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Garcia AV, Martini LI, Abache AF. Pharmacologic interventions for primary glenohumeral osteoarthritis. JAAPA 2024; 37:1-8. [PMID: 38916373 DOI: 10.1097/01.jaa.0000000000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
ABSTRACT Primary glenohumeral osteoarthritis is a multifactorial condition with a complex cause that affects patients across different age groups, impairing physiologic and psychologic well-being, and substantially reducing patient quality of life and overall productivity. To effectively manage this condition, healthcare providers need to be well informed about treatment guidelines, as well as the available therapeutic options and the evidence supporting their use. Nonsurgical interventions should be regarded as the primary treatment option, particularly for patients in the initial phases of this condition. No conclusive guidelines exist for treating young and active patients, and the literature lacks high-quality data to evaluate the efficacy, safety, and long-term consequences of several interventions, regardless of patient characteristics and expectations.
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Affiliation(s)
- Ausberto Velasquez Garcia
- Ausberto Velasquez Garcia practices orthopedic surgery at the Clinica Universidad de los Andes in Chile and is a research fellow at the Mayo Clinic in Rochester, Minn. Liborio Ingala Martini practices orthopedic surgery at IVSS Dr. Luis Ortega Hospital and the Hospital Clinicas del Este, both in Porlamar, Venezuela. Andres Franco Abache practices orthopedic surgery at the Hospital de Especialidades Guayaquil MSP in Guayaquil, Ecuador. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Schneider BS, Hao KA, Taylor JK, Wright JO, Wright TW, Pazik M, Schoch BS, King JJ. Influence of acromioclavicular joint arthritis on outcomes after reverse total shoulder. JSES Int 2024; 8:111-118. [PMID: 38312293 PMCID: PMC10837712 DOI: 10.1016/j.jseint.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Although substantial motion at the acromioclavicular joint (ACJ) occurs during overhead shoulder motion, the influence of ACJ arthritis on postoperative outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) is unclear. We assessed the influence of ACJ arthritis, defined by degenerative radiographic changes, and its severity on clinical outcomes after primary rTSA. Methods We conducted a retrospective review of a prospectively collected shoulder arthroplasty database of patients that underwent primary rTSA with a minimum 2-year clinical follow-up. Imaging studies of included patients were evaluated to assess ACJ arthritis classified by radiographic degenerative changes of the ACJ; severity was based upon size and location of osteophytes. Both the Petersson classification and the King classification (a modified Petersson classification addressing superior osteophytes and size of the largest osteophyte) were used to evaluate the severity of degenerative ACJ radiographic changes. Severe ACJ arthritis was characterized by large osteophytes (≥2 mm). Active range of motion (ROM) in abduction, forward elevation, and external and internal rotation as well as clinical outcome scores (American Shoulder and Elbow Surgeons Shoulder, Constant, Shoulder Pain and Disability Index, simple shoulder test, University of California, Los Angeles scores) were assessed both preoperatively and at the latest follow-up; outcomes were compared based on severity of ACJ arthritis. Multivariable linear regression models were used to determine whether increasing severity of ACJ arthritis was associated with poorer outcomes. Results A total of 341 patients were included with a mean age of 71 ± 8 years and 55% were female. The mean follow-up was 5.1 ± 2.4 years. Preoperatively, there were no differences in outcomes based on the severity of ACJ pathology. Postoperatively, there were no differences in outcomes based upon the severity of ACJ arthritis except for greater preoperative to postoperative improvement in active internal rotation in patients with normal or grade 1 ACJ arthritis vs. grade 2 and 3 (3 ± 2 vs. 1 ± 2 and 1 ± 3, P = .029). Patients with ACJ arthritis and osteophytes ≥2 mm had less favorable Shoulder Pain and Disability Index scores, corresponding to greater pain (-49.3 ± 21.5 vs. -41.3 ± 26.8, P = .015). On multivariable linear regression, increased severity of ACJ arthritis was not independently associated with poorer postoperative ROM or outcome scores. Conclusion Overall, our results demonstrate that greater ACJ arthritis severity score is not associated with poorer outcome scores and has minimal effect on ROM. However, patients with the largest osteophytes (≥2 mm) did have slightly worse pain postoperatively. Radiographic presence of high-stage ACJ arthritis should not alter the decision to undergo rTSA.
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Affiliation(s)
| | - Kevin A. Hao
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jeremy K. Taylor
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Jonathan O. Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas W. Wright
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Marissa Pazik
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
| | - Bradley S. Schoch
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Joseph J. King
- Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA
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Ruzbarsky JJ, Peebles AM, Watkins L, Kruse AR, Lilley BM, Eble SK, Denard PJ, Romeo AA, Provencher MT. Effect of osteophyte removal on simulated range of motion using 3-dimensional preoperative planning software for reverse total shoulder arthroplasty. JSES Int 2024; 8:104-110. [PMID: 38312277 PMCID: PMC10837730 DOI: 10.1016/j.jseint.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Glenohumeral osteophytes (OPs) can adversely influence postoperative range of motion (ROM) following shoulder arthroplasty due to mechanical impingement. Though commercial three-dimensional preoperative planning software (3D PPS) is available to simulate ROM before and after OP resection, little is known about the magnitude of effect OPs and their subsequent removal have on simulated glenohumeral ROM. Methods Included patients were 1) indicated for reverse total shoulder arthroplasty (rTSA) using 3D PPS and 2) presented with glenoid and/or humeral head OPs on preoperative two-dimensional computed tomography (2D-CT) imaging. Thirty patients met the inclusion criteria (9 females, 21 males; mean age 70.45 ± 4.99 years, range 63-80 years). All subjects (n = 30) presented with humeral OPs (mean volume: 2905.16 mm3, range 109.1-11,246 mm3), while 11 subjects also presented with glenoid OPs (mean volume 108.06 mm3, range 37.59-791.4 mm3). Preoperative CTs were used to calculate OP volume (mm3) and OP circumferential extent (clockface). Mean clockface position for circumferential humeral OPs originated at 6:09 (range 4:30-7:15) and extended to 8:51 (range 8:15-10:15). Mean clockface position for glenoid OPs originated at 3:00 (range 2:00-5:00) and extended to 6:16 (range 3:00-7:30). 3D implants on PPS were standardized to achieve 0° of version, 0° of inclination and 4 mm of net lateralization. Thirty-nine and thirty-six mm glenospheres were used for males and females, respectively. 3D PPS was used to evaluate simulated ROM differences before and after OP removal in the planes of adduction (ADD), abduction, internal rotation (IR), external rotation (ER), extension, and flexion. Impact of OP volume and circumferential extent on pre and postop removal ROM were also analyzed. Results Humeral OP removal significantly increased impingement-free ADD, IR, ER, extension, and flexion. Removal of larger (mm3) humeral OPs positively correlated with improvement in IR (R = 0.452, P = .011), ER (R = 0.394, P = .033), and flexion (R = 0.500, P < .01). Greater circumferential extent of humeral OPs correlated with worse preremoval ROM in the planes of ADD (R = 0.364, P = .02) and extension (R = 0.403, P = .04), and improvements in ER postop removal (R = 0.431, P = .03). Conclusion Humeral OP removal significantly increases impingement-free ADD, IR, ER, extension, and flexion in simulated 3D PPS models following rTSA. Magnitude of simulated ROM improvement is influenced by initial humeral OP volume and circumferential clockface extent. Surgeons should consider these effects when using 3D PPS for rTSA planning to optimize postoperative ROM prognostics.
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Affiliation(s)
- Joseph J Ruzbarsky
- The Steadman Clinic, Vail, CO, USA
- Steadman Philippon Research Institute, Vail, CO, USA
| | | | | | - Amelia R Kruse
- Steadman Philippon Research Institute, Vail, CO, USA
- William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Stephanie K Eble
- Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | | | - Anthony A Romeo
- Department of Orthopaedic Surgery, DuPage Medical Group, Chicago, IL, USA
| | - Matthew T Provencher
- The Steadman Clinic, Vail, CO, USA
- Steadman Philippon Research Institute, Vail, CO, USA
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Silva FD, Ramachandran S, Chhabra A. Glenohumeral osteoarthritis: what the surgeon needs from the radiologist. Skeletal Radiol 2023; 52:2283-2296. [PMID: 36287234 DOI: 10.1007/s00256-022-04206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 02/02/2023]
Abstract
Glenohumeral osteoarthritis (GHOA) is a widely prevalent disease with increasing frequency due to population aging. Both clinical manifestations and radiography play key roles in the initial diagnosis, staging, and management decisions. Radiographic disease progression evaluation is performed using validated staging systems, such as Kellgren and Lawrence, Samilson, and Hamada. For young patients with mild to moderate GHOA and failed conservative treatment, arthroscopic preservation surgery (APS) is usually considered. Older patients and those with severe GHOA benefit from different types of arthroplasties. Preoperative magnetic resonance imaging (MRI) is essential for APS surgical planning, as it maps repairable labral, cartilage, and rotator cuff lesions. For arthroplasty planning, the status of glenoid cartilage and intactness of rotator cuff as well as glenoid morphology represent key factors guiding the decision regarding the most suitable hardware design, whether resurfacing, partial, total, or reverse joint replacement. Pre-surgical MRI or alternatively computed tomography arthrogram is employed to evaluate the cartilage and rotator cuff. Finally, three-dimensional computed tomography (3D CT) is indicated to optimally assess the glenoid morphology (to determine Walch classification, version, inclination, and bone loss) and analyze the necessity for glenoid osteotomy or graft augmentation to correct the glenoid structural abnormalities for future success and longevity of the shoulder implants or chosen constructs. Understanding the purpose of each imaging and treatment modality allows more efficient image interpretation. This article reviews the above concepts and details what a surgeon needs from a radiologist and could benefit from accurate reporting of preoperative imaging studies.
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Affiliation(s)
| | | | - Avneesh Chhabra
- Musculoskeletal Radiology, UT Southwestern, Dallas, TX, 75390-9178, USA.
- Orthopedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA.
- Johns Hopkins University, Baltimore, MD, USA.
- University of Dallas, Irving, TX, USA.
- Walton Centre for Neuroscience, Liverpool, UK.
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Kirschner JS, Cheng J, Creighton A, Santiago K, Hurwitz N, Dundas M, Beatty N, Kingsbury D, Konin G, Abutalib Z, Chang R. Efficacy of Ultrasound-Guided Glenohumeral Joint Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Glenohumeral Osteoarthritis: A Randomized, Double-Blind Controlled Trial. Clin J Sport Med 2022; 32:558-566. [PMID: 35316820 PMCID: PMC9481749 DOI: 10.1097/jsm.0000000000001029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/31/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the efficacy of ultrasound-guided hyaluronic acid (HA) versus leukocyte-poor platelet-rich plasma (LP-PRP) injection in the treatment of glenohumeral osteoarthritis. DESIGN Double-blind randomized controlled trial. SETTING Academic institution. PATIENTS Seventy patients with chronic glenohumeral osteoarthritis were randomly assigned to receive a single injection of HA (n = 36) or LP-PRP (n = 34). INTERVENTIONS Leukocyte-poor platelet-rich plasma was processed using Harvest/TerumoBCT Clear PRP kits. Ultrasound-guided injections of 6 mL HA or 6 mL LP-PRP into the glenohumeral joint were performed. Patients, the injecting physician, and outcomes assessor were blinded to treatment assignments. MAIN OUTCOME MEASURES Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) score, current/average numerical rating scale (NRS) pain scores, satisfaction, and side effects were assessed at the 5 follow-up time points over 12 months. RESULTS Baseline characteristics were similar between groups. There were no significant between-group differences regarding SPADI, ASES, and current/average NRS pain scores at any time point up to 12 months postinjection ( P > 0.05). However, significant improvements in SPADI, ASES, and current/average NRS pain scores were observed in both groups starting at 1 or 2 months ( P < 0.01, P < 0.01, P < 0.001, and P < 0.01, respectively). These improvements were observed regardless of osteoarthritis severity. For patients who received LP-PRP, there was no effect of platelet yield on outcomes. Side effect and satisfaction rates were similar between groups. CONCLUSIONS There were no differences in pain and functional outcomes after a single injection of LP-PRP versus HA. However, significant improvements in pain and function were observed after both treatments in patients with glenohumeral osteoarthritis.
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Affiliation(s)
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Andrew Creighton
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Kristen Santiago
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Nicole Hurwitz
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Mark Dundas
- Department of Physical Medicine & Rehabilitation, Yale New Haven Hospital, New Haven, Connecticut
| | - Nicholas Beatty
- Department of Rehabilitation Medicine, Mount Sinai Hospital, New York, New York
- Regenerative SportsCare Institute, New York, New York
| | - Dallas Kingsbury
- Department of Rehabilitation Medicine, NYU Langone Health, New York, New York
| | - Gabrielle Konin
- Department of Radiology, Hospital for Special Surgery, New York, New York; and
| | - Zafir Abutalib
- Biostatistics Core, Hospital for Special Surgery, New York, New York
| | - Richard Chang
- Department of Rehabilitation Medicine, Mount Sinai Hospital, New York, New York
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A validated algorithm using current literature to judge the appropriateness of anatomic total shoulder arthroplasty utilizing the RAND/UCLA appropriateness method. J Shoulder Elbow Surg 2022; 31:e332-e345. [PMID: 35066118 DOI: 10.1016/j.jse.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Currently, appropriateness criteria evaluating when to perform total shoulder arthroplasty (TSA) is lacking. In the absence of society guidelines and limited quality evidence, the RAND/University California in Los Angeles (UCLA) method provides a suitable alternative to evaluate appropriateness and assist in clinical decision making. Given the rise in utilization, appropriateness criteria for TSA have the potential to be an extremely powerful tool for improving quality of care and controlling costs. Thus, the goal of this study was to test explicit criteria to assess the appropriateness of TSA decision making using the RAND/UCLA appropriateness method. METHODS A review of recent scientific literature to gather available evidence about the use, effectiveness, efficiency, and the risks involved in surgical intervention was performed by a shoulder/elbow fellowship trained physician. Based on pertinent variables including age, rotator cuff status, previous surgical management, mobility, symptomatology, and imaging classifications, 186 clinical scenarios were created. Appropriateness criteria for TSA were developed using a modified Delphi method with a panel consisting of American Shoulder and Elbow Surgeons (ASES) members. A second panel of ASES members rated the same scenarios, with reliability testing performed to compare groups. RESULTS Panel members reached agreement in 40 (64%) indications. TSA was appropriate in 15 (24%) of indications. For patients with severe symptomatology, TSA was often appropriate for patients aged <75 years and inconclusive or inappropriate for patients aged >75 years. Among patients aged <65 years, TSA varied between appropriate and inconclusive, often dependent on Walch classification. For patients with moderate symptomatology, TSA was inappropriate or inconclusive for patients aged <65 or >75 years. When compared to the second panel's results, moderate agreement was obtained with a weighted kappa statistic of 0.56. CONCLUSIONS Using the RAND/UCLA method, ASES members created an appropriateness decision tree for pertinent patient variables. This presents the data in a manner that streamlines the clinical decision-making process and allows for rapid and more reliable determination of appropriateness for practitioners. The decision tree is based on a combination of clinical experience from high-volume ASES-member surgeons and a comprehensive review of current evidence. This tool can be used as part of a broader set of factors, including individual patient characteristics, prior studies, and expert opinion, to inform clinical decision making, improve quality of care, and control costs.
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Makhija M, Sethi J, Kataria C, Singh H, Phadke V. Fluoroscopic measurements of the glenohumeral joint position and space in true anteroposterior and axillary views – a reliability study. COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Two-dimensional (2D) fluoroscopy has been used in shoulder pathologies to estimate the humeral head position (HHP) in the true anteroposterior (AP) view. However, there is a lack of evidence regarding the reliability estimating it in the axillary view and in measuring the shoulder joint space width (JSW). True AP view images (n=36) of subjects with adhesive capsulitis were taken in supine in multiple arm abduction positions. The axillary view images (n=48) were taken in supine and prone in 75° of abduction. The HHP was assessed in the glenoid reference frame. The position and radius of the humeral head along with the superior, inferior, anterior, posterior, and middle JSWs were measured in each image. All the images were coded and randomly presented twice to a physiotherapist at a gap of 48-72 h for intra-rater reliability and to 2 therapists and an orthopaedic surgeon for inter-rater reliability. Reliability was expressed using intraclass correlation coefficients (ICC) and standard error of measurement (SEM). In both the views, inter-rater, and intra-rater reliability was excellent for the radius of the humeral head (inter-rater – 0.95-0.97 and intra-rater -0.98)], moderate (ICC: 0.70 and 0.76), and excellent (ICC: 0.89 and 0.93) for HHP. The reliability for JSWs was moderate to good (ICC: 0.66-0.82) for inter-rater and good to excellent (ICC: 0.75-0.95) for intra-rater analysis. The SEM for HHP and JSWs were <0.4 mm for intra-rater analysis, and <0.7 mm for inter-rater reliability in both views. The study demonstrated that the glenohumeral arthrokinematic parameters can be measured with good to excellent levels of reliability when using 2 D fluoroscopy. The study is part of a clinical trial (Clinical Trial Registry India: CTRI/2018/12/016657).
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Affiliation(s)
- M. Makhija
- Amity Institute of Physiotherapy, Amity University Campus, Sector-125, Noida 201301, Uttar Pradesh, India
| | - J. Sethi
- Amity Institute of Physiotherapy, Amity University Campus, Sector-125, Noida 201301, Uttar Pradesh, India
| | - C. Kataria
- Indian Spinal Injuries Centre-Institute of Rehabilitation Sciences, Sector-C, Vasant Kunj, New Delhi 110070, India
| | - H. Singh
- Orthopedics Department, Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, New Delhi 110070, India
| | - V. Phadke
- Research Department, Indian Spinal Injuries Centre, Sector-C, Vasant Kunj, New Delhi 110070, India
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Märtens N, März V, Bertrand J, Lohmann CH, Berth A. Radiological changes in shoulder osteoarthritis and pain sensation correlate with patients’ age. J Orthop Surg Res 2022; 17:277. [PMID: 35570309 PMCID: PMC9107673 DOI: 10.1186/s13018-022-03137-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Osteoarthritis (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). Methods Forty-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. Results There 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. Conclusion This 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. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03137-x.
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Dislocation Arthropathy of the Shoulder. J Clin Med 2022; 11:jcm11072019. [PMID: 35407627 PMCID: PMC8999818 DOI: 10.3390/jcm11072019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 12/04/2022] Open
Abstract
Glenohumeral osteoarthrosis (OA) may develop after primary, recurrent shoulder dislocation or instability surgery. The incidence is reported from 12 to 62%, depending on different risk factors. The risk of severe OA of the shoulder following dislocation is 10 to 20 times greater than the average population. Risk factors include the patient’s age at the first episode of instability or instability surgery, bony lesions, and rotator cuff tears. For mild stages of OA, arthroscopic removal of intraarticular material, arthroscopic debridement, or arthroscopic arthrolysis of an internal rotation contracture might be sufficient. For severe stages, mobilization of the internal rotation contracture and arthroplasty is indicated. With an intact rotator cuff and without a bone graft, results for anatomical shoulder arthroplasty are comparable to those following primary OA. With a bone graft at the glenoidal side, the risk for implant loosening is ten times greater. For the functional outcome, the quality of the rotator cuff is more predictive than the type of the previous surgery or the preoperative external rotation contracture. Reverse shoulder arthroplasty could be justified due to the higher rate of complications and revisions of non-constrained anatomic shoulder arthroplasties reported. Satisfactory clinical and radiological results have been published with mid to long term data now available.
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Son JH, Seo ZW, Choi W, Lee YY, Kang SW, Lee CH. Etiologic Factors of Rotator Cuff Disease in Elderly: Modifiable Factors in Addition to Known Demographic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063715. [PMID: 35329402 PMCID: PMC8948663 DOI: 10.3390/ijerph19063715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Ju Hyun Son
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan-si 50612, Korea; (J.H.S.); (Z.W.S.); (W.C.)
| | - Zee Won Seo
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan-si 50612, Korea; (J.H.S.); (Z.W.S.); (W.C.)
| | - Woosik Choi
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan-si 50612, Korea; (J.H.S.); (Z.W.S.); (W.C.)
| | - Youn-Young Lee
- Woon-gok Liberal Arts Education College, Halla University, Wonju-si 26404, Korea;
| | - Suk-Woong Kang
- Department of Orthopedics, Pusan National University Yangsan Hospital, Yangsan-si 50612, Korea;
| | - Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan-si 50612, Korea; (J.H.S.); (Z.W.S.); (W.C.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan-si 50612, Korea
- Correspondence:
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Kim DH, Min SG, Lee HS, Lee HJ, Park KH, Chung SW, Dehdashtian A, Yoon JP. Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2021; 29:998-1005. [PMID: 33095332 DOI: 10.1007/s00167-020-06307-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 09/28/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair. METHODS A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up. RESULTS Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA. CONCLUSION The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung Gi Min
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho Seok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyeong Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea
| | - Amir Dehdashtian
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea.
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12
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Simon MJK, Aartsen VE, Coghlan JA, Strahl A, Bell SN. Shoulder injections with autologous conditioned serum reduce pain and disability in glenohumeral osteoarthritis: longitudinal observational study. ANZ J Surg 2021; 91:673-679. [PMID: 33609074 DOI: 10.1111/ans.16672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/22/2020] [Accepted: 01/30/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Currently, non-surgical treatments for glenohumeral osteoarthritis (GH-OA) mainly aim to reduce pain. Autologous conditioned serum (ACS), Orthokine, an interleukin-1 inhibitor from the patient's own blood has an anti-inflammatory effect. The objective was to determine whether intra-articular injections of this ACS improved symptoms in patients with GH-OA and delayed the need for a shoulder replacement. METHODS A total of 36 consecutive patients, 40 shoulders, with OA received up to 6-weekly intra-articular injections of ACS were included. Imaging of GH-OA, range of motion, visual analogue scale (VAS) pain, Shoulder Pain And Disability Index (SPADI), American Shoulder and Elbow Surgeons and Constant scores were assessed pre-injection and post treatment at 3 months. At a minimum of 2 years, VAS and SPADI scores and whether anyone had progressed to a shoulder replacement were recorded. RESULTS Outcomes 3 months post-ACS injections demonstrated on average statistically significant improvement (P < 0.05) of all measurements: SPADI (54.3 ± 21.5 vs 43.7 ± 23.7), Constant score (50.5 ± 14.1 vs 57.1 ± 17.4), VAS pain (4.8 ± 2.2 vs 3.7 ± 2.4) and range of motion. Of these, 16 shoulders progressed to a shoulder replacement, nine cases quickly (0.6 ± 0.2 years) and seven cases were delayed by 3.1 ± 1.7 years. The other 18 cases had significant improvement in pain, SPADI (58.0 ± 19.6 to 31.8 ± 21.4; P < 0.01) scores and no progression to a shoulder replacement at 3.6 ± 1.0 years follow-up. There was no correlation of glenoid Walch score or joint space with clinical outcome parameters. CONCLUSION ACS injections in the shoulder joint for OA can reduce pain and disability, and postpone the need for a shoulder replacement.
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Affiliation(s)
- Maciej J K Simon
- Department of Orthopaedics, The University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia
| | - Vivian E Aartsen
- Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia.,School of Medicine, The University of Groningen, Groningen, The Netherlands
| | - Jennifer A Coghlan
- Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - André Strahl
- Department of Orthopaedics, The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon N Bell
- Melbourne Shoulder and Elbow Centre, Melbourne, Victoria, Australia.,Department of Surgery, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Victoria, Australia
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13
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Sahoo S, Derwin KA, Zajichek A, Entezari V, Imrey PB, Iannotti JP, Ricchetti ET. Associations of preoperative patient mental health status and sociodemographic and clinical characteristics with baseline pain, function, and satisfaction in patients undergoing primary shoulder arthroplasty. J Shoulder Elbow Surg 2020; 30:e212-e224. [PMID: 32860879 PMCID: PMC7907259 DOI: 10.1016/j.jse.2020.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Shoulder pain and dysfunction are common indications for shoulder arthroplasty, yet the factors that are associated with these symptoms are not fully understood. This study aimed to investigate the associations of patient and disease-specific factors with preoperative patient-reported outcome measures (PROMs) in patients undergoing primary shoulder arthroplasty. We hypothesized that worse mental health status assessed by the Veterans RAND 12-Item Health Survey (VR-12) mental component score (MCS), glenoid bone loss, and increasing rotator cuff tear severity would be associated with lower values for the preoperative total Penn Shoulder Score (PSS) and its pain, function, and satisfaction subscores. METHODS We prospectively identified 12 patient factors and 4 disease-specific factors as possible statistical predictors of preoperative PROMs in patients undergoing primary shoulder arthroplasty at a single institution over a 3-year period. Multivariable statistical modeling and Akaike information criterion comparisons were used to investigate the unique associations with, and relative importance of, these factors in accounting for variation in the preoperative PSS and its subscores. RESULTS A total of 788 cases performed by 12 surgeons met the inclusion criteria, with a preoperative median total PSS of 31 points (pain, 10 points; function, 18 points; and satisfaction, 1 point). As hypothesized, a lower VR-12 MCS was associated with lower preoperative PSS pain, function, and total scores, but patients with intact status or small to medium rotator cuff tears had modestly lower PSS pain subscores (ie, more pain) than patients with large to massive superior-posterior rotator cuff tears. Glenoid bone loss was not associated with the preoperative PSS. Female sex and fewer years of education (for all 4 outcomes), lower VR-12 MCS and preoperative opioid use (for all outcomes but satisfaction), and rotator cuff tear severity (for pain only) were the factors most prominently associated with preoperative PROMs. CONCLUSION In addition to mental health status and rotator cuff tear status, patient sex, years of education, and preoperative opioid use were most prominently associated with preoperative PROMs in patients undergoing shoulder arthroplasty. Further studies are needed to investigate whether these factors will also predict postoperative PROMs.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peter B. Imrey
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph P. Iannotti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA,Address for Correspondence: Eric T. Ricchetti, M.D. Department of Orthopaedic Surgery, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, 9500 Euclid Avenue, Mail Code A40, Cleveland, Ohio 44195, USA, Telephone: 216-445-6915, ,
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15
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Kohan EM, Hill JR, Lamplot JD, Aleem AW, Keener JD, Chamberlain AM. Severity of Glenohumeral Osteoarthritis Does Not Correlate With Patient-Reported Outcomes. J Shoulder Elb Arthroplast 2020; 4:2471549220901873. [PMID: 34497959 PMCID: PMC8282148 DOI: 10.1177/2471549220901873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/27/2019] [Accepted: 12/27/2019] [Indexed: 11/17/2022] Open
Abstract
Background Patient pain and clinical function are important factors in decision-making
for patients with glenohumeral osteoarthritis (GHOA). The correlation
between radiographic severity of arthritis and demographic factors with
modern patient-reported outcome measures has not yet been well defined. Methods This cross-sectional study included 256 shoulders in 246 patients presenting
with isolated GHOA. All patients obtained standard radiographs and completed
the American Shoulder and Elbow Surgeons score, Simple Shoulder Test (SST),
Shoulder Activity Scale, Visual Analog Scale, and Patient-Reported Outcome
Measurement Information System (PROMIS) computer adaptive tests at the time
of presentation. Radiographs were graded according to the Samilson–Prieto
classification. Mean pain and functional scores were compared between the
radiographic grades of osteoarthritis (OA) and demographic factors. Results There were 6 shoulders rated as grade 1 OA, 41 shoulders as grade 2, 149
shoulders as grade 3a, and 65 shoulders as grade 3b. There was excellent
interobserver reliability in grade of OA (κ = 0.77). There were no
significant differences in patient-reported pain or any validated measure of
clinical function between radiographic grades of OA
(P > .05). Males reported higher
function and lower pain scores than females
(P = .001–.066), although only the
values for the SST and PROMIS physical function test were clinically
relevant. Discussion While gender correlated with pain and function, the clinical relevance is
limited. Radiographic severity of GHOA does not correlate with
patient-reported pain and function, and symptoms should remain the primary
determinants of surgical decision-making. Further investigation is necessary
to examine whether radiographic severity of OA influences improvement
following operative intervention in this population.
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Affiliation(s)
- Eitan M Kohan
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Jeffrey Ryan Hill
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Joseph D Lamplot
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Alexander W Aleem
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
| | - Aaron M Chamberlain
- Department of Orthopaedic Surgery, Washington University in Saint Louis, Saint Louis, Missouri
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16
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Abstract
Glenohumeral arthritis in the young adult is a particularly challenging condition for which optimal treatment algorithms have yet to be established. Arthroscopic joint-preserving treatments have the advantage of delaying arthroplasty in this younger population while maintaining the patient's natural anatomy and do not appear to compromise later arthroplasty. Various surgical techniques are available such that the overall procedure is tailored to the patient's individual pathology. Most short- and mid-term studies show good outcomes with low conversion to total shoulder arthroplasty and sustained improvements in functional outcome scores.
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Affiliation(s)
- David C Carver
- Lake Tahoe Sports Medicine Fellowship, 212 Elks Point Road, Suite 200, PO Box 11889, Zephyr Cove, NV 89448, USA. https://twitter.com/carversportsmed
| | - Tyler J Brolin
- Department of Orthopaedic Surgery, Campbell Clinic, University of Tennessee Health Science Center, Memphis, TN 38104, USA.
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17
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Lorbach O. [Anatomical total shoulder replacement in glenohumeral osteoarthritis : Indications, current implants, and clinical results]. DER ORTHOPADE 2019; 47:383-389. [PMID: 29511786 DOI: 10.1007/s00132-018-3544-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IMPLANT DESIGNS Within the last 50 years, implants for shoulder replacement have developed rapidly. Monobloc-stems in few sizes were changed to modular implant systems that allow for an individual adaption of the stem, as well as adaption of the humeral head component according to the specific anatomic situation of the patient. Moreover, stemless und short stem implants are available, which may highly simplify primary implantation, especially in posttraumatic cases as well as in revision cases with a need for removal or change of the implants. Concerning the glenoid component, cemented PE-inlays were further modified to increase long-term survival rates. Moreover, cement-free modular "metal-backs" allow for a conversion to a reverse total shoulder arthroplasty without removal of the "metal back" component. RESULTS Long-term survival rates of total shoulder arthroplasties achieve comparable survival rates to knee and hip arthroplasties with good to excellent clinical long-term results. In addition to an experienced surgeon, the key to a successful surgical result is the correct and timely indication, as massive contractures of the soft tissues as well as excessive abrasion of the glenoid bone may significantly impair the functional results.
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Affiliation(s)
- O Lorbach
- Sporthopaedicum Berlin, Bismarckstraße 45-47, 10627, Berlin, Deutschland.
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18
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Mehl J, Imhoff AB, Beitzel K. [Osteoarthritis of the shoulder: pathogenesis, diagnostics and conservative treatment options]. DER ORTHOPADE 2019; 47:368-376. [PMID: 29464283 DOI: 10.1007/s00132-018-3542-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PATHOGENESIS Osteoarthritis of the shoulder is characterized by a progressive degenerative process, which is based on chronic inflammation with intra-articular release of different cytokines and proteolytic enzymes. The main predisposing factors are a history of trauma or surgery, as well as chronic overuse or instability of the glenohumeral joint. Affected patients especially suffer from impaired joint function and pain, which are often associated with cognitive and psychosocial restrictions. DIAGNOSTICS Possible co-pathologies have to be evaluated carefully both clinically and radiologically as they must be taken into account in the therapeutic procedure. If arthroplasty of the shoulder is planned, a pre-operative CT scan is mandatory in order to evaluate the bone stock of the glenoid, which has a decisive influence on the choice of implant. TREATMENT Conservative treatment options are oral pain medication, physical therapy, and intra-articular injections, whereby, in comparison to corticosteroids, hyaluronic acid seems to be advantageous especially with respect to the duration of a positive clinical effect.
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Affiliation(s)
- J Mehl
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - A B Imhoff
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - K Beitzel
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland
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19
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Jungmann PM, Gersing AS, Woertler K, Dietrich TJ, Baum T, Baumann F, Bensler S. Reliable semiquantitative whole‐joint MRI score for the shoulder joint: The shoulder osteoarthritis severity (SOAS) score. J Magn Reson Imaging 2018; 49:e152-e163. [DOI: 10.1002/jmri.26251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Pia M. Jungmann
- Department of NeuroradiologyUniversity Hospital Zurich, University of Zurich Zurich Switzerland
- Department of RadiologyTechnical University of Munich Munich Germany
| | | | - Klaus Woertler
- Department of RadiologyTechnical University of Munich Munich Germany
| | - Tobias J. Dietrich
- Radiology and Nuclear MedicineKantonsspital St. Gallen St. Gallen Switzerland
| | - Thomas Baum
- Department of NeuroradiologyTechnical University of Munich Munich Germany
| | - Frederic Baumann
- Clinical and Interventional AngiologyUniversity Hospital Zurich, University of Zurich Zurich Switzerland
| | - Susanne Bensler
- Institute of RadiologyCantonal Hospital Baden Baden Switzerland
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20
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Tran G, Cowling P, Smith T, Bury J, Lucas A, Barr A, Kingsbury SR, Conaghan PG. What Imaging-Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review. Arthritis Care Res (Hoboken) 2018. [PMID: 29513925 PMCID: PMC6099421 DOI: 10.1002/acr.23554] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective Shoulder symptoms are common, and imaging is being increasingly used to help with management. However, the relationship between imaging and symptoms remains unclear. This review aims to understand the relationship between imaging‐detected pathologies, symptoms, and their persistence. Methods A systematic review using Medline, EMBASE, Cochrane, and grey literature was conducted to April 2017. The cross‐sectional and longitudinal relationships between imaging‐detected abnormalities and symptoms were analyzed and associations qualitatively characterized by a best‐evidence synthesis based on study design, covariate adjustment, and the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Modalities included ultrasound, magnetic resonance imaging (MRI), radiographs, positron emission tomography (PET), bone scintigraphy, and computed tomography. Results A total of 6,569 abstracts was screened and 56 articles were included. In total, 50 studies did not adjust for covariates and 36 analyzed individual pathologies only. The majority of studies showed conflicting results. There was no significant association between most imaging features and symptoms among high‐quality, cross‐sectional studies. There was low‐quality evidence that enhancement of the joint capsule on MRI and increased uptake on PET were associated with symptoms in adhesive capsulitis. Based on high‐quality longitudinal studies, enlarging rotator cuff tears were associated with an increased incidence of symptoms. Conclusion There were conflicting results on the association of imaging features with shoulder symptoms and their persistence. The existing evidence was very low in quality, based on the GRADE methodology. Further high‐quality studies are required to understand the relationship between imaging and shoulder symptoms and to determine the appropriate role of imaging in care pathways.
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Affiliation(s)
| | - Paul Cowling
- Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Julie Bury
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | | | | | - Philip G Conaghan
- University of Leeds, Leeds, and Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, Nottingham, UK
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21
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Juel NG, Brox JI, Hellund JC, Holte KB, Berg TJ. The prevalence of radiological glenohumeral osteoarthritis in long-term type 1 diabetes: the Dialong shoulder study. Scand J Rheumatol 2017; 47:325-330. [PMID: 29239667 DOI: 10.1080/03009742.2017.1397189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study compares the prevalence of radiological osteoarthritis (OA) in patients with type 1 diabetes mellitus (DM1) for > 45 years and controls, and explores the association with shoulder pain and glycaemic burden in patients with DM1. METHOD The Dialong study is a cross-sectional, observational study with 30 years of historical data on long-term glycaemic control. We included 102 patients with DM1 and 73 diabetes-free controls. Demographic data, worst shoulder pain last week [numeric rating scale (NRS) 0-10], pain on abduction at examination (NRS 0-10), and current and historical glycosylated haemoglobin (HbA1c) levels were collected. Standardized shoulder X-rays were taken and interpreted for OA applying the Kellgren-Lawrence classification. RESULTS In the diabetes group (49% women), the mean ± sd duration of DM1 was 50.6 ± 4.8 years, mean 30 year HbA1c 7.4%, and age 61.9 ± 7.1 years. The mean age of controls (57% women) was 62.6 ± 7.0 years. Radiological glenohumeral OA was found in 36 diabetes patients (35%) and 10 controls (14%) [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.6 to 7.5; p = 0.002]. Few persons had moderate and severe OA [6.9% vs 1.3%, OR 5.3 (95% Cl 0.6 to 44.1); p = 0.1]. Fifteen diabetes patients had painful OA versus two controls (adjusted OR 5.4, 95% CI 0.6 to 47.9; p = 0.13). There was no association between OA and long-term glycaemic burden (mean 30 year HbA1c) in the diabetes group (p > 0.2). CONCLUSIONS Radiological glenohumeral OA was more common in patients with DM1 than in controls for mild, but not moderate and severe OA. The radiological findings were not associated with shoulder pain or long-term glycaemic burden.
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Affiliation(s)
- N G Juel
- a Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.,b Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway
| | - J I Brox
- b Department of Physical Medicine and Rehabilitation , Oslo University Hospital , Oslo , Norway.,c Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - J C Hellund
- d Department of Radiology , Oslo University Hospital , Oslo , Norway
| | - K B Holte
- a Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway
| | - T J Berg
- a Department of Endocrinology, Morbid Obesity and Preventive Medicine , Oslo University Hospital , Oslo , Norway.,c Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway.,e The Norwegian Diabetics Center , Oslo , Norway
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22
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Habermeyer P, Magosch P, Weiß C, Hawi N, Lichtenberg S, Tauber M, Ipach B. Classification of humeral head pathomorphology in primary osteoarthritis: a radiographic and in vivo photographic analysis. J Shoulder Elbow Surg 2017; 26:2193-2199. [PMID: 28943071 DOI: 10.1016/j.jse.2017.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/11/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to characterize the pathologic changes of the osteoarthritic humeral head. METHODS The study included 55 patients with primary osteoarthritis who underwent anatomic shoulder arthroplasty. Several radiologic parameters (radiography, magnetic resonance imaging) were assessed. Humeral head deformity in the transverse plane and humeral cartilage erosion in the coronal plane were chosen for photographic measurements from the resected humeral heads. RESULTS In the coronal plane, 82% of patients presented with an aspherical humeral head shape with a significantly longer caudal osteophyte. In the transverse plane, 50% of all patients showed a decentered apex. Patients with an aspherical humeral head shape in the transverse plane showed an aspherical humeral head shape in the coronal plane in 94% and a significantly longer osteophyte than patients with spherical humeral head shape, showing a 3-dimensional deformity of the humeral head during progression of primary osteoarthritis. Patients with an osteophyte length between 7 and 12 mm were associated with a glenoid type B2 in 30% and a decentered apex in the transverse plane in 38%. Patients with a humeral osteophyte longer than 13 mm were significantly more frequently associated with a type B2 glenoid (71%; P < .0001) and a decentered apex in the transverse plane in 52%. CONCLUSION It seems that the progression of primary osteoarthritis of the glenohumeral joint is characterized by an increasing 3-dimensional deformity of the humeral head related to the glenoid morphology. We therefore propose an extended Samilson-Prieto classification with type A (spherical) and type B (aspherical) and grade I-IV osteophytes.
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Affiliation(s)
| | - Petra Magosch
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany; Orthopaedic and Trauma Surgery Center, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Christel Weiß
- Medizinische Fakultät Mannheim, Abteilung für Medizinische Statistik, Biomathematik und Informationsverarbeitung, Mannheim, Germany
| | - Nael Hawi
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany
| | - Sven Lichtenberg
- German Joint Centre, ATOS Clinic Heidelberg, Heidelberg, Germany
| | - Mark Tauber
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany; Department of Traumatology and Sports Injury, Paracelsus Medical University, Salzburg, Austria
| | - Bastian Ipach
- German Shoulder Centre, ATOS Clinic Munich, Munich, Germany
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Autologous Concentrated Bone Marrow Grafting for the Treatment of Osteonecrosis of the Humeral Head: A Report of Five Shoulders in Four Cases. Case Rep Orthop 2017; 2017:4898057. [PMID: 28713606 PMCID: PMC5496114 DOI: 10.1155/2017/4898057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/30/2017] [Accepted: 05/25/2017] [Indexed: 11/23/2022] Open
Abstract
Five shoulders in four patients affected by advanced osteonecrosis of the humeral head were treated with autologous concentrated bone marrow grafting. Bone marrow sample was aspirated from the iliac crests, concentrated by a centrifugation technique, and injected into the necrotic site. The shoulders were evaluated radiologically with X-ray scoring and clinically with measurement of range of motion and pain score (visual analogue scale, VAS). The mean follow-up period was 49.4 (range, 24–73) months. The concentration ratio of nucleated cells was calculated and the number of transplanted mesenchymal stem cells (MSC) was estimated by a colony-forming assay. All four shoulders with stage 3 disease achieved joint sparing. One shoulder with stage 4 disease required replacement surgery. Clinical evaluation of the spared joints showed improvement in range of motion in two cases and deterioration in two cases. VAS scores were 0 after surgery in three cases. The mean concentration ratio was 2.73, and the mean number of transplanted MSC was 1125. The outcomes of autologous concentrated bone marrow grafting for advanced osteonecrosis of the humeral head were varied. Further research is needed to determine the effectiveness and the indications of the present surgery.
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24
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Schleich C, Bittersohl B, Antoch G, Krauspe R, Zilkens C, Kircher J. Thickness Distribution of Glenohumeral Joint Cartilage. Cartilage 2017; 8:105-111. [PMID: 28345405 PMCID: PMC5358826 DOI: 10.1177/1947603516651669] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
High-resolution 3-dimensional cartilage-specific magnetic resonance imaging (MRI) was performed at 3 T to test the following hypotheses: (1) there is a nonuniform cartilage thickness distribution both on the proximal humerus and on the glenoid surface and (2) the glenohumeral joint as a combined system is congruent with the level of the joint cartilage surface without substantial radial mismatch. Inclusion of 38 volunteers (19 females, mean age 24.34 ± 2.22 years; range 21-29 years) in a prospective study. Measurements of: cartilage thickness in 3 regions and 3 zones; radius of both circles (glenoid and humeral cartilage) for congruency calculation using 3-T MRI with 3-dimensional dual-echo steady-state sequence with water excitation. A homogenous mean cartilage thickness (1.2-1.5 mm) and slightly higher values for the glenoidal articulating surface radii both in the mid-paracoronar section (2.4 vs. 2.1 cm, P < 0.001) and in the mid-paraaxial section (2.4 vs. 2.1 cm, P < 0.001) compared with the humeral side were observed. The concept of a radial mismatch between the humeral head and the glenoid in healthy human subjects can be confirmed. This study provides normative data for the comparison of joint cartilage changes at the shoulder for future studies.
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Affiliation(s)
- Christoph Schleich
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Department of Orthopedics, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Jörn Kircher
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany,Department of Orthopedic Surgery, Klinik Fleetinsel Hamburg, Hamburg, Germany,Jörn Kircher, Department of Orthopedic Surgery, Klinik Fleetinsel Hamburg, Admiralitätstrasse 3-4, Hamburg 20489, Germany.
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Hawi N, Magosch P, Tauber M, Lichtenberg S, Martetschläger F, Habermeyer P. Glenoid deformity in the coronal plane correlates with humeral head changes in osteoarthritis: a radiographic analysis. J Shoulder Elbow Surg 2017; 26:253-257. [PMID: 27720560 DOI: 10.1016/j.jse.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND A variety of measurements can be used to assess radiographic osteoarthritic changes of the shoulder. This study aimed to analyze the correlation between the radiographic humeral-sided Samilson and Prieto classification system and 3 different radiographic classifications describing the changes of the glenoid in the coronal plane. METHODS The study material included standardized radiographs of 50 patients with idiopathic osteoarthritis before anatomic shoulder replacement. On the basis of radiographic measurements, the cases were evaluated using the Samilson and Prieto grading system, angle β, inclination type, and critical shoulder angle by 2 independent observers. RESULTS Classification measurements showed an excellent agreement between observers. Our results showed that the humeral-sided Samilson and Prieto grading system had a statistically significant good correlation with angle β (observer 1, r = 0.74; observer 2, r = 0.77; P < .05) and a statistically significant excellent correlation with the inclination type of the glenoid (observer 1, r = 0.86; observer 2, r = 0.8; P < .05). A poor correlation to the critical shoulder angle was observed (r = -0.14, r = 0.03; P > .05). CONCLUSIONS The grade of humeral-sided osteoarthritis according to Samilson and Prieto correlates with the glenoid-sided osteoarthritic changes of the glenoid in the coronal plane described by the angle β and by the inclination type of the glenoid. Higher glenoid-sided inclination is associated with higher grade of osteoarthritis in primary shoulder osteoarthritis.
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Affiliation(s)
- Nael Hawi
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany; Trauma Department, Hannover Medical School, Hannover, Germany.
| | - Petra Magosch
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany; University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Mark Tauber
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany; Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria
| | - Sven Lichtenberg
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany
| | | | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic Munich, Munich, Germany
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Kircher J. [Shoulder endoprosthesis in the elderly : Hemiarthroplasty or total shoulder arthroplasty? Anatomic or reverse?]. DER ORTHOPADE 2016; 46:40-47. [PMID: 27921129 DOI: 10.1007/s00132-016-3365-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Implantation of reverse shoulder endoprostheses is becoming more popular for elderly patients besides the well-established standard anatomic endoprostheses. The reasons for this are the increased life expectancy, age-dependent degeneration of the rotator cuff leading to cuff tear arthropathy, posttraumatic disability after failed osteosynthesis and primary reverse fracture arthroplasty. Stemless implants are more frequently used for primary osteoarthritis with the bone quality being the limiting factor. Modern implant systems allow the stepwise extension from bone preserving primary implants to modular and convertible revision implants that allow a partial exchange of components. Revision surgery, especially that of reverse arthroplasty, has limited potential for secondary treatment options and therefore implantation and revision should be performed in specialized treatment facilities.
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Affiliation(s)
- J Kircher
- Schulter- und Ellenbogenchirurgie, Klinik Fleetinsel Hamburg, Admiralitätstr. 3-4, 20459, Hamburg, Deutschland.
- Orthopädische Klinik, Universitätsklinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40255, Düsseldorf, Deutschland.
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Murena L, Guindani N, Turino S, Grassi FA, Cherubino P. Long-term outcome of Rockwood capsular shift for recurrent shoulder dislocation. J Orthop Surg (Hong Kong) 2016; 24:392-397. [PMID: 28031514 DOI: 10.1177/1602400325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To review the long-term outcome of Rockwood capsular shift for recurrent shoulder dislocation secondary to trauma. METHODS Records of 30 males and 4 females who underwent Rockwood capsular shift for recurrent (≥2 episodes) anterior shoulder dislocation were reviewed. An additional Bankart repair with different techniques was performed in 24 of the patients by 2 different surgeons. The outcome was assessed using the Western Ontario Shoulder Instability Index (WOSI) and the Western Ontario Osteoarthritis of the Shoulder (WOOS) index questionnaires, the modified Rowe score, and the Constant-Murley score. Shoulder range of motion (ROM) was measured. Degenerative joint changes were evaluated on radiographs. RESULTS During a mean follow-up of 13 (range, 10-16) years, 6 (18%) patients had a mean of 1.2 recurrent dislocations. Four of the patients reported a traumatic event during recurrent dislocation. Of the 6 patients, 3 had undergone a Bankart lesion repair. Better Rowe and adjusted Constant scores were associated with lower age at first dislocation, at the index surgical procedure, and at follow-up. Four patients developed glenohumeral osteoarthritis: 2 were mild or moderate and 2 were severe and symptomatic. Glenohumeral osteoarthritis was associated with follow-up duration (p=0.03) and poorer Rowe score (p=0.012), adjusted Constant score (p=0.001), and WOOS score (p=0.006). CONCLUSION Rockwood capsular shift can preserve shoulder ROM, with rates of recurrent dislocation and degenerative joint changes comparable with other techniques.
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Affiliation(s)
- Luigi Murena
- Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università degli studi di Trieste, Italy
| | - Nicola Guindani
- USC Ortopedia e Traumatologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Turino
- Azienda Ospedaliera, Ospedali Civili di Legnano, Milano, Italy
| | - Federico A Grassi
- Dipartimento di Scienze della Salute, Università del Piemonte Orientale A. Avogadro, Novara, Italy
| | - Paolo Cherubino
- Dipartimento di Biologia e Scienza della Vita. Università dell'Insubria, Varese, Italy
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Bittersohl B, Kircher J, Miese FR, Dekkers C, Habermeyer P, Fröbel J, Antoch G, Krauspe R, Zilkens C. T2* mapping and delayed gadolinium-enhanced magnetic resonance imaging in cartilage (dGEMRIC) of humeral articular cartilage--a histologically controlled study. J Shoulder Elbow Surg 2015; 24:1644-52. [PMID: 25958213 DOI: 10.1016/j.jse.2015.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/27/2015] [Accepted: 03/07/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cartilage biochemical imaging modalities that include the magnetic resonance imaging (MRI) techniques of T2* mapping (sensitive to water content and collagen fiber network) and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, sensitive to the glycosaminoglycan content) can be effective instruments for early diagnosis and reliable follow-up of cartilage damage. The purpose of this study was to provide T2* mapping and dGEMRIC values in various histologic grades of cartilage degeneration in humeral articular cartilage. METHODS A histologically controlled in vitro study was conducted that included human humeral head cartilage specimens with various histologic grades of cartilage degeneration. High-resolution, 3-dimensional (3D) T2* mapping and dGEMRIC were performed that enabled the correlation of MRI and histology data. Cartilage degeneration was graded according to the Mankin score, which evaluates surface morphology, cellularity, toluidine blue staining, and tidemark integrity. SPSS software was used for statistical analyses. RESULTS Both MRI mapping values decreased significantly (P < .001) with increasing cartilage degeneration. Spearman rank analysis revealed a significant correlation (correlation coefficients ranging from -0.315 to 0.784; P < .001) between the various histologic parameters and the T2* and T1Gd mapping values. CONCLUSION This study demonstrates the feasibility of 3D T2* and dGEMRIC to identify various histologic grades of cartilage damage of humeral articular cartilage. With regard to the advantages of these mapping techniques with high image resolution and the ability to accomplish a 3D biochemically sensitive imaging, we consider that these imaging techniques can make a positive contribution to the currently evolving science and practice of cartilage biochemical imaging.
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Affiliation(s)
- Bernd Bittersohl
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Jörn Kircher
- Klinik Fleetinsel Hamburg, Clinic for Orthopedic Surgery, Hamburg, Germany.
| | - Falk R Miese
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Christin Dekkers
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Peter Habermeyer
- ATOS-Klinik Heidelberg, Department of Shoulder and Elbow Surgery, Heidelberg, Germany
| | - Julia Fröbel
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Düsseldorf, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
| | - Christoph Zilkens
- Medical Faculty, Department of Orthopaedics, University Düsseldorf, Düsseldorf, Germany
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Kircher J, Kuerner K, Morhard M, Krauspe R, Habermeyer P. Age-related joint space narrowing independent of the development of osteoarthritis of the shoulder. INTERNATIONAL JOURNAL OF SHOULDER SURGERY 2014; 8:95-100. [PMID: 25538427 PMCID: PMC4262869 DOI: 10.4103/0973-6042.145213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Purpose: It is commonly accepted that the glenohumeral joint space remains unchanged until the onset of osteoarthritis, at which point progressive degenerative changes, and joint space narrowing occur. The aim of this study was to evaluate the radiographic width of the glenohumeral joint space in patients of different ages: Those with otherwise normal radiographs, those with a history of instability, those with calcific tendonitis, and those with a radiologic diagnosis of osteoarthritis. Materials and Methods: In this retrospective study, two independent investigators measured the glenohumeral joint width on true anteroposterior and axillary views of standardized shoulder radiographs taken from 2002 to 2009. The digital image resolution was 0.01 mm. Group I comprised 60 patients with normal shoulder radiographs, Group II comprised 53 patients with instability but normal radiographs, Group III comprised 109 patients with radiologically proven calcific tendonitis, and Group IV comprised 120 patients with manifest osteoarthritis. Results: The interobserver reliability (r) was 0.621-0.862. The mean joint space width was significantly different among Groups I-IV (central anteroposterior: 4.28 ± 0.75 mm, 3.12 ± 0.73 mm, 2.87 ± 0.80 mm, and 1.47 ± 1.07 mm, respectively; P = 0.001; central axillary: 6.12 ± 1.09 mm, 3.92 ± 0.77 mm, 3.34 ± 0.84 mm, and 1.08 ± 1.12 mm, respectively; P = 0.001). There was a significant negative correlation between the joint space width and age at all measured levels in both projections (P < 0.001). Conclusions: The glenohumeral joint space width decreases with increasing age beginning in early adulthood, and this effect is enhanced by osteoarthritis. Level of Evidence: Level II, retrospective study.
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Affiliation(s)
- Jörn Kircher
- Department of Orthopaedics, Shoulder and Elbow Surgery, Klinik Fleetinsel, Admiralitätstrasse 3-4, 20489 Hamburg, German, Germany ; Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, German, Germany ; Department of Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, 69115 Heidelberg, German, Germany
| | - Konstanze Kuerner
- Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, German, Germany
| | - Markus Morhard
- Department of Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, 69115 Heidelberg, German, Germany
| | - Rüdiger Krauspe
- Department of Orthopaedics, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, German, Germany
| | - Peter Habermeyer
- Department of Shoulder and Elbow Surgery, ATOS Clinic, Bismarckstrasse 9-15, 69115 Heidelberg, German, Germany
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Kobayashi T, Takagishi K, Shitara H, Ichinose T, Shimoyama D, Yamamoto A, Osawa T, Tajika T. Prevalence of and risk factors for shoulder osteoarthritis in Japanese middle-aged and elderly populations. J Shoulder Elbow Surg 2014; 23:613-9. [PMID: 24561177 DOI: 10.1016/j.jse.2013.11.031] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/20/2013] [Accepted: 11/22/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of shoulder osteoarthritis (OA) in populations older than 40 years and to examine risk factors and the relationship with shoulder function. METHODS The respondents in this study consisted of 541 patients who underwent general medical examinations in April 2012 as residents of a single village. The mean age was 65.2 ± 11.0 years (range, 40-89 years), and 341 (63.0%) of the respondents were women. Anteroposterior radiographs of the bilateral shoulder joints were obtained, and the subjects were classified into 3 groups (non-OA, mild OA, and moderate-severe OA) according to the Samilson-Prieto method. With respect to risk factors for shoulder OA, a logistic regression analysis was performed. RESULTS Shoulder OA was detected in 17.4% (94 of 541) of the patients. The incidence of OA in both shoulders was 3.1% (17 of 541), and the prevalence of shoulder OA among the respondents 65 years of age or older (20.3%) was significantly higher than that observed among the respondents younger than 65 years (11.1%). The risk of shoulder OA increased according to age, with an odds ratio of 5.59 in the respondents 60 to 69 years of age (P = .027), 11.59 in the respondents 70 to 79 years of age (P = .004), and 10.77 in the respondents 80 years of age and older (P = .004). CONCLUSIONS The prevalence of shoulder OA was 17.4%, and the risk factor for shoulder OA was age.
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Affiliation(s)
- Tsutomu Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toshihisa Osawa
- Department of Orthopaedic Surgery, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Jungmann PM, Liu F, Link TM. What has imaging contributed to the epidemiological understanding of osteoarthritis? Skeletal Radiol 2014; 43:271-5. [PMID: 24346338 PMCID: PMC3925496 DOI: 10.1007/s00256-013-1783-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/28/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Pia M. Jungmann
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Felix Liu
- Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry Street, Suite 5700, San Francisco, CA 94107, USA
| | - Thomas M. Link
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
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Gialanella B, Bertolinelli M. Corticosteroids injection in rotator cuff tears in elderly patient: pain outcome prediction. Geriatr Gerontol Int 2013; 13:993-1001. [PMID: 24131759 DOI: 10.1111/ggi.12046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2013] [Indexed: 11/27/2022]
Abstract
AIM The aim of this prospective study was to evaluate the effect of corticosteroids intra-articular injections on pain in patients with rotator cuff tear (RCT), and to identify predictors for pain outcomes. METHODS A total of 60 patients with RCT were enrolled. All patients underwent rehabilitation; 20 patients received a single intra-articular injection of 40 mg triamcinolone acetonide and 20 patients had a repeat injection at a 21-day interval. Backward stepwise regression analysis was used to predict effectiveness and improvement of pain. The independent variables were age, sex, symptom duration, tear size, passive range of motion (ROM), active ROM, non-steroidal anti-inflammatory drugs request, pain at rest, number of triamcinolone injections and severity of osteoarthritis at admission. RESULTS At 3 and 6 months, patients who received triamcinolone had higher effectiveness and improvement in pain during activities and pain at night than those of control group. At the 3-month interval post-therapy, active ROM was the only predictor for effectiveness in pain during activity, effectiveness in pain at night and improvement in pain at night. Six months after therapy, active ROM was a predictor for improvement in pain at night. Age was a predictor for effectiveness in pain at night, whereas tear size of RCT was a predictor for effectiveness and improvement in pain during activity. CONCLUSIONS Corticosteroids can relieve pain in RCT. Active ROM is the most important predictor of pain outcomes. This finding can be useful to physicians when deciding on the type of patients who might best benefit from intra-articular injections of corticosteroids.
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Affiliation(s)
- Bernardo Gialanella
- Operative Unit for Recovery and Functional Rehabilitation, Fondazione Salvatore Maugeri IRCCS, Lumezzane (BS), Italy
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Kircher J, Bittersohl B, Zilkens C, Hedtmann A, Krauspe R. Biometrical analysis of the shoulder joint regarding glenoid implant dimensions for arthroplasty. Surg Radiol Anat 2013; 36:321-5. [PMID: 24005377 DOI: 10.1007/s00276-013-1197-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/22/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Reduced bone stock and difficult intraoperative orientation are challenges in glenoid replacement surgery. New implant designs and methods for fixation, such as locking screws, extra-long central pegs and/or central compression screws are targeting these issues. The objective of this study is the analysis of the glenoid dimension regarding maximum central peg diameter and peg length (PL), and maximum screw length (SL) for glenoid fixation. METHODS Retrospective analysis of magnetic resonance imaging (n = 50) scans. Measurement of the maximum inferior glenoid diameter (GD), SL, maximum length of a 9.9, 10 and 11.4 mm central peg (PL) in the transverse plane; glenoid version (GV), humeral head diameter (HHD). Two independent measurements. RESULTS Mean age: 49.0 ± 15.7 years (17-80) (n = 20 female, 49.6 ± 16.0; n = 30 male, 48.6 ± 15.7). Mean values of measurement were GD: 28.9 ± 3.7 mm (21-39); SL: 34.1 ± 4.9 mm (26-44); PL 9.9 mm: 19.4 ± 4.3 mm (9-30); PL 10 mm: 19.0 ± 4.4 mm (8-30); PL 11.4 mm: 16.5 ± 4.1 mm (7-26) with significant gender differences (p = 0.001; p = 0.022; p = 0.001); GV: -0.6° ± 4.9° (-10 to 11); HHD: 50.0 mm ± 4.9 (41-61). There was good correlation between PL and SL (r = 0.32, p = 0.024) and for GD and PL (r = 0.61, p = 0.001; r = 0.57, p = 0.001; r = 0.96, p = 0.001). The ratio of HHD and GD was very constant with 0.6 ± 0.07. CONCLUSIONS These data indicate the high interindividual variability of glenoid morphology including significant gender-related differences. The good correlation between humeral head size and GD and maximum central PL can be helpful for cases with reduced bone stock in decision-making about implant size and bone grafting.
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Affiliation(s)
- Jörn Kircher
- Department of Orthopedics, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40255, Düsseldorf, Germany,
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Godinho GG, Santos FML, França FO, Freitas JMA, Mesquita FAS, Silva TSDA. Videoarthroscopic treatment of glenohumeral osteoarthritis. Rev Bras Ortop 2013; 48:69-79. [PMID: 31304114 PMCID: PMC6565914 DOI: 10.1016/j.rboe.2011.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/28/2011] [Indexed: 11/20/2022] Open
Abstract
Objetive To evaluate possible benefits obtained through the use of surgical videoarthrosco- py in the management of glenohumeral osteoarthritis. Methods We evaluated 37 patients (38 shoulders) who underwent through surgical videoar- throscopy in the period between November 1999 and May 2009 (minimum follow-up of two years). Twenty five patients attend for revaluation and thirteen were interviewed by telephonic contact. Functional assessments were performed (UCLA, Constant, and measu- rement of range of motion -ROM-), as well as pre and post surgical radiographics. We eva- luated the influence of the following factors in the final results: the presence of chondral lesions, joint space narrowing, osteophyte presence, associated injuries (rotator cuff torn or instability), and follow-up. Among those patients interviewed by phone we evaluated the satisfaction level and if they would submit themselves again to the surgical procedure. Results It was observed significant gain towards to the function (UCLA) and the internal rotation, as well as the association between dissatisfaction and pre surgical joint space reduced. Among the operated patients, 84% were satisfied with the results and 86.6% would repeat the procedure. Conclusion Surgical videoarthroscopy presents a relevant role in management of the glenohumeral osteoarthritis, providing improvement of functional results and high levels of satisfaction.
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Affiliation(s)
- Glaydson Gomes Godinho
- Head of the Shoulder Surgery and Rehabilitation Service, Orthopedic Hospital (HO), Hospital Belo Horizonte (HBH) and Lifecenter Hospital (HLC), Belo Horizonte, MG, Brazil
- Corresponding author. Rua Prof. Otávio Coelho de Magalhães, 111, bl. C, 2° piso, Mangabeiras, CEP: 30210-300, Belo Horizonte, MG, Brazil.
| | | | - Flavio Oliveira França
- Surgeon in the Shoulder Surgery and Rehabilitation Service, HO and HLC, Belo Horizonte, MG, Brazil
| | | | | | - Thiago Serpa de Azevedo Silva
- Resident Physician (R4) in the Shoulder Surgery and Rehabilitation Service, HO, HBH and HLC, Belo Horizonte, MG, Brazil
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Millett PJ, Horan MP, Pennock AT, Rios D. Comprehensive Arthroscopic Management (CAM) procedure: clinical results of a joint-preserving arthroscopic treatment for young, active patients with advanced shoulder osteoarthritis. Arthroscopy 2013; 29:440-8. [PMID: 23544687 DOI: 10.1016/j.arthro.2012.10.028] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 10/22/2012] [Accepted: 10/23/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the surgical outcomes of 29 active patients (30 shoulders) with end-stage, symptomatic glenohumeral arthritis undergoing the comprehensive arthroscopic management (CAM) procedure. METHODS In this institutional review board-approved study, patients with advanced glenohumeral osteoarthritis (OA) underwent the CAM procedure, a joint-preserving arthroscopic treatment. All subjects were candidates for shoulder arthroplasty. The CAM procedure involves the combination of glenohumeral chondroplasty; removal of loose bodies if present; humeral osteoplasty and osteophyte resection (goat's beard deformity); anterior, posterior, and inferior capsular release; subacromial decompression; axillary nerve neurolysis; and biceps tenodesis. Outcome measures included pain, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, and satisfaction. For survivorship analysis, failure was defined as progression to shoulder arthroplasty. RESULTS The mean age was 52 years (range, 33 to 68 years), and there were 23 men and 6 women. Of the 30 shoulders, 6 progressed to an arthroplasty at a mean of 1.9 years (range, 0.9 to 3.4 years). Patients with less than 2.0 mm of joint space on radiographs were more likely to undergo arthroplasty (P = .037). For shoulders that did not progress to arthroplasty (n = 24), the mean follow-up was 2.6 years (range, 2.1 to 4.7 years). The American Shoulder and Elbow Surgeons scores significantly improved from 58 points (SE, 2.4) to 83 points (SE, 3.3) (P < .001), and pain levels decreased with activities of daily living, work, recreation, and sleep (P < .05). The median patient satisfaction rating was 9 (range, 3 to 10). Survivorship analysis showed a 92% survival rate at 1 year and 85% at 2 years. Patients with larger osteophytes had greater improvement in postoperative range of motion but were less satisfied (r = 0.479, P = .038). CONCLUSIONS The CAM procedure reduced pain, improved function, and provided reasonable short-term durability for our cohort of young, active patients with advanced shoulder OA and may serve as a joint-preserving alternative to arthroplasty. Patients with less than 2 mm of joint space had a significantly higher failure rate. The CAM procedure is a viable surgical option in young, active patients with advanced OA, showing survivorship of 85% at 2 years. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Godinho GG, Santos FML, França FO, Freitas JMA, Mesquita FAS, Silva TSDA. Tratamento Videoartroscópico da Osteoartrite Glenoumeral. Rev Bras Ortop 2013. [DOI: 10.1016/j.rbo.2011.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kircher J, Morhard M, Patzer T, Magosch P, Lichtenberg S, Habermeyer P. Do anatomic variants of the acromion shape in the frontal plane influence pain and function in calcifying tendinitis of the shoulder? Knee Surg Sports Traumatol Arthrosc 2012; 20:368-72. [PMID: 21660537 DOI: 10.1007/s00167-011-1563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 05/23/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the relationship of a large acromion index and calcifying tendinitis of the supraspinatus tendon at the shoulder. MATERIALS AND METHODS Between 2002 and 2008, 109 consecutive patients with isolated calcifying tendinitis of the supraspinatus tendon were prospectively analysed by clinical investigation and standardized radiographs. Deposit size and appearance were measured and classified according to Bosworth and Gartner. The acromion index (AI) was calculated based on measurements on true anteroposterior radiographs. Pain record on VAS scale, active and passive range of motion and the constant score (CS) were recorded. RESULTS The mean age of the patients was 48.2 ± 8.0 (n = 46 male 48.6 ± 7.3; n = 63 female 47.9 ± 8.6; P > 0.05). Pain and function were not significantly correlated with deposit size or classification. The acromion index (mean 0.64 ± 0.08) was not significantly correlated with the affected or dominant side, gender, deposit size or classification or any functional parameter like pain and the CS or its subgroups. CONCLUSION The theoretical concept of a high acromion index resulting in an increased resulting upward force against the subacromial space, which influences pain and function in calcifying tendinitis of the shoulder, was not supported.
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Affiliation(s)
- Jörn Kircher
- Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany.
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Oh JH, Chung SW, Oh CH, Kim SH, Park SJ, Kim KW, Park JH, Lee SB, Lee JJ. The prevalence of shoulder osteoarthritis in the elderly Korean population: association with risk factors and function. J Shoulder Elbow Surg 2011; 20:756-63. [PMID: 21530320 DOI: 10.1016/j.jse.2011.01.021] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/17/2010] [Accepted: 01/01/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to document the prevalence of shoulder osteoarthritis (OA) in the elderly population in South Korea, to determine the risk factors for shoulder OA, and to evaluate the relationship with function. MATERIALS AND METHODS This project was part of a population-based prospective cohort study of health, aging, and common geriatric diseases in the elderly population of the authors' area of Seongnam. A total of 1118 residents were randomly invited, and 679 participated. The mean age of respondents was 71.8 ± 5.7 years (range, 65-97 years), and 396 (58.3%) were women. Bilateral shoulder radiographs were taken, and the grade of OA was evaluated using the Samilson-Prieto method. Functional status was evaluated using the Disabilities of Arm, Shoulder and Hand (DASH) instrument. RESULTS Radiographic primary shoulder OA was detected in 109 people (16.1%), and secondary OA in 9 (1.3%). There were 77 shoulders of grade 1 (11.3%), 23 of grade 2 (3.4%), and 9 of grade 3 (1.3%). The risk of shoulder OA increased according to age, with odds ratio (OR) of 2.20 in patients aged 70 to 74 years (P = .004) and 3.42 in patients aged 75 years and older (P < .001). Knee OA was also a significant risk factor for shoulder OA (OR, 1.96; P = .002). The DASH score was significantly higher in the OA group and increased according to the grade of shoulder OA (P < .001). CONCLUSION Primary shoulder OA is not as rare as previously reported. Our data also demonstrated that older age and knee OA were determining risk factors for shoulder OA, and shoulder OA was related to poor function.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Korea
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Is there an association between a low acromion index and osteoarthritis of the shoulder? INTERNATIONAL ORTHOPAEDICS 2009; 34:1005-10. [PMID: 19894048 DOI: 10.1007/s00264-009-0898-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 10/12/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
Abstract
The aim of this study was to evaluate the relationship between a low acromion index and osteoarthritis of the shoulder. Three patient groups were used: (I) instability, n = 53; (II) calcifying tendonitis, n = 109; and (III) osteoarthritis, n = 120. Standardised digital X-rays were evaluated from the true anteroposterior and axillary views. Joint space width at three levels in each plane and the size of humeral osteophytes were measured and osteoarthritis was graded according to Samilson. The acromion index was calculated according to Nyffeler et al. (J Bone Joint Surg Am 88:800-805, 2006) in the true anteroposterior view. There were two independent investigators. Interobserver reliability was excellent for all measurements in the anteroposterior (AP) projection but inferior in the axillary projections, especially in group III. The mean acromion index was 0.64 ± 0.07 in group I, 0.64 ± 0.08 in group II and 0.73 ± 0.12 in group III. The acromion index was not correlated with the joint space width nor with the size of the osteophytes or the Samilson grading in group III. The data of the study did not show a significant association between a low acromion index and typical signs of osteoarthritis at the shoulder. The theoretical concept of a small acromion index associated with the development of osteoarthritis of the shoulder is not supported.
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