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Journal of Shoulder and Elbow Surgery Jan 2020Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this...
BACKGROUND
Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI.
METHODS
In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared.
RESULTS
Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed.
CONCLUSION
FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.
Topics: Adolescent; Adult; Female; Fluoroscopy; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Posture; Prospective Studies; Shoulder; Shoulder Joint; Young Adult
PubMed: 31378683
DOI: 10.1016/j.jse.2019.05.025 -
Musculoskeletal Surgery Mar 2023Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related...
PURPOSE
Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty.
METHODS
Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview.
RESULTS
At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant.
CONCLUSIONS
Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used.
LEVELS OF EVIDENCE
Level II.
Topics: Humans; Aluminum; Shoulder; Hypersensitivity; Metals; Arthroplasty, Replacement; Shoulder Joint
PubMed: 34719773
DOI: 10.1007/s12306-021-00729-4 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Indications and techniques for tendon transfer in irreparable rotator-cuff tear have greatly progressed and are no longer restricted to external rotation deficit. The... (Review)
Review
Indications and techniques for tendon transfer in irreparable rotator-cuff tear have greatly progressed and are no longer restricted to external rotation deficit. The present article first reviews the various types of tear and corresponding tendon transfers and the biomechanics of the pseudoparalytic shoulder. The indication of choice for tendon transfer is iterative tear following failure of isolated long biceps tenotomy or partial repair. Latissimus dorsi, inferior trapezius and pectoralis major transfer are the 3 types to be used after failure of primary surgery. Latissimus dorsi transfer is indicated for partial loss of active limb elevation or isolated loss of internal rotation. Inferior trapezius transfer is best indicated for isolated active external rotation deficit. In pseudoparalytic shoulder with total loss of active elevation or combined loss of elevation and active external rotation, isolated transfer is insufficiently powerful to restore active range of motion and should be associated to reverse arthroplasty. We describe the various transfer techniques and report their results.
Topics: Arthroplasty; Humans; Range of Motion, Articular; Rotator Cuff; Rotator Cuff Injuries; Rupture; Shoulder Joint; Tendon Transfer; Tenotomy
PubMed: 31843509
DOI: 10.1016/j.otsr.2019.05.023 -
The Journal of Bone and Joint Surgery.... Nov 2007There is no simple method available to identify patients who will develop recurrent instability after an arthroscopic Bankart procedure and who would be better served by...
There is no simple method available to identify patients who will develop recurrent instability after an arthroscopic Bankart procedure and who would be better served by an open operation. We carried out a prospective case-control study of 131 consecutive unselected patients with recurrent anterior shoulder instability who underwent this procedure using suture anchors. At follow-up after a mean of 31.2 months (24 to 52) 19 (14.5%) had recurrent instability. The following risk factors were identified: patient age under 20 years at the time of surgery; involvement in competitive or contact sports or those involving forced overhead activity; shoulder hyperlaxity; a Hill-Sachs lesion present on an anteroposterior radiograph of the shoulder in external rotation and/or loss of the sclerotic inferior glenoid contour. These factors were integrated in a 10-point pre-operative instability severity index score and tested retrospectively on the same population. Patients with a score over 6 points had an unacceptable recurrence risk of 70% (p < 0.001). On this basis we believe that an arthroscopic Bankart repair is contraindicated in these patients, to whom we now suggest a Bristow-Latarjet procedure instead.
Topics: Adolescent; Adult; Arthroscopy; Athletic Injuries; Female; Follow-Up Studies; Humans; Joint Instability; Male; Middle Aged; Postoperative Care; Radiography; Range of Motion, Articular; Secondary Prevention; Shoulder Joint; Suture Anchors; Treatment Outcome
PubMed: 17998184
DOI: 10.1302/0301-620X.89B11.18962 -
Journal of Orthopaedics and... Jul 2019The advancement of technologies in orthopaedic surgery should provide the surgeon with precise and trustworthy support for pre-operative planning, intra-operative... (Review)
Review
The advancement of technologies in orthopaedic surgery should provide the surgeon with precise and trustworthy support for pre-operative planning, intra-operative guidance and post-operative follow-up. The request for greater accuracy, predictable results and fewer complications, is the engine of digital evolution in pre-operative planning and computer-assisted surgery (CAS). It is an evolution rather than a revolution, and in the last few years these developments have begun to involve shoulder replacement surgery, too.
Topics: Arthroplasty, Replacement, Shoulder; Humans; Joint Diseases; Shoulder Joint; Surgery, Computer-Assisted
PubMed: 31317280
DOI: 10.1186/s10195-019-0535-1 -
Journal of Orthopaedic Surgery (Hong... 2020There is limited literature to guide shoulder surgeons in the management of juvenile idiopathic arthritis (JIA). We aim to help clinicians to formulate an approach to... (Review)
Review
There is limited literature to guide shoulder surgeons in the management of juvenile idiopathic arthritis (JIA). We aim to help clinicians to formulate an approach to the surgical management of the condition through a review of the available literature on arthroplasty in JIA, general considerations when operating on patients with inflammatory arthropathy and recommendations based on the authors' experience. Four articles report formal data on arthroplasty in JIA with favourable improvements in post-operative pain and function scores after the long-term follow-up. Significant heterogeneity in treatment and a lack of standardisation in quantitative outcomes highlights the need for further larger scale and higher quality research. The aim of this study is to review the evidence and provide information on preoperative evaluation of surgical candidates, operative techniques, choice of implant design and to evaluate functional outcomes in patients who undergo shoulder arthroplasty.
Topics: Arthritis, Juvenile; Arthroplasty, Replacement, Shoulder; Humans; Range of Motion, Articular; Shoulder Joint; Treatment Outcome
PubMed: 31916484
DOI: 10.1177/2309499019890615 -
Arthritis Research & Therapy Jun 2012Shoulder pathology is a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common... (Review)
Review
Shoulder pathology is a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common disorders of the shoulder leading to pain, disability, and degeneration. While research in cartilage regeneration has not yet been translated clinically, the field of shoulder arthroplasty has advanced to the point that joint replacement is an excellent and viable option for a number of pathologic conditions in the shoulder. Rotator cuff disease has been a significant focus of research activity in recent years, as clinicians face the challenge of poor tendon healing and irreversible changes associated with rotator cuff arthropathy. Future treatment modalities involving biologics and tissue engineering hold further promise to improve outcomes for patients suffering from shoulder pathologies.
Topics: Humans; Joint Diseases; Shoulder; Shoulder Joint
PubMed: 22709417
DOI: 10.1186/ar3846 -
Orthopaedics & Traumatology, Surgery &... Dec 2014Suprascapular nerve entrapment was first described in 1959 by Kopell and Thompson. Although rare, this condition is among the causes of poorly explained shoulder pain in... (Review)
Review
Suprascapular nerve entrapment was first described in 1959 by Kopell and Thompson. Although rare, this condition is among the causes of poorly explained shoulder pain in patients with manifestations suggesting a rotator-cuff tear but normal tendons by imaging studies. Suprascapular nerve entrapment may cause 2% of all cases of chronic shoulder pain. Among the many reported causes of suprascapular nerve entrapment, the most common are para-labral cysts, usually in the spinoglenoid notch, and microtrauma in elite athletes. The potential relevance of concomitant rotator-cuff tears remains debated. Less common causes include tumours, scapular fractures, and direct trauma involving traction. Early diagnosis and treatment are crucial to avoid the development of irreversible muscle wasting. Endoscopic surgery to treat the various causes of suprascapular nerve compression has superseded open nerve release.
Topics: Arthroscopy; Decompression, Surgical; Humans; Nerve Compression Syndromes; Range of Motion, Articular; Shoulder; Shoulder Joint
PubMed: 25454727
DOI: 10.1016/j.otsr.2014.10.002 -
BioMed Research International 2019The incidence of septic arthritis of the shoulder joint is increasing as the population ages. The prevalence of shoulder infection is also increasing because of the...
BACKGROUND
The incidence of septic arthritis of the shoulder joint is increasing as the population ages. The prevalence of shoulder infection is also increasing because of the growing use of arthroscopy and expansion of procedures in the shoulder. However, cultures do not always identify all microorganisms, even in symptomatic patients. The incidence of negative cultures ranges from 0% to 25%. Few studies have reported clinical features and treatment outcomes of culture-negative shoulder infections. This cohort study addresses culture-negative shoulder joint infections in nonarthroplasty patients. This study aimed to compare clinical characteristics and treatment outcomes of patients with culture-negative results to those with culture-positive results. Our hypothesis was that culture-negative infections would have more favorable outcomes than culture-positive infections.
METHODS
We retrospectively reviewed data of 36 patients (17 culture-negative and 19 culture-positive) with shoulder infections between June 2004 and March 2015. The minimum follow-up duration was 1.2 years (mean, 5 ± 3.8 years; range, 1.2-11 years). We assessed preoperative demographic data and characteristics, laboratory markers, imaging and functional scores, intraoperative findings, and postoperative findings of both groups.
RESULTS
Culture-negative patients (17/36, 47.2%) had a significantly lower occurrence of repeated surgical debridement (culture-negative vs. culture-positive: 1.2 ± 0.4 vs. 2.4 ± 1.7, = 0.002) without osteomyelitis. In the multiple logistic regression analysis, the presence of osteomyelitis [odds ratio (OR) = 9.7, 95% confidence interval (CI): 1.0-91.8, =0.04)] and the number of surgical debridements (OR = 5.3, 95% CI: 1.3-21.6, =0.02) were significantly associated with culture-positive infections.
CONCLUSIONS
Culture-negative infections without osteomyelitis are less severe than culture-positive infections. Culture-negative infections can be controlled more easily and are not necessarily a negative prognostic factor for shoulder joint infections.
Topics: Adult; Aged; Aged, 80 and over; Arthroscopy; Female; Humans; Inflammation; Logistic Models; Male; Middle Aged; Rotator Cuff; Shoulder Joint; Staphylococcal Infections; Treatment Outcome
PubMed: 30891455
DOI: 10.1155/2019/3756939 -
BMC Veterinary Research May 2020Arthroscopic surgery is described as a minimally invasive technique for diagnosis, exploration and treatment of joint disorders. It allows intraarticular structures to...
BACKGROUND
Arthroscopic surgery is described as a minimally invasive technique for diagnosis, exploration and treatment of joint disorders. It allows intraarticular structures to be assessed accurately, thereby improving the diagnostic capabilities, and it broadens the spectrum of surgical techniques feasible for treatment of articular pathologies in cattle. This study aimed to assess for cattle the described arthroscopic approaches to the shoulder joint of horses, and to describe the appearance of the corresponding intraarticular structures of the shoulder joint. Additionally, to perform histological examination where tissues were identified and assessed arthroscopically, but the tissue type was uncertain using cadaveric limbs from cattle of different age categories without any signs of orthopedic diseases of the front limbs.
RESULTS
An anatomic and arthroscopic investigation with 34-cadaveric forelimbs from 20-cattle was performed. The arthroscope was inserted either immediately cranial or 1-cm caudal to the tendon of the infraspinatus muscle for the cranial and caudal approaches, respectively. The shoulder joints were examined with the limbs in either horizontal non-pulled position, abducted non-pulled position using a three-pod limb holder adjustable in height, or horizontal manually pulled position. Arthroscopy was performed using a rigid 30°arthroscope (18-cm length, 4-mm outer diameter) to view the synovial pouches with their synovial villi and the following structures: cranial rim of the glenoid, cranial portion of the humeral head, incisura-glenoidalis, caudal rim of the glenoid, caudal portion of the humeral head, and cranial and caudal cul-de-sac. Abduction of the limb allowed improved visualization of the lateral portion of the joint. Pulling the limb facilitated investigation of the medial portion of the joint. Generally, the distention range was higher in younger as compared to adult cattle, and visualization of the medial portion of the joint was, therefore, facilitated in younger animals. The main complications observed were subcutaneous fluid extravasations and partial-thickness articular cartilages wear-lines.
CONCLUSION
The described arthroscopic techniques allowed good overall visualization of the most relevant anatomical structures within the healthy cadaveric joint. Further investigations are warranted to evaluate the diagnostic and therapeutic applications of these techniques and the prognosis of arthroscopic surgery as a tool for the treatment of joint lesions.
Topics: Animals; Arthroscopy; Cattle; Shoulder Joint
PubMed: 32448261
DOI: 10.1186/s12917-020-02337-z