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Journal of Shoulder and Elbow Surgery Dec 2023Systemic disorders including diabetes mellitus, obesity, and depression affect the outcomes of reverse shoulder arthroplasty (RSA). Sarcopenia (a general skeletal muscle...
BACKGROUND
Systemic disorders including diabetes mellitus, obesity, and depression affect the outcomes of reverse shoulder arthroplasty (RSA). Sarcopenia (a general skeletal muscle disorder) is common in elderly people, but its effect on patients after RSA is not clear. We hypothesized that the preoperative sarcopenia indices of grip strength and general skeletal muscle mass would correlate with the clinical outcomes of RSA.
METHODS
Grip strength and general skeletal muscle mass were measured in patients scheduled (between 2016 and 2021) for primary RSA to treat cuff tear arthropathy, an unrepairable cuff tear, or osteoarthritis with a large cuff tear. Before surgery, grip strength was measured using a hydraulic dynamometer and general skeletal muscle mass was calculated from the appendicular relative skeletal muscle mass index (aRSMI) using dual-energy X-ray absorptiometry. In all, 58 patients were included; the minimal follow-up duration was 12 months. The postoperative clinical results (pain, active range of motion, shoulder strength, and functional scores) were evaluated during scheduled outpatient visits. We calculated correlations between the preoperative sarcopenia indices, and the clinical results at the final follow-up.
RESULTS
The mean preoperative grip strength and aRSMI were 21.6 ± 4.0 kg and 5.98 ± 0.84 kg/m in females and 30.6 ± 7.5 kg and 7.21 ± 0.94 kg/m in males, respectively; the grip strength and aRSMI were not associated with each other (P = .083). Ten females (25%) and 10 males (56%) met the criteria for sarcopenia. The postoperative abduction shoulder strength and Constant-Murley shoulder score increased significantly with higher preoperative grip strength (R = 0.420 and P = .001; and R = 0.497 and P < .001, respectively) and the American Shoulder and Elbow Surgeons score was related to the preoperative aRSMI (R = 0.320, P = .039).
CONCLUSIONS
The shoulder strength and functional score after RSA correlated positively with the preoperative grip strength. Measuring grip strength before RSA allows the surgeon to predict shoulder strength after RSA.
Topics: Male; Female; Humans; Aged; Shoulder; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Sarcopenia; Treatment Outcome; Hand Strength; Range of Motion, Articular; Retrospective Studies; Rotator Cuff Injuries
PubMed: 37516347
DOI: 10.1016/j.jse.2023.06.033 -
Journal of Orthopaedic Research :... Mar 2024The purpose of this study was to develop a multivariable model to determine the extent to which a combination of etiological factors is associated with supraspinatus...
The purpose of this study was to develop a multivariable model to determine the extent to which a combination of etiological factors is associated with supraspinatus tendon tears. Fifty-four asymptomatic individuals (55 ± 4 years) underwent testing of their dominant shoulder. Diagnostic ultrasound was used to assess for a supraspinatus tendon tear. The etiological factors investigated included demographics (age and sex), tendon impingement during shoulder motion (via biplane videoradiography), glenohumeral morphology (via computed tomography imaging), family history of a tear (via self-report), occupational shoulder exposure (via shoulder job exposure matrix), and athletic exposure (via self-report). Univariate relationships between etiological predictors and supraspinatus tears were assessed using logistic regression and odds ratios (ORs), while multivariable relationships were assessed using classification and regression tree analysis. Thirteen participants (24.1%) had evidence of a supraspinatus tear. Individuals with a tear had a higher critical shoulder angle (OR 1.2, p = 0.028) and acromial index (OR 1.2, p = 0.016) than individuals without a tear. The multivariable model suggested that a tear in this cohort can be explained with acceptable accuracy (AUROC = 0.731) by the interaction between acromial index and shoulder occupational exposure: a tear is more likely in individuals with a high acromial index (p < 0.001), and in individuals with a low acromial index and high occupational exposure (p < 0.001). The combination of an individual's glenohumeral morphology (acromial index) and occupational shoulder exposure may be important in the development of supraspinatus tears.
Topics: Humans; Rotator Cuff; Shoulder Joint; Rotator Cuff Injuries; Shoulder; Rupture
PubMed: 37814893
DOI: 10.1002/jor.25699 -
Journal of Shoulder and Elbow Surgery Oct 2023Recently, there has been a rapid shift from open shoulder surgery to arthroscopic shoulder procedures for treating several shoulder pathologies. This shift is mainly due... (Review)
Review
BACKGROUND
Recently, there has been a rapid shift from open shoulder surgery to arthroscopic shoulder procedures for treating several shoulder pathologies. This shift is mainly due to reduced postoperative complications and 30-day readmission. Although the 30-day readmission rate is low, the risk still exists. One way to minimize the risk factors is to analyze all the risk factors contributing to the 30-day readmission following shoulder arthroscopy.
METHODS
Electronic databases such as PubMed, Google Scholar, and Cochrane library were searched. Studies were selected based on predefined inclusion and exclusion criteria. Newcastle-Ottawa score was used for the quality assessment of individual studies. Two reviewers extracted data from the selected studies. Results were evaluated through narrative analysis and presented as an odds ratio with 95% confidence interval. A meta-analysis was not possible due to the heterogeneity in the available data.
RESULTS
A total of 12 studies evaluating 494,038 patients were selected in our review. All the studies have a low risk of bias (median = 8). Significant factors predicting readmission included age, gender, COPD (chronic obstructive pulmonary disorder), steroid use, smoking, preoperative opioid use, higher American Society of Anesthesiologists (ASA) score (3 or higher), and general and regional anesthesia vs. regional anesthesia alone.
CONCLUSION
Through our systematic review, we tried to identify risk factors that can predict 30-day readmission following shoulder arthroscopy. These include age > 65 years, COPD, steroid use, opioid use, and OR time > 90 mins. These high-risk patients could be triaged earlier by identifying these parameters, and effective pre and post-operative surveillance could minimize 30-day readmission risk following shoulder arthroscopy.
Topics: Humans; Aged; Shoulder; Arthroscopy; Patient Readmission; Analgesics, Opioid; Postoperative Complications; Risk Factors; Pulmonary Disease, Chronic Obstructive; Steroids; Retrospective Studies
PubMed: 37263483
DOI: 10.1016/j.jse.2023.04.027 -
PLoS Medicine Nov 2023Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the... (Randomized Controlled Trial)
Randomized Controlled Trial
Surgery with locking plate or hemiarthroplasty versus nonoperative treatment of 3-4-part proximal humerus fractures in older patients (NITEP): An open-label randomized trial.
BACKGROUND
Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking.
METHODS AND FINDINGS
The primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. Between February 2011 and December 2019, 160 patients 60 years and older with 3- and 4-part PHFs were randomly assigned in 1:1:1 fashion in block size of 10 to undergo nonoperative treatment (control) or operative intervention with LP or HA. In total, 54 patients were assigned to the nonoperative group, 52 to the LP group, and 54 to the HA group. Five patients assigned to the LP group were reassigned to the HA group perioperatively due to high comminution, and all of these patients had 4-part fractures. In the intention-to-treat analysis, there were 42 patients in the nonoperative group, 44 in the LP group, and 37 in the HA group. The outcome assessors were blinded to the study group. The mean DASH score at 2-year follow-up was 30.4 (standard error (SE) 3.25), 31.4 (SE 3.11), and 26.6 (SE 3.23) points for the nonoperative, LP, and HA groups, respectively. At 2 years, the between-group differences were 1.07 points (95% CI [-9.5,11.7]; p = 0.97) between nonoperative and LP, 3.78 points (95% CI [-7.0,14.6]; p = 0.69) between nonoperative and HA, and 4.84 points (95% CI [-5.7,15.4]; p = 0.53) between LP and HA. No significant differences in primary or secondary outcomes were seen in stratified age groups (60 to 70 years and 71 years and over). At 2 years, we found 30 complications (3/52, 5.8% in nonoperative; 22/49, 45% in LP; and 5/49, 10% in HA group, p = 0.0004) and 16 severe pain-related adverse events. There was a revision rate of 22% in the LP group. The limitation of the trial was that the recruitment period was longer than expected due to a high number of exclusions after the assessment of eligibility and a larger exclusion rate than anticipated toward the end of the trial. Therefore, the trial was ended prematurely.
CONCLUSIONS
In this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01246167.
Topics: Humans; Female; Middle Aged; Aged; Shoulder; Fracture Fixation; Hemiarthroplasty; Treatment Outcome; Shoulder Fractures; Humeral Fractures
PubMed: 38015877
DOI: 10.1371/journal.pmed.1004308 -
Sensors (Basel, Switzerland) Aug 2023This study aimed to evaluate the reliability of the RSQ Motion sensor and its validity against the Propriometer and electronic goniometer in measuring the active range...
This study aimed to evaluate the reliability of the RSQ Motion sensor and its validity against the Propriometer and electronic goniometer in measuring the active range of motion (ROM) of the shoulder. The study included 15 volunteers (mean age 24.73 ± 3.31) without any clinical symptoms with no history of trauma, disease, or surgery to the upper limb. Four movements were tested: flexion, abduction, external and internal rotation. Validation was assessed in the full range of active shoulder motion. Reliability was revised in full active ROM, a fixed angle of 90 degrees for flexion and abduction, and 45 degrees for internal and external rotation. Each participant was assessed three times: on the first day by both testers and on the second day only by one of the testers. Goniometer and RSQ Motion sensors showed moderate to excellent correlation for all tested movements (ICC 0.61-0.97, LOA < 23 degrees). Analysis of inter-rater reliability showed good to excellent agreement between both testers (ICC 0.74-0.97, LOA 13-35 degrees). Analysis of intra-rater reliability showed moderate to a good agreement (ICC 0.7-0.88, LOA 22-37 degrees). The shoulder internal and external rotation measurement with RSQ Motion sensors is valid and reliable. There is a high level of inter-rater and intra-rater reliability for the RSQ Motion sensors and Propriometer.
Topics: Humans; Young Adult; Adult; Shoulder; Reproducibility of Results; Upper Extremity; Range of Motion, Articular; Rotation
PubMed: 37687955
DOI: 10.3390/s23177499 -
Journal of Shoulder and Elbow Surgery Dec 2023Reverse shoulder arthroplasty (RSA) increases the moment arm of the deltoid; however, there is limited knowledge on the accompanying changes in muscle architecture that...
BACKGROUND
Reverse shoulder arthroplasty (RSA) increases the moment arm of the deltoid; however, there is limited knowledge on the accompanying changes in muscle architecture that play a role in muscle force production. The purpose of this study was to use a geometric shoulder model to evaluate the anterior deltoid, middle deltoid, and supraspinatus regarding (1) the differences in moment arms and muscle-tendon lengths in small, medium, and large native shoulders and (2) the impact of 3 RSA designs on moment arms, muscle fiber lengths, and force-length (F-L) curves.
METHODS
A geometric model of the native glenohumeral joint was developed, validated, and adjusted to represent small, medium, and large shoulders. Moment arms, muscle-tendon lengths, and normalized muscle fiber lengths were assessed for the supraspinatus, anterior deltoid, and middle deltoid from 0° to 90° of abduction. RSA designs were modeled and virtually implanted, including a lateralized glenosphere with an inlay 135° humeral component (lateral glenoid-medial humerus [LGMH]), a medialized glenosphere with an onlay 145° humeral component (medial glenoid-lateral humerus [MGLH]), and a medialized glenosphere with an inlay 155° humeral component (medial glenoid-medial humerus [MGMH]). Descriptive statistics were used to compare moment arms and normalized muscle fiber lengths.
RESULTS
As shoulder size increased, the moment arms and muscle-tendon lengths for the anterior deltoid, middle deltoid, and supraspinatus increased. All RSA designs achieved greater moment arms for the anterior and middle deltoid, with the MGLH design achieving the largest increase. The resting normalized muscle fiber length of the anterior and middle deltoid was substantially increased in the MGLH (1.29) and MGMH (1.24) designs, shifting the operating ranges of these muscles to the descending portions of their F-L curves, whereas the LGMH design maintained a resting deltoid fiber length (1.14) and operating range similar to the native shoulder. All RSA designs demonstrated a decrease in the native supraspinatus moment arm in early abduction, with the largest decrease in the MGLH design (-59%) and minimal decrease in the LGMH design (-14%). The supraspinatus operated on the ascending limb of its F-L curve in the native shoulder and remained on this portion of the F-L curve for all RSA designs.
CONCLUSION
Although the MGLH design maximizes the abduction moment arm for the anterior and middle deltoid, overlengthening of the muscle may compromise deltoid muscle force production by forcing the muscle to operate on the descending portion of its F-L curve. In contrast, the LGMH design increases the abduction moment arm for the anterior and middle deltoid more modestly while allowing the muscle to operate near the plateau of its F-L curve and maximizing its force-producing potential.
Topics: Humans; Shoulder; Arthroplasty, Replacement, Shoulder; Biomechanical Phenomena; Shoulder Joint; Muscle Fibers, Skeletal; Range of Motion, Articular
PubMed: 37419441
DOI: 10.1016/j.jse.2023.05.035 -
JBJS Reviews Aug 2023In smaller studies, allograft-prosthetic composite (APC) has been used for proximal humerus bone loss with some success, although with notable complication risk. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In smaller studies, allograft-prosthetic composite (APC) has been used for proximal humerus bone loss with some success, although with notable complication risk. This systematic review and meta-analysis sought to describe outcomes and complications after proximal humerus APC and how major APC complications are defined in the literature.
METHODS
A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried for articles on APC for proximal humeral bone loss secondary to tumor, fracture, or failed arthroplasty. Primary outcomes included postoperative range of motion, outcome scores (Musculoskeletal Tumor Society [MSTS], Simple Shoulder Test [SST], American Shoulder and Elbow Surgeons [ASES], Constant, visual analog scale [VAS], and subjective shoulder value [SSV]), and complication incidence. We also described individual study definitions of APC malunion/nonunion, methods of postoperative evaluation, malunion/nonunion rates, allograft fracture/fragmentation rates, and mean union time, when available. Secondarily, we compared hemiarthroplasty and reverse total shoulder arthroplasty.
RESULTS
Sixteen articles including 375 shoulders were evaluated (average age: 49 years, follow-up: 54 months). Fifty-seven percent of procedures were performed for tumors, 1% for proximal humerus trauma sequelae, and 42% for revision arthroplasty. Average postoperative forward elevation was 82° (69-94°), abduction 60° (30-90°), and external rotation 23° (17-28°). Average MSTS score was 82% (77%-87%), SST score 5.3 (4.5-6.1), ASES score 64 (54-74), Constant score 44 (38-50), VAS score 2.2 (1.7-2.7), and SSV 51 (45-58). There was a 51% complication rate with an 18% nonallograft surgical complication rate, 26% APC nonunion/malunion/resorption rate, and 10% APC fracture/fragmentation rate. Fifteen percent of nonunited APCs underwent secondary bone grafting; 3% required a new allograft; and overall revision rate was 12%. APC nonunion/malunion was defined in 2 of 16, malunion/nonunion rates in 14 of 16, fracture/fragmentation rates in 6 of 16, and mean union time (7 months) in 4 of 16 studies.
CONCLUSION
APC reconstruction of the proximal humerus remains a treatment option, albeit with substantial complication rates. In addition, there is a need for APC literature to report institutional definitions of nonunion/malunion, postoperative evaluation, and time to union for a more standardized evaluation.
LEVEL OF EVIDENCE
Level IV; systematic review. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Middle Aged; Shoulder; Humerus; Arthroplasty, Replacement, Shoulder; Fractures, Bone; Hemiarthroplasty; Allografts
PubMed: 37616466
DOI: 10.2106/JBJS.RVW.23.00061 -
Physiotherapy Theory and Practice May 2024Propulsive wheelchair capacity may be influenced by arm muscle performance. To determine whether children and adolescent wheelchair-users with spina bifida show reduced...
INTRODUCTION
Propulsive wheelchair capacity may be influenced by arm muscle performance. To determine whether children and adolescent wheelchair-users with spina bifida show reduced arm muscle strength compared to their typically developing peers and to compare muscle strength data obtained by isokinetic and handheld dynamometry (HHD).
METHODS
Participants (mean age 12.5 ± 2.5 years) were assigned to spina bifida (SB; n = 11) or control (n = 22) groups. Isokinetic dynamometry was used to measure peak torque (PT) during dynamic (60°s and 120°s) and isometric strength testing (MVIC) for shoulder and elbow flexors and extensors. HHD was used to measure MVIC of the same muscle groups.
RESULTS
SB showed reduced isokinetic PT for shoulder extensors at 60°s and 120°s, shoulder flexor MVIC, and elbow flexors at 60°s and MVIC; higher PT for shoulder flexors and elbow flexors at 120°s; and decreased MVIC for elbow flexors but not extensors compared to controls when assessed by HHD. The SB and control groups showed strong positive correlations between MVIC data obtained by the two devices for all muscle groups (r ≥ 0.81; p < .01), except for shoulder flexor MVIC in controls (r = 0.68; p < .01).
CONCLUSION
SB presented reduced levels of dynamic slow-speed and isometric shoulder and elbow muscle strength and greater dynamic high-speed shoulder and elbow flexor strength than controls possibly due to the exposure to self-sustained wheelchair ambulation. Exercise-based intervention protocols to increase slow-speed arm muscle strength should be considered in youth with SB. Strong positive correlations observed between muscle strength assessed by isokinetic dynamometry and HHD support the use of HHD in this clinical population.
Topics: Humans; Child; Adolescent; Spinal Dysraphism; Male; Female; Torque; Muscle Strength; Muscle Strength Dynamometer; Wheelchairs; Muscle, Skeletal; Case-Control Studies; Shoulder; Mobility Limitation; Age Factors; Isometric Contraction; Biomechanical Phenomena
PubMed: 36482746
DOI: 10.1080/09593985.2022.2150529 -
Journal of Strength and Conditioning... Feb 2024Giordano, KA, Cassidy, MM, and Oliver, GD. Length-tension differences between concentric and eccentric shoulder rotation strength. J Strength Cond Res 38(2): 253-258,...
Giordano, KA, Cassidy, MM, and Oliver, GD. Length-tension differences between concentric and eccentric shoulder rotation strength. J Strength Cond Res 38(2): 253-258, 2024-Eccentric contractions generally produce more force than concentric contractions. However, if length-tension relationships affect both contractions equally remains unknown. Therefore, our purpose was to compare concentric versus eccentric shoulder external and internal rotation strength across a continuous 90° arc. Fifty-two physically active individuals performed isokinetic concentric and eccentric shoulder external rotation and internal rotation through a 90° arc (forearm horizontal to forearm vertical) with the shoulder elevated in both the frontal and scapular planes. Statistical parametric mapping analysis compared concentric and eccentric trials within subjects. Frontal plane eccentric external rotation torque was greater than concentric 30°-90° (p < 0.01) external rotation, and concentric external rotation torque was greater 5°-15° external rotation (p = 0.01). Frontal plane, eccentric internal rotation torque was greater than concentric 15°-55° external rotation (p < 0.01), and concentric torque was greater at forearm horizontal (p = 0.05) and 70°-90° external rotation (p < 0.01). Scapular plane eccentric external rotation torque was greater than concentric 30°-90° external rotation (p < 0.01) and concentric external rotation torque was greater 5°-20° external rotation (p < 0.01). Scapular plane eccentric internal rotation torque was greater than concentric 15°-60° external rotation (p < 0.01), and concentric torque was greater at forearm horizontal (p = 0.05) and 78°-90° external rotation (p = 0.02). Coaches, clinicians, and researchers should interpret data from studies reporting isokinetic data with the understanding that isokinetic peak strength values are not comparing the same muscle length and are not an appropriate measure for all muscle lengths. Furthermore, shoulder stability is affected through decreased eccentric force production at end ranges of shoulder rotation.
Topics: Humans; Shoulder; Upper Extremity; Forearm; Scapula; Exercise Therapy
PubMed: 38258829
DOI: 10.1519/JSC.0000000000004625 -
Instructional Course Lectures 2024The bony shoulder girdle consists of the clavicle, humerus, and scapula, which work synergistically to form a complex articulation that is essential for use of the upper...
The bony shoulder girdle consists of the clavicle, humerus, and scapula, which work synergistically to form a complex articulation that is essential for use of the upper extremity. The shoulder girdle is the most common location for primary and secondary bone tumors in the upper extremity, and following resection of these tumors, reconstruction of the upper extremity is challenging. Compared with those in the lower extremity, reconstructive techniques in the upper extremity have historically been unreliable and fraught with complications and poor functional outcomes. Newer reconstructive techniques using reverse total shoulder arthroplasty and functional muscle flaps have shown promise to improve outcomes while reducing complications for proximal humerus reconstructions. Despite these advancements, reconstruction following scapulectomy remains challenging and is still associated with more frequent complications and compromised function.
Topics: Humans; Shoulder; Scapula; Humerus; Shoulder Joint; Clavicle; Bone Neoplasms
PubMed: 38090909
DOI: No ID Found