Shoulder Osteoarthritis Research Articles

Differences in Hospital Length of Stay and Cost of Hospitalization Between Income Levels in Patients Hospitalized for Shoulder Arthroplasty

Introduction There has been an increase in volume and cost of total shoulder arthroplasty (TSA). Performing procedures in high-volume inpatient centers and outpatient centers can help limit costs while preserving quality. This study aims to identify whether a difference in length of stay (LOS) and cost exists between income levels in patients hospitalized for TSA and reverse TSA (R-TSA) to identify potential disparities. Methodology NIS data defined by ICD-10 codes for patients diagnosed with primary shoulder osteoarthritis undergoing TSA or R-TSA between 2016 and 2019 were collected. Demographic, social, and comorbidity data were collected and stratified by income quartile. Results Patients had R-TSA (n = 173,695) more frequently than TSA (n = 149,075). The mean age was greater for R-TSA (71.8) than TSA (67.0) and increased by income quartile (P < 0.0001). Among TSA, LOS (days) decreased Q1 (1.50) to Q2 (1.40) and then remained consistent Q2–Q4. Among R-TSA, LOS decreased Q1 (1.67) to Q2 (1.64) to Q3 (1.62) and then increased in Q4 (1.65) (P = 0.03). The lowest income quartile had the highest cost in R-TSA and the second highest in TSA (P < 0.0001). By location, the percentage of urban teaching hospitals increased by income quartile, while the percentage of rural hospitals decreased by quartile (P < 0.0001). Conclusion Low-income shoulder arthroplasty patients had the longest LOS, high costs, and account for vast majority of rural cases. R-TSA had higher costs and LOS across income quartiles than TSA. Continued attention needs to be placed on the disparities in resource utilization for upper extremity arthroplasty among patients of different socioeconomic status.

The association between anterior shoulder joint capsule thickening and glenoid deformity in primary glenohumeral osteoarthritis.

Anterior shoulder joint capsule thickening is typically present in osteoarthritic shoulders, but its association with specific patterns of glenoid wear is incompletely understood. We sought to determine the relationship between anterior capsular thickening and glenoid deformity in primary glenohumeral osteoarthritis. We retrospectively identified 134 consecutive osteoarthritic shoulders with magnetic resonance imaging and computed tomography scans performed. Axial fat-suppressed magnetic resonance imaging slices were used to quantify the anterior capsular thickness in millimeters, measured at its thickest point below the subscapularis muscle. Computed tomography scans were used to classify glenoid deformity according to the Walch classification, and an automated 3-dimensional software program provided values for glenoid retroversion and humeral head subluxation. Multinomial and linear regression models were used to characterize the association of anterior capsular thickening with Walch glenoid type, glenoid retroversion, and posterior humeral head subluxation while controlling for patient age and sex. The anterior capsule was thickest in glenoid types B2 (5.5mm, 95% confidence interval [CI]: 5.0-6.0) and B3 (6.1mm, 95% CI: 5.6-6.6) and thinnest in A1 (3.7mm, 95% CI: 3.3-4.2; P<.001). Adjusted for age and sex, glenoid types B2 (odds ratio: 4.4, 95% CI: 2.3-8.4, P<.001) and B3 (odds ratio: 5.4, 95% CI: 2.8-10.4, P<.001) showed the strongest association with increased anterior capsule thickness, compared to glenoid type A1. Increased capsular thickness correlated with greater glenoid retroversion (r=0.57; P<.001) and posterior humeral head subluxation (r=0.50; P<.001). In multivariable analysis, for every 1-mm increase in anterior capsular thickening, there was an adjusted mean increase of 3.2° (95% CI: 2.4-4.1) in glenoid retroversion and a 3.8% (95% CI: 2.7-5.0) increase in posterior humeral head subluxation. Increased thickening of the anterior shoulder capsule is associated with greater posterior glenoid wear and humeral head subluxation. Additional research should determine whether anterior capsular disease plays a causative role in the etiology or progression of eccentric glenohumeral osteoarthritis.

Reverse Shoulder Arthroplasty in Osteoarthritis Evaluation of the Results.

The aging structure of society results in a growing need for treatment of shoulder osteoarthritis. Reverse shoulder arthroplasty (RSA) has been developed to improve the motor function and strength of the shoulder joint without increasing the risk of dislocation. The aim of the study was to assess the change in quality of life and functional assessment of the shoulder joint after RSA in patients with osteoarthritis, based on the Oxford Shoulder Score (OSS) and an assessment of joint mobility parameters. A total of 10 patients were admitted to our centre for shoulder arthroplasty between August 2020 and October 2021. The assessment of the degenerative changes was based on the Walch classification and the Samelson &amp; Prieto classification. The OSS questionnaire was used to assess function of the affected shoulder joint and pain in each patient. The range of motion in the shoulder joint was assessed in the pre- and postoperative period. A follow-up examination was performed approximately 6 months after surgery. Analysis of the OSS scores revealed a mean value of 46 points preoperatively and 25 points postoperatively. The OSS scores six months after the procedure were an average of 20.5 points lower. A statistically significant improvement was noted in shoulder flexion (mean 37), abduction (42), external rotation (34), and internal rotation (5)(p&lt;0.05). Each patient reported reduced pain and demonstrated an increased range of motion in the affected shoulder joint and functional improvement.

Prevalence of and factors associated with osteoarthritis and pain in retired Olympians compared with the general population: part 2 – the spine and upper limb

Objectives(1) To determine the prevalence of spine and upper limb osteoarthritis (OA) and pain in retired Olympians; (2) identify risk factors associated with their occurrence and (3) compare with a...

Total shoulder arthroplasty versus reverse total shoulder arthroplasty: Outcome comparison in osteoarthritis patients with or without concurrent rotator cuff deficiency.

Osteoarthritis (OA) is a common shoulder disorder that impacts shoulder functions. Shoulder arthroplasty is often required to restore function and quality of life. Reverse total shoulder arthroplasty (RSA), which was originally designed mainly for irreparable rotator cuff damage, has gained popularity in recent years for the treatment of advanced shoulder OA instead of the clinically standard total shoulder arthroplasty (TSA). However, this RSA has some nonnegligible flaws such as higher complications rate and economic cost, not mention the following problems caused by irreversible physical structural damage. Therefore, the employment of RSA needs to be carefully considered. This study aimed to compare TSA and RSA in OA patients with or without rotator cuff damage to better guide clinical decision making. We believe the radical use of RSA in patients without rotator cuff deficiency may cause more harm than good.We queried the Nationwide Inpatient Sample (NIS) database from 2011 to 2014 to collect information on OA patients who received TSA and RSA. Patients were divided into 2 groups of comparison according to the presence of rotator cuff deficiency and matched with propensity score analysis.A total of 57,156 shoulder arthroplasties were identified. RSA patients in the rotator cuff deficiency group had significant higher transfusion rates and longer hospital stays. RSA patients without rotator cuff deficiency had a statistically significantly higher number of implant-related mechanical complications, acute upper respiratory infections and postoperative pain. Overall, RSA incurred higher costs in both groups.For OA patients with rotator cuff deficiencies, RSA has its benefits as complication rates were comparable to TSA. For those patients without rotator cuff deficiencies, the use of RSA should be reconsidered as there were more complications with higher severity.

Platelet-rich Plasma in the Management of Shoulder Disorders: Basic Science and Implications Beyond the Rotator Cuff.

Platelet-rich plasma (PRP) is an autologous mixture produced by centrifugal separation of whole blood. Understanding the clinical efficacy of PRP remains a challenge in the field of sports medicine, including the treatment of various shoulder conditions. Animal studies have examined the biologic actions of PRP on the rotator cuff tendon and shoulder capsule. Human studies have reported the outcomes of PRP in the management of subacromial impingement syndrome, rotator cuff tears, frozen shoulder, and glenohumeral osteoarthritis. These studies highlight the role of PRP in the nonsurgical management of these conditions and its utilization in the perioperative setting to augment tissue healing and optimize the surgical outcomes. The role of PRP as an adjunct therapy in patients undergoing rotator cuff repair has been in the spotlight during the last decade; however, a limited number of studies have examined the role of PRP in the management of non-rotator cuff shoulder conditions. This article aims to provide an overview of the biologic actions of PRP on shoulder tissues and to summarize the outcomes of PRP injection in patients with rotator cuff and non-rotator cuff disease of the shoulder. We sought to organize the existing literature and to provide recommendations on the use of PRP in various shoulder conditions, based on the existing evidence.

Lesser Tuberosity Osteotomy Combined with Anteroinferior Capsulectomy for Anatomic Shoulder Arthroplasty

Adequate subscapularis tendon mobilization and glenoid exposure are critical to a successful anatomic total shoulder arthroplasty. A lesser tuberosity osteotomy allows for direct bone-to-bone healing while maintaining the strong tendon-to-bone attachment of the subscapularis tendon insertion. Excision of the typically thickened and contracted anteroinferior capsule in osteoarthritic shoulders can help mobilize the subscapularis, theoretically allowing for optimal soft-tissue balance, decreased tension on the subscapularis repair, improved glenoid exposure, and anatomic repair. In this Technical Note and accompanying video, we describe our technique for lesser tuberosity osteotomy with anteroinferior capsulectomy for anatomic total shoulder arthroplasty. This technique reliably and reproducibly produces good results in terms of glenoid exposure, soft-tissue balance, and postoperative subscapularis function.

Platelet-Rich Plasma and Rehabilitation for Upper Extremity Musculoskeletal Pathologies

Background: Platelet-rich plasma (PRP) is considered in clinical practice for its role in facilitating the body’s own healing processes, with the potential to complement physical therapy in managing musculoskeletal pathologies of the upper extremity. Methods: Eligible studies must be randomized with clinical/quasi-experimental trials with complete data analysis, and published in English. They have to recruit participants aged &gt;18 years; have at least two groups, with one intervention group receiving PRP injection alone or PRP injection and rehabilitation, and the comparison group receiving either rehabilitation alone or a control group receiving saline and rehabilitation; and finally include at least one outcome measure of pain, disability, or quality of life. An electronic search was conducted using PubMed, Embase, Cochrane, Pedro, and clinicaltrials.gov. Methodological quality was assessed using the Cochrane Collaboration Risk of Bias (RoB) tool. The grading of recommendations assessment, development, and evaluation approach was used to provide an overall assessment of the quality of evidence. Meta-analyses were conducted across outcomes within each pathology when possible. Results: A total of 13 studies assessing adhesive capsulitis, carpal tunnel syndrome, lateral epicondylal-gia, rotator cuff tendinopathy, subacromial impingement syndrome, and shoulder osteoarthritis were included with an average RoB score of 8.77 out of 12 across all studies. Meta-analyses for rotator cuff tendinopathy (n = 49) revealed a significant effect on pain (cm) (mean difference [MD] -2.53; 95% confidence interval [CI]: −5.02, −0.04; I2 statistic = 51%; P = 0.05), quality of life (MD 16.82; 95% CI: 0.40, 33.25; I2 = 0%; P = 0.04), and disability (standardized mean difference [SMD]: −0.64; 95% CI: −1.24, −0.04; I2 = 0%; P = 0.04) favoring PRP and physical therapy as long-term follow-up (moderate level of evidence). All other meta-analyses for adhesive capsulitis and carpal tunnel demonstrated nonsignificant effects. Conclusions: This systematic review demonstrated that PRP is a beneficial adjunct to physical therapy for reducing pain and improving disability and quality of life (moderate level of evidence) when compared to placebo plus physical therapy for the management of rotator cuff tendinopathy.

Total shoulder arthroplasty for osteoarthritis in patients with Parkinson's disease: a matched comparison of 90-day adverse events and 5-year implant survival.

Patients with Parkinson's disease and shoulder osteoarthritis may be indicated for total shoulder arthroplasty. However, short- and long-term outcomes after total shoulder arthroplasty in this population remain poorly characterized. A retrospective matched case-control study was performed using data abstracted from the 2010-2018 PearlDiver Mariner administrative database. Patients undergoing total shoulder arthroplasty were identified, and those with and without the diagnosis of Parkinson's disease were matched (1:10) based on age, gender, Elixhauser comorbidity index, diabetes, chronic kidney disease, obesity, coronary artery disease, and congestive heart failure. Ninety-day incidence of adverse events were compared with multivariate regressions. Implant survival was also assessed for up to 5 years, based on the occurrence of revision surgery. Kaplan-Meier implant survival curves were compared using a log-rank test. In total, 478 patients with Parkinson's disease were matched to 4715 patients without Parkinson's disease. After adjusting for demographic and comorbid factors, patients with Parkinson's disease had significantly higher odds of prosthetic dislocation (odds ratio=3.07, P=.001), but did not experience increased odds of other 90-day adverse events. Five-year follow-up was available for 428 (89.5%) of those with Parkinson's disease and 3794 (80.5%) of those without Parkinson's disease. There was 97.2% implant survival in the Parkinson's disease cohort and 97.7% implant survival in the matched control cohort (not significantly different, P=.463). Patients with Parkinson's disease undergoing total shoulder arthroplasty, compared with patients without Parkinson's disease, have 3-fold higher odds of periprosthetic dislocation in the 90-day postoperative period, but equivalent rates of other short-term adverse events as well as implant survival at 5 years. Accordingly, surgeons should be mindful of the short-term risk of implant instability but should have confidence in long-term total shoulder implant success in the Parkinson's disease population.

Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies

Study DesignInvited review. BackgroundShoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments. PurposeThe purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder. MethodsA search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review. ResultsThis review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation. ConclusionsThe shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.

Paper 79: Increasing Shoulder Osteoarthritis Severity (SOAS) Score Predicts Lower PROMIS-UE Score Following Rotator Cuff Repair

Objectives:Mild to moderate glenohumeral osteoarthritis (GHOA) is a common finding among patients who are evaluated for rotator cuff (RC) tears. However, the impact of pre-operative shoulder joint degeneration on patient-reported outcomes (PROs) following RC repair (RCR) is not well-established. Certain studies have reported a negative association between radiographic findings of glenohumeral osteoarthritis (GHOA) and RCR PROs, while other studies have found no substantial association. The purpose of this study was to apply the MRI-based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between pre-operative shoulder pathology present on MRI with post-operative PROMIS-UE scores. We hypothesized that patients with higher pre-operative SOAS scores, indicating greater shoulder pathology, would have lower post-operative PROMIS-UE scores following RCR.Methods:Seventy-one MRIs corresponding to 71 patients were analyzed by two independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each sub-score. Spearman’s correlations were calculated between averaged SOAS scores, patient demographics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, BMI, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as p<0.05.Results:The mean PROMIS-UE score of this cohort was 51.5 ± 7.5 (Table 1), while the average total SOAS score was 21.5 ± 8.4 (Table 2). There was a negative correlation between increasing total SOAS score and worsening post-operative PROMIS-UE score (r = -0.24, p = 0.04) (Table 3). Both cartilage wear (r = -0.33, p = 0.0045) and AC joint degeneration (r = -0.24, p = 0.048) individually demonstrated negative correlations with PROMIS-UE score (Table 3). SOAS cartilage score was an independent negative predictor of PROMIS-UE score in a multiple variable linear regression with patient age and sex (β = -1.05, p = 0.038) (Table 4).Conclusions:In this cohort of patients undergoing RCR, increasing pre-operative total SOAS score was predictive of lower post-operative PROMIS-UE scores. SOAS sub-scores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and AC joint degeneration. Cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient demographic factors in multivariate analysis. Pre-operative GH cartilage wear and AC joint degeneration may warrant particular attention and counseling in patients undergoing RCR.Table 1.Characteri&tici of Study SubjectTable 2.ICCs and Average SQAS ScoresTable 3.Summary of CorrelationsTable 4.Multivariate Regression of SOAS Variables to Predict PROMIS-UE

3D-MRI versus 3D-CT in the evaluation of glenoid deformity in glenohumeral arthritis using Dixon 3D FLASH sequence.

To compare MRI with 3D reconstructions and 3D-CT with respect to assessment of glenoid wear in osteoarthritic shoulders. 3D reconstructions were generated for CT and MR (utilizing the Dixon technique) imaging performed on 29 osteoarthritic shoulders. Two reviewers independently performed glenoid morphometric measurements and evaluated glenoid erosion. Mean differences between the two modalities were calculated. Inter-observer agreement was calculated using kappa coefficient. The combined mean absolute difference (bias) in glenoid version between 3D-CT and 3D-MRI was 2.7° ± 1.6° (range 0.15-7.85, P value = 0.7). The combined mean absolute difference in glenoid inclination between 3D-CT and 3D-MRI was 6.8° ± 4.1° (range 0.8°-15.75°, P value = 0.17). No significant inter-reader variation in glenoid version and inclination measurements on 3D-CT and 3D-MRI was found (P > 0.05). The inter-reader reliability for both CT and MRI was high for Walch grading of glenoid bone loss (κ = 1, κ = 0.81, respectively). 3D-MRI is comparable to 3D-CT with respect to axial glenoid bone loss, as measured by glenoid version. However, for coronal bone loss estimation, measured by glenoid inclination, 3D-CT remains the gold standard. Thus, 3D-MR can be used as an alternative for preoperative assessment of glenoid version in arthritic shoulders.

Radiological changes in shoulder osteoarthritis and pain sensation correlate with patients’ age

PurposeOsteoarthritis (OA) is one of the most common musculoskeletal disorders in the aging population. The correlation of radiographic OA severity, disability and pain is variable and inconsistent for the different joints. This study aims to elucidate the relationship between histological and radiological signs of shoulder OA with pain sensation and functional impairment to potentially adapt the recommendation for surgical treatment for primary total shoulder arthroplasty (TSA).MethodsForty-four patients with shoulder OA undergoing TSA using an anatomic stemless implant were included in this study. The radiological OA severity was scored pre-operatively on true ap X-rays according to the Kellgren–Lawrence score (KL-Score). Acromial types according to Bigliani were defined by pre-operative radiological images. The histological OA severity was determined according to the OARSI-Score using bone–cartilage sections from loaded areas of the humeral head. Pain was quantified using the visual analog scale (VAS). The functional status was assessed by the items “mobility” and “strength” out of the Constant–Murley score (CS Score). Demographic data including BMI, age, gender, diabetes mellitus and smoking were recorded.ResultsThere was no correlation between radiographic and histological severity in shoulder OA. However, a correlation of age and the severity of radiological changes was observed. Further, pain did not correlate with histological or radiological scores, whereas it correlated with age and the presence of diabetes mellitus. The functional shoulder status (mobility, strength) correlated with the severity of radiological changes, but not with the histologic scoring, which correlated with nicotine abuse.ConclusionThis study shows that increased age is the main determinant of radiological changes in shoulder OA, as well as pain. Therefore, age and pain sensation should be considered as important parameters for the recommendation for TSA.

Quantitative statistical shape model-based analysis of humeral head migration, Part 2: Shoulder osteoarthritis.

We wanted to investigate the quantitative characteristics of humeral head migration (HHM) in shoulder osteoarthritis (OA) and their possible associations with scapular morphology. We quantified CT-scan-based-HHM in 122 patients with a combination of automated 3D scapulohumeral migration (=HHM with respect to the scapula) and glenohumeral migration (=HHM with respect to the glenoid) measurements. We divided OA patients in Group 1 (without HHM), Group 2a (anterior HHM) and Group 2b (posterior HHM). We reconstructed and measured the prearthropathy scapular anatomy with a statistical shape model technique. HHM primarily occurs in the axial plane in shoulder OA. We found "not-perfect" correlation between subluxation distance AP and scapulohumeral migration values (rs = 0.8, p < 0.001). Group 2b patients had a more expressed prearthropathy glenoid retroversion (13° vs. 7°, p < 0.001) and posterior glenoid translation (4 mm vs. 6 mm, p = 0.003) in comparison to Group 1. Binary logistic regression analysis indicated prearthropathy glenoid version as a significant predictor of HHM (χ² = 27, p < 0.001). Multivariate regression analysis showed that the pathologic version could explain 56% of subluxation distance-AP variance and 75% of the scapulohumeral migration variance (all p < 0.001). Herewith, every degree increase in pathologic glenoid retroversion was associated with an increase of 1% subluxation distance-AP, and scapulohumeral migration. The occurrence of posterior HHM is associated with prearthropathy glenoid retroversion and more posterior glenoid translation. The reported regression values of HHM in the function of the pathologic glenoid version could form a basis towarda more patient-specific correction of HHM.

Ultrasound-guided continuous radiofrequency ablation of the suprascapular nerve for chronic shoulder pain secondary to osteoarthritis: a retrospective cohort study.

The objective of this study is to retrospectively evaluate the use of ultrasound-guided continuous radiofrequency (CRF) lesioning of the suprascapular nerve for treating chronic shoulder pain, due to osteoarthritis. We describe a modified distal and selective ablation technique in the spinoglenoid notch, with motor and sensory stimulation, which protects the motor branch of the nerve from ablation. A retrospective analysis was performed of patients, who underwent ultrasound-guided CRF lesioning of the suprascapular nerve from October 2013 to January 2020. During the procedure, the CRF electrode is placed in the spinoglenoid notch, at the distal suprascapular nerve capsular branch. Motor and sensory stimulations are used to confirm the position. CRF lesioning is applied up to three times, at 3 different points, for 1 min each time, at 80° C. In total, 127 first CRF suprascapular nerve lesioning procedures were performed on 101 patients with chronic shoulder pain secondary to osteoarthritis. One hundred nineteen diagnostic ultrasound-guided suprascapular nerve corticosteroid injections were performed prior to ablation. Mean pre-injection Visual Analogue Scale pain score (VAS) was 8.3, with post-injection VAS score of 4.4 at 24 h and 4.5 at 2 weeks. Mean pre-CRF lesioning VAS pain score was 7.7 with post-CRF lesioning VAS score of 4.4 at 24 h and 4.5 at 2 weeks. Ultrasound-guided CRF lesioning of the suprascapular nerve in the spinoglenoid notch is a safe treatment for chronic osteoarthritic shoulder pain, with repeat treatments infrequently required. It is associated with significant improvement in VAS pain scores. • Ultrasound-guided continuous radiofrequency lesioning of the suprascapular nerve in the spinoglenoid notch is a safe treatment for chronic shoulder pain in degenerative disease, with repeat treatments infrequently required. • The procedure is performed under ultrasound guidance, without the use of ionising radiation.

Survey of Shoulder Osteoarthritis in Patients who Underwent Total Hip Arthroplasty for Hip Osteoarthritis.

To the best of our knowledge, no previous studies have reported a relationship between osteoarthritis (OA) of the lower limbs and OA of the shoulder joints. We evaluated the correlation between shoulder OA and hip OA. We collected contrast-enhanced computed tomography (CECT) images of the shoulder joints of 159 patients with hip OA who underwent primary total hip arthroplasty (THA). The images, taken 1 week after THA to monitor venous thromboembolism (VTE), were used to examine the prevalence of shoulder OA. They were compared with those of 103 controls who underwent CECT during the same period to monitor VTE. Shoulder OA was observed in 15% of the controls and 24% of the THA patients. Although the rate was somewhat higher in the THA group, the difference was not significant. However, in the THA group, significantly more patients with bilateral hip OA (33%) had shoulder OA than those with unilateral hip OA (17%). In summary, the prevalence of shoulder OA was significantly higher in patients with bilateral hip OA. In these patients, pain and instability in the hip joints require them to use arm support to stand up or walk, putting the weight-bearing shoulder at risk of developing OA.

116 Determining factors associated with treatment outcomes in patients with shoulder arthritis

OBJECTIVES/GOALS: For shoulder osteoarthritis (OA), the understanding of the patient-specific factors that determine success of both non-operative and operative treatment options is limited. This study aims to identify key factors associated with the response and the heterogeneity of outcomes for both types of treatment. METHODS/STUDY POPULATION: Patients diagnosed with shoulder OA and treated with either reverse/anatomic total shoulder arthroplasty (rTSA/TSA) or non-operative management at the University of California, San Francisco were enrolled in this study. They were followed for a year to ascertain phenotypic traits and patient-reported outcomes (PROs). Magnetic Resonance Imaging (MRI) was used to calculate the Shoulder Osteoarthritis Severity (SOAS) score, a semi-quantitative global assessment of shoulder OA, and to measure fat fractions of rotator cuff muscles. A Microsoft Kinect camera was used to determine the Reachable Workspace (RWS). Linear regression models were used to assess the associations between baseline demographic and radiographic factors on outcomes related to shoulder function. RESULTS/ANTICIPATED RESULTS: It is anticipated that the pre-operative MRI-based SOAS score will be inversely correlated with the magnitude of improvement in PROs 1 year after rTSA/TSA and non-operative management of shoulder OA for the surgical replacement and non-operative cohorts, respectively. Additionally, the non-operative patients who convert to rTSA/TSA within 1 year of observation will have higher SOAS scores compared to patients who continue with non-operative management. The surgical replacement patients with an infraspinatus fat fraction of more than 5% will have worse shoulder function, as measured by RWS, compared to patients with an infraspinatus fraction less than 5%. DISCUSSION/SIGNIFICANCE: MRI may be a novel technique to better predict prognosis of shoulder OA management. This will allow for the development of appropriate algorithms in the prescription of treatments and may be used to counsel patients regarding their expected outcomes or to recommend alternative treatments.

Etiologic Factors of Rotator Cuff Disease in Elderly: Modifiable Factors in Addition to Known Demographic Factors.

With the aging society, musculoskeletal degenerative diseases are becoming a burden on society, and rotator cuff disease is one of these degenerative diseases. The purpose of this study was to examine the incidence of shoulder osteoarthritis and the etiologic factors of rotator cuff disease in the Korean elderly population. A total of 102 patients performing ultrasonography were recruited, and their demographic factors were analyzed. As functional factors, visual analog scale and the peak torque of external and internal rotators of the shoulder using an isokinetic dynamometer were measured. As an anatomical factor, the acromiohumeral distance in the plain radiograph of the glenohumeral anterior-posterior view was used. There were more female patients (65.7%) than male patients (34.3%). The age range with the highest number of respondents was 50–59 years old. The mean visual analogue score was 4.09 (Min 1 to Max 9). Age and dominant hand side factors appear to be the crucial etiologic factors of the presence and severity of rotator cuff disease. The lower net value of the external rotator strength is weakly related to the presence of rotator cuff disease after adjusting for age, and this is the only modifiable factor in the study.

High Volume PRP Therapy.

The PRP method is widely used to support healing and regeneration in musculoskeletal and aesthetic medicine. The current literature, however, brings contradictory reports as to its effectiveness, which, at least in part, should be attributed to the diversity of methods for producing the concentrate, including the use of various volumes of whole blood, single vs double centrifugation vs filtration, use of thrombin vs calcium chloride to activate the process, and, finally, the use of an anticoagulant. The aim of the study was to retrospectively evaluate the effectiveness of high-volume PRP therapy with the Angel® system (Arthrex) in our patients. A total of 400 therapies were performed on 299 patients. The most frequently represented indications were knee osteoarthritis (OA), n = 164, including mild (n = 30), moderate (n = 38), and advanced (n = 96) stage; lumbar degenerative disc disease (LDDD), n = 54; rotator cuff injuries (RCI), n = 52; lumbar spinal stenosis (LSS), n = 37; cervical degenerative disc disease (CDDD), n = 17; and shoulder OA, n = 12. Therapies for LDDD and LSS patients were additionally divided with respect to the route of administration (periradicular vs epidural). The assessment tool was the modified Macnab scale. Follow-up examinations were performed at two and six months after PRP administration. Indicators of treatment success were defined as the percentage of satisfactory results and the percentage ratio of satisfactory results to non-satisfactory results after 2 and 6 months of follow-up (S/NS2 and S/NS6). For the advanced stage of knee OA, the results were compared in three age groups (under 66, 67-73 and over 74). For the entire treatment group, the mean S/NS2 ratio was 1.56; in the group of the most frequently represented indications, the highest satisfaction ratio was obtained in LDDD (2.84), and the lowest in the group of RCI (0.96). The mean value of the S/ NS6 ratio was 2.24, being the highest in mild knee OA (4.79) and CDDD (4.67), and the lowest in shoulder OA (0.72). In the age group over 74 years, the frequency of non-satisfactory results shows an increase in patients with advanced knee OA. 1. High-volume PRP therapy can be used as a local regenerative and anti-inflammatory treatment, demonstrating the highest efficacy in early knee OA and CDDD. 2. High PRP therapy demonstrates a high safety profile. 3. The final effects of the therapy develop over a period of several months of follow-up and depend on the severity of the degenerative process and the patient&apos;s age.

Cooled Radiofrequency Ablation for Chronic Joint Pain Secondary to Hip and Shoulder Osteoarthritis.

Osteoarthritis (OA) of the shoulder and hip is a leading cause of physical disability and mental distress. Traditional nonsurgical management alone is often unable to completely address the associated chronic joint pain. Moreover, a large number of patients are not eligible for joint replacement surgery owing to comorbidities or cost. Radiofrequency ablation (RFA) of articular sensory nerve fibers can disrupt the transmission of nociceptive signals by neurolysis, thereby providing long-term pain relief. A subtype of RFA, cooled RFA (CRFA), utilizes internally cooled electrodes to generate larger ablative zones compared with standard RFA techniques. Given the complex variable innervation of large joints such as the glenohumeral and hip joints, a larger ablative treatment zone, such as that provided by CRFA, is desired to capture a greater number of afferent nociceptive fibers. The suprascapular, axillary, and lateral pectoral nerve articular sensory branches are targeted during CRFA of the glenohumeral joint. The obturator and femoral nerve articular sensory branches are targeted during CRFA of the hip. CRFA is a promising tool in the interventionalist's arsenal for management of OA-related pain and symptoms, particularly in patients who cannot undergo, have long wait times until, or have persistent pain following joint replacement surgery. An invited commentary by Tomasian is available online. ©RSNA, 2022.