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Herman ZJ, Nazzal EM, Engler ID, Kaarre J, Drain NP, Sebastiani R, Tisherman RT, Rai A, Greiner JJ, Hughes JD, Lesniak BP, Lin A. Overhead athletes have comparable intraoperative injury patterns and clinical outcomes to non-overhead athletes following surgical stabilization for first-time anterior shoulder instability at average 6-year follow-up. J Shoulder Elbow Surg 2024; 33:1219-1227. [PMID: 38081472 DOI: 10.1016/j.jse.2023.10.022] [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: 06/26/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND HYPOTHESIS Anterior shoulder instability is a common problem affecting young, athletic populations that results in potential career-altering functional limitations. However, little is known regarding the differences in clinical outcomes after operative management of overhead vs. non-overhead athletes presenting with first-time anterior shoulder instability. We hypothesized that overhead athletes would have milder clinical presentations, similar surgical characteristics, and diminished postoperative outcomes when compared with non-overhead athletes after surgical stabilization following first-time anterior shoulder instability episodes. METHODS Patients with first-time anterior shoulder instability events (subluxations and dislocations) undergoing operative management between 2013 and 2020 were included. The exclusion criteria included multiple dislocations and multidirectional shoulder instability. Baseline demographic characteristics, imaging data, examination findings, and intraoperative findings were retrospectively collected. Patients were contacted to collect postoperative patient-reported outcomes including American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index score, Brophy activity index score, and Subjective Shoulder Value, in addition to return-to-work and -sport, recurrent dislocation, and revision rates. RESULTS A total of 256 patients met the inclusion criteria, of whom 178 (70%) were non-overhead athletes. The mean age of the entire population was 23.1 years. There was no significant difference in concomitant shoulder pathology, preoperative range of motion, or preoperative strength between cohorts. A greater proportion of overhead athletes presented with instability events not requiring manual reduction (defined as subluxations; 64.1% vs. 50.6%; P < .001) and underwent arthroscopic surgery (97% vs. 76%, P < .001) compared with non-overhead athletes. A smaller proportion of overhead athletes underwent open soft-tissue stabilization compared with non-overhead athletes (1% vs. 19%, P < .001). Outcome data were available for 60 patients with an average follow-up period of 6.7 years. No significant differences were found between groups with respect to recurrent postoperative instability event rate (13.0% for overhead athletes vs. 16.8% for non-overhead athletes), revision rate (13.0% for overhead athletes vs. 11.1% for non-overhead athletes), American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index score, Brophy score, Subjective Shoulder Value, or rates of return to work or sport. CONCLUSION Overhead athletes who underwent surgery after an initial instability event were more likely to present with subluxations compared with non-overhead athletes. With limited follow-up subject to biases, this study found no differences in recurrence or revision rates, postoperative patient-reported outcomes, or return-to-work or -sport rates between overhead and non-overhead athletes undergoing shoulder stabilization surgery following first-time instability events. Although larger prospective studies are necessary to draw firmer conclusions, the findings of this study suggest that overhead athletes can be considered in the same treatment pathway for first-time dislocation as non-overhead athletes.
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Affiliation(s)
- Zachary J Herman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Ehab M Nazzal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Janina Kaarre
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicholas P Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Romano Sebastiani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert T Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ajinkya Rai
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Jonathan D Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Miller M, Feldman MD. Editorial Commentary: Biceps Management During Rotator Cuff Tear: Confounding Variables Result in Unclear Indications. Arthroscopy 2024:S0749-8063(24)00325-6. [PMID: 38703924 DOI: 10.1016/j.arthro.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
Is "killing the biceps" during rotator cuff repair a capital crime or a lawful act? One of the most passionately debated topics in shoulder surgery is what to do with the biceps during rotator cuff repair: save it, tenotomize it, or perform tenodesis. Results of repair are not very successful, and given that repair of massive rotator cuff tears shows a 40% to 57% failure rate, there is renewed interest in sparing the biceps tendon as a humeral head depressor-or so that it may be used as a local graft for revision rotator cuff repair. The literature regarding tenodesis versus biceps sparing during rotator cuff repair is controversial. There are so many confounding variables affecting rotator cuff repair outcomes (tear size, comorbidities, age, tissue quality, etc.) that we do not believe that anything less than a randomized, prospective study that matches groups is likely to provide a conclusive verdict.
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Bernstorff MA, Schumann N, Schwake L, Somberg O, Balke M, Schildhauer T, Königshausen M. Shoulder pathologies in CrossFit: a magnetic resonance imaging study of 51 cases. J Sports Med Phys Fitness 2024; 64:475-482. [PMID: 38445843 DOI: 10.23736/s0022-4707.24.15071-2] [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: 03/07/2024]
Abstract
BACKGROUND Recent scientific work shows that the most common injuries in CrossFit© occur in the shoulder joint. This paper aims to provide a review of shoulder pathologies in a young CrossFit© cohort via MRI and clinical examination. METHODS A survey was conducted in 13 CrossFit "boxes" in Germany, in which athletes with recurrent shoulder pain could report for a clinical examination and MRI diagnostic. Fifty-one CrossFit athletes with chronic shoulder pain agreed to participate in the study and were then examined physically and by MRI. RESULTS Fifty-one active CrossFit athletes aged 21-45 years (mean 33.7 years, 35 male and 16 female) were recruited. The most frequently detected pathologies were partial lesions of the supraspinatus tendon (N.=25; 49%) and labral lesions (N.=11; 21.6%). The findings also identified partial lesions of the subscapularis tendon (N.=9; 17.6%), pulley lesions (N.=9; 17.6%), and partial lesions of the infraspinatus muscle (N.=2; 3.9%). CONCLUSIONS These data demonstrate the need for a specific focus on particular shoulder injuries in CrossFit. Knowledge about the type of shoulder pathologies caused by CrossFit training allows for training-specific adaptations with regard to prevention, as well as a more targeted, sport-specific therapy. This study is the first in the literature to present on structural changes in the shoulders of active CrossFit athletes.
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Affiliation(s)
- Maria A Bernstorff
- Department of Orthopedic and Trauma Surgery, BG University Hospital, Bochum, Germany -
| | - Norman Schumann
- Institute for Mathematics, Ruhr University Bochum, Bochum, Germany
| | - Lisa Schwake
- Institute of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Ole Somberg
- Department of Orthopedic and Trauma Surgery, BG University Hospital, Bochum, Germany
| | - Maurice Balke
- Institute of Medicine, Witten-Herdecke University, Cologne, Germany
| | - Thomas Schildhauer
- Department of Orthopedic and Trauma Surgery, BG University Hospital, Bochum, Germany
| | - Matthias Königshausen
- Department of Orthopedic and Trauma Surgery, BG University Hospital, Bochum, Germany
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Vargas L, Charen D, Huang HH, Poeran J, Colvin A. Analysis of common shoulder injuries in collegiate baseball players. PHYSICIAN SPORTSMED 2022; 50:394-399. [PMID: 34047242 DOI: 10.1080/00913847.2021.1934910] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Baseball players are highly susceptible to shoulder injuries due to repetitive overhead throwing. The purpose of this study was to investigate men's collegiate baseball shoulder injury rates and associated risk factors. METHODS Using the NCAA Injury Surveillance Program (ISP) database, shoulder injury data for men's baseball players was analyzed from 2009-2010 through 2013-2014. Only the most common shoulder injuries were examined, including acromioclavicular (AC) sprain, anterior dislocation, biceps tear, biceps tendinitis, SLAP (superior labrum from anterior to posterior) tear, non-SLAP labral tear, rotator cuff tear, rotator cuff tendinitis, and shoulder impingement. Statistical analysis was performed using proportion ratios (PR). Statistical significance was initially defined as p < 0.05; a post-hoc Bonferroni adjustment was applied using a p < 0.005 threshold balancing the likelihood of false positive and false negative findings. RESULTS Overall, 138 shoulder injuries were identified of which 51.4% occurred during practice. Rotator cuff pathology represented 45.6% of all injuries, with rotator cuff tears significantly more likely to be season-ending injuries (PR 2.5, 95% CI 1.2-5.6, p = 0.019). Pitching or throwing was the mechanism of injury in 100% of players with rotator cuff tendonitis, 87.5% of SLAP tears, 70% of players with biceps tendinitis, and 67% of players with rotator cuff tears. Biceps tendinitis (PR 3.9, 95% CI 1.2-12.5, p = 0.024) and SLAP tears (PR 6.4, 95% CI 1.6-25.0, p = 0.008) were significantly more likely to be chronic. SLAP tears were significantly more likely to be recurrent (PR 5.5, 95% CI = 1.5-20.4, p = 0.010). Being a freshman or sophomore was significantly associated with a lower proportion of biceps tendinitis (PR = 0.2, 95% CI = 0.04-0.8, p = 0.028). All anterior shoulder dislocations occurred while running the bases or sliding, and AC sprains were significantly associated with contact (PR 20.6, 95% CI = 2.5-168.7, p = 0.0048). CONCLUSIONS Repetitive overhead throwing in college baseball is a common cause of overuse shoulder injuries. These athletes are especially susceptible to rotator cuff pathology, which is significantly more likely to cause season-ending injuries. While we have to interpret these results in light of both adjusted and unadjusted p-values, this information signifies the importance of shoulder injury prevention strategies by physicians and trainers taking care of collegiate baseball players.
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Affiliation(s)
- Luilly Vargas
- New York University Langone Orthopedic Hospital, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel Charen
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hsin-Hui Huang
- Department of Orthopedic Surgery, Department of Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Department of Orthopedic Surgery, Department of Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexis Colvin
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Stop, Drop, and Roll! An Arthroscopic Technique for Anterior Glenoid Labrum Repair in the Lateral Decubitus Position. Arthrosc Tech 2021; 10:e241-e247. [PMID: 33532235 PMCID: PMC7823146 DOI: 10.1016/j.eats.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023] Open
Abstract
This article describes a simple and reproducible arthroscopic technique for passing sutures in the shoulder glenoid labrum in the lateral decubitus position for orthopaedic surgeons. Communicating and teaching surgeons how to perform certain maneuvers with precision can be challenging at times. This technique will simplify and more efficiently communicate the advanced arthroscopic motor skill of passing sutures in the shoulder. It will facilitate skill acquisition while teaching surgeons in training how to perform the procedure.
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Molnár S, Hunya Z, Pavlik A, Bozsik A, Shadgan B, Maffulli N. SLAP Lesion and Injury of the Proximal Portion of Long Head of Biceps Tendon in Elite Amateur Wrestlers. Indian J Orthop 2020; 54:310-316. [PMID: 32399150 PMCID: PMC7205930 DOI: 10.1007/s43465-020-00041-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/07/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Injuries to the proximal portion of the tendon of the long head of the biceps are challenging, and often only diagnosed at arthroscopy. However, it is important to be able to formulate a preoperative plan based on physical examination and imaging studies, so as to inform patients correctly, plan the likely procedure, and give indication to length and modalities of rehabilitation. MATERIALS AND METHODS Eleven elite wrestlers who suffered their injury between 2008 and 2018 were investigated retrospectively. We aimed to identify an association between the mechanism and the symptoms of the biceps-labral complex injury. RESULTS The injury was sustained at a mean age of 20.63 years, and most wrestlers were middle or light weight. All injuries occurred during shoulder movements in closed kinetic chain with the elbow extended, the forearm pronated and the shoulder slightly elevated. The surgical procedures performed were tenodesis in three wrestlers, reinsertion in seven wrestlers, and one tenotomy of the tendon of the long head of the biceps. The postoperative rehabilitation was shorter (1-3 month) in case of tenodesis or tenotomy, and markedly longer after reinsertion (6-9 months). CONCLUSIONS Injuries to the proximal part of long head of biceps tendon are relatively frequent in elite wrestlers, reflecting the high functional demands imposed on the upper limb. Though necessitating surgery, in these athletes, such injuries are not career ending, and most of our elite athletes returned to high performance levels after surgery.
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Affiliation(s)
- Szabolcs Molnár
- Department of Traumatology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
- University of Physical Education, Budapest, Hungary
| | - Zsolt Hunya
- Department of Orthopedics, University of Debrecen, Debrecen, Hungary
| | - Attila Pavlik
- Department of Sports Surgery, National Institute for Sports Medicine, Budapest, Hungary
| | - Attila Bozsik
- Department of Traumatology, Medical Centre Hungarian Defence Forces, Budapest, Hungary
| | - Babak Shadgan
- Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Nicola Maffulli
- Department of Musculoskeletal Disorder, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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