Subacromial Bursitis Research Articles

Arthroscopic management of synovial chondromatosis of the shoulder: A case report

Synovial chondromatosis of the shoulder is a rare entity that is generally mono-articular and uncommon in diarthrodial joints. Treatment of synovial chondromatosis of the shoulder includes open arthrotomy retrieval of loose bodies and synovectomy. With advances in arthroscopy, the same could be achieved using arthroscopic techniques. This case report describes a case report of a 35-year-old male patient who presented with complaints of pain and restriction of movement for 6 months. The MRI of the patient was suggestive of multiple loose bodies in the shoulder joint, in the subdeltoid region, and subscapularis muscle with subacromial bursitis. Arthroscopically more than 100 loose bodies were retrieved with subacromial decompression. Shoulder synovial chondromatosis has been rarely reported in the literature. The malignant transformation although rare, but it is still a possibility. The recurrence rate varies from 3.2% to 22.3%. Open arthrotomy, synovectomy, and retrieval of loose bodies cause delayed recovery and more morbidity with high chances of subscapularis insufficiency due to the need of subscapularis tenotomy. Arthroscopic treatment although have limitations such as limited visualization, limited synovectomy, and difficult interventions around the axillary recess or biceps sheath, but provides with the advantage of lesser morbidity and early rehabilitation. Synovial chondromatosis can be successfully treated arthroscopically as it provides intra-articular and extra articular access with early rehabilitation, lesser morbidity, and early recovery.

Relationship between shoulder ultrasound findings and disease activity in patients with rheumatoid arthritis: A pilot study.

Objectives The aim of this study was to investigate whether shoulder ultrasound (US) findings were associated with disease activity and pain level in rheumatoid arthritis (RA) patients.Patients and methods Between April 2019 and November 2019, a total of 60 shoulders of 30 female patients with RA (mean age: 53.8±12.0 years; range, 30 to 65 years) were included. The patients were questioned about shoulder pain and their Disease Activity Score-28 (DAS28) was estimated. After clinical examination with shoulder impingement tests, both shoulders were evaluated by US.Results Of 60 shoulders examined by shoulder US, the most common shoulder pathology was supraspinatus tendinopathy (n=33, 55%). The prevalence of subdeltoid bursitis on US was significantly higher in the group with moderate disease activity, compared to the group with low disease activity (p<0.05). There were no significant differences in the physical examination findings of patients with low and moderate disease activity. In terms of US findings, subscapularis tendinopathy, glenohumeral joint and acromioclavicular joint degeneration, and subacromial bursitis were more common in shoulders with a history of pain, compared to non-painful shoulders.Conclusion Shoulder US may be useful for demonstrating shoulder involvement in patients with RA, independent of the presence of shoulder pain.

THE DIAGNOSTIC VALUE OF MAGNETIC RESONANCE IMAGING IN SUBACROMIAL IMPINGEMENT SYNDROME

The retrospective study was performed on 45 patients with subacromial impingement syndrome who underwent magnetic resonance imaging (MRI) which then were compared with the results of their arthroscopy.&#x0D; Results: 95.2% out of the cases were found to have type II and III acromion morphology; 73.8% had subacromial enthesophyte spurs; 66.7% had subacromial bursitis; 97.6% showed lesions of supraspinatus tendons in which partial–thickness rotator cuff tear was the most commonly seen. MRI showed a sensitivity (Sn) of 91.6%, specificity (Sp) of 72.2%, positive predictive value (PPV) of 81.4%, negative predictive value (NPV) of 86.67% in diagnosing subacromial bursitis. For partial-thickness rotator cuff tear, it showed a Sn of 92.5%, Sp of 93.3%, PPV of 96.1%, NPV of 87.5%. In evaluation of full-thickness rotator cuff tear, MRI showed a Sn of 100% and Sp of 100%.

Subacromial impingement syndrome: association of multiple magnetic resonance imaging parameters with shoulder function and pain

IntroductionShoulder pain is one of the most common complaints in orthopaedics. This study focusses on the relationship between shoulder function in subacromial impingement syndrome and imaging criteria in magnetic resonance imaging (MRI).Materials and methodsThis prospective clinical trial included 69 patients treated for subacromial impingement syndrome. Shoulder function (Constant Score, range of abduction, abduction force) and pain were correlated with the following MRI parameters: tendinosis of the rotator cuff, “halo-sign” around the biceps tendon, subacromial distance, critical shoulder angle, size of subacromial osteophytic spurs and maximum width of subacromial and subdeltoid bursa. Statistical analyses included Pearson’s and Spearman’s coefficients of correlation, multiple regression analysis and Student’s t-test.ResultsThe Constant Score was correlated positively with the critical shoulder angle (r = 0.313; p = 0.009) and inversely with a “halo-sign” around the biceps tendon (rho = −0.384; p = 0.001). There was no significant correlation between spur size and shoulder function, but the size of the subacromial and subdeltoid bursae was positively correlated with the subacromial spur’s size (subacromial bursa: coronal plane: r = 0.327; p = 0.006; sagittal view: r = 0.305; p = 0.011; subdeltoid bursa coronal view: r = 0.333 p = 0.005). The width of the subdeltoid bursa in coronal plane was positively correlated with shoulder pain (r = 0.248; p = 0.004) and negatively with the range of abduction (r = −0.270; p = 0.025), as well as the mean (r = −0.332; p = 0.005) and maximum (r = −0.334; p = 0.005) abduction force.ConclusionsShoulder function and pain in subacromial impingement are best predicted by the width of the subdeltoid bursa measured in the coronal MRI plane as an indicator of bursitis as well as the presence of a “halo-sign” around the biceps tendon indicating glenohumeral joint effusion. Presence of a subacromial spur could lead to subacromial and subdeltoid bursitis, which impairs shoulder function. Shoulder function seems not to be compromised by the presence of a subacromial spur in absence of bursitis.This study was registered at the German Clinical Trials Register on 08 February 2013 (ID: DRKS00011548).

Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

Objectives:Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods:A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant.Results:239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention.Conclusions:Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

Role of Magnetic Resonance Imaging and Ultrasonography in Evaluation of Chronic Non osseous Shoulder Pain.

Background: Chronic shoulder pain is a common clinical presentation. It is of osseous or non-osseous origin. In non-osseous shoulder pain, proper diagnosis is critical. Magnetic resonance imaging [MRI] is the standard diagnostic modality. However, it is expensive and not available in many medical centers. Thus, the availability of cheap alternative is crucial. Aim of the work: The current research aimed to assess the diagnostic performance of ultrasonography versus conventional MRI in different causes of chronic non-osseous shoulder pain. Patients and Methods: Fourty patients with chronic shoulder pain due to different causes were participated in the current work. They were selected from Al-Azhar University Hospital [Damietta]. All were assessed on clinical basis [history, physical examination and laboratory investigations]. Then, all were submitted to radiological investigations [Plain X-ray, shoulder ultrasound, and Magnetic resonance imaging]. The diagnostic value of ultrasound was estimated versus that of magnetic resonance imaging. Results: by ultrasound, tendinosis was reported in 55.0%, partial thickness tear in 27.5%, articular surface in 20.0%, full thickness tear in 12.5%, bursal surface [7.5%], neoplastic [2.5%] and infraspinatus tendon full thickness tear [2.5%]. Ultrasound able to diagnose supraspinatus tendinopathy [91.7%], full thickness complete tear [83.3%], supraspinatus impingement [85.3%], subacromial subdeltoid bursitis [92.0%] and long head biceps tenosynovitis [84.2%]. Otherwise, ultrasound specificity is over its sensitivity power for partial thinness tear on articular [80.0%] or bursal surfaces [85.3%], full thickness complete tear [94.1%], shoulder joint effusion [92.3%], LHB tenosynovitis [85.7%] and labral tears [100.0%]. Conclusion: Shoulder ultrasound could be considered as a reasonable alternative to magnetic resonance imaging in the diagnosis of different causes of chronic shoulder pain. However, its value widely different from condition to another. Thus, it could be used as a rapid screening tool, and the use of MRI could be ascribed for specific conditions [cases with lower ultrasound sensitivity].

866 A Lateral Approach Is More Likely to Be Successful Than A Posterior Approach for An Injection to Reach the Subacromial Space

Abstract Background Subacromial injections are common for diagnosis and therapy of shoulder impingement secondary to subacromial bursitis. We evaluated the likelihood of a successful subacromial injection from both the posterior and lateral injection sites. Method We reviewed 100 MRI scans of the shoulder and recorded measurements in both the sagittal (representative of posterior injection) and coronal (representative of lateral injection) orientations. We compared these to the lengths of standard needles. Multiple measurements were taken: Results Measuring along the angle of the acromion demonstrated shorter mean distances from the lateral injection site. The distance from skin to mid-point of the acromion) provided mean values of 51.4mm for posterior and 40.1mm for lateral. A standard 40mm (green) needle would reach the midpoint of the acromion in 58% of lateral measurements and 23% from posterior. Conclusions Injections are more likely to enter the subacromial space from a lateral rather than a posterior entry point.

Comparison of the corticosteroid injection and hyaluronate in the treatment of chronic subacromial bursitis: A randomized controlled trial

Objective: To analyse the effectiveness of corticosteroid (CS) and hyaluronic acid (HA) subacromial – subdeltoid (SASD) injection compared with normal saline (NS) in patients with chronic subacromial bursitis (CSB). Design: A prospective three-arm double-blinded randomised controlled trial. Setting: Rehabilitation department of two teaching hospitals. Subjects: Patients with CSB (N = 186) divided into CS (N = 68), HA (N = 60), and NS (N = 58) groups. Interventions: Three SASD injections under ultrasound guidance: group A, 20 mg of triamcinolone; group B, 2.5 mL of HA; and group C, 2.5 mL of NS. Outcome measures: The primary outcome measures were the pain visual analogue scale (VAS) score at eight weeks. The secondary outcomes were scores on the Shoulder Pain and Disability Index (SPADI) and Shoulder Disability Questionnaire. Results: At eight weeks, the pain VAS scores during activity were 2.56 ± 2.29, 3.65 ± 2.50, and 4.71 ± 2.83 in the CS, HA, and NS groups, respectively (CS vs NS, P < 0.001; HA vs NS, P = 0.013; CS vs HA, P = 0.010). SPADI scores were 40.83 ± 21.75, 36.92 ± 22.78, and 33.35 ± 23.38 in the CS, HA, and NS groups, respectively (CS vs NS, P < 0.001; HA vs NS, P = 0.197; CS vs HA, P = 0.004). Conclusion: Ultrasound-guided corticosteroid injection into the subacromial – subdeltoid bursa was proven to be effective and superior to hyaluronic acid and normal saline injection for treating CSB. Hyaluronic acid injection was only marginally more effective than normal saline injection. Trial Registration: ClinicalTrials.gov: NCT02702206

Resistance band training after triamcinolone acetonide injection for subacromial bursitis: A randomized clinical trial.

ObjectiveTo investigate the effect of progressive resistance training using resistance (elastic) bands on subacromial bursitis following triamcinolone acetonide injection.DesignRandomized clinical trial.PatientsA total of 68 patients with subacromial bursitis were randomized to a triamcinolone acetonide group or a triamcinolone acetonide plus resistance band training group.MethodsVisual analogue scale, Constant scores, range of motion, proprioception, and muscle strength were evaluated at pretreatment and at 3, 12 and 24 weeks’ follow-up. Re-treatment ratio was calculated at one-year follow-up.ResultsAt 3 and 12 weeks, both the triamcinolone acetonide group and triamcinolone acetonide plus resistance band training group showed a significant improvement in Visual analogue scale score, Constant score, range of motion, proprioception and muscle strength. Although the scores in the triamcinolone acetonide group had not increased at 24 weeks compared with baseline, the scores in the triamcinolone acetonide plus resistance band training group showed continued improvement at 24 weeks. A lower proportion of patients in the triamcinolone acetonide plus resistance band training bands group than in the triamcinolone acetonide group had received re-treatment at one-year follow-up (12.1% vs 82.9%).ConclusionProgressive resistance training with resistance (elastic) bands has the advantages of extending the benefits of corticosteroid injection and maintaining long-term effects on shoulder function in patients with subacromial bursitis.LAY ABSTRACTSubacromial bursitis is characterized by pain and stiffness of the shoulders. Corticosteroid injection is widely used in treating subacromial bursitis; however, with differing views on its long-term effects in preventing shoulder symptoms. Resistance (elastic) band training is commonly used to promote muscle activation during shoulder rehabilitation. The aim of this study was to investigate the effect of progressive resistance training with elastic bands on subacromial bursitis following triamcinolone acetonide injection. Patients with subacromial bursitis were randomized to a triamcinolone acetonide group or a triamcinolone acetonide plus resistance band training group. The triamcinolone acetonide group received triamcinolone acetonide injection only. Meanwhile, the triamcinolone acetonide plus resistance band training group received triamcinolone acetonide injection and resistance band training. At 3 and 12 weeks, both the triamcinolone acetonide group and triamcinolone acetonide plus resistance band training group showed a significant improvement in pain relief, mobility, and muscle strength. A lower proportion of patients in the triamcinolone acetonide plus resistance band training group than in the triamcinolone acetonide group had received re-treatment at the oneyear follow-up (12.1% vs 82.9%). Thus, training with resistance (elastic) bands has the advantages of extending the benefits of corticosteroid injection and maintaining long-term effects on shoulder function in subacromial bursitis.

Shoulder Impingement (Care of the Young Athlete)

Patient Education| 2021 Shoulder Impingement (Care of the Young Athlete) Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Shoulder Impingement (Care of the Young Athlete). Pediatric Patient Education 2021; 10.1542/peo_document568 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsPediatric Patient Education Search Advanced Search Subjects: Care of the Young Athlete Topics: athlete, shoulder region, pain Shoulder impingement is an overuse injury that causes achy pain on the front or side of the shoulder. The pain is felt most when the arm is overhead or extended to the side. Shoulder impingement also is called rotator cuff tendonitis, subacromial impingement, supraspinatus tendonitis, and shoulder bursitis. Shoulder impingement is common in swimmers and athletes who play baseball, tennis, and volleyball. It can also occur in weight lifters, gymnasts, divers, and rowers. Causes include a rapid increase in overhead activity, weakness or strength imbalance in the rotator cuff or scapular muscles, postural abnormalities, shoulder joint instability, or improper training or technique. The following is information from the American Academy of Pediatrics summarizing treatment phases and goals for shoulder impingement. Treating shoulder impingement involves limiting activities that cause pain and using ice and nonsteroidal anti-inflammatory drugs (NSAIDs) to... © 20122012 American Academy of Pediatrics. Reviewed 7/2020. All rights reserved. You do not currently have access to this content.

1559. Methicillin Susceptible Staphylococcus aureus Is The Predominant Organism In Septic Bursitis With The Majority Involving The Olecranon Bursa: A Study Of 61 Cases

BackgroundBursae are fluid filled structures between mobile parts of the musculoskeletal system to reduce friction between surfaces by lubrication. The most frequently infected are the olecranon and prepatellar bursae. In reported studies there is male preponderance, a relationship to occupational or recreational activities, a mean age of about 50 years and the most frequent organism being Staphylococcus aureus. The frequency of methicillin resistance is not well documented.MethodsWe analyzed approximately 7000 Staphylococcus aureus isolates reported by the laboratory over a 3-year period in 10 of our network hospitals, 9 in Eastern Pennsylvania and one in adjacent Warren County, New Jersey and found 61 cases of S. aureus septic bursitis.ResultsOnly 13/61 (21.3%) were caused by methicillin resistant S. aureus (MRSA), 8 olecranon (61.5%), 4 prepatellar (30.8%) and one subacromial (7.7%). Only one in MRSA group (olecranon bursitis) was female. The mean age of MRSA cases was 58.5. Methicillin susceptible S. aureus (MSSA) predominated with 34/48 (70.8%) olecranon bursitis (28M/6F), 11/48 (22.9%) prepatellar bursitis (10M/1F) and 3/48 (6.3%) sub acromial bursitis (1M/2F) with a mean age of 61.9. Overall (MRSA +MSSA), 51/61 (83.6%) were male and 10/61 (16.4%) were female. The olecranon bursa was involved in 42/61 (68.9%), prepatellar bursa 15/54 (24.6%) and subacromial bursa 4/54 (6.6%). The mean age for the entire group was 61.2 with the youngest 23 and the oldest 93. The occupational history was recorded only in a few patients e.g. roofer, floor worker, construction worker. Three in the MSSA group had bacteremia (2 subacromial bursitis and 1 olecranon bursitis). There was 1 death from gram negative sepsis which was unrelated. The majority were successfully treated with a combination of drainage and antibiotics.ConclusionIn summary, our study shows a predominance of olecranon bursitis, with a higher incidence in males and majority caused by MSSA. The mean age around 61 was higher than the mean age in prior reports around 50 years. Elbows and knees accounted for 57/61 (93%) cases of septic bursitis. Avoidance of activities involving friction or repeated trauma to elbows and knees should help prevention of septic bursitis. As far as we are aware, this is the largest series of septic bursitis reported.Disclosures All Authors: No reported disclosures

Ultrasonography as diagnostic tool in rotator cuff injuries of shoulder

Introduction: Rotator Cuff injuries are quite common in adults with or without trauma. These are suspected on clinical history and examination and commonly confirmed by Ultrasonography and MRI of shoulder. This study aims to use Ultrasonography of shoulder as the main diagnostic tool for such injuries. Material and Methods: A total of 30 patients suspected to have complete or incomplete tear of Rotator Cuff were subjected to Clinical Examination of Shoulder including specific tests for Rotator Cuff Muscles, X-ray and Ultrasonography of shoulder. Diagnosis by clinical examination and Ultrasonography was compared. Observation and Results: Out of 30 cases studied, on clinical examination, 10 cases had complete tear of supraspinatus, 19 cases had incomplete tear of supraspinatus with or without subscapularis, and 1 case had isolated subscapularis tear. Ultrasonography noted full thickness tear of supraspinatus in 8 cases, incomplete tear of supraspinatus with or without subscapularis, in 20 cases, bicipital tendinitis in 01 case and subacromial subdeltoid bursitis in 01 case. Conclusion: Ultrasonography confirms the clinical diagnosis of rotator cuff tear with satisfactory sensitivity and specificity. It can be used as a first line diagnostic tool for diagnosis of Rotator cuff tear as it confirms the clinical suspicion and its results are comparable to MRI. Keywords: Rotator Cuff tear, Ultrasonogprahy, Shoulder.

Posterior Humeral Avulsion of the Glenohumeral Ligament: A Rare and Nonspecific Injury

Posterior Humeral Avulsion of the Glenohumeral Ligament: A Rare and Nonspecific Injury

Rational use of shoulder MRI in the private setting: specialist-ordered MRIs influence clinical management significantly more often than primary care physicians.

The aim of this study was to determine the difference in proportion of shoulder MRIs that influence the management plan of shoulder patients based on whether MRI was ordered by a shoulder specialist, orthopaedic surgeon or primary care provider prior to referral to a specialist. This observational analytical study was conducted in a private practice setting. Data were obtained from 153 MRIs performed on 151 patients. Seventy-seven MRIs were ordered by a specialist shoulder surgeon and 76 by a primary care provider (general practitioner, non-operative sports medicine physician or physiotherapist). Specialist-ordered MRIs influenced patient management significantly more often than primary care-ordered MRIs (82% vs. 22%, p < 0.001). Fifty-four percent of referral letters from primary care providers to the specialist did not have documentation of a physical examination, yet an MRI had been ordered. The most common diagnoses for primary care-ordered MRIs which did not have influence on patient management were subacromial bursitis and adhesive capsulitis. With less than 25% of primary care-ordered shoulder MRIs influencing clinical management, questions must be raised about the indications for MRI. Greater than 50% of referrals contained no documented physical examination, suggesting that MRI is being relied upon for assessment. If access to private MRI was to be rationalized, perhaps shoulder specialist-ordered CT and X-ray could be covered by insurance providers. Currently, they are not covered in our system, yet are more likely to influence clinical management than primary care-ordered MRIs, which are currently covered by insurance without restriction on indications.

Shoulder Bursitis from Routine Vaccination

Many reports have suggested that vaccination in the deltoid muscle can trigger subdeltoid or subacromial bursitis. However, shoulder bursitis is so

Risk for Subdeltoid Bursitis After Influenza Vaccination: A Population-Based Cohort Study.

Subdeltoid bursitis has been reported as an adverse event after intramuscular vaccination in the deltoid muscle. Most published case reports involved influenza vaccine. To estimate the risk for subdeltoid bursitis after influenza vaccination. Retrospective cohort study. The Vaccine Safety Datalink, which contains health encounter data for 10.2 million members of 7 U.S. health care organizations. Persons who received an inactivated influenza vaccine during the 2016-2017 influenza season. Potential incident cases were identified by searching administrative data for persons with a shoulder bursitis diagnostic code within 180 days after receiving an injectable influenza vaccine in the same arm. The date of reported bursitis symptom onset was abstracted from the medical record. A self-controlled risk interval analysis was used to calculate the incidence rate ratio of bursitis in a risk interval of 0 to 2 days after vaccination versus a control interval of 30 to 60 days, which represents the background rate. The attributable risk was also estimated. The cohort included 2943493 vaccinated persons. Sixteen cases of symptom onset in the risk interval and 51 cases of symptom onset in the control interval were identified. The median age of persons in the risk interval was 57.5 years (range, 24 to 98 years), and 69% were women. The incidence rate ratio was 3.24 (95% CI, 1.85 to 5.68). The attributable risk was 7.78 (CI, 2.19 to 13.38) additional cases of bursitis per 1 million persons vaccinated. The results may not be generalizable to vaccinations done in other types of health care settings. Although an increased risk for bursitis after vaccination was present, the absolute risk was small. Centers for Disease Control and Prevention.

Shoulder pain syndrome in patients engaged in physical culture and sports: modern aspects of rehabilitation

The aim of the study was to estimate rehabilitation efficiency in the sportsmen and physical culture professionals with a shoulder pain syndrome. Materials and methods: 980 patients with a shoulder pain syndrome undergo rehabilitation treatment. The reasons of acute or chronic shoulder pain syndrome were: acute trauma (7% of cases) or chronic microtraumatization (93% of cases) of shoulder tissues during the physical culture activities and sport. Rotary cuff pathology was diagnosed in 88% of patients, long head of biceps pathology - in 5%, acromioclavicular joint pathology - in 4%, the subacromial bursitis in 2% of cases, damage of the glenoid labrum (Bankarta) in 1%. Clinical methods (including the quality of life questionnaire -DASH) and instrumental methods (USD and MRI) were used. The differentiated rehabilitation programs (with the use of modern physical therapy methods) were recommended considering features of shoulder pathology, a patients clinical condition and their physical (including sports) activity. Results: Excellent and good results were stated in 98% of patients with a shoulder pain syndrome. 2% of patients were directed for the surgical intervention (rotary cuff and glenoid labrum restoration). Compensation of a shoulder pain syndrome was stated in 82% of patients; in 16% of patients the pain syndrome had significantly decreased. In 87% of patients function of the injured shoulder joint was restored, in 11% of patients - it significantly improved. Strength of shoulder muscles and a humeroscapular rhythm were restored and the quality of life (according to the DASH questionnaire) improved in 98% of patients. Conclusion. Use of the differentiated programs of rehabilitation using modern physical techniques allows to receive excellent and good results in all patients with a shoulder pain syndrome involved physical culture and sport.

7-T clinical MRI of the shoulder in patients with suspected lesions of the rotator cuff

BackgroundTo evaluate feasibility and diagnostic performance of clinical 7-T magnetic resonance imaging (MRI) of the shoulder.MethodsEight patients with suspected lesions of the rotator cuff underwent 7-T MRI before arthroscopy. Image quality was scored for artifacts, B1+ inhomogeneities, and assessability of anatomical structures. A structured radiological report was compared to arthroscopy. In four patients, a visual comparison with pre-existing 1.5-T examinations was performed.ResultsRegarding image quality, the majority of the sequences reached values above the middle of each scoring scale. Fat-saturated proton density sequences showed least artifacts and best structure assessability. The most homogenous B1+ field was reached with gradient-echo sequences. Arthroscopy did not confirm tendinopathy/partial tear of supraspinatus in 5/8 patients, of subscapularis in 5/6, and of infraspinatus in one patient; only a partial lesion of the subscapularis tendon was missed. Pathologic findings of long bicipital tendon, acromioclavicular joint, glenohumeral cartilage, labrum, and subacromial subdeltoideal bursa were mainly confirmed; exceptions were one lesion of the long bicipital tendon, one subacromial bursitis, and one superior glenoid labrum anterior-to-posterior lesion, missed on 7-T MRI. Evaluating all structures together, sensitivity was 86%, and specificity 74%. A better contrast and higher image resolution was noted in comparison to previous 1.5-T examinations.Conclusions7-T MRI of the shoulder with diagnostic image quality is feasible. Overrating of tendon signal alterations was the main limitation. Although the diagnostic performance did not reach the current results of 3-T MRI, our study marks the way to implement clinical 7-T MRI of the shoulder.

Streptobacillus moniliformis bacteraemia and septic arthritis in a child

Streptobacillus species are zoonotic pathogens colonising the oral cavity and upper respiratory tract of rats and other rodents.1 Transmission occurs via bites or scratches, referred to as rat-bite fever, or ingestion of contaminated food or water, referred to as Haverhill fever.1,2 Streptobacillus species are rarely isolated due to fastidious growth requirements, inhibition by sodium polyanethol sulfonate anticoagulant in blood culture bottles, and susceptibility to commonly-used antibiotics.1 A 12-year-old immunocompetent female with pet mice and rats presented with fever, left shoulder pain, and rash for five days. Examination demonstrated left axillary lymphadenopathy and left glenohumeral joint restricted range of motion, swelling, and warmth. Ultrasound confirmed a moderate glenohumeral joint effusion and subacromial bursitis. Arthroscopic washout of the joint revealed diffuse, non-purulent, synovitis. The synovial fluid cell count was 15,300×106/L with a mononuclear cell predominance. Streptobacillus moniliformis was isolated in culture of blood (paediatric blood culture bottle) and synovial fluid specimens after approximately 72 hours at the microbiology laboratory at Nepean Hospital. The patient admitted to kissing her pet rodents on their mouths and sustaining scratches to the skin of her hands whilst bathing them. She recovered completely with intravenous ceftriaxone for one week then oral amoxycillin for three weeks.

Correlation between the Findings of Magnetic Resonance Imaging Shoulder and Shoulder Arthroscopy

Introduction: Shoulder pain is a significant cause of decreased functional activity of an individual. The overall prevalence of shoulder pain is 16-26%, which makes it the third most common cause among musculoskeletal complaints. The cause of pain in the shoulder is often difficult to evaluate, and diagnosis is usually ambiguous because physical findings are poorly reproducible. The diagnosis therefore, requires multiple imaging modalities. Therapeutic arthroscopy is “the current gold standard” for diagnosing shoulder pathologies, however the procedure is invasive, needs hospitalisation and anaesthesia. Aim: To correlate the findings of Magnetic Resonance Imaging (MRI) shoulder with the findings of shoulder arthroscopy and subsequently determine sensitivity, specificity and accuracy of MRI in diagnosing shoulder pathologies. Materials and Methods: Forty two patients suffering from chronic shoulder pain for a period of more than six weeks, having symptoms of instability, clinical signs of tear or impingement, or functional limitation of the affected shoulder were included in this study. The patients included were in the age group of 18-80 years. Subsequently, MRI followed by arthroscopy of the shoulder was done and the findings of MRI were compared to that of arthroscopy using kappa statistics. Results: In this study along with rotator cuff tear (26 patients), subacromial bursitis (26 patients), was the other most common shoulder pathology. The sensitivity of MRI in detecting shoulder pathologies varied from poor (0.28) for Superior Labrum Anterior Posterior (SLAP) lesion to very good (0.88) for Bankart’s tear and (0.8) for synovial chondromatosis to excellent for rotator cuff tears (0.92). Although sensitivity of MRI was variable for different shoulder pathologies, specificity was comparatively high in detecting all of the above shoulder pathologies. The accuracy of MRI was highest (0.95) in diagnosing synovial chondromatosis, followed by bankart’s lesion (0.92), and rotator cuff tear (0.88). Conclusion: MRI is a very useful and effective tool in diagnosing various shoulder pathologies with exception of SLAP tears where its sensitivity diminishes significantly.