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1.
Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodeses Produce Similar Outcomes: A Randomized Prospective Analysis.
Forsythe, B, Zuke, WA, Agarwalla, A, Puzzitiello, RN, Garcia, GH, Cvetanovich, GL, Yanke, AB, Verma, NN, Romeo, AA
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2020;(1):23-32
Abstract
PURPOSE To directly compare subjective and objective outcomes of arthroscopic suprapectoral biceps tenodesis (ASPBT) below the bicipital groove and open subpectoral biceps tenodesis (OSPBT) performed with interference screw fixation. METHODS A total of 77 patients indicated for biceps tenodesis who met the inclusion and exclusion criteria were randomized into the ASPBT and OSPBT groups. All tenodesis procedures implemented PEEK (polyether ether ketone) interference screws. Patients underwent a clinical examination that included range of motion and strength assessment at 3, 6, and 12 months postoperatively. Patients completed the American Shoulder and Elbow Surgeons (ASES) shoulder score, Single Assessment Numeric Evaluation score, and Constant score preoperatively and at 6 and 12 months postoperatively. RESULTS Seventy-five patients were analyzed with a mean age of 50.3 ± 10.4 years and a mean body mass index of 28.9 ± 6.3. All patients had arthroscopic evidence of biceps pathology and underwent either an ASPBT (n = 37) or OSPBT (n = 38). The surgical time was significantly greater for ASPBT than for OSPBT (16.9 ± 8.4 minutes vs 9.8 ± 3.1 minutes, P < .001). One patient underwent conversion from the ASPBT group to the OSPBT group because of shearing of a severely attenuated tendon preventing an ASPBT. No significant difference (P > .05) was found in strength or anterior shoulder pain at 3 months, 6 months, and 1 year, and no significant difference (P > .05) was found in clinical outcome scores (ASES, Constant subjective, and Single Assessment Numeric Evaluation) between the 2 groups at 6 months and 1 year. The improvement in the ASES score exceeded the minimal clinically important difference (12 points) in both groups. CONCLUSIONS No differences in patient-reported outcome measures, functional outcomes, or complication rates were found after ASPBT compared with OSPBT. However, the results of this investigation must be interpreted with caution because this study may be underpowered to detect statistical differences. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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2.
Osteointegration of a Biocomposite Suture Anchor After Arthroscopic Shoulder Labral Repair.
Sugaya, H, Suzuki, K, Yoshimura, H, Tanaka, M, Yamazaki, T, Watanabe, M, Iwaso, H, Inaoka, T, Sugimoto, H, Matsuki, K, et al
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2019;(12):3173-3178
Abstract
PURPOSE To evaluate osteoconductivity of a poly-L-lactide co-glycolide (PLG)-calcium sulfate (CS)-β-tricalcium phosphate (β-TCP) biocomposite suture anchor after arthroscopic shoulder labral repair. METHODS The subjects of this study were patients who participated in a clinical trial for acquisition of marketing approval of a PLG-CS-β-TCP biocomposite anchor in Japan. They underwent arthroscopic labral repair using the anchor, and computed tomographic (CT) images of the glenoid were obtained 2 years after surgery. Osteoconductivity at the anchor sites was evaluated with the CT images using the established ossification quality score. Shoulder function scores including the Rowe score and Japanese Shoulder Society shoulder instability score were also assessed 2 years after surgery. RESULTS CT images and functional scores were obtained from 37 patients, comprising 29 men and 8 women with a mean age of 29 years (range, 25-33 years) at surgery. A total of 148 anchors were implanted in the 37 shoulders. Osteoconductivity was seen in 133 of 148 anchor sites (90.0%) 2 years after implantation. No significant differences in osteoconductivity were found by anchor diameter or position. The Rowe score significantly improved from 39.9 points (95% confidence interval [CI], 33.8-45.9 points) preoperatively to 96.6 points (95% CI, 95.1-98.1 points) at 2 years postoperatively (P < .001). The Japanese Shoulder Society shoulder instability score also significantly improved, from 63.1 points (95% CI, 58.4-67.7 points) preoperatively to 96.3 points (95% CI, 94.7-97.8 points) at 2 years postoperatively (P < .001). CONCLUSIONS Biocomposite suture anchors made of PLG, CS, and β-TCP exhibited some osteoconductivity 2 years after arthroscopic labral repair, as well as good clinical outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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3.
Comparison of 2 Exercise Rehabilitation Programs for Multidirectional Instability of the Glenohumeral Joint: A Randomized Controlled Trial.
Warby, SA, Ford, JJ, Hahne, AJ, Watson, L, Balster, S, Lenssen, R, Pizzari, T
The American journal of sports medicine. 2018;(1):87-97
Abstract
BACKGROUND The recommended initial treatment for multidirectional instability (MDI) of the shoulder is a rehabilitation program, yet there is very low-quality evidence to support this approach. Purpose/Hypothesis: The purpose was to compare the Watson MDI program and Rockwood Instability program among patients with nontraumatic, nonstructural MDI. The hypothesis was that the Watson MDI program would produce clinically and statistically superior outcomes over the Rockwood Instability program. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Forty-one participants with MDI were randomly allocated to the Watson MDI or Rockwood Instability program. Participants attended 12 weekly physiotherapy sessions for exercise prescription. Outcomes were assessed at baseline and 6, 12, and 24 weeks after randomization. Primary outcomes were the Melbourne Instability Shoulder Score (MISS) and the Western Ontario Shoulder Index (WOSI). Secondary outcomes included the Orebro Musculoskeletal Pain Questionnaire, pain, muscle strength, scapular upward rotation, scapular coordinates, global rating of change, satisfaction scales, limiting angle in abduction range, limiting factor in abduction range, and incidence of dislocation. Primary analysis was by intention to treat based on linear mixed models. RESULTS Between-group differences showed significant effects favoring the Watson program for the WOSI (effect size [ES], 11.1; 95% CI, 1.9-20.2; P = .018) and for the limiting factor in abduction (ES, 0.1; 95% CI, 0.0-1.6; P = .023) at 12 weeks, and for the WOSI (ES, 12.6; 95% CI, 3.4-21.9; P =. 008), MISS (ES, 15.4; 95% CI, 5.9-24.8; P = .002), and pain (ES, -2.0; CI: -2.3 to -0.7, P = .003) at 24 weeks. CONCLUSION For people with MDI, 12 sessions of the Watson MDI program were more effective than the Rockwood program at 12- and 24-week follow-up. Registration: ACTRN12613001240730 (Australian New Zealand Clinical Trials Registry).
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4.
Prestructural cartilage assessment using MRI.
Link, TM, Neumann, J, Li, X
Journal of magnetic resonance imaging : JMRI. 2017;(4):949-965
Abstract
UNLABELLED Cartilage loss is irreversible, and to date, no effective pharmacotherapies are available to protect or regenerate cartilage. Quantitative prestructural/compositional MR imaging techniques have been developed to characterize the cartilage matrix quality at a stage where abnormal findings are early and potentially reversible, allowing intervention to halt disease progression. The goal of this article is to critically review currently available technologies, present the basic concept behind these techniques, but also to investigate their suitability as imaging biomarkers including their validity, reproducibility, risk prediction and monitoring of therapy. Moreover, we highlighted important clinical applications. This review article focuses on the currently most relevant and clinically applicable technologies, such as T2 mapping, T2*, T1ρ, delayed gadolinium enhanced MRI of cartilage (dGEMRIC), sodium imaging and glycosaminoglycan chemical exchange saturation transfer (gagCEST). To date, most information is available for T2 and T1ρ mapping. dGEMRIC has also been used in multiple clinical studies, although it requires Gd contrast administration. Sodium imaging and gagCEST are promising technologies but are dependent on high field strength and sophisticated software and hardware. LEVEL OF EVIDENCE 5 J. Magn. Reson. Imaging 2017;45:949-965.
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5.
Segmentation of Bone with Region Based Active Contour Model in PD Weighted MR Images of Shoulder.
Sezer, A, Sezer, HB, Albayrak, S
Computational and mathematical methods in medicine. 2015;:754894
Abstract
Proton density (PD) weighted MR images present inhomogeneity problem, low signal to noise ratio (SNR) and cannot define bone borders clearly. Segmentation of PD weighted images is hampered with these properties of PD weighted images which even limit the visual inspection. The purpose of this study is to determine the effectiveness of segmentation of humeral head from axial PD MR images with active contour without edge (ACWE) model. We included 219 images from our original data set. We extended the use of speckle reducing anisotropic diffusion (SRAD) in PD MR images by estimation of standard deviation of noise (SDN) from ROI. To overcome the problem of initialization of the initial contour of these region based methods, the location of the initial contour was automatically determined with use of circular Hough transform. For comparison, signed pressure force (SPF), fuzzy C-means, and Gaussian mixture models were applied and segmentation results of all four methods were also compared with the manual segmentation results of an expert. Experimental results on our own database show promising results. This is the first study in the literature to segment normal and pathological humeral heads from PD weighted MR images.
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6.
A penetration-based finite element method for hyperelastic 3D biphasic tissues in contact: Part 1--Derivation of contact boundary conditions.
Un, K, Spilker, RL
Journal of biomechanical engineering. 2006;(1):124-30
Abstract
In this study, we extend the penetration method, previously introduced to simulate contact of linear hydrated tissues in an efficient manner with the finite element method, to problems of nonlinear biphasic tissues in contact. This paper presents the derivation of contact boundary conditions for a biphasic tissue with hyperelastic solid phase using experimental kinematics data. Validation of the method for calculating these boundary conditions is demonstrated using a canonical biphasic contact problem. The method is then demonstrated on a shoulder joint model with contacting humerus and glenoid tissues. In both the canonical and shoulder examples, the resulting boundary conditions are found to satisfy the kinetic continuity requirements of biphasic contact. These boundary conditions represent input to a three-dimensional nonlinear biphasic finite element analysis; details of that finite element analysis will be presented in a manuscript to follow.
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7.
Calcific tendinitis of the shoulder.
Hurt, G, Baker, CL
The Orthopedic clinics of North America. 2003;(4):567-75
Abstract
Calcific tendinitis of the shoulder is a process involving calcium deposition commonly in the rotator cuff tendons. It is a cell-mediated process that is often chronic in nature, but it is usually self-limiting with regard to its acute pain states. Nonoperative management is still the treatment of choice and is successful in up to 90% of patients. When conservative measures fail, a needling technique or surgical removal may be indicated; the trend is toward arthroscopic management. Acromioplasty should not be performed without radiographic signs of impingement. If a resulting large rotator cuff defect is found after removal of the calcific deposit, it may be worthwhile to close the defect arthroscopically with suture to prevent cuff tear progression and to promote healing.
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8.
Crystal deposition disease of the shoulder (including calcific tendonitis and milwaukee shoulder syndrome).
Halverson, PB
Current rheumatology reports. 2003;(3):244-7
Abstract
Calcific tendinitis of the shoulder is a dynamic process. Osteopontin is present in cells surrounding tendon calcifications. Resorption is probably mediated by cathepsin K-containing multinucleated giant cells. Rotator cuff tears are associated with an inflammatory response based on the presence of interleukin-1 and a proliferative synovitis. Metalloproteinases are found in the synovial fluids of patients with rotator cuff tears. Some patients with large rotator cuff tears progress to a severe destructive arthropathy characterized by large joint effusions, which are noninflammatory but contain basic calcium phosphate crystals. These crystals stimulate metalloproteinase production in vitro and also suppress metalloproteinase inhibitor production. Mutations in the ank gene result in decreased extracellular inorganic pyrophosphate in murine progressive ankylosis, and increased extracellular inorganic pyrophosphate in some cases of familial chondrocalcinosis.
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9.
The effects of various therapeutic measures on shoulder strength and muscle soreness after baseball pitching.
Yanagisawa, O, Miyanaga, Y, Shiraki, H, Shimojo, H, Mukai, N, Niitsu, M, Itai, Y
The Journal of sports medicine and physical fitness. 2003;(2):189-201
Abstract
AIM: This study was intended as an investigation of the effects of various therapeutic measures on the shoulder strength and muscle soreness after baseball pitching. EXPERIMENTAL DESIGN participants threw 98 pitches in a simulated single game. The mode of the therapeutic measures after pitching were classified into 4 groups; the control group (CON), the ice treatment group (IT), the light shoulder exercise group (LSE) and the ice treatment with LSE group (ILSE). Each therapeutic measure was applied to the dominant shoulder immediately after pitching. PARTICIPANTS 7 healthy, skilled baseball pitchers. MEASURES both shoulder strength and muscle soreness were measured before pitching, immediately after pitching (Post-P), at the time of the therapeutic measure (Post-TM), and 24 hours after pitching (Post-24 h). RESULTS All 4 groups showed shoulder strength losses in shoulder abduction, internal/external rotation with no shoulder abduction or with the shoulder abducted to 90 degrees immediately after pitching. ILSE had greater recovery from Post-P values at Post-TM or Post-24 h than the other methods in all 5 shoulder strengths. On the other hand, the soreness in shoulder internal rotation was increased significantly from Post-P and continued by Post-24 h. Both IT and ILSE had beneficial effects on reducing the shoulder muscle soreness at Post-TM or Post-24 h. CONCLUSION The findings of this study suggested that ILSE was the optimal therapeutic measure against decreased shoulder strength or increased shoulder muscle soreness resulting from the repetitive baseball pitching.
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10.
A comparison of the effects of exercise and lifestyle modification on the resolution of overuse symptoms of the shoulder in polio survivors: a preliminary study.
Klein, MG, Whyte, J, Esquenazi, A, Keenan, MA, Costello, R
Archives of physical medicine and rehabilitation. 2002;(5):708-13
Abstract
OBJECTIVE To compare the effectiveness of exercise and lifestyle modification therapy in treating shoulder symptoms in polio survivors with lower-extremity weakness. DESIGN A randomized parallel group study. SETTING Research laboratory. PARTICIPANTS Twenty-three subjects recruited from a cohort of 194 polio survivors who had participated in a previous study had bilateral hip-extensor and knee-extensor weakness and reported experiencing shoulder pain on a regular basis with daily activity. INTERVENTIONS Subjects were randomly assigned to 1 of 3 treatment groups. Members of group 1 were placed on a home exercise program that focused on strengthening their hip and knee extensors. Members of group 2 were instructed in lifestyle modification techniques designed to avoid shoulder overuse. Members of group 3 received both interventions. MAIN OUTCOME MEASURES Shoulder symptoms were quantified in terms of number and severity. Isometric strength of bilateral hip and knee extensors was measured with a hand-held dynamometer. RESULTS Symptoms improved in all 3 groups. However, members of the exercise-only group (group 1) were the only ones to show a significant difference in both number and severity of symptoms when pre- and posttreatment values were compared. CONCLUSIONS Both exercise and lifestyle modification therapies that focus on reducing the stress related to lower-extremity weakness are effective in treating shoulder overuse symptoms in polio survivors. A trend toward greater improvement in shoulder symptoms in subjects who participated in the exercise program and who also showed a trend toward increased knee-extensor strength supports muscle strength and/or endurance as a key factor.