JSES reviews, reports, and techniques最新文献

{"title":"Acromiohumeral center edge angle for predicting degenerative rotator cuff tear in aging patients: a retrospective study","authors":"Nithi Pakmanee MD ,&nbsp;Nuttawut Chanalithichai MD ,&nbsp;Siravich Suvithayasiri MD ,&nbsp;Tanadul Jarrusrojwuttikul MD ,&nbsp;Sasikarn Wanitchakorn MD ,&nbsp;Sittan Aimprasittichai MD","doi":"10.1016/j.xrrt.2025.100590","DOIUrl":"10.1016/j.xrrt.2025.100590","url":null,"abstract":"<div><h3>Background</h3><div>The etiology of degenerative rotator cuff tears (DRCTs) is unclear, although certain distinct acromion morphologies may correlate with degenerative processes. Numerous radiographic measurements attempting to describe acromion morphology have been described previously. This study aimed to validate and study the relationship between the acromiohumeral center edge angle (ACEA) and DRCTs. We also aimed to compare the predictive value of ACEA to more widely studied parameters, including acromion index (AI), lateral acromion angle (LAA), and critical shoulder angle (CSA). We hypothesize that ACEA is a valid and reliable method for predicting DRCTs. Patients who have higher ACEA are more likely to experience DRCTs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 204 shoulder radiographs obtained from patients aged ≥ 40 years. The study population was divided into 2 groups based on rotator cuff status as identified by magnetic resonance imaging. We compared various radiologic parameters in 108 patients with partial and full-thickness DRCTs to 96 patients with intact rotator cuffs. Two independent authors measured the ACEA, AI, LAA, and CSA values on a standardized anteroposterior shoulder radiograph.</div></div><div><h3>Results</h3><div>The mean ACEA was significantly higher in the DRCT group than in the intact group (33.11° vs. 24.56°, <em>P</em> &lt; .001). The ACEA has excellent reliability (intraclass correlation coefficient, 0.99). The cutoff value was determined to be &gt; 29.88° (sensitivity, 0.69; specificity, 0.78). ACEA had the best predictive value (area under the curve: 0.76) and reliability compared with AI, LAA, and CSA.</div></div><div><h3>Conclusion</h3><div>Our study shows that ACEA is an effective predictor of DRCTs. Patients with an ACEA &gt; 29.88° on plain radiography were more likely to have DRCTs.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100590"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466809","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}

{"title":"Outpatient total elbow arthroplasty—outcomes and complications: a systematic review and meta-analysis","authors":"Vishwajeet Singh MBBS, MRCS ,&nbsp;Naadir Nazar MBChB, BSc, PGCertMEd ,&nbsp;Lowilius Wiyono MD ,&nbsp;Axler Jean Paul MD ,&nbsp;Joideep Phadnis MD, FRCS (Tr&Orth)","doi":"10.1016/j.xrrt.2025.100592","DOIUrl":"10.1016/j.xrrt.2025.100592","url":null,"abstract":"<div><h3>Background</h3><div>Total elbow arthroplasty (TEA) is a surgical procedure used in the management of arthritis and fractures. Outpatient total elbow arthroplasty (OTEA) could be a valid option to reduce workforce burden and cost, provided it can be proven to be equally safe and effective as inpatient TEA. This meta-analysis was conducted to evaluate the efficacy and safety of OTEA.</div></div><div><h3>Methods</h3><div>A literature search was performed in PubMed, Embase, Scopus, and Google Scholar using DistillerSR, with predetermined keywords based on the Patient/Problem, Intervention, Control, and Outcome criteria. Studies characterizing OTEA and/or inpatient TEA were included. Total readmissions, revision rates, cost difference, and functional outcome scores were assessed for outpatient vs. inpatient TEA. Risk of bias assessment was performed using the Risk of Bias in Nonrandomized Studies of Interventions tool.</div></div><div><h3>Results</h3><div>Five studies fulfilled the inclusion criteria. Seven hundred twenty-five patients in the outpatient group and 1,461 patients in the inpatient group (control). Incidence of complications was significantly higher in the inpatient cohort compared to the outpatient TEAs (inpatient n = 121 (%) vs. outpatient n = 51 (%), <em>P</em> = .037) Readmissions occurred in 84/1,166 cases (7%). There was no significant difference in the readmission rate between the inpatient (57/745, 7%) and the outpatient (27/421, 6%). The cost of OTEA was lower than inpatient TEA, with a mean of 26, 817 USD in the inpatient group when compared to 18,412 USD for OTEA.</div></div><div><h3>Discussion</h3><div>Clinical results of outpatient vs. inpatient TEA were similar with respect to overall complications, readmissions, and functional scores, and outpatient TEA was more cost effective. Our review indicates that outpatient TEA can be considered by individual care providers after development of appropriate local pathways. This review highlights the need for further high-quality studies in this niche but clinically important field.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100592"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520576","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}

{"title":"The impact of social deprivation on reverse total shoulder arthroplasty outcomes","authors":"Kelly E. Jacoby BS,&nbsp;Logan M. Andryk MD,&nbsp;Andrew Valiquette MD,&nbsp;Matthew Van Boxtel MD,&nbsp;Evan Cox BA,&nbsp;Steven I. Grindel MD ,&nbsp;Alexander Graf MD","doi":"10.1016/j.xrrt.2025.100589","DOIUrl":"10.1016/j.xrrt.2025.100589","url":null,"abstract":"<div><h3>Background</h3><div>Social deprivation has previously been shown to have a negative correlation with patients' overall health. In addition, higher levels of social deprivation have been shown to be correlated with poor postoperative outcomes following orthopedic procedures and health-care–related quality of life. The purpose of this study is to evaluate how a patient's level of social deprivation level, as measured by the Area Deprivation Index (ADI), affects patients with rotator cuff arthropathy (RCA) and their experience with reverse total shoulder arthroplasty (rTSA).</div></div><div><h3>Methods</h3><div>A retrospective review, with an evidence level of 3, composed of 119 patients (133 shoulders) with primary RCA who underwent rTSA by a single surgeon at a single institution from 2005-2020. Social deprivation was determined using the patient's ADI score. Preoperative and postoperative range of motion, visual analog scale scores, American Shoulder and Elbow Surgeon scores, Constant–Murley Scores, and Simple Shoulder Test scores were recorded for each patient. Patients were grouped into terciles based on their level of social deprivation and comparisons were made between the groups. Analysis of variance and student t-testing were used to determine statistically significant differences between the groups.</div></div><div><h3>Results</h3><div>Significant functional improvements were observed following rTSA for patients with RCA. Preoperatively, patients from the most deprived group showed lower average Simple Shoulder Test scores (1.62 vs. 3.04, <em>P</em> = .026), while postoperatively, these patients showed lower external rotation with their arm at the side (33° vs. 42°, <em>P</em> = .044). Otherwise, there were no significant differences in pain or functional outcomes between the ADI groups preoperatively or postoperatively. Notching and postoperative complication rates were also not statistically different between the 3 groups (<em>P</em> = .886 and <em>P</em> = .697, respectively).</div></div><div><h3>Conclusion</h3><div>rTSA is a safe and effective procedure for patients from all levels of social deprivation, and patients can experience similar postoperative shoulder pain and function regardless of their socioeconomic status.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100589"},"PeriodicalIF":0.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467939","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}

{"title":"A comparison between a patient-specific bone regenerative implant and the osteochondral allograft procedure in a Hill-Sachs lesion, a cadaveric study","authors":"Michał S. Gałek-Aldridge MD ,&nbsp;Koen Willemsen MD, PhD ,&nbsp;Sophie H. Nelissen MD ,&nbsp;Bart C.H. van der Wal MD, PhD ,&nbsp;Jos Malda PhD ,&nbsp;Michel P.J. van den Bekerom MD, PhD (Prof.) ,&nbsp;Arthur van Noort MD, PhD","doi":"10.1016/j.xrrt.2025.100591","DOIUrl":"10.1016/j.xrrt.2025.100591","url":null,"abstract":"<div><h3>Background</h3><div>Anterior shoulder instability with &gt;30% humeral bone loss is typically treated with an osteochondral allograft (OCA), though complications and reoperation rates remain high (20%-30%). New methods such as 3D printing are being researched to mitigate these results. This study compares the surface geometry and biomechanical integrity of a 3D-printed biodegradable, patient-specific bone regenerative implant (O3D) to traditional OCA in the treatment of Hill-Sachs lesions (HSLs).</div></div><div><h3>Methods</h3><div>In 14 cadaveric shoulders, HSLs were created in a uniaxial biomechanical set-up and confirmed using imaging. The shoulders were randomized over 2 groups: group A, OCA surgery, and group B, magnesium phosphate-polycaprolactone 3D-printed implant (O3D). After the reconstruction of the HSLs, imaging was performed to measure surface morphology and articular congruence. Finally, uniaxial biomechanical testing was performed to measure postimplantation stability.</div></div><div><h3>Results</h3><div>The average force needed to create a HSL was 1120 N. Implant surface area and joint surface area showed no significant difference between the groups (<em>P</em> = .69 and <em>P</em> = .48). Articular step-off and implantation gap showed no significant difference (<em>P</em> = .67 and <em>P</em> = .54). However, O3D demonstrated significantly better joint congruence (1.26 ± 0.29 mm) than OCA (3.17 ± 1.43 mm, <em>P</em> = .044). Breakout compression forces were not significantly different (<em>P</em> = .80) between the groups: OCA (152 ± 91 N) vs. O3D (144 ± 37 N). Micro computed tomography revealed differing failure mechanisms: cortical compression in OCA vs. layer deformation in O3D, reflecting their respective architectures.</div></div><div><h3>Conclusion</h3><div>Both OCA and O3D implants effectively restored joint integrity in large HSLs. The O3D implant showed superior congruence and equivalent biomechanical performance, illustrating a 3D-personalized, regenerative alternative to allografts.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100591"},"PeriodicalIF":0.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145520560","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}

{"title":"Traumatic posterior shoulder dislocation with associated acromion fracture: a report of 2 cases","authors":"Alexander J. Vervaecke MD ,&nbsp;Alain Meyer MD ,&nbsp;Bastian Sigrist MSc ,&nbsp;Christian Gerber MD, PhD ,&nbsp;Jean-David Werthel MD, PhD","doi":"10.1016/j.xrrt.2025.09.006","DOIUrl":"10.1016/j.xrrt.2025.09.006","url":null,"abstract":"","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100587"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323110","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}

{"title":"National trends in medicare utilization and reimbursement fees for common shoulder arthroscopy procedures performed in ambulatory surgery centers from 2013 to 2022","authors":"Ashlyn A. Donovan MD ,&nbsp;Henry Hojoon Seo BA ,&nbsp;Kevin A. Hao MD ,&nbsp;Seungjun Lee BA ,&nbsp;Robert L. Parisien MD ,&nbsp;Xinning Li MD","doi":"10.1016/j.xrrt.2025.09.001","DOIUrl":"10.1016/j.xrrt.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Arthroscopic shoulder surgeries rank high among the most commonly performed orthopedic procedures at ambulatory surgery centers (ASCs). However, evolving Medicare reimbursement policies have impacted the financial landscape of these procedures. Understanding the utilization and reimbursement trends is paramount to providing accessible patient care for surgeons and facilities. This study reviews the recent national trends in utilization and billing practices for arthroscopic shoulder operations performed in ASCs for Medicare patients from 2013 to 2022.</div></div><div><h3>Methods</h3><div>This study analyzed Medicare Part B claims data using the Centers for Medicare and Medicaid Services Medicare Physician &amp; Other Practitioners database. Current Procedural Terminology (CPT) codes for arthroscopic shoulder operations were used to identify data from 2013 to 2022. The top 4 utilized arthroscopic shoulder CPT codes were included for analysis. Outcomes analyzed included yearly service counts and allowed reimbursement rates from Medicare. The reimbursements reported in the database were a combined value of both the surgeon fee and ASC facility fee. This data was stratified by geographical region. All monetary values for charges and reimbursements were adjusted to the 2022 US dollar.</div></div><div><h3>Results</h3><div>A total of 435,094 arthroscopic shoulder Medicare claims over the 4 most utilized CPT codes were identified between 2013 to 2022. The number of procedures increased annually by an average of 0.7%, resulting in an overall increase of 6.9% over this 10-year period (from 37,796 to 40,397, <em>P</em> = .180). Arthroscopic rotator cuff repair (CPT 29827) increased by an average of 3.1% annually, a substantial overall increase of 36.1% (<em>P</em> = .004). During the study period, average reimbursements decreased by 2.4% (from $1,782 to $1,740, <em>P</em> = .086). Trends in utilization and billing in ASCs varied by procedure and region, with the South having the highest utilization consistently while the Northeast had the highest reimbursement rate despite a decline. Other regions, such as the West, Midwest, and South, exhibited growth in reimbursement trends.</div></div><div><h3>Conclusion</h3><div>Arthroscopic shoulder procedures are increasingly performed in ASCs. However, reimbursements for these procedures declined during the study period (2013-2022). These findings highlight the growing dominance of ASCs as a preferred surgical setting for shoulder arthroscopy procedures. However, this pattern of decreasing reimbursement could threaten the financial sustainability of these procedures. Policy reforms aimed toward securing efficient and cost-effective avenues to provide high-value care while still fostering incentives for physicians to treat patients covered by Medicare are paramount.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100582"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290076","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}

{"title":"Multifragmentary proximal humeral fractures—precise fracture anatomy of the tuberosities identified with three-dimensional computed tomography","authors":"Kazuya Tamai MD, PhD ,&nbsp;Hiroyasu Mizuhara MD ,&nbsp;Hideaki Asai MD, PhD ,&nbsp;Yuji Yamaguchi MD, PhD ,&nbsp;Yuichi Nagase MD, PhD ,&nbsp;Sakae Tanaka MD, PhD","doi":"10.1016/j.xrrt.2025.09.004","DOIUrl":"10.1016/j.xrrt.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Although the Neer classification of proximal humeral fractures typifies fracture anatomy, clinical practice often presents cases in which distinguishing between fracture types can be challenging. Moreover, many atypical fractures, including shield fractures, have been documented. These indicate that the fracture anatomy of the tuberosities is not as simple as Neer's description, particularly in multifragmentary fractures. We hypothesized that three-dimensional computed tomography (3DCT) could provide a comprehensive view of the fractured tuberosities in multifragmentary proximal humeral fractures.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 80 patients, aged 34 to 94 years, who sustained multifragmentary proximal humeral fractures. The initial diagnosis of the surgeons identified 37 three-part fractures, 16 four-part fractures, 19 four-part valgus-impacted fractures, and 8 fracture-dislocations, according to the Neer classification. Pretreatment volume rendering 3DCT scans, including a superior view, were reviewed by 2 orthopedic surgeons. Tuberosity fractures were categorized as single tuberosity pattern (displacement of either the greater or the lesser tuberosity), dual tuberosity pattern (separate displacement of both tuberosities), or shield pattern (displacement of both tuberosities as well as the bicipital groove, encircling the humeral head).</div></div><div><h3>Results</h3><div>The interobserver reliability for categorizing tuberosity fracture patterns was 0.725 in terms of the Cohen's kappa. Tuberosity fractures were identified as a single tuberosity pattern in 41% of cases, a dual tuberosity pattern in 13%, and a shield pattern in 36%. Most of the three-part fractures had a single tuberosity pattern, while all four-part valgus impacted fractures had a shield pattern. Detailed observation of the single tuberosity patterns revealed that, in 68% of cases, the fracture line was located 5 to 10 mm posterior to the anterior margin of the greater tuberosity, leaving the anteriormost portion of the greater tuberosity unfractured.</div></div><div><h3>Conclusion</h3><div>3DCT clearly demonstrated 3 patterns of tuberosity fracture: single, dual, and shield patterns. A shield pattern, an anatomical neck fracture laterally, was common among multifragmentary proximal humeral fractures. In greater tuberosity fractures, the fracture line was located posterior to the supraspinatus tendon insertion in many instances, while a fracture of the entire greater tuberosity was uncommon.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100585"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290139","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}

{"title":"Snapping triceps syndrome: a review of the literature and proposed operative treatment algorithm","authors":"William Zhan Xia FRCS (Tr & Orth) ,&nbsp;Amin Abukar MBBS BSc (Hons), MRCS PG Cert (Clin Ed) ,&nbsp;Hani Moosavi MPharm, MBChB, PGCert MedEd ,&nbsp;Nikhita Nandi BSc (Hons) ,&nbsp;Abbas Rashid FRCS (Tr & Orth)","doi":"10.1016/j.xrrt.2025.08.017","DOIUrl":"10.1016/j.xrrt.2025.08.017","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to conduct a review of the literature on snapping triceps syndrome and to provide an overview on the epidemiology, mechanism, clinical presentation, diagnostic techniques, and treatments of this condition. In addition, we evaluate available evidence base of the current treatments so to recommend appropriate operative techniques in snapping triceps syndrome.</div></div><div><h3>Methods</h3><div>Clinical studies were searched in 5 databases for “snapping triceps” and other similar key search terms. A total of 24 relevant studies were identified. From these we extracted information about number and demographics of patients, presenting symptoms, treatments, and outcomes.</div></div><div><h3>Results</h3><div>A total of 64 patients were recorded. 90.6% (58/64) of the patients had coexisting instability of the ulnar nerve and 64.1% (41/64) had concomitant symptoms of ulnar neuropathy. Surgeries were performed in 67.2% (43/64) of the patients. The snapping triceps was unrecognized during the index surgery of the elbow in as high as 44.2% (19/43) of the operated patients. An operative treatment algorithm was proposed for snapping triceps syndrome.</div></div><div><h3>Conclusion</h3><div>Snapping triceps syndrome is a rare orthopedic condition but often misdiagnosed. The treatments are determined by the severity of presenting symptoms and the conditions which alter the triceps angle. In patients treated with surgery, it is crucial to make sure full resolution of the snapping by examining all dislocating structures during passive elbow motion and/or myoelectrical stimulation. Excellent results of surgery can be achieved with meticulous evaluation.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100580"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145323139","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}

{"title":"Image-guided versus landmark-guided suprascapular nerve block for shoulder pain in rotator cuff tears: a systematic review","authors":"Andrew Kailin Zhou MB, BChir, MA (Cantab), MRCS (Eng) ,&nbsp;Dave Osinachukwu Duru BA Hons (Cantab) ,&nbsp;Saroop Nandra iBSc, MBBS, MRCS (Eng) ,&nbsp;Andrew Metcalfe MBChB, BMedSc, PhD, FRCS (Tr&Orth) ,&nbsp;Salma Chaudhury MB, BChir, MA (Cantab), PhD (Oxon), FRCS (Orth)","doi":"10.1016/j.xrrt.2025.09.002","DOIUrl":"10.1016/j.xrrt.2025.09.002","url":null,"abstract":"<div><h3>Background</h3><div>Suprascapular nerve block (SSNB) is a recognized treatment for chronic shoulder pain, including pain from rotator cuff tears. While it is purported that image-guided SSNB improve injection accuracy over landmark-guided techniques, the impact on clinical outcomes remains unclear. This systematic review compared image-guided vs. landmark-guided SSNB in patients with rotator cuff tears, evaluating efficacy, pain relief, functional improvement, complications, and duration of relief.</div></div><div><h3>Methods</h3><div>We searched PubMed, MEDLINE, Cochrane Library, Embase, and CINAHL (inception to April 2025) for prospective or retrospective studies comparing image-guided (ultrasound, fluoroscopy, computed tomography, or arthroscopic) to landmark-guided SSNB. Two reviewers independently screened titles/abstracts and full texts, with discrepancies resolved by consensus. Data on pain outcomes, functional scores, complications, and duration of pain relief were extracted. Risk of bias was assessed for each study.</div></div><div><h3>Results</h3><div>Thirty studies were included, comprising 25 randomized controlled trials, 2 nonrandomized prospective studies, and 3 retrospective studies, totaling 2,205 patients. Both image-guided and landmark-guided techniques significantly reduced pain and improved shoulder function, with pain reduction typically ranging from 3.2 to 5.5 points on a 0-10 visual analog scale at 48 hours postoperatively. There was no consistent evidence indicating superior clinical outcomes with image-guided techniques in terms of pain relief, functional improvement, complication rates, or duration of analgesia.</div></div><div><h3>Conclusion</h3><div>Both image-guided and landmark-guided SSNB techniques provide effective pain relief and functional improvement in patients with rotator cuff-related shoulder pain. Despite potential procedural advantages of image guidance, such as reduced needle repositioning and higher first-attempt success rates, these benefits did not translate into consistently superior clinical outcomes. This systematic review suggests landmark-guided SSNB offer similar outcomes to image-guided techniques, with implications for resource and expertise availability.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100583"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145290077","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}

{"title":"Dynamic assessment of deltoid stiffness using shear wave elastography: a reliability study in healthy adults","authors":"Jesse Seilern und Aspang MD,&nbsp;Frank L. Vazquez BSAT,&nbsp;Joanne Y. Zhou MD,&nbsp;Jaden Hardrick BS,&nbsp;Zaamin B. Hussain MD, EdM,&nbsp;Sarah M. Taub PA-C,&nbsp;Brittany R. Arnold NP,&nbsp;Michael B. Gottschalk MD,&nbsp;Eric R. Wagner MD, MS, FAAOS, CAQ","doi":"10.1016/j.xrrt.2025.08.018","DOIUrl":"10.1016/j.xrrt.2025.08.018","url":null,"abstract":"<div><h3>Background</h3><div>Deltoid tension plays an important role in maintaining shoulder function. Understanding normative values is essential for accurately restoring deltoid mechanics in pathological conditions; however, there is a notable lack of data on this topic, particularly with respect to objective measurement methods. Shear wave elastography (SWE) is an ultrasound-based imaging modality that provides real-time quantitative assessment of muscle stiffness. This study evaluates the reliability and validity of SWE for measuring deltoid stiffness in different shoulder positions.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted on 21 healthy volunteers without shoulder pathology (8 males and 13 females; mean age 30.6 ± 5.6 years). Twelve SWE measurements of the middle deltoid were obtained for each side (left/right) and shoulder position (resting at side and 90° abduction) using a standardized measurement technique. Measurements were performed by 4 independent operators with varying levels of training and experience in ultrasound measurement (2 expert and 2 novice operators). Intraoperator and interoperator reliability were assessed using the median values for each measuring position, side, and measurer. Validity was assessed using Student's t-tests for resting vs. abducted positions, while reliability was evaluated with intraclass correlation coefficients (ICCs) and paired t-tests for side-to-side consistency.</div></div><div><h3>Results</h3><div>The mean SWE values were 48.37 kilopascals (kPa) (left) and 47.64 kPa (right) at rest, and 158.48 kPa (left) and 155.45 kPa (right) in abduction. Tension was significantly higher in abduction compared to rest (156.97 kPa vs 48.01 kPa, <em>P</em> &lt; .001), confirming construct validity by demonstrating SWE's ability to differentiate muscle stiffness across functional states. Interoperator reliability was good (ICC 0.79), and intraoperator reliability was also good (ICC &gt;0.78). Reliability was also good between the 2 expert operators (ICC 0.878) and the 2 novice operators (0.797), as well as between expert and novice groups (ICC 0.762), indicating reliable measurements across experience levels. No significant difference was found between left and right measurements (<em>P</em> = .656).</div></div><div><h3>Conclusion</h3><div>SWE is a reliable and valid method for quantifying deltoid muscle stiffness across functional states. Its reproducibility across operator experience levels and sensitivity to dynamic changes support its potential clinical utility in perioperative assessment and rehabilitation of shoulder conditions.</div></div>","PeriodicalId":74030,"journal":{"name":"JSES reviews, reports, and techniques","volume":"6 1","pages":"Article 100581"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145418610","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}