American Shoulder Elbow Surgeons Research Articles

Outcomes after revision surgery for glenoid baseplate failure in reverse shoulder arthroplasty

Background The purpose of this study was to report clinical outcomes in patients who underwent revision surgery for glenoid baseplate failure after index reverse shoulder arthroplasty (RSA). Methods A retrospective review was performed to identify patients from 2010 to 2020 at a single institution who sustained glenoid baseplate failure after RSA and underwent revision surgery. Exclusion criteria included periprosthetic joint infection or lack of minimum 1 year clinical and radiographic follow-up. Included patients were contacted for clinical outcomes (American Shoulder Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain, Single Assessment Numeric Evaluation (SANE) and Patient Satisfaction scores). Results A total of 24 patients were identified, and 22 out of 24 (92%) patients were available for clinical follow-up at a mean period of 3.4 years after final revision surgery. The mean age was 70 years, and 15 out of 22 (68%) patients were female. A total of 17 patients were revised to RSA, and five patients were revised to hemiarthroplasty. For the 22 included patients, the mean follow-up ASES score was 64.6, VAS pain was 2.4 and SANE was 58%, which were all significantly improved versus pre-revision. In total, 64% of patients were satisfied or completely satisfied. Discussion Revision surgery after glenoid baseplate failure in RSA yields unpredictable clinical outcomes. Revision to RSA or hemiarthroplasty both resulted in modest functional results with persistent mild pain.

Poster 159: At-home physical therapy with a remote monitoring digital health platform leads to similar patient reported outcomes compared to traditional in-office physical therapy following shoulder surgery

Objectives: Physical therapy (PT) following shoulder surgery has traditionally occurred via in-office supervised visits. Recently digital health tools with remote patient monitoring (RPM) have emerged as an option to enhance the ability to both monitor and encourage engagement of home PT. The appeal of such tools has been accelerated by the impact of COVID-19 on the healthcare system. The primary purpose of this study was to compare patient-reported outcomes (PROs) following shoulder surgery of patients who completed at-home PT with a digital rehab application to patients who completed in-office supervised PT. The secondary purpose was to assess engagement among patients who used digital PT. Methods: A retrospective matched comparative evaluation was performed of patients who underwent arthroscopic shoulder surgery or shoulder arthroplasty at a single institution between April 2020 and May 2021. Patients who underwent home-based physical therapy with a digital remote monitoring platform (PT Genie; Orland, FL) were identified and age and procedure matched (arthroscopy or arthroplasty) to a cohort of patients that underwent in-office physical therapy. The digital platform provided remote monitoring capabilities with measurement of range of motion. PROs measured preoperatively and at 1 year postoperative included visual analog scale pain score (VAS), American Shoulder Elbow Surgeons Score (ASES), and Single Assessment Numeric Evaluation (SANE). Engagement measured as the number of sessions recorded was analyzed in the digital PT based on 6 age groups (≤40, 41-50, 51-60, 61-70, 71-80, and 81+). Statistical analysis using the student t-test to compare means was performed using SPSS version 17 (SPSS Inc., Chicago). Results: A total of 862 patients were identified, including 396 arthroscopic surgeries (198 in each PT group) and 466 in the arthroplasty group (233 patients in each PT group). The groups were similar at baseline other than a higher preoperative ASES score in the digital PT arthroplasty group (Table 1). There was no significant difference in any PROs between the two groups at 1-year follow-up. The highest engagement in the digital PT group was observed in the arthroplasty group and over the age of 50 (Figure 1). Conclusions: There appears to be no difference in PROs following shoulder surgery whether physical therapy is performed in-office or at home via a digital platform. Interestingly, engagement with digital PT was highest in older patients, suggesting that the technology is not a large barrier. Although further study is needed to confirm these findings, benefits of digital PT with remote monitoring may include: 1) Decreased cost for the healthcare system, 2) Decreased travel time for the patient, and 3) Scheduling efficiency and improved access to the PT for the patient.

Anterior deltoid muscle reflection using a deltopectoral approach is safe and does not influence outcome of reverse shoulder arthroplasty.

The deltopectoral approach is well accepted for shoulder arthroplasty procedures. The extended deltopectoral approach with detachment of the anterior deltoid from the clavicle allows increased joint exposure and can protect the anterior deltoid from traction injury. The efficacy of this extended approach has been demonstrated in anatomical total shoulder replacement surgery. However, this has not been shown in reverse shoulder arthroplasty (RSA). The primary aim of this study was to evaluate the safety of the extended deltopectoral approach in RSA. The secondary aim was to evaluate the performance of the deltoid reflection approach in terms of complications, surgical, functional and radiological outcomes up to 24 months post-surgery. A prospective non-randomized comparative study was performed between January 2012 and October 2020 including 77 patients in the deltoid reflection group and 73 patients in the comparative group. Decision for inclusion was based on patient and surgeon factors. Complications were recorded. Patients were followed up for at least 24 months to evaluate their shoulder function and ultrasound evaluation. Functional outcome measures included the Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder Elbow Surgeons score (ASES), pain intensity (VAS 0-100), range of motion (forward flexion (FF), abduction (AD), and external rotation (ER)). A regression analysis was performed to evaluate any factors of influence on the VAS. There were no significant differences in the rate of complications between the two groups (14.5% in the deltoid reflection group and 13.8% in the comparative group, p=0.915). Ultrasound evaluation was available in 64 (83.1%) patients, and no proximal detachment was observed. In addition, there were no significant differences in functional outcome measures both preoperatively and at 24 months post-surgery between the groups on Mean VAS pain, OSS, DASH, ASES, FF, ABD, and ER. Adjustment for possible confounders in a regression model indicated that only prior surgery significantly influenced the VAS pain (p=0.031, 95%CI 0.574 - 11.67) after surgery. Deltoid reflection (p=0.068), age (p=0.466), sex (p=0.936), glenoid graft (p=0.091), prosthesis manufacturer (p=0.382) and preop VAS score (p=0.362) were not of influence. Results of this study show an extended deltopectoral approach for RSA is safe. Selected reflection of the anterior deltoid muscle improved exposure and prevents anterior deltoid muscle injury followed by re-attachment. Patients had similar functional scores preop and at 24 months compared to a comparative group. Furthermore, ultrasound evaluation showed intact re-attachments.

Exactech Equinoxe anatomic versus reverse total shoulder arthroplasty for primary osteoarthritis: case controlled comparisons using the machine learning–derived Shoulder Arthroplasty Smart score

<h2>Abstract</h2><h3>Background</h3> The role of reverse total shoulder arthroplasty (rTSA) for glenohumeral osteoarthritis (GHOA) with an intact rotator cuff remains unclear with prior investigations demonstrating similar patient reported outcome measures (PROMs) to anatomic total shoulder arthroplasty (aTSA). However, legacy PROMs are subject to skewed distributions with many patients achieving the maximum possible score (ceiling scores). We evaluated a cohort of primary rTSAs performed for GHOA with an intact rotator cuff compared to a case matched cohort of aTSAs utilizing the Shoulder Arthroplasty Smart score (SAS), a machine learning derived PROM which eliminates the ceiling effect. <h3>Methods</h3> A retrospective review of an international shoulder arthroplasty database was performed between 2001 and 2020. Patients undergoing rTSA for rotator cuff intact GHOA (n = 367) were matched 1:1 with aTSA controls (n = 367) with a minimum of 2-year follow-up. Assessed variables included patient demographics, range of motion, American Shoulder Elbow Surgeons score (ASES), Constant, Simple Shoulder Test (SST), and the SAS score. <h3>Results</h3> Preoperatively, the SAS (49.0 vs. 45.2; <i>P</i> < .001), SST (4.7 vs. 4.1; <i>P</i> = .002), and Constant score (42.5 ± 15.3 vs. 38.1 ± 14.2; <i>P</i> < .001) were greater in aTSA versus rTSA. Similarly, the SAS score (82.3 vs. 77.6; <i>P</i> < .001) and SST score (10.8 vs. 10.3; <i>P</i> = .003) remained greater in aTSA postoperatively. In contrast, no differences in the ASES (<i>P</i> = .103) or Constant scores (<i>P</i> = .108) were found between aTSA and rTSA patients postoperatively. Improvement preoperatively to postoperatively did not differ between aTSA and rTSA patients when assessed using the SAS (<i>P</i> = .257), ASES (<i>P</i> = .888), or SST scores (<i>P</i> = .510). However, a higher rate of improvement in the Constant score (31.8 vs. 35.0; <i>P</i> = .022) was observed in the rTSA compared to aTSA. A higher rate of complications (5.4% vs. 1.6%; <i>P</i> = .008). and revision surgery (4.1% vs. 0.5%; <i>P</i> = .002) were observed in aTSA compared to rTSA. <h3>Conclusions</h3> Patients undergoing shoulder arthroplasty for rotator cuff intact GHOA experienced higher rates of complications and revisions in aTSA compared to rTSA, but similar levels of clinical improvement between implants when evaluated using a validated outcome score without a ceiling effect. Unlike the ASES and SST scores which are limited by ceiling effects, a higher mean postoperative SAS score after aTSA was observed but preoperative to postoperative SAS differences were similar to after rTSA.

Poor Psychological Readiness Inhibits Return to Play Following Operative Management of Superior-Labrum Anterior-Posterior Tears

The purposes of this study were to determine why athletes did not return to play (RTP) following operative management of superior-labrum anterior-posterior (SLAP) tears, compare these athletes to those who did RTP, and evaluate the SLAP-Return to Sport after Injury (SLAP-RSI) score to assess the psychological readiness of athletes to RTP after operative management of SLAP tears. A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 24-month follow-up was performed. Outcome data, including visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, patient satisfaction, and whether they would undergo the same surgery again was collected. Additionally, the rate and timing of return to work (RTW), the rate and timing of RTP, SLAP-RSI score, and VAS during sport were evaluated, with subgroup analysis among overhead and contact athletes. The SLAP-RSI is a modification of the Shoulder Instability-Return to Sport after Injury (SI-RSI) score, with a score >56 considered to be a passing score for being psychologically ready to RTP. The study included 209 athletes who underwent operative management of SLAP tears. A significantly higher percentage of patients who were able to return to play passed the SLAP-RSI benchmark of 56 compared to those who were unable to return (82.3% vs 10.1%; P < .001), and the mean overall SLAP-RSI scores were also significantly higher among those capable of returning to play (76.8 vs 50.0; P < .0001). Additionally, there was a significant difference between the two groups in every component of the SLAP-RSI score (P < .05 for all). Fear of reinjury and the feeling of instability were the most common reasons for not returning to play among contact athletes. Residual pain was the most common complaint among overhead athletes. A binary regression model predicting return to sports was performed, which demonstrated ASES score (odds ratio [OR]: 1.04, 95%; (confidence interval [CI]: 1.01-1.07; P= .009), RTW within 1 month after surgery (OR: 3.52, 95%; CI: 1.01-12.3; P= .048), and SLAP-RSI score (OR: 1.03, 95%; CI: 1.01-1.05; P= .001) were all associated with greater likelihood of return to sports at final follow-up. Following the operative management of SLAP tears, patients who are unable to RTP exhibit poor psychological readiness to return, which may be due to residual pain in overhead athletes or fear of reinjury in contact athletes. Lastly, the SLAP-RSI tool in combination with ASES proved to be useful in identifying patients' psychological and physical readiness to RTP. Level IV, prognostic case series.

Arthroplasty as Primary Treatment for Metadiaphyseal Proximal Humerus Fractures: A Viable Alternative to Osteosynthesis for the Elderly.

in the elderly patient population, where fracture comminution, osteoporotic fractures, and associated arthritis or rotator cuff pathologies dominate, metadiaphyseal proximal humeral fracture is a challenging subset of fractures to treat. This study reports on cementless long-stem reverse total shoulder arthroplasty (RTSA) as primary treatment of metadiaphyseal proximal humeral fractures in elderly patients. Between January 2018 and October 2021, 22 consecutive patients sustained proximal humerus fractures with metadiaphyseal extension and underwent surgery with cementless long-stem RTSA. Patients older than 60 years with minimum 1 year of clinical and radiographic follow-up were included. Patient demographics, range of motion, and patient reported outcomes [Visual Analog Scale (VAS) pain scale, Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), and American Shoulder Elbow Surgeon (ASES) scores] were retrospectively collected. Postoperative X-rays were evaluated for fracture and tuberosity union. There were 14 eligible patients with a median age of 71 years (range 61-91 years) and a median 13 months follow-up. At final follow-up, the median active elevation was 120° (range 80°-150°), external rotation was 40° (range 0°-50°), and internal rotation was 40° (range 0°-80°). Median VAS was 2 (range 0-8), SST was 71% (range 33%-92%), SSV was 78% (range 20-90%), and ASES was 73 (range 17-90). All patients exhibited radiographic union. There were five minor complications in three patients: postoperative neuropathy, tuberosity nonunion, scapula notching, and proximal humeral stress shielding. Cementless long-stem RTSA is a viable alternative to primary fracture fixation in the elderly patient population with metadiaphyseal proximal humerus fractures.

Substantial clinical benefit values demonstrate a high degree of variability when stratified by time and geographic region.

A Substantial Clinical Benefit (SCB) value is the amount of change in a patient-reported outcome measure required for a patient to feel they significantly improved from an intervention. Previously published SCB values are often cited by researchers when publishing outcomes data. Where these SCB values are set can have a large impact on the conclusions drawn from a study citing them. As such, the goal of this study was to determine the generalizability of SCB values for a procedure when stratified by time from surgery and geographic region. A nationwide outcomes database was utilized to obtain preoperative, one-year, and two-year postoperative outcome measurements for patients who underwent anatomic total shoulder arthroplasty (TSA) or reverse TSA. The data were divided into three geographic regions: the South, the Midwest, and the West. An East region was not included due to its limited number of patients. SCB values were calculated for four outcomes measures: Single Assessment Numeric Evaluation score, American Shoulder Elbow Surgeons score, Visual Analog Scale, and Western Ontario Osteoarthritis of the Shoulder score. SCB values were calculated for each region, for each procedure, and at both one and two years postoperatively. To determine the variability of potential SCBs within each region, simulated datasets were created to determine a distribution of possible calculated SCBs. A total of 380 anatomic TSA patients and 543 reverse TSA patients were included for analysis. There was a high degree of variability of SCB values when stratified by procedure, time, and region. While some simulated datasets did produce homogenous SCB distributions among regions, some outcome measures demonstrated a large heterogeneity in distribution among regions, with concomitant large distributions of values within individual regions. There is notable heterogeneity of SCB values when stratified by region or time. The current method of citing previously published SCB values for determining the efficacy of an intervention may be inappropriate. It is likely that this variability holds true in other areas of orthopedics.

Short-term clinical effectiveness of 5% lidocaine patch after arthroscopic rotator cuff repair: study protocol for a randomized, double-blinded, placebo-controlled clinical trial

BackgroundArthroscopic rotator cuff repair (ARCR) often causes unbearable postoperative pain, even more severe than before surgery. Opioids are the drugs of choice for temporary postoperative analgesia. However, this conventional approach also has some side effects and potential for drug abuse. The aims of this study are expected to verify the effect of 5% lidocaine patch (LP5) on the intensity of early postoperative pain, functional recovery and quality of life in patients undergoing ARCR.MethodsIn this randomized, double-blind, and placebo-controlled clinical trial, a total of 102 postoperative patients undergoing ARCR will be randomly assigned to either the LP5 group, receiving topical lidocaine analgesia, or the placebo control group. The primary outcome measure will be the change in the American Shoulder Elbow Surgeons score from pre-operation to 90 days post-operation. Secondary outcomes will include pain scores, range of motion, opioid use, safety indicators, blinding assessment and several shoulder function score questionnaires. The effect of the allocated treatment will be assessed at preoperative baseline and at 7-, 14-, 30- and 90-day postoperatively.DiscussionIn this study, the efficacy and safety of the 5% lidocaine patch will be evaluated in terms of short-term clinical symptoms in patients undergoing ARCR. The results of this study will help determine whether LP5 is effective in early functional recovery in ARCR and whether it relieves pain and reduces opioid consumption.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR2200060108. Registered on 19 May 2022.

Arthroscopic-Assisted Double-Bundle Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tape Provides Superior Vertical Stability Than the Single-Bundle Reconstruction for Acute Acromioclavicular Joint Dislocation

This study aimed to compare clinical and radiologic outcomes between single- and double-bundle arthroscopic-assisted coracoclavicular (CC) ligament reconstruction using cortical fixation buttons with suture tapes for acute acromioclavicular (AC) joint dislocation. Patients who underwent arthroscopic-assisted CC ligament reconstruction using cortical fixation buttons with suture tapes for acute AC joint dislocation from July 2014 to March 2019 were identified. This study included patients treated for acute AC joint dislocation within 2 weeks after an injury, with a Rockwood classification of III or V and at least 2 years of follow-up. Patients were divided into 2 groups based on the reconstruction technique: group I (single-bundle technique) and group II (double-bundle technique). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Constant score, and visual analog scale for pain score between the 2 groups. On the plain radiograph, the CC interval ratio (CCIR) was measured to evaluate maintenance of CC interval fixation. Postoperative complications, including reduction failure, were also documented. Fifty-eight patients (26 in group I, 32 in group II) were enrolled. There were no significant differences in CCIR between the 2 groups preoperatively and 3 months postoperatively. However, the CCIR of group I was significantly greater than that of group II 6 months postoperatively (group I: 160.5% ± 48.5%, group II: 125.4% ± 38.9% at 6 months postoperatively, P= .01; group I: 164.0% ± 57.3%, group II: 123.2% ± 35.9% at the last visit, P= .01). Despite radiologic differences, the clinical outcomes demonstrated no significant differences between 2 the groups (ASES score: 93.5 ± 5.2 in group I, 94.4 ± 4.5 in group II, P= .54; Constant score: 92.9 ± 5.3 in group I, 94.8 ± 4.3 in group II, P= .16). Reduction failure occurred in 4 patients (15.3%) in group I and in 1 patient (3.2%) in group II (P= .16). Arthroscopic-assisted double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes provided superior vertical stability than the single-bundle technique. Level III, retrospective comparative study.

Gender does not impact clinical outcomes following SLAP repair.

The purpose of the current study was to investigate whether pain, function, satisfaction, return to play (RTP), or psychological readiness to RTP differ between sexes post-operatively following SLAP repair. A retrospective review of patients who underwent arthroscopic repair of a SLAP tear was performed. The American Shoulder & Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS), Subjective Shoulder Value (SSV), patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. Clinical outcomes were compared between male and female patients. Our study included 169 patients treated with SLAP repair, 133 of them male (78.7%) and 36 of them female (21.3%), with an average age of 32.3 ± 8.3 and 33.4 ± 6.8 respectively. The mean follow-up duration was 5.8 years. At final follow up, there was no difference between treatment groups in any of the functional outcome measures assessed (p > 0.05). There is no difference in clinical outcomes, function, satisfaction, or revision procedures in mid- to long-term follow-up after SLAP repair between male and female patients. This data is useful in the preoperative counselling of patients undergoing arthroscopic management of symptomatic superior labral pathology. III.

High Rate of Satisfaction and Return to Play at 5-Year Follow-Up After Arthroscopic Superior-Labrum Anterior-Posterior Repairs

The purpose of this study was to evaluate the outcomes of patients 5 years postoperatively following arthroscopic SLAP repair, and to evaluate factors associated with satisfaction. A retrospective review of patients who underwent SLAP repair with a minimum of 5-year follow-up was performed. Recurrence, visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, satisfaction, whether they would undergo the same surgery again, and the rate, level and timing of return to play (RTP) were evaluated. Multilinear regression models were used to evaluate factors affecting postoperative satisfaction. Overall, 122 patients who underwent SLAP repair were included, with a mean age of 33.4 years. 81% were males, and 58.2% were participating in sport preoperatively. The mean follow-up was 86.4 ± 14.4 months. At final follow up, the mean satisfaction was 87.7%, and the mean SSV was 82.9. Overall, the rate of RTP was 85.9%, with 64.8% returning at the same level at a mean of 10.5 ± 8 months. Ultimately, 13 (10.7%) patients had a further surgery, including 10 (8.2%) patients that had a biceps tenodesis. VAS during sport (P= .025), SSV (P < .001), and time to RTP (P= .0056), were associated with higher satisfaction. There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes but with one-tenth of patients requiring revision surgeries. Additionally, while there was an overall high rate of RTP, there was only a modest rate of RTP at their preinjury level, and overhead athletes took longer to RTP. IV, case series.

Deltoid fatigue part 2: a longitudinal assessment of anatomic total shoulder arthroplasty over time.

Gradual loss of overhead range of motion (ROM) has been observed after reverse shoulder arthroplasty (RSA). It remains unclear if this is caused by the effect of RSA design on muscle fiber lengthening or is part of the natural aging process of the shoulder musculature. Although studies have attempted to evaluate deltoid fatigue after RSA, there is a paucity of literature evaluating this effect after anatomic shoulder arthroplasty (aTSA), which would be expected to occur due to aging alone. The purpose of this study is to evaluate the effect of time on overhead ROM after aTSA and compare this with previous data on a similar cohort of RSAs. We hypothesized that overhead ROM would decrease gradually over time in both groups without differences between prosthesis types. A retrospective review of 384 aTSAs without complications was performed over a 10-year period. All shoulders were treated for primary osteoarthritis using a single implant system. Patients were evaluated longitudinally at multiple postoperative time points. At least 1 follow-up visit was between 1 and 2 years postoperatively and another at least 5 years after surgery. ROM and patient reported outcome measures (PROMs) were evaluated using linear-mixed models for repeated measures. These results were compared with a previously evaluated cohort of 165 well-functioning RSAs analyzed using the same methodology. Primary aTSA shoulders were observed to lose 0.7° of abduction per year starting 1 year postoperatively (P = .001). Smaller losses were observed in external rotation (-0.3°/yr, P = .06) and internal rotation (-0.04/yr, P < .001). However, no significant losses were observed in forward elevation (P = .8). All PROMs diminished slowly over time, but these changes did not exceed the minimally clinically important difference when modeled over 10 years (Simple Shoulder Test -0.08/yr, P < .001; American Shoulder Elbow Surgeons -0.5/yr, P < .001; University of California Los Angeles Shoulder Score -0.2/yr, P < .001). When compared with a similarly analyzed cohort of RSAs, overhead ROM decreased at a slower rate in the aTSA cohort (abduction -0.7° vs. -0.8°/yr, P = .9; FE -0.06° vs. -0.8°/yr, P = .05). In the well-functioning aTSA, gradual loss of ROM occurs in all planes of motion except forward elevation. However, these losses are small and have little meaningful impact relative to minimally clinically important difference thresholds on PROMs. Progressive loss of abduction seen in both aTSA and RSA is likely secondary to aging of the periscapular and rotator cuff musculature. When compared with RSA, loss of motion after aTSA was statistically similar, calling into question the belief that RSA-induced deltoid fatigue leads to loss of overhead motion over time.

Preoperative factors associated with loss of range of motion after reverse shoulder arthroplasty.

Reverse total shoulder arthroplasty (RTSA) is a successful procedure, often allowing patients to achieve better range of motion (ROM) compared with their preoperative baseline. However, there is a subset of patients who either fail to improve or lose ROM postoperatively. These patients are at increased risk of poor satisfaction and patient-reported outcomes. To date, characteristics of this subset of patients have not been well described. The purpose of this study is to determine risk factors associated with loss of ROM after primary RTSA. A retrospective review using a commercial international RTSA database (Exactech Inc., Gainesville, FL, USA) of patients who underwent primary RTSA between 2007 and 2017 was performed. A total of 123 (7.7%) shoulders lost ≥10° of forward elevation (FE) (group 1, P1) and 183 (11.4%) lost ≥10° of external rotation (ER) (group 2, P2). Univariate and multivariate analyses were performed comparing these patients with control cohorts to evaluate risk factors for loss of motion. Better preoperative abduction, FE, ER, and internal rotation were each associated with greater loss of FE (P1 < .001) and ER (P2 < .001) postoperatively. Higher preoperative Simple Shoulder Test (P1 < .001, P2 < .001), Constant (P1 < .001, P2 < .001), Shoulder Pain and Disability Index (P1 < .001, P2 < .001), American Shoulder Elbow Surgeons (P1 < .001), and University of California at Los Angeles (P1 < .001) scores were also strongly associated with loss of ROM postoperatively. Other factors associated with a higher risk of losing ROM included a diagnosis of irreparable rotator cuff tear (P1 = .038), rotator cuff arthropathy (P1 = .017, P2 ≤ .001), and inflammatory arthropathy (P1 = .021). After multivariate analysis, higher preoperative FE (P1 < .001), internal rotation (P1 = -.018), and weight (P1 = .008) remained significant predictors of loss of FE. Better preoperative FE (P2 = .003), ER (P2 < .001), and University of California at Los Angeles score (P2 < .001) remained significant predictors of loss of ER. Patients who lost FE or ER were more likely to report lower satisfaction scores than their counterparts who did not lose ROM (P1 < .001, P2 < .001). Patients with greater preoperative shoulder ROM or higher patient-reported outcomes are at higher risk of losing ROM after primary RTSA. They are also at higher risk of reporting lower postoperative satisfaction, though the majority were still satisfied. Surgeons should strongly counsel patients with well-preserved preoperative function on the risk of loss of ROM.

Calcific tendinitis of the shoulder in the Korean population: demographics and its relation with coexisting rotator cuff tear.

BackgroundTo evaluate the demographics, clinical and radiographic features of calcific tendinitis of the shoulder in the Korean population, specifically focusing on the incidence of coexisting rotator cuff tear.MethodsBetween October 2014 and January 2015, we performed a prospective multicenter study with 506 patients from 11 training hospitals in Korea. We collected data of demographics and radiographic analysis based on simple radiographs, clinical assessments based on visual analog scale (VAS) and the American Shoulder Elbow Surgeons (ASES) score, and treatment modalities that are used currently. We also evaluated coexisting rotator cuff tear by ultrasonography (US) or magnetic resonance imaging (MRI) images.ResultsThere were 402 female patients (79%) with mean age of 55 years (range, 31–87 years). Mean duration of symptoms was 16 months. Mean size of calcific materials was 11.4 mm (range, 0–35 mm). Mean value of VAS and ASES scores were 6.5 (range, 1–10) and 47 (range, 8–95), respectively. Of 383 patients (76%), 59 (15%) had rotator cuff tear including 15 full-thickness tears on US or MRI. Patients with rotator cuff tears were significantly associated with older age, recurrent symptoms, menstrual disorders in females, and having undergone calcification removal surgery and rotator cuff repair (all p<0.05).ConclusionsThis study reported demographic, radiographic, and clinical features of calcific tendinitis of the shoulder in Korean population, which were not different from those of Western population. Coexisting rotator cuff tear was found with 15% incidence in this large series, suggesting that further radiographic study to evaluate rotator cuff tear might be needed in some calcific tendinitis patients of older age and presenting with recurrent symptoms.

Ibuprofen Use Did Not Affect Outcome Metrics After Arthroscopic Rotator Cuff Repair,

PurposeTo determine whether patients who are prescribed ibuprofen after arthroscopic rotator cuff repair have significantly different patient-reported outcomes for pain, function, and overall health at baseline and 1 and 2 years after operation relative to patients only prescribed opioids.MethodsPatients who underwent a rotator cuff repair by a total of 3 surgeons and participated in the outcomes registry from 2012 to 2016 were screened for inclusion in this study. Inclusion criteria were primary arthroscopic rotator cuff repair, at least 2 years from the date of surgery and over the age of 18. Exclusion criteria were revision and open rotator cuff repair. All patients followed the standard postoperative rehabilitation protocol for rotator cuff repair. Patients were divided into 2 cohorts. Group I included patients who received ibuprofen/nonsteroidal anti-inflammatory agents (NSAID) after surgery (n = 281), and Group II consisted of patients who did not receive ibuprofen/NSAID after surgery (n = 182). Patient-reported outcome measures for Visual Analogue Scale, American Shoulder Elbow Surgeons score, Single Assessment Numeric Evaluation score, Simple Shoulder Test and The Veterans Rand 12-Item Health Survey were collected preoperatively and at 3 and 6 months, 1 year, and 2 years after surgery. Statistical analysis was performed to compare patient-reported outcome measures between Group I and II.ResultsThis study consisted of 463 patients who underwent arthroscopic rotator cuff repair, and patients were divided into 2 cohorts. There were 281 patients who did not receive ibuprofen/NSAID after operation in Group I and 182 patients who did receive ibuprofen in Group II. There were no statistically significant differences between the 2 groups in age at treatment, mean body mass index, gender, ethnicity, diabetes, and number of rotator cuff tendons involved; however, there was a statistically significant difference in receiving worker’s compensation (P = .005), and this was subsequently adjusted for in our analysis. There were no significant differences in patient-reported outcomes for all metrics between the group prescribed ibuprofen and the group that was not prescribed ibuprofen at 1 and 2 years after surgery or in change from baseline.ConclusionPatients receiving ibuprofen did as well as patients who did not receive ibuprofen after arthroscopic rotator cuff repair on patient-reported outcome measures assessing shoulder pain, function, and overall health.Level of EvidenceLevel III, retrospective comparative study.

Results of repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection for recurrence of frozen shoulder

BackgroundThis study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC.MethodsA consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter.ResultsThe initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group.ConclusionsA repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient’s informed consent.Trial registrationRetrospectively registered

Proximal vs Distal Approach of Ultrasound-guided Suprascapular Nerve Block for Patients With Adhesive Capsulitis of the Shoulder: Prospective Randomized Controlled Trial

ObjectivesTo evaluate the early clinical outcomes of ultrasound (US)-guided suprascapular nerve block (SSNB) using a proximal approach compared with a distal approach for outpatient treatment of adhesive capsulitis. DesignRandomized controlled trial. SettingOutpatient clinic ParticipantsParticipants (N=47) with symptomatic adhesive capsulitis. InterventionsParticipants were randomly assigned to either US-guided SSNB using a proximal approach (n=23, proximal group) or a distal approach (n=24, distal group). Main Outcome MeasuresThe primary outcome measure was the visual analog scale (VAS) for pain at week 12. Secondary outcomes included the American Shoulder Elbow Surgeon’s (ASES) score, University California Los Angeles score, Short Form-36 mental and physical component summaries, and range of motion. All patients completed clinical follow-up at 2, 6, and 12 weeks after treatment. On US images, depth and insertion angle of needle during injection were measured. ResultsThe VAS significantly improved in both groups at week 12. After treatment, no significant differences were found in early clinical outcomes (weeks 2, 6, and 12) between groups (all P>.05), except that ASES at 2 weeks showed a significantly higher score in the distal group than in the proximal group (87.1±4.8 and 83.0±6.3, respectively; P=.014). The mean depth and insertion angle of needle was significantly lower (depth: 13.4±3.9 and 30.6±4.3 mm, respectively; P<.001; insertion angle: 19.6°±6.4° and 38.7°±5.8°; P<.001) in the proximal group than in the distal group. ConclusionsThis study demonstrated that proximal approach of US-guided SSNB provided favorable short-term outcomes of pain and functional improvement and that outcomes were comparable to those of the distal approach in adhesive capsulitis. The suprascapular nerve was located more superficially and easily identified in the proximal approach, suggesting that this method might improve the accuracy of injection.

Clinical and Imaging Outcomes After Revision Open Rotator Cuff Repair: A Retrospective Review of a Midterm Follow-Up Study.

Revision open rotator cuff repair (ORCR) has been associated with unpredictable functional outcome with concerns of deltoid detachment. The aim of this study was to evaluate the clinical and imaging outcomes of revision ORCR. The study retrospectively reviewed 30 consecutive patients (mean age 60.4 ± 7.2years) who underwent revision ORCR after failed rotator cuff repair. Pain visual analog scale (VAS), Constant and American Shoulder Elbow Surgeon (ASES) score were assessed preoperatively and at mean 58-month follow-up (range 24-120months). The acromio-humeral distance (AHD) was measured on pre- and postoperative radiograph. Tear size and fatty infiltration of rotator cuff were evaluated by preoperative magnetic resonance imaging (MRI) study. The retear rate, change of fatty infiltration and deltoid origin integrity were evaluated by postoperative MRI. There was significant improvement of pain VAS and functional outcome scores (all p < 0.001). AHD showed no significant change after surgery. On postoperative MRI, the retear rate was 43% (13/30). However, the size of the tendon defect was smaller than that of pre-revision tear (p = 0.006). The patients who had intact tendon had significantly better functional outcomes than those with retear. The intact group had significantly higher AHD both pre- and postoperatively than the retear group. There was no change of fatty infiltration after surgery. Four patients (13%, 4/30) showed thinning of deltoid origin on postoperative MRI, but showed no weakness on clinical examination. Revision ORCR resulted in improved outcomes in pain relief and shoulder function, with low rate of subclinical deltoid thinning.

The Patient-Rated Elbow Evaluation and the American Shoulder and Elbow Surgeons—Elbow form capture aspects of functioning that are important to patients with elbow injuries

Study DesignThis is a cross-sectional study. IntroductionThe Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons–elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice. Purpose of the StudyTo use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e. MethodsOne hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement. ResultsA total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475–driving (35%) and D440–fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%. DiscussionThis study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section (‘d’ categories) of the ICF, this validated that these PROMs measure this conceptual domain. ConclusionThe PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e.

Clinical Results after Arthroscopic Treatment of Septic Shoulder with Proximal Bone Involvement.

If osteomyelitis is confined to the proximal humerus, arthroscopic debridement with multiple punctures at the infected bone might be sufficient to eradicate the septic shoulder with bone involvement. From 2005 to 2017, 15 patients received arthroscopic debridement with multiple punctures. We included patients with septic shoulder arthritis with proximal bone involvement and excluded patients with glenohumeral joint destruction or extension of bone involvement to the diaphysis of the humerus. We performed multiple punctures for drainage of proximal humerus after complete arthroscopic debridement of septic soft tissue. Infection laboratory studies and postoperative magnetic resonance image were evaluated. For clinical outcome measurements, range of motion, pain visual analog scale, functional visual analog scale, American shoulder elbow surgeon scores, constant scores, and simple shoulder test were evaluated. There were 11 males and 4 females with a mean age of 53years (range 28-73years). Mean follow-up was 32months (range 12-115months). There was no reinfection case. The postoperative C-reactive protein levels were normalized in all. The postoperative magnetic resonance image showed no bony involvement of the proximal humerus in all patients except one patient. The clinical scores and range of motion were significantly improved postoperatively. Six patients underwent secondary surgery for rotator cuff tear at a mean time period of 25months (range 4-104months) from the index period. Septic shoulder with proximal bone involvement can be successfully treated with arthroscopic debridement with multiple punctures. Level IV, treatment study.