Adult Shoulder Research Articles

Ultrasound- Versus Landmark-Guided Corticosteroid Injections in Patients With Shoulder Pain: A Meta-Analysis and Systematic Review.

This meta-analysis evaluated the effects of ultrasound-guided (USG) and landmark-guided (LMG) injections of corticosteroids into the shoulder joint cavity of patients with shoulder pain. The PubMed database was searched for articles (January 1, 2004-December 31, 2023) comparing USG and LMG injections of corticosteroids for the treatment of adult shoulder pain. Two authors independently performed data extraction and appraisal. The outcome measures collected were visual analogue scale (VAS) score and VAS score change at 1 and 6 weeks postinjection and range of motion (ROM) at 6 weeks postinjection. Thirteen studies including 656 patients were reviewed (USG and LMG groups, 328 patients each). The VAS score at 1 week postinjection and the ROM in abduction at 6 weeks postinjection were statistically different, but there were no statistically significant differences in other outcomes. This meta-analysis indicated that USG corticosteroid injection may have a better effect than LMG corticosteroid injection for early-stage shoulder pain and abduction in the mid- to long-term, but does not affect later shoulder pain or other ROMs.

Factors associated with frozen shoulder in adults: a retrospective study

ObjectiveThis study aims to explore the risk factors associated with frozen shoulder patients and further analyze the relationship between gender and diabetes with frozen shoulder.MethodWe have reviewed the data of 1205 frozen shoulder patients in China's Xinjiang region from 2018 to 2023. The collected information included patients' gender, occupation, place of origin, marital status, age, the season of disease onset, duration of illness, etiology, surgical history, hypertension, diabetes, respiratory diseases, knee joint disease, hyperlipidemia, cardiovascular diseases, cervical spondylosis, lumbar disc herniation, rheumatoid arthritis, hyperuricemia, sleep quality, smoking and alcohol consumption, and constipation. We have used multifactor logistic regression analysis to identify the risk factors for a frozen shoulder.ResultsSingle-factor logistic regression analysis showed that the number of females, patients with diabetes, knee joint disease, constipation, and patients with poor sleep quality in the observation group are higher than in the control group (P < 0.05). There were no statistically significant differences between the two groups in terms of occupation, place of origin, marital status, age, season of disease onset, duration of illness, etiology, surgical history, hypertension, respiratory diseases, hyperlipidemia, cardiovascular diseases, cervical spondylosis, lumbar disc herniation, rheumatoid arthritis, hyperuricemia, smoking, and alcohol consumption history (P > 0.05).Multivariate analysis showed that the final model included four variables: gender, diabetes history, sleep, and constipation. Among them, the OR values of gender and diabetes history were more significant than 1, indicating that they were independent risk factors for frozen shoulder, while the OR values of sleep and constipation were less than 1, suggesting that they were negatively associated with the occurrence of frozen shoulder.ConclusionThe results of this study suggest that gender and diabetes are independent risk factors for frozen shoulder. Additionally, poor sleep quality and constipation also can be correlated with the occurrence of a frozen shoulder.

Investigating and analyzing the current situation and factors influencing chronic neck, shoulder, and lumbar back pain among medical personnel after the epidemic

BackgroundChronic shoulder and neck pain is one of the most common chronic occupational disorders, with an average incidence rate of 48.5%, severely affecting patients’ quality of life and ability to work. According to epidemiological research, the prevalence of chronic neck, shoulder, and low back pain in adults over the age of 45 ranges from 40 to 80%. According to reports, medical staff have a higher incidence rate than other populations, and there is a positive correlation between the grade of the medical institution and the incidence rate, making medical staff a priority group for the prevention of chronic neck, shoulder, and low back pain. By the end of 2022, China has been fully opened to epidemic prevention and control, the total number of patients in domestic hospitals has increased significantly, and resulting in medical personnel shoulting great pressure, which seriously affects the physical and mental health of medical personnel. The aim of this study was to explore the risk factors of chronic neck, shoulder and lumbar back pain in medical staff. To provide guidelines for medical staff to improve cervical and lumbar subacute pain and reduce the emergence of spinal lesions.MethodsFrom January to February 2023, 602 staff members of a third-grade hospital in Zunyi City were studied by Questionnaire star. Univariate and multivariate Logistic regression were used to analyze the independent risk factors of chronic neck, shoulder and lumbar back pain in medical staff, with stepwise regression utilized to choose the optimum model. The model was selected using Akaike’s information criterion (AIC) and the Hosmer-Lemeshow goodness-of-fit test.ResultsA total of 602 medical staff were polled, and the findings revealed that 588 cases of chronic neck, shoulder, and low back pain of varied severity had occurred in the previous 1 to 2 years, with a 97.7% incidence rate; logistic regression analysis revealed that anxiety level, frequency of bending over in the previous 1 to 2 years, whether related preventive measures were taken at work, gender, positive senior title, daily ambulation time, and whether the department they worked in organized independent influencing factors.ConclusionThe incidence of chronic neck, shoulder, and lumbar back pain among medical staff is high; its influencing factors are different and have not been systematically identified. Hospitals should take effective measures tailored to local conditions to improve the physical and mental health of medical staff.

Intra-Articular Hyaluronic Acid for Osteoarthritis of the Hip, Shoulder, and Ankle

What Is the Issue?&#x0D; &#x0D; Osteoarthritis (OA) is a chronic disease of the joints, such as the hip, shoulder, and ankle. OA causes the joints to be painful, unstable, and less functional. In adults 55 years and younger, joint trauma is a common cause of OA.&#x0D; Hyaluronic acid (HA) is a naturally occurring molecule found in human cells that provides lubrication when injected into the joint. HA injections are a less invasive option than surgery, with potentially fewer complications.&#x0D; To support decision-making about treating hip, shoulder, or ankle OA in adults 55 years and younger, it is important to understand the potential benefits and harms of using HA in this population.&#x0D; &#x0D; What Did We Do?&#x0D; &#x0D; We reviewed the clinical effectiveness of high molecular weight (MW) injection of HA in adults between the ages of 18 and 55 years with OA of the hip, shoulder, or ankle joints to guide decisions on the use of high MW HA injection.&#x0D; An information specialist searched for peer-reviewed and grey literature sources published on January 1, 2013 to December 12, 2023. One reviewer screened citations and selected and critically appraised the included studies.&#x0D; &#x0D; What Did We Find?&#x0D; &#x0D; The evidence for this report was based on observational before-and-after studies. We found no relevant comparative studies examining the effect of high MW HA versus placebo or no treatment.&#x0D; While most studies reported post-treatment outcome improvements, it is uncertain whether high MW injection of HA improves pain, function, and disability in adults 55 years and under with hip, shoulder, or ankle OA. This is due to the low-quality evidence, small sample sizes, and methodological problems. Serious side effects of high MW HA were not reported.&#x0D; &#x0D; What Does This Mean?&#x0D; &#x0D; Due to the uncertainty of the clinical effectiveness evidence, health care providers and decision-makers may consider other factors when considering high MW IA-HA for patients with hip, shoulder, or ankle OA; these factors could include acceptability, feasibility, costs, health equity, and patient values and preferences.&#x0D; Future research from randomized studies in large populations is needed to understand the effectiveness and safety of high MW HA injections for hip, shoulder, and ankle OA.&#x0D;

Treatment of acromioclavicular dislocation of the shoulder in adults - press review

Introduction: Acromioclavicular joint dislocation is one of the most common shoulder injuries treated in a sport‐active population. In this article we reviewed the epidemiology, symptoms, and various surgical techniques for the treatment of acromioclavicular dislocation.&#x0D; Material and methods: The work was based on medical articles collected in PubMed, websites and medical books. The research was conducted by looking at keywords such as: "acromioclaviculal dislocation", "treatment of acromioclaviculal dislocation ".&#x0D; Results: There are many methods of treating acromioclaviculal dislocation, ranging from conservative treatment to surgical treatment.&#x0D; Conclusions: Treating acute and chronic ACJ injuries is still a challenging task.The myriad of existing techniques is indicative for the uncertainty regarding this topic and a gold standard has not yet been determined. However, when diagnosed correctly and treated accordingly, results are overall satisfactory.

Rate of occurrence of respiratory complications in patients who undergo shoulder arthroplasty with a continuous interscalene brachial plexus block and associated risk factors

IntroductionContinuous interscalene nerve block techniques are an effective form of targeted non-opioid postoperative analgesia for shoulder arthroplasty patients. One of the limiting risks, however, is potential phrenic nerve blockade with...

The effect of tablet tilt angles and time on posture, muscle activity, and discomfort at the neck and shoulder in healthy young adults.

Although young adults regularly perform tablet writing, biomechanics during the tablet writing with different tilt angles has not been studied. The objective of this study was to compare posture, muscle activity, and discomfort at the neck and shoulder between tablet writing with 0° (horizontal) and 30° tablet tilt angles over 40 minutes in healthy young adults. Twenty participants wrote continuously for 40 minutes on a tablet with both tilt angles in a randomized order. Between conditions, there was a 5-minute activity break. Differences in neck and shoulder posture, muscle activity, and discomfort between both tablet tilt angles and changes in the outcomes every 10 minutes over 40 minutes were investigated. With the tilted tablet, there were lower neck flexion (Z = -4.637, P<0.001), lower shoulder extension (Z = -3.734, P<0.001), and lower neck Visual Analogue Scale (VAS) (left; Z = -4.699, P<0.001 and right; Z = -3.874, P<0.001) as compared to the no tilt condition. However, the right upper trapezius muscle activity was higher in the tilted condition as compared to the no tilt one. Over 40 minutes, the neck VAS (left; χ2(4) = 30.235, P<0.001 and right; χ2(4) = 32.560, P<0.001) and heart rate variability (χ2(4) = 12.906, P = 0.012) showed notable increases after 20 minutes compared to baseline. In conclusion, adjusting the tablet tilt to 30° and limiting time spent to 20 minutes are recommended for young adults during the tablet writing to prevent neck problems.

Prevalence of and Risk Factors for Adhesive Capsulitis of the Shoulder in Older Adults from Germany.

This study aimed to investigate the prevalence of and risk factors for adhesive capsulitis in older adults from Germany. The one-year and lifetime prevalence of adhesive capsulitis were assessed in adults aged ≥65 years with at least one visit to one of 1207 general practices in Germany in 2021. Associations between physical and psychiatric conditions and adhesive capsulitis were further assessed in older patients diagnosed for the first time with adhesive capsulitis in general practices in 2010-2021 (index date) and matched (1:5) to patients without adhesive capsulitis using a propensity score based on age, sex, and the index year. In adults without adhesive capsulitis, the index date was a randomly selected visit date in 2010-2021. The one-year and lifetime prevalence of adhesive capsulitis in older adults in 2021 were 0.4% and 2.4%, respectively. In 8439 patients with and 42,195 patients without adhesive capsulitis, 12 conditions were positively and significantly associated with adhesive capsulitis. Effect sizes were strongest for other and unspecified osteoarthritis (OR = 1.93), injury to the shoulder and upper arm (OR = 1.85), and injury to the thorax (OR = 1.47). Based on these findings, adhesive capsulitis can occur at older age, and osteoarthritis and injuries are major risk factors.

Physiological Offset Parameters of the Adult Shoulder Joint-A MRI Study of 800 Patients.

Highlights 800 shoulder MRIs were retrospectively evaluated for humeral, glenoidal and latero-glenoidal humeral offset, as well as cortical and humeral shaft axis offset.Significantly higher values for all analysed offset parameters were found in male shoulder joints compared to female shoulder joints.Significant side-specific differences were found for humeral, glenoidal and latero-glenoidal humeral offset.A correlation of the offset parameters with age or the osteoarthritis grade exist only for cortical offset.These results should be considered in shoulder diagnostics and surgery. Background: Humeral offset (HO) and glenoidal offset (GO) are important morphological parameters in diagnostics and therapy for shoulder pathologies. However, physiological reference values have not yet been sufficiently determined. The aim of the present study was to establish physiological reference values for shoulder offset parameters (SOPs). Methods: MRI images of the shoulder joints of 800 patients (mean age: 50.13 years [±16.01]) were analysed retrospectively. HO, GO, lateral glenoidal humeral offset (LGHO), humeral shaft axis offset (HAO) and cortical offset (CO) were measured. SOPs were examined for associations with age, gender, side and osteoarthritis. Results: The mean HO was 26.19 (±2.70), the mean GO was 61.79 (±5.67), the mean LGHO was 54.49 (±4.69), the mean HAO was 28.17 (±2.82) and the mean CO was 16.70 (±3.08). For all SOPs, significantly higher values were measured in male shoulders. There was a significantly (p < 0.001) higher mean value for HO, GO and LGHO in right shoulders. There was a significant correlation between age and LGHO, and HAO and CO, but not between age and HO or GO. Shoulders with osteoarthritis and non-osteoarthritis did not differ in the mean value of HO, GO, LGHO and HAO, except for CO (p = 0.049). Conclusion: Reference values for SOPs in the adult shoulder joint were determined for the first time. Significant gender-specific differences were found for all measured SOPs. In addition, it was seen that for some SOPs, the joint side and the patient’s age has to be taken into account in shoulder diagnostics and surgery.

Interrater and Intrarater Reliability of the EasyForce Dynamometer for Assessment of Maximal Shoulder, Knee and Hip Strength.

This study aimed to determine the interrater and intrarater reliability of EasyForce dynamometer for assessing shoulder, knee, and hip muscle strength in healthy young adults. Shoulder, knee, and hip maximal isometric strength were measured using the EasyForce in healthy adults (11 women and 12 men). Three repetitions of shoulder internal rotation, abduction, knee flexion, extension, and hip abduction and adduction were performed. The tests were performed by three raters on the same day. The results showed good to high inter- and intrarater reliability (intraclass correlation coefficient range: 0.63–0.91). Moreover, the absolute reliability of the EasyForce was slightly higher than acceptable for all tests (CV > 10%) except for hip abduction on the right leg (CV = 7.2%). The EasyForce dynamometer can be considered a reliable tool for assessing shoulder internal rotation and abduction, knee extension and flexion, as well as hip abduction and adduction strength. The EasyForce dynamometer showed no differences between the raters’ measurements, which could be of great importance for professionals who want to perform the tests regardless of their strength on the values.

Efficacy of Transosseous Tunnel Placement for Triple Endobutton Plate in Acromioclavicular Joint Reconstruction: A Three-Dimensional Printing Guide Design Technology.

ObjectiveExplore an accurate transosseous tunnel drilling method based on three‐dimensional (3D) printing technology for acromioclavicular joint reconstruction (ACD), design a guide design, and evaluate its accuracy.MethodsUsing Mimics software to reconstruct 100 cases of acromioclavicular joint computed tomography (CT) data. In design 2, the non‐collinear tunnel is superimposed on the 3D model, and a virtual drilling is performed between the clavicle and the coracoid using a triple inner gusset. Then, in the Geomagic Studio software model, an elliptical plane is calculated and extracted as a guide design for precise drilling. Then put the design and the 3D shoulder model together for 3D printing. Ten lengths were measured, and the effects of the virtual model, the actual model, and the guide rail design were compared.ResultsWe successfully compared 10 parameters of 3D virtual model and actual model. There was no significant difference between actual and virtual bone tunnels in 10 measurements (P > 0.05).ConclusionsThe accuracy of ACD combined with 3D printing guidance design technology in the transosseous tunnel of adult shoulder is reliable.

Acromial type in Brazilian young adults

Introduction: Acromion curved and hooked play a key role in shoulder impingement syndrome. Little is known about the acromial type in Brazilian population. Aim: To describe the acromial type profile in Brazilian young adults; to evaluate its correlation to gender and handedness and the occurrence of symmetry between genders. Methodology: Forty acromions of 20 Brazilian adults, both genders, between 21-25 years old were studied. The acromion type was classified by Bigliani/Epstein method by supraspinatus outlet view radiographs. Results: As there was no gender difference in the occurrence of acromial type, we considered male and female groups together. Thus, of the 20 right acromions, we found 5 (25%) type I, 8 (40%) type II and 7 (35%) type III. Of the 20 left acromions, we found 4 (20%) type I, 11 (55%) type II and 5 (25%) type III. The only left-handed volunteer (100%) presented for the right and left shoulder acromial type III. Of the 19 right-handed volunteers, 5 (26.3%) presented right acromion type I, 8 (42.1%) type II, and 6 (31.6%) type III; for the left acromion, 4 (21.1%) presented type I, 11 (57.9%) type II, and 4 (21.1%) type III. Acromial symmetry occurred in female (60%) and male (70%) groups. Conclusion: Type II acromion was the most predominant for right and left shoulder in Brazilian young adults. There was no correlation between acromial type and gender. It was not possible to analyze the correlation between acromial type and handedness. Acromial type tends to be symmetric in our sample.

Reliability of Image Capture Technique for the Measurement of Upper Limb Active Joint Position Sense in Healthy Adults

Objective: Proprioception is the conscious perception of limb position, motion, balance, and pressure. It has a vital role in movement control, especially motor planning and neuromuscular feedback mechanism. To investigate the proprioceptive function, it is essential to use the best measurement method. Different techniques and approaches have been introduced, which are usually expensive and not applicable for clinical use. One of these methods is the image capture technique which is easy and practical. Stillman introduced this technique to measure the joint position sense of the knee considering all variables affecting it and reported its good reliability. Many studies have used this technique for knee and lower limb joints and reported its good reliability, while few studies have used this technique for the upper limb joints. Therefore, this study investigates the reliability of the image capture technique for measuring the Active Joint Position Sense (AJPS) of the left shoulder and elbow in healthy adults. If it yields a good result, it can be used as an available and cost-effective method by clinicians. Materials &amp; Methods: In this methodological study, the participants were 10 healthy adults (5 men, 5 women) aged 18-40 years. To assess the AJPS, we used image capture technology which is one of the most reliable methods for the lower limb joint position sense measurement. Markers were attached on elbow and shoulder landmarks, and photos were taken during the reproduction of angles by participants. Then, the photos were entered into AutoCAD software, and the angles were calculated by drawing line segments from landmarks and connecting them. The absolute error and relative error (the difference between the initial and reproduced angles) were used to measure accuracy. The AJPS was assessed for internal and external rotation of the shoulder and elbow flexion. The measurements were repeated two hours later to assess intra-day reliability and two days later to assess inter-day reliability. Interclass Correlation Coefficient (ICC) and Standard Error of Measurement (SEM) were used for statistical analysis. Results: The ICC of inter-day reliability of the test for all shoulder and elbow movements in relative and absolute errors was reported as excellent (≥0.92). Intra-day reliability was reported excellent (≥0.90) for elbow flexion, and internal rotation of the shoulder in both relative and absolute errors were excellent (0.94). For external rotation of the shoulder, it was excellent in relative error (0.94) and good in absolute error (0.80). All measurements had absolute reliability based on the SEM results. Conclusion: The image capture technique is a simple, cost-effective, and available method tool for measuring AJPS and proprioception in upper limbs by clinicians and researchers.

Arthroscopic Bankart repair combined with Reimplissage for the treatment of recurrent anterior dislocation of shoulder in adults with Hill-Sachs defect

To investigate the method and clinical effects of the treatment of recurrent anterior dislocation of shoulder with Hill-Sachs injury by arthroscopic Bankart repair and Remplissage. From March 2016 to March 2019, 106 patients with recurrent anterior dislocation of shoulder with glenoid bone defect less than 20% underwent arthroscopic Bankart repair, including 76 males and 30 females, aged from 18 to 45 (27.3±8.6) years, 59 cases of left shoulder and 47 cases of right shoulder. Range of motion (ROM), American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score and Rowe score were used to evaluate shoulder functionand stability before and after operation. All patients were followed up, and the duration ranged from 21 to 60 months, with a mean of (41.5± 8.5) months. One patient developed infection after operation, and the infection was controlled after arthroscopic debridement again. The remaining patients did not have clinical complications such as infection, intra articular hematocele and redislocation. Shoulder flexion and lifting increased from (158.33±15.72) ° preoperatively to (169.43±10.04) ° at the latest follow up, and internal rotation changed from T7 (T4 to T10) preoperatively to T8 (T5 to T10) at the latest follow up;the average lateral external rotation and abduction 90 ° external rotation decreased from (58.46±15.51) ° preoperatively and (99.37±14.09) ° to (53.18±14.90) ° and (92.52±13.10) ° at the latest follow up, respectively. The ASES score, Constant -Murley score and Rowe score were significantly improved. The clinical effect of rehabilitation of Bankart repair combined with Remplissageunder arthroscopy in the treatment of recurrent dislocation of shoulder joint in adults with Hill-Sachs defect is satisfactory. Although the external rotation function is weaker than that before operation, it can effectively reconstruct the shoulder function and avoid the occurrence ofdislocation after operation.

Study on the mechanical differences between single-row belt rivets and double-row suture bridge in repairing rotator cuff injury

To compare and analyze the mechanical differences between single-row suture anchor fixation for repairing rotator cuff injuries and double-row suture bridges for repairing rotator cuff injuries from a biomechanical perspective. The CT scan data of healthy adult shoulder joint were imported into Mimics, Geomagics and Hypermesh to carry out reverse reconstruction of two repair models, material assignment and mesh division, and the tearing of supraspinatus muscle was designed. After treatments, the load and boundary conditions were applied to the shoulder joint in ABAQUS software. The shoulder joint was fixed with four working conditions including flexion 15 °, flexion 30 °, internal rotation 15 ° and internal rotation 30 ° after anchor fixationand repair. The stress changes of the upper rotator cuff muscle and the anchor with thread were compared under these four conditions. Under the two flexion conditions, the stress of the supraspinatus in the double row suture bridge fixation model was 8.3% and 12% less than that in the single-row suture anchor fixation, respectively. Under the two internal rotation conditions, the stress of supraspinatus in the double row suture bridge fixation model was 47% and 48% less than that in the single row fixation repair model, respectively. The "load sharing" effect between the two rows of four anchors makes the stress distribution more dispersed, increases the contact area between the supraspinatus muscle and the humerus, reduces the stress of the anchor, avoids the serious stress concentration phenomenon, and explains the advantages of the fixation method of the double row suture bridge from the biomechanical angle.

Morphologically high‐grade trichoblastic carcinoma: a clinicopathological study with long‐term clinical follow‐up

Trichoblastic carcinomas (malignant trichoblastomas) are rare and poorly documented neoplasms characterized by malignant transformation of a pre-existing benign trichoblastoma and subdivided histologically into low- and high-grade tumours. While morphologically low-grade trichoblastic carcinomas show an indolent behaviour, the morphologically high-grade variant has been associated with poor prognosis, but little is known about their true biologic potential. The present study aims to better define the clinico-pathological features and outcome of morphologically high-grade trichoblastic carcinomas. Four high-grade trichoblastic carcinomas were retrieved from departmental files and the clinical and histopathological features and follow-up were recorded. The tumours presented as nodules on the scalp, neck and shoulder of adults (median age: 40 years, range: 30-55) with a female predominance of 3:1. Three patients had a longstanding history with recent change. Histologically, three tumours were characterized by an expansile cellular nodule composed of sheets of pleomorphic epithelioid cells with brisk mitotic activity and necrosis arising in a background of a benign trichoblastoma. One tumour displayed a more gradual transition from a benign trichoepithelioma to an undifferentiated carcinoma with an infiltrative growth and perineural infiltration. All patients were alive with no evidence of recurrence or metastasis following complete excision after a median follow-up of 96 months (range: 30-180). The correct diagnosis of high-grade trichoblastic carcinoma relies on adequate sampling and recognition of the benign trichoblastic precursor lesion, trichoblastoma or trichoepithelioma. Despite the concerning histologic features of the malignant component, the tumours appear to be less aggressive than previously thought.

Witnesses in Cyberbullying: Roles and Dilemmas

This study explored youths’ perceptions of the nature and dilemmas of being a bystander in cyberbullying. Although there are many benefits of peer interactions through social media, there are risks, including cyberbullying. Bystanders are integral in the dynamics and harm in both face-to-face and cyberbullying. Using a qualitative approach, authors share youth voices on the experience of witnessing cyberbullying and the dilemmas they face in deciding whether and how to respond to support a peer. Authors conducted thematic analysis of qualitative interviews with 16 adolescents. Youths described a range of feelings experienced by witnesses, from discomfort and anger to moral disengagement and justification for cyberbullying. Youths reported three forms of bystander roles: outsider, assistant, and defender, consistent with traditional bullying. The dilemmas they faced in witnessing and intervening that emerged were consistent with the five stages of bystander decision making. Youths indicated that the solutions for cyberbullying rest on the shoulders of adults.

Trends in the Treatment of Biceps Pathology: An Analysis of the American Board of Orthopaedic Surgery Database.

Background:Long head of biceps tendon pathology is a well-described source of pain in the anterior adult shoulder. Shoulder arthroscopic surgeons face this condition on a frequent basis because of the increasing aging population. Trends in treatment for this condition have varied over recent decades. An understanding of these trends may help orthopaedic surgeons counsel these patients.Purpose:To evaluate trends in treatment selection, patient population, and complications in recent part II examinees of the American Board of Orthopaedic Surgery (ABOS) board examination.Study Design:Cross-sectional study.Methods:Using a database maintained by the ABOS, we accessed and analyzed examinee data from 2008 to 2019 to evaluate trends in the following categories: examination year/subspecialty, region, patient age/sex, International Classification of Diseases code, Current Procedural Terminology code, and complications. These data points were analyzed for all board-eligible candidates from 2008 to 2019.Results:The annual number of proximal biceps tendon (PBT) procedures performed increased significantly from 597 cases in 2008 to 2203 cases in 2019 (P < .001). Incidence of biceps tendon tenotomy significantly decreased between the years 2007 and 2018 (P < .001). Both open and arthroscopic biceps tenodesis significantly increased between 2007 and 2018 (P < .001). Most PBT cases were performed simultaneously with other procedures (17,283/17,861; 96.8%). The most common PBT procedure performed overall was open tenodesis of long tendon of biceps (∼60.8%). Complication rates for PBT procedures reported each year did not significantly change between 2007 and 2018 (7.5% vs 9.7%; P = .103).Conclusion:PBT procedures are being increasingly performed among recently trained orthopaedic surgeons. Proximal biceps tenotomy has significantly declined, whereas proximal biceps tenodesis, open or arthroscopic, has significantly increased, demonstrating a possible shift in the standard of care among new surgeons.

Interactive associations of sex and hyperlipidemia with calcific tendinitis of the shoulder in Taiwanese adults.

Calcific tendinitis (CT) of the shoulder is a painful disorder usually identified in individuals aged 40 and 60 years. The estimated global prevalence of CT is 2.7% to 36%. We examined the association of hyperlipidemia and sex with CT of the shoulder using Taiwan Biobank (TWB) and the National Health Insurance Research Database (NHIRD).Data were available for 9903 TWB participants who were recruited between 2008 and 2015. We used multiple logistic regression analysis to estimate the odds ratios (OR) and 95% confidence intervals (CI) for CT of the shoulder.Overall, 1564 women, and 1491 men were identified with hyperlipidemia. Women, compared to men, had higher odds of CT of the shoulder (OR, 1.53; 95% CI, 1.08–2.16). Hyperlipidemia, compared to no hyperlipidemia, was associated with an increased risk of CT (OR, 1.40; 95% CI, 1.02–1.93). The test for interaction was significant for sex and hyperlipidemia (P = .006). After stratification, the odds ratio for CT was 1.95 (95% CI, 1.30–2.92) in women and 0.82 (95% CI, 0.48–1.39) in men, respectively. Compared to men with no hyperlipidemia, the odds ratio was 0.86 (95% CI, 0.53–1.38) for men with hyperlipidemia and 2.00 (95% CI, 1.29–3.10) for women with hyperlipidemia.Importantly, our findings indicated that the risk for CT of the shoulder was higher among Taiwanese women with hyperlipidemia. However, CT risk among their male counterparts with hyperlipidemia was not significant.

Applied anatomical study on suprascapular nerve protection in reverse total shoulder arthroplasty

BackgroundThis study aimed to investigate the three-dimensional (3D) anatomical relationship between the suprascapular nerve and scapula, and the method of protecting the suprascapular nerve in reverse total shoulder arthroplasty (RTSA)MethodsIn the present study, 12 fresh adult cadaver shoulder specimens were dissected. X-ray and computed tomography (CT) were used to investigate the 3D scapular and suprascapular nerve images.ResultsThe results revealed that the best fitting baseplate diameter was 24.73 ± 1.56 mm. Furthermore, the baseplate diameter correlated with the glenoid cavity width. After the osteotomy, a simulated screw placement on the baseplate was performed. The dangerous area for the posterior screw placement was at the angle between the upper edge and transverse axis exceeding 38° and between the lower edge and transverse axis exceeding 76°. The distance between the nearest point of the nerve and osteotomy plane was 15.38 ± 2.02 mm, and the angle between the projection point of the nearest point and transverse axis was 27.33 ± 7.96°, which was the dangerous area for retractor placement. The suitable angle between the superior screw and longitudinal axis was 21.67 ± 13.27°, and the suitable superior screw length was 34.66 ± 2.41 mm.ConclusionIn RTSA, the baseplate size correlates with the glenoid cavity width. The relationship between the screw and suprascapular nerve and retractor placement position should be carefully considered to avoid damaging the suprascapular nerve.