouped into low, medium and higher levels of support. Exercises were introduced at variable timescales tending to introduce passive and pendular exercises first. Complications were reported in 243 incidences (9.1%). There was vast variation in how long patients were immobilised for, types of slings used and when and how exercises were introduced and progressed. No relationship was found between complications and these components. Research to identify the most effective approach is required.
{"title":"How long is the arm immobilised after a conservatively managed displaced proximal humerus fracture and does early mobilisation effect complication rates: A systematic review","authors":"H. Tunnicliffe, P. Divall, Seth O’Neill, Harvinder Singh, David Wright","doi":"10.1177/17585732241239011","DOIUrl":"https://doi.org/10.1177/17585732241239011","url":null,"abstract":"Conservative management of displaced proximal humerus fractures involves a period of rest in a sling followed by physiotherapy. The aim of this review is to provide a narrative synthesis of how long immobilisation is used, types of slings, when and how exercises are introduced, and if complications may be associated with these components. A systematic search of the literature was undertaken. Two researchers screened relevant articles using Covidence software, with a third reviewer consulted for consensus. Data was extracted and a narrative synthesis is presented. Thirty-nine studies were included (3059 studies screened, 159 full-text reviews). This included a cohort of 2664 patients with a mean age of 70.9. Time immobilised in sling ranged from 1 to 6 weeks. Sling types were variable and were grouped into low, medium and higher levels of support. Exercises were introduced at variable timescales tending to introduce passive and pendular exercises first. Complications were reported in 243 incidences (9.1%). There was vast variation in how long patients were immobilised for, types of slings used and when and how exercises were introduced and progressed. No relationship was found between complications and these components. Research to identify the most effective approach is required.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-18DOI: 10.1177/17585732241239952
Ryan M. Cox, Nikhil Mandava, Alayna K Vaughan, M. Ramsey, Charles L Getz, S. Namdari
The purpose of this retrospective study was to analyze time to fracture union, complications, and outcomes of postoperative periprosthetic humerus fractures after primary shoulder arthroplasty. Retrospective review of patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty at a single institution. Fractures were classified according to the Worland Classification system. Both non-operatively and operatively treated patients were included. The primary study outcomes were time to union and complications. There were 46 patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty, 18 were treated non-operatively and 28 were treated operatively. There were seven (25%) patients who underwent surgery after failed non-operative management. There was only one (2.2%) patient who had a nonunion at final follow-up. The average American Shoulder and Elbow Surgeons Shoulder Score, Single Assessment Numeral Evaluation, and visual analog scale pain scores were 73.5 ± 22.7, 66.5 ± 23.1, and 2.2 ± 2.4, respectively. There was a high rate of union for both non-operatively and operatively treated periprosthetic fractures. However, there was a high rate of cross-over from non-operative to operative treatment and a high complication rate for both cohorts. For properly indicated patients, non-operative and operative treatment can result in satisfactory patient outcomes.
{"title":"Management of periprosthetic humerus fractures after shoulder arthroplasty","authors":"Ryan M. Cox, Nikhil Mandava, Alayna K Vaughan, M. Ramsey, Charles L Getz, S. Namdari","doi":"10.1177/17585732241239952","DOIUrl":"https://doi.org/10.1177/17585732241239952","url":null,"abstract":"The purpose of this retrospective study was to analyze time to fracture union, complications, and outcomes of postoperative periprosthetic humerus fractures after primary shoulder arthroplasty. Retrospective review of patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty at a single institution. Fractures were classified according to the Worland Classification system. Both non-operatively and operatively treated patients were included. The primary study outcomes were time to union and complications. There were 46 patients who sustained a postoperative periprosthetic humerus fracture after primary shoulder arthroplasty, 18 were treated non-operatively and 28 were treated operatively. There were seven (25%) patients who underwent surgery after failed non-operative management. There was only one (2.2%) patient who had a nonunion at final follow-up. The average American Shoulder and Elbow Surgeons Shoulder Score, Single Assessment Numeral Evaluation, and visual analog scale pain scores were 73.5 ± 22.7, 66.5 ± 23.1, and 2.2 ± 2.4, respectively. There was a high rate of union for both non-operatively and operatively treated periprosthetic fractures. However, there was a high rate of cross-over from non-operative to operative treatment and a high complication rate for both cohorts. For properly indicated patients, non-operative and operative treatment can result in satisfactory patient outcomes.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140389628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-11DOI: 10.1177/17585732241237168
Denise Eygendaal
{"title":"‘Wicked problems’ in elbow surgery","authors":"Denise Eygendaal","doi":"10.1177/17585732241237168","DOIUrl":"https://doi.org/10.1177/17585732241237168","url":null,"abstract":"","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140251626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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