1
|
Akdemir M, Kılıç Aİ, Kurt C, Çapkın S. Better short-term outcomes of mini-open rotator cuff repair compared to full arthroscopic repair. Clin Shoulder Elb 2024; 27:212-218. [PMID: 38738322 PMCID: PMC11181071 DOI: 10.5397/cise.2023.00745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as miniopen and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. METHODS A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups. RESULTS Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317). CONCLUSIONS Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique. Level of evidence: III.
Collapse
Affiliation(s)
- Mehmet Akdemir
- Department of Orthopedics and Traumatology, İzmir Ekol Hospital, İzmir, Türkiye
| | - Ali İhsan Kılıç
- Department of Orthopedics and Traumatology, İzmir Bakırçay University, İzmir, Türkiye
| | - Cengizhan Kurt
- Department of Orthopedics and Traumatology, İzmir Bakırçay University, İzmir, Türkiye
| | - Sercan Çapkın
- Department of Orthopedics and Traumatology, İzmir Bakırçay University, İzmir, Türkiye
| |
Collapse
|
2
|
Randelli P, Compagnoni R, Ferrua P, Ricci M, La Verde L, Mekky AF, De Silvestri A, Menon A. Efficacy of Subchondroplasty in the Treatment of Pain Associated With Bone Marrow Lesions in the Osteoarthritic Knee. Orthop J Sports Med 2023; 11:23259671231163528. [PMID: 37213661 PMCID: PMC10192663 DOI: 10.1177/23259671231163528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/25/2023] [Indexed: 05/23/2023] Open
Abstract
Background Bone marrow lesions (BMLs) are common subchondral defects revealed by magnetic resonance imaging (MRI) in patients with osteoarthritis, often associated with pain and functional limitation. Subchondroplasty (SCP) is a relatively new technique in which bone substitute material (BSM) is injected inside BML areas to provide structural support to the subchondral bone, preventing its collapse and reducing pain. Purpose/Hypothesis The purpose of this study was to characterize changes in pain, functional and radiological outcomes, conversion to knee replacement, and complications after SCP. We hypothesized that ≥70% of patients would achieve a reduction in pain of ≥4 points on a numeric rating scale (NRS) at a 6-month follow-up after SCP. Study Design Case series; Level of evidence, 4. Methods Patients with symptomatic knee BMLs who underwent SCP were prospectively evaluated preoperatively and at 1, 6, 12, and 24 months postoperatively. Functional outcomes were measured with the NRS for pain, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC) scores. Radiographs and MRI were performed preoperatively and at 6- and 12-month follow-ups to verify edema healing and changes in bone structure. Results A total of 50 patients were included in the study. The mean follow-up was 26 months (24-30 months). Compared with preoperative values, the mean NRS score decreased at every follow-up point (P < .0001 for all) and the IKDC, WOMAC, and KSS scores improved significantly at 6- and 12-month follow-ups. At 6 months postoperatively, 27 patients (54%) registered a reduction on the NRS of ≥4 points. Postoperative MRI revealed a hypointense zone surrounded by a hyperintense signal at the injection site. Standard radiography showed osteoarthritis grade worsening in 4 (8%) patients. Knee replacement was performed in 11 patients -in 7 patients due to the worsening or persistence of disabling symptoms and in 4 patients due to the progression of osteoarthritis. The leakage of BSM occurred in 6 patients without any clinical consequences during the study period. Conclusion About half of the study patients achieved a reduction in the NRS of 4 points at the 6-month follow-up after SCP. Registration NCT04905394 (ClinicalTrials.gov identifier).
Collapse
Affiliation(s)
- Pietro Randelli
- U.O.C. 1° Clinica Ortopedica, ASST
Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics,
Department of Biomedical Sciences for Health, Università degli Studi di Milano,
Milan, Italy
- REsearch Center for Adult and Pediatric
Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health,
Università degli Studi di Milano, Milan, Italy
| | - Riccardo Compagnoni
- U.O.C. 1° Clinica Ortopedica, ASST
Gaetano Pini-CTO, Milan, Italy
- Department of Biomedical, Surgical and
Dental Sciences, Università degli Studi di Milano, Milano, Italy
| | - Paolo Ferrua
- U.O.C. 1° Clinica Ortopedica, ASST
Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics,
Department of Biomedical Sciences for Health, Università degli Studi di Milano,
Milan, Italy
| | - Martina Ricci
- U.O.C. 1° Clinica Ortopedica, ASST
Gaetano Pini-CTO, Milan, Italy
| | - Luca La Verde
- U.O.C. 1° Clinica Ortopedica, ASST
Gaetano Pini-CTO, Milan, Italy
- Università degli Studi di Milano,
Milano, Italy
- Luca La Verde, MD, U.O.C.
1° Clinica Ortopedica, ASST Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122
Milan, Italy ()
| | - Ahmed Farid Mekky
- U.O.C. 1° Clinica Ortopedica, ASST
Gaetano Pini-CTO, Milan, Italy
- Knee and Shoulder Arthroscopy Unit,
Department of Orthopedic Surgery, Tanta University, Egypt
| | - Annalisa De Silvestri
- Biometry and Clinical Epidemiology,
Scientific Direction, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alessandra Menon
- U.O.C. 1° Clinica Ortopedica, ASST
Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics,
Department of Biomedical Sciences for Health, Università degli Studi di Milano,
Milan, Italy
- REsearch Center for Adult and Pediatric
Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health,
Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
3
|
Hartnett DA, Milner JD, DeFroda SF. Osteoarthritis in the Upper Extremity. Am J Med 2023; 136:415-421. [PMID: 36740213 DOI: 10.1016/j.amjmed.2023.01.025] [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: 12/12/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
Osteoarthritis is a common cause of morbidity in an increasingly aging population. Although the weight-bearing joints of the leg and foot are frequently affected by osteoarthritis, degenerative changes in the joints of the upper extremity are likewise common and can be both particularly debilitating for affected individuals and uniquely challenging for the health care providers managing it. The present review seeks to overview the epidemiology, anatomy, diagnosis, and management of osteoarthritis in the joints of the shoulder, elbow, and hand with the intent of providing accessible and relevant information to the range of medical professionals involved in patient care.
Collapse
Affiliation(s)
- Davis A Hartnett
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, Mass.
| | - John D Milner
- Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Steven F DeFroda
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia Mo
| |
Collapse
|
4
|
Farkhondeh Fal M, Junker M, Mader K, Frosch KH, Kircher J. Morphology of the acromioclavicular-joint score (MAC). Arch Orthop Trauma Surg 2023; 143:1523-1529. [PMID: 35381874 PMCID: PMC9957884 DOI: 10.1007/s00402-022-04407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/27/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION To date there is no generally accepted specific definition or classification of acromioclavicular (AC) joint osteoarthritis. The aim of this study is to analyze morphological parameters using magnetic resonance imaging (MRI) and to develop a scoring system as a basis for decision making to perform an AC-joint resection. MATERIALS AND METHODS In a retrospective-monocentric matched pair study, healthy and affected subjects were investigated using T2 MRI scans in the transverse plane. There were two groups, group 1 (n = 151) included healthy asymptomatic adults with no history of trauma. In group 2, we included n = 99 patients with symptomatic AC joints, who underwent arthroscopic AC-joint resection. The central and posterior joint space width and the AC angle were measured. Morphological changes such as cartilage degeneration, cysts and bone edema were noted. Malalignment of the joint was defined as: posterior joint space width < 2 mm in conjunction with an AC angle > 12°. A scoring system consisting of the measured morphologic factors was developed. RESULTS Symptomatic and asymptomatic patients showed significant differences in all measured items. We observed a significant difference in the MAC score for symptomatic and asymptomatic patients (mean 10.4 vs. 20.6, p = 0.0001). The ROC (receiver operator characteristic) analysis showed an excellent AUC of 0.899 (p = 0.001). The sensitivity of the MAC score was 0.81 and the specificity 0.86. The MAC score shows a significant moderate correlation with age (r = 0.358; p = 0.001). The correlation of age and the development of symptoms was only weak (r = 0.22, p = 0.001). Symptomatic patients showed significantly more frequent malalignment compared to asymptomatic patients (p = 0.001), but the positive predictive value that a patient with malalignment is also symptomatic is only 55%. CONCLUSION Patients with symptomatic AC joints showed a typical pattern of morphological changes on axial MRI scans with early posterior contact of the joint surfaces, reduction of joint space and malalignment as the basis for the development of a scoring system. The MAC score shows excellent test characteristics, and therefore, proved to be both an appropriate guidance for clinical practice as well as an excellent tool for comparative studies and is superior to the assessment of malalignment alone. LEVEL OF EVIDENCE Level IV, retrospective diagnostic study.
Collapse
Affiliation(s)
- Milad Farkhondeh Fal
- Department of Trauma and Orthopaedic Surgery, University Hospital Hamburg Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.
| | - Marius Junker
- grid.459906.70000 0001 0061 4027Orthopaedic University Hospital Friedrichsheim, Marienburgerstr. 2, 60528 Frankfurt, Germany
| | - Konrad Mader
- grid.13648.380000 0001 2180 3484Department of Trauma and Orthopaedic Surgery, University Hospital Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Karl Heinz Frosch
- grid.13648.380000 0001 2180 3484Department of Trauma and Orthopaedic Surgery, University Hospital Hamburg Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
| | - Jörn Kircher
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Admiralitätstrasse 3-4, 20459 Hamburg, Germany ,grid.411327.20000 0001 2176 9917Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
| |
Collapse
|
5
|
Arnet U, de Vries WH, Eriks-Hoogland I, Wisianowsky C, van der Woude LHV, Veeger DHEJ, Berger M. MRI evaluation of shoulder pathologies in wheelchair users with spinal cord injury and the relation to shoulder pain. J Spinal Cord Med 2022; 45:916-929. [PMID: 33617411 PMCID: PMC9661987 DOI: 10.1080/10790268.2021.1881238] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To describe the number, specifics and co-occurrence of shoulder pathologies detected by MRI in manual wheelchair users with spinal cord injury and to evaluate the association between shoulder pathologies and presence of shoulder pain. DESIGN Cross-sectional observation study. SETTING Community. PARTICIPANTS Fifty-one wheelchair-dependent persons with spinal cord injury (44 males, 7 females, median age 50 years (IQR 14), median time since injury 24 years (IQR 16)) were allocated to pain or no-pain group based on the Wheelchair User Shoulder Pain Index. INTERVENTIONS Not applicable. OUTCOME MEASURES All persons underwent shoulder MRI. Pathologies were scored blinded by two experienced radiologists. Participant characteristics, number and severity of shoulder pathologies were analyzed descriptively. Logistic regression was performed to evaluate the association between MRI findings and shoulder pain. RESULTS The median number of co-occurring MRI findings per person ranged from 0 to 19 (out of 31 possible findings). The cluster of MRI findings occurring most often together were tendon tears of supraspinatus (present in 84%), subscapularis (69%) and biceps (67%) and osteoarthritis of acromioclavicular joint (80%). When correcting for age and time since injury, the logistic regression showed no statistically significant correlation between the individual pathologies and shoulder pain. CONCLUSION MRI findings of shoulder pathology are very frequent in persons with and without shoulder pain. Therefore, when diagnosing the cause of shoulder pain and planning interventions, health care professionals should keep this finding in mind and MRI should not be interpreted without careful consideration of clinical history and functional testing.
Collapse
Affiliation(s)
- Ursina Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland,Correspondence to: Ursina Arnet, Swiss Paraplegic Research, Guido A. Zächstrasse 4, 6207, Nottwil, Switzerland; Ph: +41 41 939 65 99.
| | - Wiebe H. de Vries
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | | | - Lucas H. V. van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, Groningen, Netherlands,Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - DirkJan H. E. J. Veeger
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | | | | |
Collapse
|
6
|
Joo Y, Moon JY, Han JY, Bang YS, Kang KN, Lim YS, Choi YS, Kim YU. Usefulness of the acromioclavicular joint cross-sectional area as a diagnostic image parameter of acromioclavicular osteoarthritis. World J Clin Cases 2022; 10:2087-2094. [PMID: 35321173 PMCID: PMC8895195 DOI: 10.12998/wjcc.v10.i7.2087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/06/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acromioclavicular joint (ACJ) space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis (ACJO). However, the morphology of the ACJ space is irregular because of osteophyte formation, subchondral irregularity, capsular distention, sclerosis, and erosion. Therefore, we created the ACJ cross-sectional area (ACJCSA) as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.
AIM To hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.
METHODS ACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance (S-MR) imaging that revealed no evidence of ACJO. Oblique coronal, T2-weighted, fat-suppressed S-MR images were acquired at the ACJ level from the two groups. We measured the ACJCSA and the ACJ space width (ACJSW) at the ACJ on the S-MR images using our imaging analysis program. The ACJCSA was measured as the cross-sectional area of the ACJ. The ACJSW was measured as the narrowest point between the acromion and the clavicle.
RESULTS The average ACJCSA was 39.88 ± 10.60 mm2 in the normal group and 18.80 ± 5.13 mm2 in the ACJO group. The mean ACJSW was 3.51 ± 0.58 mm in the normal group and 2.02 ± 0.48 mm in the ACJO group. ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals. Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm2, with 91.4% sensitivity and 90.0% specificity.
CONCLUSION The optimal ACJSW cutoff score was 2.37 mm, with 88.6% sensitivity and 96.7% specificity. Even though both the ACJCSA and ACJSW were significantly associated with ACJO, the ACJCSA was a more sensitive diagnostic image parameter.
Collapse
Affiliation(s)
- Young Joo
- Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, School of Medicine, CHA University, Ilsan, Gyeonggi-do 10414, South Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, Seoul 03080, South Korea
| | - Jung Youn Han
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, School of Medicine, Seongnam, Gyeonggi-do 13496, South Korea
| | - Yun-Sic Bang
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, School of Medicine, Seongnam, Gyeonggi-do 13496, South Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul 05715, South Korea
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
| | - Young-Soon Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
| | - Young-Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International St. Mary’s Hospital, Incheon 22711, South Korea
| |
Collapse
|
7
|
Garry CB, Adsit MH, Land V, Sanderson G, Sheppard SG, Balazs GC. Bony Edema and Clinical Examination Findings Predict the Need for Distal Clavicle Excision at the Time of Shoulder Arthroscopy. HSS J 2022; 18:63-69. [PMID: 35087334 PMCID: PMC8753536 DOI: 10.1177/15563316211008457] [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: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 02/03/2023]
Abstract
Background: Deciding to perform a distal clavicle excision for acromioclavicular joint arthritis, especially in conjunction with other arthroscopic shoulder procedures, is challenging for surgeons. Studies have reported mixed results on the value of magnetic resonance imaging (MRI) in decision making. Purpose: We sought to correlate MRI findings with clinical symptoms and the surgeon's decision to perform a distal clavicle excision. Methods: We compared MRI, clinical examination, and MRI findings of 200 patients who underwent distal clavicle excision for symptomatic acromioclavicular joint arthritis with 200 patients who underwent arthroscopic shoulder procedures for other reasons. Univariate statistics were used to determine correlations between physical examination findings, MRI findings, and the decision to perform distal clavicle excision. A binary logistic regression model was used to determine independent predictors of need for distal clavicle excision. Results: There was no difference in mean age, sex, and race between groups. Advanced acromioclavicular joint osteoarthritis was strongly correlated with positive physical examination findings. Bony edema correlated strongly with tenderness at the acromioclavicular joint but not pain with cross-body adduction testing. There was no association between higher MRI grade of osteoarthritis and the need for distal clavicle excision. Regression analysis identified both physical examination findings and bony edema on MRI as independent predictors of the need for distal clavicle excision. Conclusion: In the setting of positive clinical examination findings and bony edema of the distal clavicle, surgeons should feel reassured that distal clavicle excision is likely indicated.
Collapse
Affiliation(s)
- Conor B. Garry
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | | | - Vaughn Land
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Galen Sanderson
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Sean G. Sheppard
- Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - George C. Balazs
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, VA, USA,George C. Balazs, MD, Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708, USA.
| |
Collapse
|
8
|
Yiannakopoulos CK, Vlastos I, Theotokatos G, Galanis N. Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:2090-2095. [PMID: 32556365 DOI: 10.1007/s00167-020-06098-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/10/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the significance of untreated primary acromioclavicular joint (ACJ) osteoarthritis, encountered during arthroscopic rotator cuff repair (RCR), as a cause of persistent symptomatology and need for revision surgery. METHODS In a cohort of 811 consecutive patients older than 55 years who underwent RCR, the effect of primary ACJ osteoarthritis presence was prospectively examined. A total of 497 patients with mild/moderate and severe ACJ osteoarthritis based on preoperative MRI evaluation were allocated to Group A (n = 185, symptomatic ACJ) and Group B (n = 312, asymptomatic ACJ). Distal clavicle excision was not performed regardless of the presence of pain. The minimum follow-up was 28 months (28-46). The visual analogue scale (VAS) pain scores were assessed for ACJ pain on palpation, the cross body adduction test, the Constant-Murley, and the American Shoulder and Elbow Surgeons (ASES). RESULTS The overall loss to follow-up rate was 3.82% (19 patients: 11 in Group A and eight in Group B). The mean ASES score at the latest follow-up was 91.16 ± 9.3 and 92.37 ± 10.44 in Groups A and B, respectively, and the mean Constant-Murley score was 96.36 ± 5.7 and 95.76 ± 4.6 in Groups A and B, respectively. There was no statistical significance between regarding both scores. Localised ACJ pain on palpation and pain on cross body adduction were diminished in both the symptomatic and asymptomatic group. There were five cases (1%: two in Group A and three in Group B) with persistent ACJ pain who had failed the conservative treatment, and ACJ excision was necessary to alleviate the symptoms. All revision operations were uncomplicated with symptom resolution. CONCLUSION Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. Routine distal clavicle excision is not absolutely necessary, even in patients with symptomatic ACJ osteoarthritis. LEVEL OF EVIDENCE II, Prospective cohort study.
Collapse
Affiliation(s)
- Christos K Yiannakopoulos
- Metropolitan General Hospital, Athens, Greece. .,School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.
| | - Iakovos Vlastos
- Metropolitan General Hospital, Athens, Greece.,School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Theotokatos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikiforos Galanis
- Orthopaedic Department, Medical School, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
| |
Collapse
|
9
|
Gallinet D, Barth J, Labattut L, Collin P, Metais P, Bonnevialle N, Godeneche A, Garret J, Clavert P. Benefits of distal clavicle resection during rotator cuff repair: Prospective randomized single-blind study. Orthop Traumatol Surg Res 2020; 106:S207-S211. [PMID: 32943383 DOI: 10.1016/j.otsr.2020.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Rotator cuff tears often occur in combination with acromioclavicular (AC) arthropathy. But it can be difficult to separate pain caused by the rotator cuff tear from pain caused by the AC joint, despite clinical and other examinations. Distal clavicle resection (DCR) is increasingly being done at the same time as arthroscopic rotator cuff repair. The aim of this study was to compare the functional outcomes 1 year after arthroscopic rotator cuff repair between patients who simultaneously undergo DCR and patients who do not. The primary hypothesis was that DCR improves the clinical outcomes. MATERIAL AND METHODS This was a prospective, multicenter, randomized, single-blind study of 200 patients who underwent isolated supraspinatus repair using the same technique. The patients were randomized into two groups: 97 patients who also underwent DCR and 103 patients who did not. The patients were followed until 1 year postoperative according to a standardized radiological and clinical review protocol. RESULTS At 1 year postoperative, all the clinical outcomes were worse in the DCR group, although only external rotation with elbow at side (53° vs. 59°, p=0.04) and the SSV (86.5 vs. 90.1, p=0.04) were statistically different. Overall shoulder pain was higher in the DCR group during the first 3 months postoperative (p=0.04). At 1 year, the DCR group had more residual pain; this pain was mainly located on the superior side of the shoulder (p=0.03), especially when more than 11 mm was resected (p=0.01). More of the shoulders in the DCR group had failures in rotator cuff healing based on ultrasonography (p=0.5). CONCLUSION Our hypothesis was not confirmed. We do not recommend doing routine DCR with arthroscopic rotator cuff repair. LEVEL OF EVIDENCE I, prospective randomized simple blind study.
Collapse
Affiliation(s)
- David Gallinet
- Centre Épaule Main Besançon, 16, rue Madeleine Brès, 25000 Besançon, France.
| | - Johannes Barth
- Centre ostéoarticulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Echirolles, France
| | - Ludovic Labattut
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital François Mitterrand CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France
| | - Philippe Collin
- Institut locomoteur de l'ouest, 7, boulevard de la Boutière, 35760 Saint Grégoire, France
| | - Pierre Metais
- Elsan Hôpital privé la Châtaigneraie, 63110 Beaumont, France
| | - Nicolas Bonnevialle
- Hôpital Pierre Paul Riquet, CHRU de Toulouse, place Baylac, 31059 Toulouse, France
| | - Arnaud Godeneche
- Centre Orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France
| | - Jérôme Garret
- Clinique du Parc, 155, boulevard Stalingrad, 69006 Lyon, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, Hautepierre 2, CHRU Strasbourg, avenue Molière, 67200 Strasbourg, France
| | -
- 15, rue Ampère, 92500 Rueil Malmaison, France
| |
Collapse
|
10
|
Candela V, Villani C, Preziosi Standoli J, Scacchi M, Gumina S. AC joint osteoarthritis: The role of genetics. An MRI evaluation of asymptomatic elderly twins. J Anat 2020; 238:1023-1027. [PMID: 33073352 DOI: 10.1111/joa.13340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The anatomy of the articular surfaces has historically identified as major responsible for acromioclavicular joint osteoarthritis (ACJO). On the other side, the almost 100% prevalence of ACJO in subjects over 50 years old seems to suggest a multifactorial etiology. We compared ACJO between asymptomatic elderly monozygotic (MZ) and dizygotic (DZ) twins to investigate the influence of genetics and environmental factors. MATERIALS AND METHODS Thirty pairs of twins [15MZ-15DZ; mean age (SD): 63.70 (3.31); range: 53-72] were retrospectively enrolled. ACJO was evaluated on MRI through a 4-grade severity scale and ACJ configuration was assessed. Information regarding work activity were obtained. Heritability index was calculated. RESULTS The intraclass correlation coefficient (ICC) value of 0.868 (95% CI; 0.798 to 0.917). An ICC values of 0.889 (95% CI; 0.798 to 0.944) and 0.843 (95% CI, 0.712 to 0.920) were found in the MZ and DZ groups, respectively. The polychoric correlation was 0.857 in the MZ twins and 0.757 in the DZ twins. The calculated heritability index was 0.20 (20%), and the contribution of the shared environment (c2) and unique environment (e2) was 0.66 (66%) and 0.14 (14%), respectively. No relationship between job types and ACJO in both the total cohort (r = 0.089; p = 0.499) and in the monozygotic (r = 0.247; p = 0.187) and the dizygotic twin groups (r = -0.084; p = 0.658) was found. CONCLUSIONS The role of genetics on ACJO accounts for only 20%; a specific anatomical configuration of the articular surfaces only partially acts on the development of joint osteoarthritis. Environmental factors have the greatest impact. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Vittorio Candela
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Polo Pontino, Sapienza, University of Rome, Rome, Italy.,ICOT, Latina, Italy
| | - Ciro Villani
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Umberto I Hospital, Sapienza, University of Rome, Rome, Italy
| | - Jacopo Preziosi Standoli
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Sant'Andrea Hospital, Sapienza, University of Rome, Rome, Italy
| | | | - Stefano Gumina
- Department of Anatomy, Histology, Legal Medicine and Orthopaedics, Polo Pontino, Sapienza, University of Rome, Rome, Italy.,ICOT, Latina, Italy
| |
Collapse
|
11
|
The Ultrasonographic Features of Shoulder Pain Patients in a Tertiary Hospital in South China. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3024793. [PMID: 32908880 PMCID: PMC7468624 DOI: 10.1155/2020/3024793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 11/17/2022]
Abstract
Methods Patients with shoulder pain were recruited in an outpatient rehabilitation clinic at the Third Affiliated Hospital of Sun Yat-Sen University from January 1, 2017, to June 30, 2018. These shoulder pain patients with or without limitation in joint movement can be included in the study. All of them received musculoskeletal ultrasound scanning. Demographic and imaging data including age, gender, duration of shoulder pain, pain side, and pathologies found by musculoskeletal ultrasound imaging were collected and analyzed. Patients were divided into three groups: <45 years (young group), between 45 and 60 years (middle-aged group), and >60 years (elderly group). The rates of various shoulder pathologies were evaluated and compared between the groups. Results This study recruited a total of 346 patients with shoulder pain. There were more female (62.1%) than male patients (37.9%), with the largest number of patients in the 45-60 years of age group (40.5%). Forty-eight percent of patients had shoulder pain within a period of 3 months. A total of 380 shoulders were assessed using musculoskeletal ultrasound imaging. The occurrence rate of subacromial disorder (83.8%) was the highest. The rate of supraspinatus tendinopathy, acromioclavicular joint degeneration, and adhesive shoulder capsulitis varied significantly between age groups (P < 0.05). The rate of acromioclavicular joint degeneration was the highest in the elderly group followed by the middle-aged and young groups (P < 0.0167). The rate of supraspinatus tendinopathy and adhesive capsulitis in the middle-aged and elderly groups was significantly higher than that in the young group (P < 0.0167). Conclusions Musculoskeletal ultrasound can be a useful imaging tool in making an accurate diagnosis of shoulder pain. The occurrence rates of different shoulder pain pathologies in all age groups were thoroughly calculated in this study. More female and more subcoracoid disorder patients than western countries are attributed to repetitive lifting in daily life and work in this study. Correlations between these pathologies and their associated images can be a solid foundation for the development of artificial intelligence in diagnosing the cause of shoulder pain.
Collapse
|
12
|
Flores DV, Goes PK, Gómez CM, Umpire DF, Pathria MN. Imaging of the Acromioclavicular Joint: Anatomy, Function, Pathologic Features, and Treatment. Radiographics 2020; 40:1355-1382. [PMID: 32762593 DOI: 10.1148/rg.2020200039] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The acromioclavicular joint is an important component of the shoulder girdle; it links the axial skeleton with the upper limb. This joint, a planar diarthrodial articulation between the clavicle and the acromion, contains a meniscus-like fibrous disk that is prone to degeneration. The acromioclavicular capsule and ligaments stabilize the joint in the horizontal direction, while the coracoclavicular ligament complex provides vertical stability. Dynamic stability is afforded by the deltoid and trapezius muscles during clavicular and scapular motion. The acromioclavicular joint is susceptible to a broad spectrum of pathologic entities, traumatic and degenerative disorders being the most common. Acromioclavicular joint injury typically affects young adult males and can be categorized by using the Rockwood classification system as one of six types on the basis of the direction and degree of osseous displacement seen on conventional radiographs. MRI enables the radiologist to more accurately assess the regional soft-tissue structures in the setting of high-grade acromioclavicular separation, helping to guide the surgeon's selection of the appropriate management. Involvement of the acromioclavicular joint and its stabilizing ligaments is also important for understanding and classifying distal clavicle fractures. Other pathologic processes encountered at this joint include degenerative disorders; overuse syndromes; and, less commonly, inflammatory arthritides, infection, metabolic disorders, and developmental malformations. Treatment options for acromioclavicular dysfunction include conservative measures, resection arthroplasty for recalcitrant symptoms, and surgical reconstruction techniques for stabilization after major trauma.
Collapse
Affiliation(s)
- Dyan V Flores
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Paola Kuenzer Goes
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Catalina Mejía Gómez
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Darwin Fernández Umpire
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| | - Mini N Pathria
- From the Institute of Radiology, St. Luke's Medical Center Global City, Department of Radiology, Philippine Orthopedic Center, Maria Clara St, Santa Mesa Heights, Quezon City, Metro Manila, Philippines 1100 (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); Department of Musculoskeletal Radiology, Ayudas Diagnósticas Sura, Medellín, Colombia (C.M.G.); Department of Radiology, Clínica Internacional, Lima, Peru (D.F.U.); and Department of Radiology, UCSD Health System, San Diego, Calif (M.N.P.)
| |
Collapse
|
13
|
Bulkmans K, Peeters I, De Wilde L, Van Tongel A. The relationship of the acromion to the distal clavicle in normal and symptomatic degenerated acromioclavicular joints. Arch Orthop Trauma Surg 2020; 140:465-472. [PMID: 31428850 DOI: 10.1007/s00402-019-03258-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Although degenerative osteoarthritis of the acromioclavicular joint is a common finding on technical investigations, not every patient experiences pain or function loss. The difference between symptomatic and asymptomatic patients is currently not elucidated. Therefore, we want to investigate the acromioclavicular relationship in normal, asymptomatic, and symptomatic degenerated ACJ. MATERIALS AND METHODS 84 normal ACJ, 39 asymptomatic degenerated ACJ, and 30 symptomatic degenerated ACJ were 3D reconstructed. The morphological dimensions and the relationship of the acromion and distal clavicle were measured using computational software. The reproducibility of this technique was evaluated using inter- and intra-observer reliability. RESULTS The mean anteroposterior and superoinferior distance of both the clavicle and acromion was significantly larger in asymptomatic and symptomatic degenerative ACJ compared to the normal ACJ (p < 0.001). In symptomatic osteoarthritic ACJ, both the anterior and posterior borders of the acromion were significantly more anterior to the borders of the clavicle than in the normal group and asymptomatic group (p < 0.001). Subsequent ROC curve analysis resulted in a sensitivity of 86.7% and a specificity of 88.6% for anterior subluxation of the ACJ. This technique showed an excellent inter- and intra-observer reliability. CONCLUSIONS In patients with degenerative ACJ, both the distal clavicle and acromion are enlarged. In asymptomatic patients, the AC relationship is the same as in normal patients, in contrast, in patients with symptomatic degenerative ACJ, the acromion is subluxated anteriorly compared to the clavicle.
Collapse
Affiliation(s)
- Kristof Bulkmans
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - Ian Peeters
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - Lieven De Wilde
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - Alexander Van Tongel
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium.
| |
Collapse
|
14
|
Jenkins PJ, Stirling PHC, Ireland J, Elias-Jones C, Brooksbank AJ. The changing incidence of arthroscopic subacromial decompression in Scotland. Bone Joint J 2020; 102-B:360-364. [DOI: 10.1302/0301-620x.102b3.bjj-2019-0752.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Aims The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location. Methods Scottish Morbidity Records were reviewed retrospectively between March 2014 and April 2018 to identify records for every admission to each NHS hospital. The Office of Population Censuses and Surveys (OPCS-4) surgical codes were used to identify patients undergoing primary ASD. Patients who underwent acromioclavicular joint excision (ACJE) and rotator cuff repair (RCR) were identified and grouped separately. Procedure rates were age and sex standardized against the European standard population. Results During the study period the number of ASDs fell by 649 cases (29%) from 2,217 in the first year to 1,568 in the final year. The standardized annual procedure rate fell from 41.6 (95% confidence interval (CI) 39.9 to 43.4) to 28.9 (95% CI 27.4 to 30.3) per 100,000. The greatest reduction occurred between 2017 and 2018. The number of ACJEs rose from 41 to 188 (a 3.59-fold increase). The number of RCRs fell from 655 to 560 (-15%). In the year 2017 to 2018 there were four (28.6%) Scottish NHS board areas where the ASD rate was greater than 3 standard deviations (SDs) from the national average, and two (14.3%) NHS boards where the rate was less than 3 SDs from the national average. Conclusion There has been a clear decline in the rate of ASD in Scotland since 2014. Over the same period there has been an increase in the rate of ACJE. The greatest decline occurred between 2017 and 2018, corresponding to the publication of epidemiological studies demonstrating a rise in ASD, and awareness of studies which questioned the benefit of ASD. This paper demonstrates the potential impact of information from epidemiological studies, referral guidelines, and well-designed large multicentre randomized controlled trials on clinical practice. Cite this article: Bone Joint J 2020;102-B(3):360–364
Collapse
|
15
|
Frigg A, Song D, Willi J, Freiburghaus AU, Grehn H. Seven-year course of asymptomatic acromioclavicular osteoarthritis diagnosed by MRI. J Shoulder Elbow Surg 2019; 28:e344-e351. [PMID: 31279719 DOI: 10.1016/j.jse.2019.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Asymptomatic acromioclavicular osteoarthritis (AC-OA) is a frequent finding in shoulder magnetic resonance imaging (MRI). Its natural course is unknown. Therefore, the question arises whether a resection should be performed simultaneously with shoulder surgery for another reason to prevent future pain and reoperation. The purpose of this study was to investigate the mid-term course of asymptomatic AC-OA. METHODS Overall, 114 asymptomatic AC-OA diagnosed on MRI were followed for 7 years between 2011 and 2018. At baseline, MRI signal enhancement in the clavicle and acromion, OA grade, physical demand as well as the parameters (1) Constant Score Visual Analogue Scale, (2) pain on AC-joint compression, and (3) cross-body adduction test were measured. All patients were followed up after 7 years by interview, and in case of symptoms by clinical examination. The endpoint "deterioration" was reached if 2 of the 3 parameters turned worse. RESULTS Asymptomatic AC-OA remained asymptomatic in 83% of cases, 7% turned better, 10% turned worse. Physical demand and osteoarthritis grade increased the risk of deterioration, whereas MRI signal enhancement in the clavicle or acromion had no influence on outcome. During follow-up, the frequency of pain on AC-joint compression increased from 11% to 16% (P = .24), the frequency of a positive cross-body adduction test increased from 6% to 20% (P = .017), and the mean Constant Score Visual Analogue Scale increased from 10 to 13 points (P < .001) indicating less pain. CONCLUSIONS Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. A simultaneous resection of an asymptomatic AC-OA during shoulder surgery for another reason is not indicated in every patient.
Collapse
Affiliation(s)
- Arno Frigg
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland; Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.
| | - David Song
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland; Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Janick Willi
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland; Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Holger Grehn
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland
| |
Collapse
|
16
|
Singh B, Gulihar A, Bilagi P, Goyal A, Goyal P, Bawale R, Pillai D. Magnetic resonance imaging scans are not a reliable tool for predicting symptomatic acromioclavicular arthritis. Shoulder Elbow 2018; 10:250-254. [PMID: 30214490 PMCID: PMC6134526 DOI: 10.1177/1758573217724080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 07/01/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND We investigated whether magnetic resonance imaging (MRI) scans can accurately diagnose arthritis of the acromioclavicular joint (ACJ) because it has recently been suggested that bone marrow oedema on MRI scans is a predictive sign of symptomatic ACJ arthritis. METHODS The MRI scans of 43 patients (50 shoulders) who underwent ACJ excision for clinically symptomatic ACJ arthritis were compared to a control group of 43 age- and sex-matched patients (48 shoulders) who underwent an MRI scan for investigation of shoulder pain but did not have clinical symptoms or signs of ACJ arthritis. The scans were evaluated by an experienced musculoskeletal radiologist, who was blinded to the examination findings. RESULTS Bone marrow oedema was present in only 15 (30%) shoulders in the ACJ excision group, although this was higher than the six shoulders in the asymptomatic group (p = 0.03). Forty-one (82%) shoulders in the symptomatic group had grade III/IV ACJ arthritis compared to 31 (65%) in the asymptomatic group (p = 0.05). However, 44 out of 48 (92%) shoulders in the asymptomatic group had signs of osteoarthritis on MRI scans. CONCLUSIONS In contrast to recent reports, the present study shows that MRI is not helpful in making the diagnosis of ACJ arthritis. A focused history and clinical examination should remain the mainstay for surgical decision making. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Bijayendra Singh
- Bijayendra Singh, Department of Orthopaedics, Medway Maritime Hospital, Windmill Road, Gillingham ME7 5NY, UK.
| | | | | | | | | | | | | |
Collapse
|
17
|
Veen EJD, Donders CM, Westerbeek RE, Derks RPH, Landman EBM, Koorevaar CT. Predictive findings on magnetic resonance imaging in patients with symptomatic acromioclavicular osteoarthritis. J Shoulder Elbow Surg 2018; 27:e252-e258. [PMID: 29501222 DOI: 10.1016/j.jse.2018.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/26/2017] [Accepted: 01/07/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND A magnetic resonance imaging (MRI) scan of the shoulder can have added value in diagnosing symptomatic osteoarthritis of the acromioclavicular (AC) joint. Specific MRI signs have been recognized but not analyzed extensively before. This study aims to identify predictive MRI signs in patients with symptomatic AC osteoarthritis. METHODS The MRI scans of 70 patients with symptomatic AC osteoarthritis were compared with those of 70 patients with subacromial pain syndrome and no clinical signs of symptomatic AC osteoarthritis. Seven variables were evaluated on the MRI scans of the AC joint: joint space narrowing, inferior osteophytes, joint effusion, osteolysis, bone marrow edema, impression on the supraspinatus, and inferior joint distension. Logistic regression analysis of these variables was performed. RESULTS The presence of inferior osteophytes, bone marrow edema, impression on the supraspinatus, and inferior joint distension was individually associated with symptomatic AC osteoarthritis. Bone marrow edema was observed only in patients with symptomatic AC osteoarthritis. Multivariate analysis showed a significant association between inferior joint distension, as well as impression on the supraspinatus muscle, and symptomatic AC osteoarthritis. The area under the receiver operating characteristic curve in the multivariate logistic model was 0.839 (95% confidence interval, 0.771 to 0.907). Interobserver and intraobserver variability showed good to excellent κ values (range, 0.68 to 0.88). CONCLUSION We identified predictive MRI signs in patients with symptomatic AC osteoarthritis. These findings, including bone marrow edema, inferior joint distension, and impression on the supraspinatus muscle, showed good discriminative ability. They are practical and easy to use and can assist the physician in diagnosing symptomatic AC osteoarthritis.
Collapse
Affiliation(s)
- Egbert J D Veen
- Department of Orthopaedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands; Department of Orthopaedic Surgery, University Medical Center, University of Groningen, Groningen, The Netherlands.
| | - Cornelia M Donders
- Department of Orthopaedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
| | | | - Rosalie P H Derks
- Department of Radiology, Deventer Hospital, Deventer, The Netherlands
| | - Ellie B M Landman
- Department of Orthopaedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
| | - Cornelis T Koorevaar
- Department of Orthopaedic Surgery and Traumatology, Deventer Hospital, Deventer, The Netherlands
| |
Collapse
|
18
|
Malavolta EA, Gracitelli MEC, Assunção JH, Pinto GDMR, Silveira AZFD, Ferreira Neto AA. Shoulder disorders in an outpatient clinic: an epidemiological study. ACTA ORTOPEDICA BRASILEIRA 2017. [PMID: 28642666 PMCID: PMC5474408 DOI: 10.1590/1413-785220172503170849] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. METHODS: This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. RESULTS: We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64.3% (41.2% tendinopathy, 11.0% partial tears and 12.2% full-thickness tears). Adhesive capsulitis occurred in 13.5% of cases and glenohumeral instability in 8.1%. Rotator cuff disorders were more common in women, with a peak between 50 and 59 years for tendinopathy and partial tears and between 60 and 69 years for full-thickness tears. Glenohumeral instability was more frequent in men, with a peak between 30 and 39 years. CONCLUSION: The most frequent diagnosis was rotator cuff tendinopathy, followed by adhesive capsulitis, full-thickness rotator cuff tears, partial rotator cuff tears and glenohumeral instability. Rotator cuff lesions were more common in women, with a peak between 60 and 69 years for full-thickness tears. Level of Evidence IV, Case Series.
Collapse
|
19
|
Cadogan A, McNair PJ, Laslett M, Hing WA. Diagnostic Accuracy of Clinical Examination and Imaging Findings for Identifying Subacromial Pain. PLoS One 2016; 11:e0167738. [PMID: 27936246 PMCID: PMC5147961 DOI: 10.1371/journal.pone.0167738] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/19/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The diagnosis of subacromial pathology is limited by the poor accuracy of clinical tests for specific pathologies. The aim of this study was to estimate the diagnostic accuracy of clinical examination and imaging features for identifying subacromial pain (SAP) defined by a positive response to diagnostic injection, and to evaluate the influence of imaging findings on the clinical diagnosis of SAP. METHODS AND FINDINGS In a prospective, diagnostic accuracy design, 208 consecutive patients presenting to their primary healthcare practitioner for the first time with a new episode of shoulder pain were recruited. All participants underwent a standardized clinical examination, shoulder x-ray series and diagnostic ultrasound scan. Results were compared with the response to a diagnostic block of xylocaineTM injected into the SAB under ultrasound guidance using ≥80% post-injection reduction in pain intensity as the positive anaesthetic response (PAR) criterion. Diagnostic accuracy statistics were calculated for combinations of clinical and imaging variables demonstrating the highest likelihood of a PAR. A PAR was reported by 34% of participants. In participants with no loss of passive external rotation, combinations of three clinical variables (anterior shoulder pain, strain injury, absence of symptoms at end-range external rotation (in abduction)) demonstrated 100% specificity for a PAR when all three were positive (LR+ infinity; 95%CI 2.9, infinity). A full-thickness supraspinatus tear on ultrasound increased the likelihood of a PAR irrespective of age (specificity 98% (95%CI 94, 100); LR+ 6.2; 95% CI 1.5, 25.7)). Imaging did not improve the ability to rule-out a PAR. CONCLUSION Combinations of clinical examination findings and a full-thickness supraspinatus tear on ultrasound scan can help confirm, but not exclude, the presence of subacromial pain. Other imaging findings were of limited value for diagnosing SAP.
Collapse
Affiliation(s)
- Angela Cadogan
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
- * E-mail:
| | - Peter J. McNair
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Mark Laslett
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Wayne A. Hing
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| |
Collapse
|
20
|
|
21
|
High-Resolution 3-T Magnetic Resonance Imaging of the Shoulder in Nonsymptomatic Professional Baseball Pitcher Draft Picks. J Comput Assist Tomogr 2016; 40:118-25. [DOI: 10.1097/rct.0000000000000327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
|
23
|
|
24
|
Colegate-Stone TJ, Tavakkolizadeh A, Sinha J. An analysis of acromioclavicular joint morphology as a factor for shoulder impingement syndrome. Shoulder Elbow 2014; 6:165-70. [PMID: 27582932 PMCID: PMC4935063 DOI: 10.1177/1758573214525762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 01/30/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The present study aimed to determine whether acromioclavicular (AC) joint morphology was a factor in the development of symptomatic impingement necessitating AC joint excision. METHODS We performed a prospective cohort study on all patients undergoing AC joint excision for symptomatic joint pain unresponsive to conservative treatment between 2009 and 2011. This involved 106 consecutive patients (57 women, 49 men, average age 54 years, age range 33 to 76 years). Prior to surgery, radiographic classification of the AC joint was performed producing three main groups: oblique, flat or curved. Pre- and postoperative assessment was performed using the Oxford Shoulder Score and the Disabilities of the Arm, Shoulder and Hand questionnaire. RESULTS A significantly (p < 0.05) higher frequency of oblique AC joint morphology was seen in the AC joint excision study population compared to the normal population. Postoperative outcome demonstrated no significant difference (P > 0.05) between any of the three AC joint morphologies. CONCLUSIONS The present study demonstrates a significant association between the oblique AC joint morphology and those patients who develop AC joint pain requiring surgery. Outcomes of surgery were independent of joint morphology, gender or age, with all patient subgroups demonstrating significant improvement by the end of the study.
Collapse
Affiliation(s)
- Toby J Colegate-Stone
- Toby J. Colegate-Stone, Upper Limb Unit, Department
of Orthopaedic Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
Tel: +44 7977531559
| | | | | |
Collapse
|
25
|
Thakkar RS, Thakkar SC, Srikumaran U, McFarland EG, Fayad LM. Complications of rotator cuff surgery-the role of post-operative imaging in patient care. Br J Radiol 2014; 87:20130630. [PMID: 24734935 DOI: 10.1259/bjr.20130630] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low "metal presence" and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms.
Collapse
Affiliation(s)
- R S Thakkar
- 1 The Russell H. Morgan Department of Radiology and Radiology Science, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
26
|
Juel NG, Natvig B. Shoulder diagnoses in secondary care, a one year cohort. BMC Musculoskelet Disord 2014; 15:89. [PMID: 24642168 PMCID: PMC3995190 DOI: 10.1186/1471-2474-15-89] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 03/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shoulder pain is common in the general population. Reports on specific diagnoses in general populations are scarce and only from primary care. The diagnostic distribution of shoulder disorders in secondary care is not reported. Most of the clinical research in the shoulder field is done in hospital settings. The aim of this study was to identify the diagnoses in a 1-year cohort in a hospital-based outpatient clinic using standardized diagnostic criteria and to compare the results with previous studies. METHODS A diagnostic routine was conducted among patients referred to our physical medicine outpatient clinic at Oslo University Hospital. Diagnostic criteria were derived from the literature and supplemented with research criteria. RESULTS Of 766 patients diagnosed, 55% were women and the mean age was 49 years (range 19-93, SD ± 14). The most common diagnoses were subacromial pain (36%), myalgia (17%) and adhesive capsulitis (11%). Subacromial pain and adhesive capsulitis were most frequent in persons aged 40-60 years. Shoulder myalgia was most frequent in age groups under 40. Labral tears and instability problems (8%) were most frequent in young patients and not present after age 50. Full-thickness rotator cuff tears (8%) and glenohumeral osteoarthritis (4%) were more prevalent after the age of 60. Few differences were observed between sexes. We identified three studies reporting shoulder diagnoses in primary care. CONCLUSION Subacromial pain syndrome, myalgia and adhesive capsulitis were the most prevalent diagnoses in our study. However, large differences in prevalence between different studies were found, most likely arising from different use of diagnostic criteria and a difference in populations between primary and secondary care. Of the diagnoses in our cohort, 20% were not reported by the studies from primary care (glenohumeral osteoarthritis, full thickness rotator cuff tears, labral tears and instabilities).
Collapse
Affiliation(s)
- Niels G Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ullevål, Postboks 4956 Nydalen, 0424 Oslo, Norway.
| | | |
Collapse
|
27
|
|
28
|
Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain. BMC Musculoskelet Disord 2013; 14:156. [PMID: 23634871 PMCID: PMC3646690 DOI: 10.1186/1471-2474-14-156] [Citation(s) in RCA: 11] [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: 09/13/2012] [Accepted: 04/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. METHODS Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O'Brien's test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. RESULTS Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P<0.05) and combinations of traditional tests were not able to discriminate between a PAR and a negative anaesthetic response (AUC 0.507; 95% CI: 0.366, 0.647; P>0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0.41) and four positive clinical features resulted in 95% specificity (95% CI 0.90, 0.98) and a LR+ of 4.98 (95% CI 1.69, 13.84). CONCLUSIONS In this cohort of primary care patients with predominantly subacute or chronic ACJ pain of non-traumatic onset, traditional ACJ tests were of limited diagnostic value. Combinations of other history and physical examination findings were able to more accurately identify injection-confirmed ACJ pain in this cohort.
Collapse
|
29
|
Choo HJ, Lee SJ, Kim JH, Cha SS, Park YM, Park JS, Lee JW, Oh M. Can symptomatic acromioclavicular joints be differentiated from asymptomatic acromioclavicular joints on 3-T MR imaging? Eur J Radiol 2013; 82:e184-91. [DOI: 10.1016/j.ejrad.2012.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/26/2012] [Accepted: 10/29/2012] [Indexed: 11/25/2022]
|
30
|
Acromioclavicular joint arthrosis in persons with spinal cord injury and able-bodied persons. Spinal Cord 2012; 51:59-63. [DOI: 10.1038/sc.2012.89] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
31
|
Eriks-Hoogland I, Engisch R, Brinkhof MWG, van Drongelen S. Acromioclavicular joint arthritis in persons with spinal cord injury compared to able-bodied persons. Top Spinal Cord Inj Rehabil 2012; 18:128-31. [PMID: 23459223 PMCID: PMC3584756 DOI: 10.1310/sci1802-128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Inge Eriks-Hoogland
- Swiss Paraplegic Research , Nottwil , Switzerland ; Swiss Paraplegic Center , Nottwil , Switzerland
| | | | | | | |
Collapse
|
32
|
Anakwenze OA, Hsu JE, Kim JS, Abboud JA. Acromioclavicular joint pain in patients with adhesive capsulitis: a prospective outcome study. Orthopedics 2011; 34:e556-60. [PMID: 21902157 DOI: 10.3928/01477447-20110714-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diagnosis of adhesive capsulitis is a clinical diagnosis based on history and physical examination. Afflicted patients exhibit active and passive loss of motion in all planes and a positive capsular stretch sign. The effect of adhesive capsulitis on acromioclavicular biomechanics leading to tenderness has not been documented in the literature. This study reports on the incidence of acromioclavicular tenderness in the presence of adhesive capsulitis. Furthermore, we note the natural history of such acromioclavicular joint pain in relation to that of adhesive capsulitis. Over a 2-year period (2005-2007), 84 patients undergoing initial evaluation for adhesive capsulitis were prospectively examined with the use of validated outcome measures and physical examination. Acromioclavicular joint tenderness results were compared and analyzed on initial evaluation and final follow-up of at least 1 year. Forty-eight patients (57%) with adhesive capsulitis had acromioclavicular joint pain on examination. At final follow-up, as range of motion improved, a significant increase in American Shoulder and Elbow Surgeons/Penn shoulder score and decrease in number of patients with acromioclavicular pain was noted with only 6 patients with residual pain (P<.05). In the presence of adhesive capsulitis, there is not only compensatory scapulothoracic motion but also acromioclavicular motion. This often results in transient symptoms at the acromioclavicular joint, which abate as the frozen shoulder resolves and glenohumeral motion improves. This is important to recognize to avoid unnecessary invasive treatment of the acromioclavicular joint when the patient presents with adhesive capsulitis.
Collapse
Affiliation(s)
- Oke A Anakwenze
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | |
Collapse
|
33
|
Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskelet Disord 2011; 12:119. [PMID: 21619663 PMCID: PMC3127806 DOI: 10.1186/1471-2474-12-119] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 05/28/2011] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB), acromioclavicular joint (ACJ) and glenohumeral joint (GHJ). METHODS Consecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Subjects who reported less than 80% reduction in pain following either of these injections were referred for a magnetic resonance arthrogram (MRA) and GHJ diagnostic block. Differences in proportions of positive and negative imaging findings in the anaesthetic response groups were assessed using Fishers test and odds ratios were calculated a for positive anaesthetic response (PAR) to diagnostic blocks. RESULTS In the 208 subjects recruited, the rotator cuff and SAB displayed the highest prevalence of pathology on both ultrasound (50% and 31% respectively) and MRA (65% and 76% respectively). The prevalence of PAR following SAB injection was 34% and ACJ injection 14%. Of the 59% reporting a negative anaesthetic response (NAR) for both of these injections, 16% demonstrated a PAR to GHJ injection. A full thickness tear of supraspinatus on ultrasound was associated with PAR to SAB injection (OR 5.02; p < 0.05). Ultrasound evidence of a biceps tendon sheath effusion (OR 8.0; p < 0.01) and an intact rotator cuff (OR 1.3; p < 0.05) were associated with PAR to GHJ injection. No imaging findings were strongly associated with PAR to ACJ injection (p ≤ 0.05). CONCLUSIONS Rotator cuff and SAB pathology were the most common findings on ultrasound and MRA. Evidence of a full thickness supraspinatus tear was associated with symptoms arising from the subacromial region, and a biceps tendon sheath effusion and an intact rotator cuff were associated with an intra-articular GHJ pain source. When combined with clinical information, these results may help guide diagnostic decision making in primary care.
Collapse
Affiliation(s)
- Angela Cadogan
- Health & Rehabilitation Research Institute, AUT University, Northcote, Auckland, New Zealand.
| | | | | | | | | |
Collapse
|
34
|
|
35
|
Gonzalez-Lomas G, Javidan P, Lin T, Adamson GJ, Limpisvasti O, Lee TQ. Intramedullary acromioclavicular ligament reconstruction strengthens isolated coracoclavicular ligament reconstruction in acromioclavicular dislocations. Am J Sports Med 2010; 38:2113-22. [PMID: 20739579 DOI: 10.1177/0363546510371442] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Techniques for reconstruction of the dislocated acromioclavicular (AC) joint abound. Most, however, do not address the injured AC ligaments and capsule. Evidence exists supporting the horizontal stabilizing effect of these ligaments on the AC joint. A novel AC and coracoclavicular (CC) reconstruction technique with an intramedullary free-tissue graft secured by suture buttons is low-profile, technically straightforward, and reproducible. HYPOTHESIS A novel intramedullary AC reconstruction will strengthen an isolated free-tissue reconstruction of the CC ligaments. STUDY DESIGN Controlled laboratory study. METHODS Six cadaveric matched pair shoulders were tested with a custom testing system. Anterior-posterior and superior-inferior AC joint displacements (mm) were measured with AC joint compressions of 10 N, 20 N, and 30 N, and with translational loads of 10 N and 15 N. The same measurements were made after performing either a free-tissue tendon allograft CC reconstruction, or a free-tissue graft reconstruction of the CC and AC ligamentous complexes in the corresponding contralateral matched shoulder. The AC ligamentous complex was reconstructed with an intramedullary free-tissue graft secured by suture buttons. Load-to-failure testing was then performed on each construct. A paired t test was used for statistical analysis (P < .05). RESULTS Mean anterior-posterior translation of the reconstruction of the CC and AC ligamentous complexes was 50% or less than that of the CC reconstruction in all loading conditions (P < .05). Mean superior-inferior translation did not differ among the groups. Overall load-to-failure testing did not differ between groups. CONCLUSION Intramedullary AC complex reconstruction utilizing free-tissue graft for reconstruction of both the CC and AC ligaments demonstrates significantly greater initial horizontal stability than a free tissue isolated CC reconstruction and is similar to intact specimens. CLINICAL RELEVANCE This novel intramedullary AC ligament reconstruction may be considered when seeking to improve horizontal stability in an anatomical CC ligament reconstruction.
Collapse
|
36
|
Peck E, Lai JK, Pawlina W, Smith J. Accuracy of Ultrasound-Guided Versus Palpation-Guided Acromioclavicular Joint Injections: A Cadaveric Study. PM R 2010; 2:817-21. [DOI: 10.1016/j.pmrj.2010.06.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 06/08/2010] [Accepted: 06/14/2010] [Indexed: 11/29/2022]
|
37
|
Chen MR, Huang JI, Victoroff BN, Cooperman DR. Fracture of the clavicle does not affect arthritis of the ipsilateral acromioclavicular joint compared with the contralateral side: An osteological study. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2010; 92:164-8. [PMID: 20044698 DOI: 10.1302/0301-620x.92b1.22678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In an osteological collection of 3100 specimens, 70 were found with unilateral clavicular fractures which were matched with 70 randomly selected normal specimens. This formed the basis of a study of the incidence of arthritis of the acromioclavicular joint and the effect of clavicular fracture on the development of arthritis in the ipsilateral acromioclavicular joint. This was graded visually on a severity scale of 0 to 3. The incidence of moderate to severe arthritis of the acromioclavicular joint in normal specimens was 77% (100 specimens). In those with a clavicular fracture, 66 of 70 (94%) had arthritis of the acromioclavicular joint, compared to 63 of 70 (90%) on the non-injured contralateral side (p = 0.35). Clavicles with shortening of 15 mm or less had no difference in the incidence of arthritis compared to those with shortening greater than 15 mm (p = 0.25). The location of the fracture had no effect on the development of arthritis.
Collapse
Affiliation(s)
- M R Chen
- Case Western Reserve University, Cleveland, Ohio 44118, USA.
| | | | | | | |
Collapse
|
38
|
|
39
|
|
40
|
Bussières AE, Peterson C, Taylor JAM. Diagnostic imaging guideline for musculoskeletal complaints in adults-an evidence-based approach-part 2: upper extremity disorders. J Manipulative Physiol Ther 2008; 31:2-32. [PMID: 18308152 DOI: 10.1016/j.jmpt.2007.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 09/27/2007] [Accepted: 10/14/2007] [Indexed: 11/15/2022]
Abstract
PURPOSE To develop evidence-based diagnostic imaging practice guidelines to assist chiropractors and other primary care providers in decision making for the appropriate use of diagnostic imaging for upper extremity disorders. METHODS A comprehensive search of the English and French language literature was conducted using a combination of subject headings and keywords. The quality of the citations was assessed using the Quality of diagnostic accuracy studies (QUADAS), the Appraisal of Guidelines Research and Evaluation (AGREE), and the Stroke Prevention and Educational Awareness Diffusion (SPREAD) evaluation tools. The Referral Guidelines for Imaging (radiation protection 118) coordinated by the European Commission served as the initial template. The first draft was sent for an external review. A Delphi panel composed of international experts on the topic of musculoskeletal disorders in chiropractic radiology, clinical sciences, and research was invited to review and propose recommendations on the indications for diagnostic imaging. The guidelines were pilot tested and peer-reviewed by practicing chiropractors and by chiropractic and medical specialists. Recommendations were graded according to the strength of the evidence. Dissemination and implementation strategies are discussed. RESULTS Recommendations for diagnostic imaging guidelines of adult upper extremity disorders are provided, supported by over 126 primary and secondary citations. The overall quality of available literature is low, however. On average, 44 Delphi panelists completed 1 of 2 rounds, reaching over 88% agreement on all 32 recommendations. Peer review by specialists reflected high levels of agreement and perceived ease of use of guidelines and implementation feasibility. CONCLUSIONS The guidelines are intended to be used in conjunction with sound clinical judgment and experience and should be updated regularly. Future research is needed to validate their content.
Collapse
Affiliation(s)
- André E Bussières
- Chiropractic Department, Université du Québec à Trois-Rivières, Québec, Canada.
| | | | | |
Collapse
|
41
|
Acromioclavicular Joint Arthroscopy and Debridement. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2008. [DOI: 10.1097/bte.0b013e31816276cb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
42
|
Acromioclavicular Joint Disorders. Curr Sports Med Rep 2007. [DOI: 10.1097/01.csmr.0000306492.61271.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|