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Hsu C, Afifi T, Isaac Z. Shoulder pathology on advanced imaging in asymptomatic non-athlete individuals: A narrative review. PM R 2024. [PMID: 38822702 DOI: 10.1002/pmrj.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 10/04/2023] [Accepted: 01/12/2024] [Indexed: 06/03/2024]
Abstract
The prevalence of asymptomatic shoulder pathology has been shown to be high on both ultrasound and magnetic resonance imaging (MRI). The most common shoulder pathologies identified in asymptomatic, non-athlete individuals include rotator cuff pathology, acromioclavicular (AC) joint pathology, labral tears, subacromial bursitis, and calcific tendinitis. The data in the current literature suggest that asymptomatic rotator cuff tears are diagnosed on ultrasound and MRI at high rates, suggesting that rotator cuff tears may be considered an age-related, normal, degenerative change. However, there are data to suggest that the presence of an asymptomatic rotator cuff tear on imaging may predispose a patient to shoulder pain in the future, although the data remain inconclusive. AC joint arthritic changes are also common in older individuals on advanced imaging. Recent studies have reported that labral tears are common in asymptomatic shoulders, although at less frequent rates than in athletes, but more research is required on this topic. In addition, the presence of subacromial bursitis on imaging has not been found to accurately differentiate between symptomatic and asymptomatic shoulders. Finally, calcific tendinitis has been diagnosed asymptomatically, with most individuals remaining asymptomatic. Individuals who did develop pain developed severe pain, although the risk factors for developing symptomatic calcific tendinitis are unclear. In summary, given the high prevalence of shoulder pathology diagnosed on imaging, it is important to not over diagnose or complete an unnecessary workup for an asymptomatic person who is otherwise healthy.
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Affiliation(s)
- Connie Hsu
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Toqa Afifi
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Zacharia Isaac
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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2
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Vossen RJM, Puijk R, Sierevelt IN, van Noort A. Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional midterm outcomes. Clin Shoulder Elb 2024; 27:45-51. [PMID: 38268321 PMCID: PMC10938021 DOI: 10.5397/cise.2023.00073] [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: 01/20/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND It is essential to distinguish between symptomatic- and asymptomatic radiographic acromioclavicular (AC) osteoarthritis (OA) because AC-targeted physical examinations are dubious. This study aimed to determine the diagnostic value of a preoperative AC injection in discriminating between symptomatic- and asymptomatic radiographic AC OA based on patient arthroscopic distal clavicle resection (aDCR) outcomes. METHODS Forty-eight patients who underwent aDCR for AC OA were included. Their satisfaction was objectified using a 5-point Likert scale and patient willingness to repeat the surgery. The Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), and the Numerical Rating Scale (NRS) were used to assess postoperative shoulder function and pain. Patients were subdivided into groups based on their good or minimal reaction to an AC injection (good reaction: ≥7 consecutive days of pain reduction, Minimal reaction: <7 consecutive days of pain reduction). RESULTS Twenty-seven patients had a good reaction and 21 patients had a minimal reaction to the AC injection (median follow-up, 45.0 months; range, 31.0-52.8 months). No significant differences were found in level of satisfaction (P=0.234) or willingness to repeat the surgery (P=0.861). No significant differences were found in OSS (P=0.612), SSV (P=0.641), NRS at rest (P=0.684) or during activity (P=0.422). CONCLUSIONS This study found no significant differences between patients with a good reaction or a minimal reaction to an AC injection after aDCR surgery. The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome. Level of evidence: IV.
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Affiliation(s)
- Roderick Jan Maximiliaan Vossen
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
| | - Raymond Puijk
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Inger Nicoline Sierevelt
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, the Netherlands
| | - Arthur van Noort
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands
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3
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Magnusson K, Turkiewicz A, Rydén M, Englund M. Genetic Influence on Osteoarthritis Versus Other Rheumatic Diseases. Arthritis Rheumatol 2024; 76:206-215. [PMID: 37691153 DOI: 10.1002/art.42696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE We aimed to compare the genetic contribution to osteoarthritis (OA) versus other rheumatic/musculoskeletal diseases (RMDs) in the same population and to explore the role for any shared genetics between OA and other RMDs. METHODS In 59,970 Swedish twins aged 35 years or older, we estimated the heritability (the variance explained by genetic factors) of OA in peripheral joints, back and neck pain, shoulder pain (adhesive capsulitis, impingement syndrome, etc), rheumatoid arthritis, spondyloarthritis (SpA) and psoriatic arthritis, myalgia, and osteoporosis diagnosed in specialist and inpatient care. We also studied how much covariance between OA and each of the RMDs could be explained by genetics by studying phenotypic correlations in bivariate classical twin models. RESULTS Any-site OA and hip OA (50% and 64%) were among the most heritable RMDs (as compared with 23% for fibromyalgia [lowest] and 63% for SpA [highest]). The highest phenotypic correlations were between OA (any joint site) and shoulder pain in the same individual (r = 0.33, 95% confidence interval 0.31-0.35), of which 70% (95% confidence interval 52-88) could be explained by shared genetics. The phenotypic correlation between OA and back/neck pain was r = 0.25, with 25% to 75% explained by genetics. Phenotypic correlations between OA and each of the other RMDs were lower (r ~ 0.1 to r ~ 0.2), with inconclusive sources of variation. CONCLUSION OA has relatively large heritability as compared with other RMDs. The coexistence of OA and shoulder pain, as well as back pain, was common and could often be explained by genetic factors. Findings imply similar etiologies of OA and several pain conditions.
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Affiliation(s)
- Karin Magnusson
- Lund University, Lund, Sweden and Norwegian Institute of Public Health, Oslo, Norway
| | - Aleksandra Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Martin Rydén
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
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Hannah SD, Bell SN, Coghlan JA. The incidence and treatment of symptomatic acromioclavicular joint osteoarthritis following total shoulder arthroplasty. Shoulder Elbow 2023; 15:95-99. [PMID: 37692878 PMCID: PMC10492522 DOI: 10.1177/17585732221114796] [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: 08/03/2021] [Revised: 06/18/2022] [Accepted: 06/27/2022] [Indexed: 09/12/2023]
Abstract
Background Acromioclavicular joint (ACJ) Osteoarthritis (OA) is very common in the general population. Despite this, there is little mention of concomitant glenohumeral and ACJ arthropathy in the literature, and no documented incidence of symptomatic ACJ OA post total shoulder arthroplasty (TSA). We present the incidence and timescale of the problem, and the response to treatments. Methods Patients who had developed ACJ-related symptoms following a TSA were retrieved from a prospectively collected database. It was determined that these symptoms were not related to the prosthesis or other non-ACJ pathology. Results There were 230 primary anatomic total shoulder replacements carried out over a 9-year period, with 219 with adequate follow-up for analysis. Thirty-five (16%) developed a symptomatic ACJ. The majority developed symptoms within the first two years however there was one patient who developed symptoms eight years later. Twenty six percent of patients responded to a period of rest. Seventy one percent had a cortisone injection in the ACJ and in 44% of patients this was effective. Twelve (34%) patients had an arthroscopic excision of distal clavicle with good resolution of the symptoms. Discussion ACJ symptoms following a total shoulder replacement appears more common than thought and can be treated successfully.
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Affiliation(s)
- Stephen D Hannah
- Melbourne Shoulder and Elbow Centre, Brighton, Victoria, Australia
| | - Simon N Bell
- Melbourne Shoulder and Elbow Centre, Brighton, Victoria, Australia
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5
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Murphy RJ, Bintcliffe F. Ask the expert: assessment of shoulder pain in primary care. BMJ 2023; 382:1255. [PMID: 37419617 DOI: 10.1136/bmj.p1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
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Rossano A, Manohar N, Veenendaal WJ, van den Bekerom MP, Ring D, Fatehi A. Prevalence of acromioclavicular joint osteoarthritis in people not seeking care: A systematic review. J Orthop 2022; 32:85-91. [DOI: 10.1016/j.jor.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022] Open
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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.
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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.
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Agarwal A, Vani K, Batta A, Verma K, Chumber S. Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference.
Results
Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings.
Conclusion
Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.
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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.
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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
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10
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No differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2194-2201. [PMID: 33386878 DOI: 10.1007/s00167-020-06377-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To conduct a scoping review to clarify the management of acromioclavicular joint osteoarthritis, as well as to identify any existing gaps in the current knowledge. METHODS Studies were identified by electronic databases (Ovid, Pubmed) from their inception up to April 2nd, 2020. All studies reporting functional outcomes after conservative or surgical treatment of acromioclavicular joint osteoarthritis, either primary or secondary to trauma or distal clavicle osteolysis, were included. Following data were extracted: authors, year of publication, study design (prospective or retrospective), LOE, number of shoulders treated conservatively or surgically, patients' age, OA classification, type of conservative treatment, surgical approach, surgical technique, functional outcomes, complications, revisions, and length of follow-up. Descriptive statistics was used. Quality appraisal was assessed through the Cochrane risk of bias tool for LOE I/II studies, while the MINORS checklist was used for LOE III/IV studies. RESULTS Nineteen studies were included for a total of 861 shoulders. Mean age of participants was 48.5 ± 7.4 years. Mean follow-up was 43.8 ± 29.9 months. Four studies reported functional results after conservative treatment, whereas 15 studies were focused on surgical management. No studies directly compared conservative and surgical treatment. Seven studies reported a surgical approach after failure of previous conservative treatment. All studies reported functional improvement and pain relief. Complication rate was low. Overall methodological quality of included studies was very low. CONCLUSION Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. However, available data did not allow to establish the superiority of one technique over another. LEVEL OF EVIDENCE Level IV.
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Compagnoni R, Stoppani C, Menon A, Cosmelli N, Fossati C, Ranuccio F, Randelli P. Management of Acromioclavicular Osteoarthritis in Rotator Cuff Tears: A Scoping Review. JOINTS 2021; 7:199-204. [PMID: 34235385 PMCID: PMC8253604 DOI: 10.1055/s-0041-1730378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 04/18/2021] [Indexed: 11/21/2022]
Abstract
Purpose
The treatment of acromioclavicular joint (ACJ) osteoarthritis during shoulder arthroscopy is a discussed topic. The aim of this scoping review is to report the current recommendations regarding the management of this disorder in patients undergoing surgery for rotator cuff tears.
Methods
A scoping review was performed in Pubmed\Medline and Embase in March 2017, restricted to English language literature. The following keywords were used: (“rotator cuff tear” OR ” rotator cuff” OR “rotator cuff repair”) AND (“acromioclavicular joint arthritis” OR “ac joint arthritis” OR “ac joint” OR “acromioclavicular joint”). Inclusion criteria were randomized controlled trials, prospective cohort studies, retrospective trials, and therapeutic case series. Exclusion criteria were reviews, meta-analyses, and expert opinions.
Results
Two retrospective studies and three randomized controlled trials were identified. Clinical studies reported results of 443 shoulders, with an average age of 60.48 years and a mean follow-up of 31.7 months. Many differences were found regarding the design of the studies, patient's selection, surgical procedures, and instrumental and clinical evaluations. No statistically significant differences were found in clinical outcome scores between patients that underwent rotator cuff repair in association with distal clavicular resection and patients with isolated rotator cuff repair.
Conclusion
Results of this scoping review underline a lack of evidence-based recommendations about the management of ACJ osteoarthritis in association with arthroscopic rotator cuff repair. Surgical procedures such as distal clavicle resection (DCR) should be performed carefully in this cohort of patients. More prospective randomized studies are needed to reach a consensus about the correct surgical approach to DCR in patients with signs of ACJ osteoarthritis and rotator cuff tears.
Level of Evidence
Level III.
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Affiliation(s)
- Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Carlo Stoppani
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Alessandra Menon
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Nicolò Cosmelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Chiara Fossati
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | | | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, 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
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Métais P, Gallinet D, Labattut L, Godenèche A, Barth J, Collin P, Bonnevialle N, Garret J, Clavert P. Increased T2 signal intensity in the distal clavicle does not justify acromioclavicular resection arthroplasty during rotator cuff repair. Orthop Traumatol Surg Res 2020; 106:S217-S222. [PMID: 32943381 DOI: 10.1016/j.otsr.2020.08.010] [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: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Acromioclavicular (AC) arthropathy can contribute to shoulder pain; it can be treated surgically by distal clavicle resection (DCR). The aim of this study was to determine whether increased T2 signal intensity in the clavicle on MRI is an argument in favour of AC resection arthroplasty by DCR during rotator cuff repair. METHODS The MRI images from 107 shoulders in 107 patients were analysed. We looked for statistical relationships and correlations between shoulders with T2 hyperintensity (HI+) and those without (HI-) before surgery and then in shoulders with T2 hyperintensity (HI+) that underwent AC resection arthroplasty (AC+) and those who did not (AC-). RESULTS On MRI, T2 hyperintensity in the AC joint was correlated with sex (more often found in men) and radiological signs of AC arthropathy. There was no statistical correlation before surgery, particularly with AC pain, or after surgery, with outcomes in shoulders undergoing DCR. CONCLUSION When repairing rotator cuff tears, the presence of T2 hyperintensity on MRI in the distal clavicle is not a predictor of better clinical outcomes after AC resection arthroplasty is done. The AC pain may be related to the rotator cuff tear instead. LEVEL OF EVIDENCE II, prospective randomised study.
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Affiliation(s)
- Pierre Métais
- Hôpital privé La Châtaigneraie, ELSAN, 63110 Beaumont, France.
| | - David Gallinet
- Centre épaule-main, 16, rue Madeleine Brès, 25000 Besançon, France
| | - Ludovic Labattut
- Service de chirurgie orthopédique, CHU de Dijon, 14, rue PaulGaffarel, 21000 Dijon, France
| | - Arnaud Godenèche
- Ramsay Santé, hôpital privé Jean Mermoz, centre orthopédique Santy, 69008 Lyon, France
| | - Johannes Barth
- Centre ostéo-articulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France
| | | | - Nicolas Bonnevialle
- Service de chirurgie orthopédique, CHU de Toulouse, place Baylac, 31059 Toulouse, France
| | - Jérôme Garret
- Clinique du Parc, 155, boulevard Stalingrad, 69006 Lyon, France
| | - Philippe Clavert
- Service de chirurgie de l'épaule et du coude, Hautepierre 2, CHRU de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Guillotin C, Koch G, Metais P, Gallinet D, Godeneche A, Labattut L, Collin P, Bonnevialle N, Barth J, Garret J, Clavert P. Is conventional radiography still relevant for evaluating the acromioclavicular joint? Orthop Traumatol Surg Res 2020; 106:S213-S216. [PMID: 32917580 DOI: 10.1016/j.otsr.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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 Conventional radiography using an anteroposterior view of the acromioclavicular (AC) joint is the gold standard for evaluating arthritic degeneration. OBJECTIVE Based on a standardised AP view of the AC joint, the objective of this study was to determine whether this radiographic view is reliable and reproducible for evaluating the AC joint space. METHODS A cadaver scapula-clavicle unit, free of osteoarthritis, was used for this study. The scapula was positioned in a stand; and then with fluoroscopy guidance, a strict AP view of the AC joint was taken. Starting from this "0" position, a radiograph was taken by varying the angle by 5°, 10°, and 15° in every plane in space. All radiographs were taken during a single session to ensure the distance between the X-ray tube and scapula did not change. The images were then exported to OsiriX for processing; the superior and inferior AC distance and the joint area were measured. RESULTS There was no reproducibility in the AC joint measurements as a function of the incidence angle relative to a strict AP view. CONCLUSION Conventional radiography using an AP view of the AC joint cannot be used to do a fine analysis of arthritic degeneration of this joint. It is likely that only CT scan or MRI is sufficient to analyse osteoarthritis in this joint. LEVEL OF EVIDENCE IV, basic science study.
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Affiliation(s)
- Cyril Guillotin
- Service de chirurgie de l'épaule et du coude, Hautepierre 2, CHRU de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France
| | - Guillaume Koch
- Institut d'anatomie normale, faculté de médecine, 4, rue Kirschlger, 67085 Strasbourg, France
| | - Pierre Metais
- Elsan hôpital privé la Châtaigneraie, 63110 Beaumont, France
| | - David Gallinet
- Centre épaule-main de Besançon, 16, rue Madeleine-Brès, 25000 Besançon, France
| | - Arnaud Godeneche
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, 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
| | - Nicolas Bonnevialle
- Hôpital Pierre-Paul-Riquet, CHRU de Toulouse, place Baylac, 31059 Toulouse cedex 09, France
| | - Johannes Barth
- Centre ostéoarticulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France
| | - Jérôme Garret
- Clinique du Parc, 155, boulevard Stalingrad, 69006 Lyon, France
| | - Philippe Clavert
- Service de chirurgie de l'épaule et du coude, Hautepierre 2, CHRU de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France; Institut d'anatomie normale, faculté de médecine, 4, rue Kirschlger, 67085 Strasbourg, France.
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14
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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.
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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
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15
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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.
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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.)
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16
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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.
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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.
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17
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Farrell G, Watson L, Devan H. Current evidence for nonpharmacological interventions and criteria for surgical management of persistent acromioclavicular joint osteoarthritis: A systematic review. Shoulder Elbow 2019; 11:395-410. [PMID: 32269599 PMCID: PMC7094063 DOI: 10.1177/1758573219840673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/28/2019] [Accepted: 03/06/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The primary aim of this systematic review was to investigate the individual/combined effectiveness of nonpharmacological interventions in individuals with persistent acromioclavicular joint osteoarthritis. The secondary aims were to investigate the comparative effectiveness of nonpharmacological versus surgical interventions, and to identify the criteria used for defining failure of conservative interventions in individuals who require surgery for persistent acromioclavicular joint osteoarthritis. METHOD Major electronic databases were searched from inception until October 2018. Studies involving adults aged 16 years and older, diagnosed clinically and radiologically with isolated acromioclavicular joint osteoarthritis for at least three months or more were included. Studies must explicitly state the type and duration of conservative interventions. Methodological risk of bias was assessed using the Modified Downs and Black checklist. RESULTS Ten surgical intervention studies were included for final synthesis. No studies investigated the effectiveness of nonpharmacological interventions or compared them with surgical interventions. Common nonpharmacological interventions trialed from the 10 included studies were activity modification (n = 8) and physiotherapy (n = 4). Four to six months was the most often reported timeframe defining failure of conservative management (range 3-12 months). CONCLUSIONS Currently, there is no evidence to guide clinicians about the individual or combined effectiveness of nonpharmacological interventions for individuals with persistent acromioclavicular joint osteoarthritis.
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Affiliation(s)
- Gerard Farrell
- School of Physiotherapy, Dunedin, New
Zealand,Gerard Farrell, Gippsland Physiotherapy
Group, 150 Commercial Road, Morwell, Victoria, Australia.
| | - Lyn Watson
- Melbourne Shoulder Group, Victoria,
Australia
| | - Hemakumar Devan
- School of Physiotherapy, Centre for
Health, Activity, and Rehabilitation Research, University of Otago, Wellington, New
Zealand
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18
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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.
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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
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19
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McLean M, Hoban K, Gupta R, Gibson A, Brooksbank AJ, Fazzi UG, Arthur A, Martin D, Jenkins PJ, Millar NL. The epidemiology of acromioclavicular joint excision. J Orthop Surg (Hong Kong) 2018; 27:2309499018816521. [PMID: 30798777 PMCID: PMC6391558 DOI: 10.1177/2309499018816521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With the development of arthroscopic procedures such as subacromial decompression (ASAD) and rotator cuff repair (RCR), it is hypothesized that there may have been a similar rise in the performance of acromioclavicular joint excision (ACJE). The purpose of this study was to investigate the epidemiology of ACJE to examine incidence, surgical technique, age, gender of patients and associated procedures in an urban population. METHODS A prospectively collected surgical database was retrospectively examined to identify patients undergoing ACJE. Associated procedures such as ASAD or RCR were determined from these records. The demographic details (age and gender) were also recorded. RESULTS A total of 411 ACJEs were performed over the study period (n = 216 males, n = 195 female). The overall incidence increased from 9.3 per 100,000 in 2009, to a peak of 19.6 per 1,00,000 in 2013. In 349 patients, ACJE was undertaken as part of an arthroscopic procedure, of which 332 were ASAD+ACJE alone. The prevalence of arthroscopic ACJE in ASADs was 23.7% (349/1400). ACJE was performed as an open procedure in 62 (15%) cases. Those undergoing open ACJE were younger than those undergoing an arthroscopic procedure (mean difference 6.2 years, 95% CI 3.2-9.2, p < 0.001). CONCLUSIONS We demonstrate an increasing incidence of ACJE in the general population. The groups of patients most likely to undergo ACJE are women aged between 45 and 54 years old, men aged 55-64 years and the most socioeconomically deprived. The higher incidence of ACJE in the most deprived socioeconomic quintile may have public health implications. Level of Evidence: II; retrospective design: prognosis study.
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Affiliation(s)
- Michael McLean
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Katie Hoban
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Rohit Gupta
- Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Anthony Gibson
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Umberto G. Fazzi
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Angus Arthur
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - David Martin
- Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Paul J. Jenkins
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,Department of Orthopaedic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Neal L. Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,Department of Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK,Neal L. Millar, Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow G12 8TA, UK.
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20
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Does Distal Clavicle Resection Decrease Pain or Improve Shoulder Function in Patients With Acromioclavicular Joint Arthritis and Rotator Cuff Tears? A Meta-analysis. Clin Orthop Relat Res 2018; 476:2402-2414. [PMID: 30334833 PMCID: PMC6259902 DOI: 10.1097/corr.0000000000000424] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acromioclavicular joint arthritis is a common, painful, and often missed diagnosis, and it often accompanies other shoulder conditions such as rotator cuff disease. Whether distal clavicle resection is important to perform in patients undergoing surgery for rotator cuff tears and concomitant acromioclavicular joint arthritis is controversial. QUESTIONS/PURPOSES The purpose of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of distal clavicle resection on (1) outcome scores; (2) shoulder ROM, joint pain or tenderness, and joint instability; and (3) risk of reoperation among patients treated surgically for rotator cuff tears who had concomitant acromioclavicular joint arthritis. METHODS We systematically searched the PubMed, EMBASE, and Cochrane databases to find RCTs that met our eligibility criteria, which, in summary, (1) compared rotator cuff repair plus distal clavicle resection with isolated rotator cuff repair for patients who sustained a full- or partial-thickness rotator cuff tear and concomitant acromioclavicular joint arthritis; and (2) the followup period was at least 2 years. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis. Statistical heterogeneity among studies was quantitatively evaluated with the I index. No heterogeneity was detected (I = 0%; p = 0.75) in terms of acromioclavicular joint pain or tenderness, Constant score, forward flexion, external rotation, and risk of reoperation, so fixed-effect models were used in these endpoints. Heterogeneity was moderate for the American Shoulder and Elbow Surgeons (ASES) score (I = 53%; p = 0.12) and low for the visual analog scale (VAS) score (I = 35%; p = 0.22), so random-effect models were used in these endpoints. Subgroup analysis was stratified by the symptom of acromioclavicular joint arthritis. Three RCTs with 208 patients were included. We evaluated the risk of bias using the Cochrane risk-of-bias tool; in aggregate, the three RCTs included showed low to intermediate risk, although not all parameters of the Cochrane tool could be assessed for all studies. RESULTS There was no difference between the distal clavicle resection plus rotator cuff repair group and the isolated rotator cuff repair group in ASES score (mean difference =1.41; 95% confidence interval [CI], -3.37 to 6.18; p = 0.56) nor in terms of the VAS score and Constant score. Likewise, we found no difference in ROM of the shoulder (forward flexion, internal rotation, and external rotation) or acromioclavicular joint pain or tenderness between the groups (pooled results of acromioclavicular joint pain or tenderness: risk ratio [RR], 1.59; 95% CI, 0.67-3.78; p = 0.30). Acromioclavicular joint instability was only detected in the rotator cuff repair plus distal clavicle resection group. Finally, we found no difference in the proportion of patients undergoing repeat surgery between the study groups (pooled results of risk of reoperation for the rotator cuff repair plus distal clavicle resection and isolated rotator cuff repair: one of 52 versus two of 78; RR, 0.86; 95% CI, 0.11-6.48; p = 0.88). CONCLUSIONS Distal clavicle resection in patients with rotator cuff tears did not result in better clinical outcome scores or shoulder ROM and was not associated with a lower risk of reoperation. Distal clavicle resection might cause acromioclavicular joint instability in patients with rotator cuff tears and concomitant asymptomatic acromioclavicular joint arthritis. Arthroscopic distal clavicle resection is not recommended in patients with rotator cuff tears and concomitant acromioclavicular joint arthritis. Additional well-designed RCTs with more participants, long-term followup, and data on patient-reported outcomes are needed. LEVEL OF EVIDENCE Level I, therapeutic study.
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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.
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Affiliation(s)
- Bijayendra Singh
- Bijayendra Singh, Department of Orthopaedics, Medway Maritime Hospital, Windmill Road, Gillingham ME7 5NY, UK.
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22
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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.
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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
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Amirtharaj MJ, Wang D, McGraw MH, Camp CL, Degen RA, Dines DM, Dines JS. Trends in the Surgical Management of Acromioclavicular Joint Arthritis Among Board-Eligible US Orthopaedic Surgeons. Arthroscopy 2018; 34:1799-1805. [PMID: 29477607 DOI: 10.1016/j.arthro.2018.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) Define the epidemiologic trend of distal clavicle excision (DCE) for acromioclavicular (AC) joint arthritis among board-eligible orthopaedic surgeons in the United States, (2) describe the rates and types of reported complications of open and arthroscopic DCE, and (3) evaluate the effect of fellowship training on preferred technique and reported complication rates. METHODS The American Board of Orthopaedic Surgery (ABOS) database was used to identify DCE cases submitted by ABOS Part II Board Certification examination candidates. Inclusion criteria were predetermined using a combination of ICD-9 and CPT codes. Cases were dichotomized into 2 groups: open or arthroscopic DCE. The 2 groups were then analyzed to determine trends in annual incidence, complication rates, and surgeon fellowship training. RESULTS From April 2004 to September 2013, there were 3,229 open and 12,782 arthroscopic DCE procedures performed and submitted by ABOS Part II Board Eligible candidates. Overall, the annual incidence of open DCE decreased (78-37 cases per 10,000 submitted cases, P = .023). Although the annual number of arthroscopic DCE remained steady (1160-1125, P = .622), the percentage of DCE cases performed arthroscopically increased (65%-79%, P = .033). Surgeons without fellowship training were most likely to perform a DCE via an open approach (31%) whereas surgeons with sports medicine training were more likely to perform DCE arthroscopically compared with other fellowship groups (88%, P < .001). Open DCE was associated with a higher surgical complication rate overall when compared with arthroscopic DCE (9.4% vs 7.6%, respectively; P < .001). When compared with other fellowship-trained surgeons, sports medicine surgeons maintained a lower reported surgical complication rate whether performing open or arthroscopic DCE (5.5%, P = .027). CONCLUSIONS In recent years, open management of AC joint arthritis has declined among newly trained, board-eligible orthopaedic surgeons, possibly because of an increased complication rate associated with open treatment. Fellowship training was significantly associated with the type of treatment (open vs arthroscopic) rendered and complication rates. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Mark J Amirtharaj
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Dean Wang
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Michael H McGraw
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Ryan A Degen
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - David M Dines
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Joshua S Dines
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Krill MK, Rosas S, Kwon K, Dakkak A, Nwachukwu BU, McCormick F. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review. PHYSICIAN SPORTSMED 2018; 46:98-104. [PMID: 29210329 PMCID: PMC6396285 DOI: 10.1080/00913847.2018.1413920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology. METHODS A systematic review of the Medline, Ovid and Cochrane Review databases was performed to identify level one and two diagnostic studies evaluating clinical tests for AC joint pathology. Individual test characteristics were combined in series and in parallel to improve sensitivities and specificities. A secondary analysis utilized subjective pre-test probabilities to create a clinical decision tree algorithm with post-test probabilities. RESULTS The optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O'Brien's Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins-Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O'Brien's Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35). CONCLUSION No combination of special tests performed in series or in parallel creates more than a small impact on post-test probabilities to screen or confirm AC joint pathology. Paxinos sign and O'Brien's Test is the only special test combination that has a small and sometimes important impact when used both in series and in parallel. Physical examination testing is not beneficial for diagnosis of AC joint pathology when pretest probability is unequivocal. In these instances, it is of benefit to proceed with procedural tests to evaluate AC joint pathology. Ultrasound-guided corticosteroid injections are diagnostic and therapeutic. An ultrasound-guided AC joint corticosteroid injection may be an appropriate new standard for treatment and surgical decision-making. LEVEL OF EVIDENCE II - Systematic Review.
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Affiliation(s)
- Michael K Krill
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
- b Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Samuel Rosas
- c Baptist Health, Department of Orthopedic Surgery , Wake Forest University , Winston-Salem , NC , USA
| | - KiHyun Kwon
- d Florida International University Herbert Wertheim College of Medicine , Miami , FL , USA
| | - Andrew Dakkak
- a Florida Atlantic University Charles E. Schmidt College of Medicine , Boca Raton , FL , USA
| | - Benedict U Nwachukwu
- e Department of Orthopedic Surgery , Hospital for Special Surgery , New York , NY , USA
| | - Frank McCormick
- f Department of Orthopedics , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
- g Department of Sports Medicine , Harvard Medical School, Beth Israel Deaconess Medical Center , Boston , MA , USA
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Kim K, Kim HG, Song D, Yoon JY, Chung ME. Ultrasound Dimensions of the Rotator Cuff and Other Associated Structures in Korean Healthy Adults. J Korean Med Sci 2016; 31:1472-8. [PMID: 27510393 PMCID: PMC4974191 DOI: 10.3346/jkms.2016.31.9.1472] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 05/29/2016] [Indexed: 01/28/2023] Open
Abstract
In evaluating patients complaining of shoulder pain, ultrasonography is an emerging imaging tool due to convenience, low cost, high sensitivity and specificity. However, normative values of ultrasound dimensions of the shoulder to be compared with pathologic findings in Korean adults are not provided yet. We evaluated the ultrasound dimensions of the rotator cuff, long head of biceps tendon, deltoid muscle and acromioclavicular joint in Korean healthy adults. Shoulder ultrasonography was performed on 200 shoulders from 100 healthy adults. The dimensions of the thickness of rotator cuff (supraspinatus, infraspinatus, subscapularis tendon), deltoid muscle, long head of biceps tendon, subacromial subdeltoid bursa, and acromioclavicular joint interval were measured in a standardized manner. Differences in measurements among sex, age, and dominant arms were compared. The thickness of rotator cuff tendons (supraspinatus, infraspinatus, subscapularis) and deltoid muscle were significantly different between men and women. The thickness of subacromial subdeltoid bursa was significantly different between men and women for non-dominant side. In rotator cuff tendon measurements, the differences between dominant and non-dominant shoulders were not significant, which means the asymptomatic contralateral shoulder can be used to estimate the normal reference values. When stratified by age divided by 10 years, the measurements of supraspinatus, subscapularis and deltoid thickness showed tendency of increase with the age. The acromioclavicular joint interval, on the other hand, revealed decreasing tendency. This report suggests normative values of ultrasound dimensions of healthy Korean population with varying age, and can be useful as reference values in evaluating shoulder pathology, especially in rotator cuff tendon pathology.
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Affiliation(s)
- Kyeongwon Kim
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Geum Kim
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Daeheon Song
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Yoon Yoon
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung Eun Chung
- Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Cadogan A, Mohammed KD. Shoulder pain in primary care: frozen shoulder. J Prim Health Care 2016; 8:44-51. [PMID: 27477374 DOI: 10.1071/hc15018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.
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Affiliation(s)
| | - Khalid D Mohammed
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Dunedin, New Zealand
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Heterogeneous MR arthrography findings in patients with subacromial impingement syndrome – Diagnostic subgroups? J Electromyogr Kinesiol 2016; 29:64-73. [DOI: 10.1016/j.jelekin.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/28/2015] [Accepted: 06/16/2015] [Indexed: 10/23/2022] Open
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Micheroli R, Kyburz D, Ciurea A, Dubs B, Toniolo M, Bisig SP, Tamborrini G. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder. J Ultrason 2015; 15:29-44. [PMID: 26674725 PMCID: PMC4579705 DOI: 10.15557/jou.2015.0003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/19/2014] [Accepted: 12/05/2014] [Indexed: 11/22/2022] Open
Abstract
Objective High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the findings of clinical examination and high resolution ultrasonography in patients presenting with painful shoulder. Methods Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder examinations were blinded to the results of the high resolution ultrasonography and vice versa. Results In order to detect pathology of the m. supraspinatus tendon, the Hawkins and Kennedy impingement test showed the highest sensitivity (0.86) whereas the Jobe supraspinatus test showed the highest specificity (0.55). To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specificity (0.72). The infraspinatus test showed a high sensitivity (0.90) and specificity (0.74). All AC tests (painful arc IIa, AC joint tendernessb, cross body adduction stress testc) showed high specificities (a0.96, b0.99, c0.96). Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47) and the Yergason test the highest specificity (0.88). Conclusion Knowledge of sensitivity and specificity of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis.
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Affiliation(s)
| | - Diego Kyburz
- Department of Rheumatology, University Hospital of Basel, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital of Zurich, Switzerland
| | - Beat Dubs
- Sonography Institute Glattpark, Zurich, Switzerland
| | - Martin Toniolo
- Department of Rheumatology, University Hospital of Zurich, Switzerland
| | | | - Giorgio Tamborrini
- Ultrasound Center, Department of Rheumatology, Bethesda Hospital Basel, Switzerland
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Roedl JB, Nevalainen M, Gonzalez FM, Dodson CC, Morrison WB, Zoga AC. Frequency, imaging findings, risk factors, and long-term sequelae of distal clavicular osteolysis in young patients. Skeletal Radiol 2015; 44:659-66. [PMID: 25560997 DOI: 10.1007/s00256-014-2092-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/13/2014] [Accepted: 12/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Atraumatic distal clavicular osteolysis (DCO) has been described in adult male weightlifters. Our purpose was to investigate the frequency, magnetic resonance imaging (MRI) characteristics, risk factors, and long-term sequelae of DCO in young patients. MATERIALS AND METHODS Individuals with atraumatic DCO were identified in a retrospective review of 1,432 consecutive MRI shoulder reports in patients between 13 and 19 years of age. MRI findings of DCO, association with athletic activity, short-term clinical outcome after 3-6 months, and long-term clinical and MRI outcome after 2 years were analyzed. A pre-MRI questionnaire assessed the patients' athletic history including overhead activity and weightlifting. RESULTS At a mean age of 15.9 years, 6.5 % (93/1432) of patients had atraumatic DCO, and 24 % were females. The combination of an overhead sport (basketball, volleyball, tennis, swimming) and supplemental weight training was a risk factor for DCO (odds ratio = 38, p = 0.01). Ninety-three percent of patients responded to conservative therapy. On follow-up imaging, 71 % of DCO patients had acromioclavicular (AC) joint osteoarthritis (vs. 35 % in controls, p = 0.006); 79 % had flattening of the distal clavicle and interval widening of the AC joint to a mean of 5.0 mm (compared to 2.4 mm in controls, p < 0.001). Severity of DCO edema was associated with pain (p < 0.02) at initial presentation and with AC joint osteoarthritis (p = 0.004) on follow-up. CONCLUSION In athletic teenagers, the combination of weightlifting and overhead activity is a risk factor for atraumatic DCO, and females are affected in 24 %. Long-term sequelae include widening of the AC joint and AC joint osteoarthritis.
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Affiliation(s)
- Johannes B Roedl
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA,
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Outcome of distal clavicle resection in patients with acromioclavicular joint osteoarthritis and full-thickness rotator cuff tear. Knee Surg Sports Traumatol Arthrosc 2015; 23:585-90. [PMID: 24923688 DOI: 10.1007/s00167-014-3114-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to examine the impact of distal clavicle resection (DCR) on subjective and objective outcome measures in patients with acromioclavicular (AC) joint osteoarthritis (OA) and rotator cuff tear. METHODS Prospectively collected data of consecutive patients with arthroscopic evidence of OA of the ACJ with complete data at 2 years were used for the data analysis. Patients with moderate-to-severe OA of the AC joint underwent a DCR in conjunction with rotator cuff repair, while patients with mild OA of the ACJ underwent surgery related to concomitant rotator cuff tear without a DCR. RESULTS Data of 184 (72 females, 112 males, mean age: 62) patients with rotator cuff tear and varying degrees of OA of the AC joint were used for the analysis. Of 184 patients, 144 (78 %) had a resection of distal clavicle (resection group) and 40 (22 %) did not have a resection (no-resection group). Both groups showed a statistically significant (p < 0.0001) improvement in the American Shoulder and Elbow Surgeons (ASES) scores, Constant Murley score, and strength. Multivariable analysis showed that lower pre-operative ASES scores (higher disability), having a larger tear, an active compensation claim, and not having a DCR, had a negative impact on post-operative ASES scores. CONCLUSION When untreated surgically, even mild arthroscopic findings of AC joint OA may lead to a poorer outcome after rotator cuff repair. Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed. LEVEL OF EVIDENCE Retrospective outcome study, Level II.
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Alluri RK, Kupperman AI, Montgomery SR, Wang JC, Hame SL. Demographic analysis of open and arthroscopic distal clavicle excision in a private insurance database. Arthroscopy 2014; 30:1068-74. [PMID: 24863403 DOI: 10.1016/j.arthro.2014.04.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/13/2014] [Accepted: 04/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate and quantify the demographic characteristics of patients undergoing open and arthroscopic distal clavicle excision (DCE) in the United States while also describing changes in practice patterns over time. METHODS Patients who underwent DCE from 2004 to 2009 were identified by Current Procedural Terminology (CPT) codes in a national database of orthopaedic insurance records. The year of procedure, age, sex, geographic region, and concomitant rotator cuff repair or subacromial decompression (SAD) were recorded for each patient. Results were reported as the incidence of procedures identified per 10,000 patients searched in the database. RESULTS Between 2004 and 2009, 73,231 DCEs were performed; 74% were arthroscopic and 26% were open. The incidence of arthroscopic DCE increased from 37.8 in 2004 to 58.5 in 2009 (P < .001), whereas the incidence of open DCE decreased from 21.1 in 2004 to 14.1 in 2009 (P < .001). Sixty-one percent of DCEs were performed in men (P < .001). Women were more likely to undergo an arthroscopic procedure (P < .001). Arthroscopic DCE was most common in patients aged 50 to 59 years (P < .001). Open DCE was most common in patients aged 60 to 69 years (P < .001). Open rotator cuff repair and SAD were concomitantly performed in 38% and 23% of open DCEs, respectively. Arthroscopic rotator cuff repair and SAD were concomitantly performed in 33% and 95% arthroscopic DCEs, respectively. CONCLUSIONS This analysis of DCE using a private insurance database shows that arthroscopic DCEs progressively increased, whereas open DCEs concomitantly decreased between 2004 and 2009. The majority of DCEs were performed in men between the ages of 50 and 59 years. Both arthroscopic and open DCEs are frequently performed in conjunction with rotator cuff repair or SAD. LEVEL OF EVIDENCE Level IV, cross-sectional study.
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Affiliation(s)
- Ram K Alluri
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Asher I Kupperman
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Scott R Montgomery
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Sharon L Hame
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A..
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Roren A, Lefevre-Colau MM, Poiraudeau S, Fayad F, Pasqui V, Roby-Brami A. A new description of scapulothoracic motion during arm movements in healthy subjects. ACTA ACUST UNITED AC 2014; 20:46-55. [PMID: 25034959 DOI: 10.1016/j.math.2014.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 12/14/2022]
Abstract
The participation of scapula motion in arm movement is clinically well known and recent three dimensional (3D) analyses using kinematic techniques have confirmed its importance. Scapular motion relative to the thorax has a theoretical maximum of 6 degrees of freedom (DoF), resulting from rotations at both clavicular joints (3 rotational DoF each). However, most recent kinematic studies have only analysed the 3D rotations of the scapula relative to the thorax. In the present study, the 3D translations of the barycentre of the scapula were considered in order to complete the description of movement at the shoulder complex. Eight healthy subjects performed arm elevation in the sagittal and frontal planes, simulated activities of daily living (hair combing and back washing) and maximum voluntary scapula movement (forward and backward rolling). Measurements were recorded using a 6 DoF electromagnetic device and the acromial method of analysis was used. The results showed that 3D scapular rotations and translation of its barycentre were functionally consistent for all tasks. A principal component analysis (PCA) yielded three factors, explaining 97.6% of the variance. The first two factors (protraction and shrug, according to clinical descriptions) combined rotations and translations, consistent with the hypothesis that the scapula rolls over the curved thoracic surface. The third factor related to lateral-medial rotation, thus representing rotation in the plane tangential to the thorax. The PCA suggested that scapular motion can be described using these 3 DoF. This should be studied in a larger group of individuals, including patients with pathological conditions.
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Affiliation(s)
- Alexandra Roren
- Department of Physical Medicine and Rehabilitation, Cochin Hospital (AP-HP), Paris Descartes University, Paris, France
| | - Marie-Martine Lefevre-Colau
- Department of Physical Medicine and Rehabilitation, Cochin Hospital (AP-HP), Paris Descartes University, Paris, France
| | - Serge Poiraudeau
- Department of Physical Medicine and Rehabilitation, Cochin Hospital (AP-HP), Paris Descartes University, Paris, France; Institut Fédératif de Recherche sur le Handicap, INSERM, Paris, France
| | - Fouad Fayad
- Department of Rheumatology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
| | - Viviane Pasqui
- ISIR (Institute of Intelligent Systems and Robotics), CNRS UMR 7222, Paris, France; Sorbonne Universités, UPMC University Paris 06, Paris, France; ISIR-AGATHE, INSERM U 1150, Paris, France
| | - Agnès Roby-Brami
- Department of Physical Medicine and Rehabilitation, Cochin Hospital (AP-HP), Paris Descartes University, Paris, France; ISIR (Institute of Intelligent Systems and Robotics), CNRS UMR 7222, Paris, France; Sorbonne Universités, UPMC University Paris 06, Paris, France; ISIR-AGATHE, INSERM U 1150, Paris, France; Institut Fédératif de Recherche sur le Handicap, INSERM, Paris, France.
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Saccomanni B. A new test for acromio-clavicolar pathology. J Clin Orthop Trauma 2013; 4:75-9. [PMID: 26403628 PMCID: PMC3880508 DOI: 10.1016/j.jcot.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 03/01/2013] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND A prospective study was established to assess the sensitivity and specificity of the new Saccomanni (SAC) test for isolated AC pathology, and compare with 4 commonly used clinical tests. MATERIALS AND METHODS The Saccomanni (Sac) test is essentially the cross-adduction test, with the addition of attempted elevation against resistance. In a positive test, this results in some pain and the inability of the patient to maintain the arm in the adducted and elevated position against resistance. Fifty-eight patients with isolated AC joint symptoms were assessed in random order with the Saccomanni test and 4 other tests. A corticosteroid and local anaesthetic injection was administered into the AC joint space. The Saccomanni test and 4 other tests were then repeated following the injection. After the injection, a symptom free clinical examination was used as a measure of true positive tests. STUDY DESIGN Case series. RESULTS The SAC test showed a sensitivity of 98% and specificity is 91.7%. All 4 other tests were less sensitive. CONCLUSION The SAC test is a highly sensitive test in patients presenting with isolated AC related symptoms. This study is an innovation for clinical tests in the world. The primary aim of this study was to assess the diagnostic sensitivity of my newly described SAC test. From the present study, it can be concluded that the easy-to use SAC is a highly sensitive test to evaluate AC joint pathology, when compared to other standard tests. CLINICAL RELEVANCE Level III, Diagnostic Study of Nonconsecutive Patients.
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Affiliation(s)
- Bernardino Saccomanni
- Medical Doctor, Orthopaedic and Trauma Surgery, Ambulatorio di Ortopedia, via della Conciliazione, 65, 74014 Laterza (TA), Italy
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Morgenroth DC, Gellhorn AC, Suri P. Osteoarthritis in the Disabled Population: A Mechanical Perspective. PM R 2012; 4:S20-7. [DOI: 10.1016/j.pmrj.2012.01.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 01/18/2012] [Indexed: 11/30/2022]
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Kim SH, Lee YH, Shin SH, Lee YH, Baek GH. Outcome of conjoined tendon and coracoacromial ligament transfer for the treatment of chronic type V acromioclavicular joint separation. Injury 2012; 43:213-8. [PMID: 21890137 DOI: 10.1016/j.injury.2011.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/28/2011] [Accepted: 08/09/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Numerous surgical methods are used to treat acromioclavicular (AC) joint dislocations, and an anatomical reconstruction using a free tendon graft has attracted considerable attention, particularly for chronic cases. The purpose of this study was to introduce the results of lateral half conjoined tendon (LHCT) and coracoacromial ligament (CAL) transfer for chronic type V injuries. MATERIALS AND METHODS A retrospective evaluation was performed on the clinical and radiographic outcomes of the 12 patients who underwent LHCT and CAL transfer for chronic type V AC injuries and had been followed for 2 years postoperatively. All 12 patients were males with a mean age of 37.3 ± 7.7 years (range: 26-49 years) at surgery. The causes of the injury were traffic accidents (five), falls (three) and sports injuries (four). The mean time elapsed between trauma and surgery was 12.5 ± 5.4 weeks (range: 7-22 weeks). RESULTS No reduction loss was observed at the final follow-up. The postoperative coracoclavicular (CC) distance was 8.9 ± 1.6mm, which represented a significant improvement versus the preoperative status (20.3 ± 3.0mm; p < 0.001), and no significant difference was observed between the injured and uninjured contralateral sides (8.7 ± 0.8mm), postoperatively (p = 0.619). The temporary use of a Steinman pin for AC fixation did not cause any complications. On the other hand, there were eight cases of mild radiographic arthrosis at the AC joint and two cases of heterotopic ossification of the CC space, although neither affected the functional outcomes. The mean modified UCLA score was 18.5 ± 2.1 (range: 12-20), which represented an excellent result in 11 of the 12 cases. The single case with a poorer postoperative score had a pre-existing brachial plexus injury. CONCLUSIONS Despite the small study cohort, the results of LHCT and CAL transfer in chronic type V AC separation are promising. CAL transfer alone has been shown to be biomechanically insufficient for an AC reconstruction, particularly in chronic situations. The advantage of LHCT transfer is that it does not require a distant donor site or incur the costs of an allograft or implant.
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Affiliation(s)
- Sae Hoon Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Republic of Korea.
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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.
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Affiliation(s)
- Oke A Anakwenze
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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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.
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Affiliation(s)
- Angela Cadogan
- Health & Rehabilitation Research Institute, AUT University, Northcote, Auckland, New Zealand.
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Asymptomatic acromioclavicular joint arthritis in arthroscopic rotator cuff tendon repair: a prospective randomized comparison study. Arch Orthop Trauma Surg 2011; 131:363-9. [PMID: 21161250 DOI: 10.1007/s00402-010-1216-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Indexed: 02/09/2023]
Abstract
HYPOTHESIS Arthroscopic acromioclavicular joint (ACJ) resection for asymptomatic ACJ arthritis combined with rotator cuff repair leads to more satisfactory pain relief and decrease reoperation rate when inferiorly directed osteophytes present at the undersurface of ACJ. MATERIALS AND METHODS Between January 2006 and May 2008, a total of 83 patients (83 shoulders), 40 males and 43 females, who were planned to have arthroscopic repair of a tear measuring 1-3 cm in the anterior-posterior dimension with advanced ACJ arthritis with inferiorly directed osteophytes at the undersurface of the ACJ on MRI were entered into this study. Patients were randomized into two groups. Group 1 included 31 patients, who underwent arthroscopic distal clavicle resection combined with rotator cuff repair. Group 2 included 52 patients, who underwent isolated rotator cuff repair. Patients were evaluated preoperatively and postoperatively using the University of California Los Angeles (UCLA) score and the American Shoulder and Elbow Surgeons (ASES) score. Pain, tenderness on ACJ, and cross body adduction test were compared between groups. RESULTS The mean follow-up was 31.7 months (range 34-38). The UCLA scores and ASES scores were lower in group 1 at week 6 (p < .05), and week 12 (p < .05), but higher at the last follow-up at 2 years (p < .05) postoperatively. VAS score was higher in group 1 at week 6 (p < .05), and at week 12 (p < .05), but lower in group 2 at the last follow-up (p < .05). Only in group 2, two (3.8%) cases developed ACJ pain during follow-up and one (1.9%) case underwent reoperation for additional ACJ resection. CONCLUSIONS This study shows that distal clavicle resection combined with rotator cuff repair for asymptomatic ACJ arthritis with inferiorly directed osteophytes lower functional scores due to temporary pain in early postoperative periods, but better functional outcomes with satisfactory pain relief and no reoperation rate were observed after 2 years.
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van Riet RP, Bell SN. Clinical evaluation of acromioclavicular joint pathology: sensitivity of a new test. J Shoulder Elbow Surg 2011; 20:73-6. [PMID: 20850994 DOI: 10.1016/j.jse.2010.05.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Revised: 05/20/2010] [Accepted: 05/25/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND A prospective study was established to assess the sensitivity of the newly described Bell-van Riet (BvR) test for isolated AC pathology, and compare with 4 commonly used clinical tests. MATERIALS AND METHODS The BvR test is essentially the cross-adduction test, with the addition of attempted elevation against resistance. In a positive test, this results in some pain and the inability of the patient to maintain the arm in the adducted and elevated position against resistance. Fifty-eight patients with isolated AC joint symptoms were assessed in random order with the BvR test and 4 other tests. A corticosteroid and local anaesthetic injection was administered into the AC joint space. The BvR test and 4 other tests were then repeated following the injection. After the injection, a symptom free clinical examination was used as a measure of truly positive tests. RESULTS The BvR test showed a sensitivity of 98%. All 4 other tests were less sensitive. CONCLUSION The BvR test is a highly sensitive test in patients presenting with isolated AC related symptoms, and demonstrates AC joint pathology better than other accepted tests.
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Affiliation(s)
- Roger P van Riet
- Department of Orthopedic Surgery and Traumatology, Monica Hospital, Deurne (Antwerp), Belgium.
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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.
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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]
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Docimo S, Kornitsky D, Futterman B, Elkowitz DE. Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome. Curr Rev Musculoskelet Med 2010; 1:154-60. [PMID: 19468890 PMCID: PMC2684214 DOI: 10.1007/s12178-008-9024-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Osteoarthritis is one of the most common causes of pain originating from the acromioclavicular (AC) joint. An awareness of appropriate diagnostic techniques is necessary in order to localize clinical symptoms to the AC joint. Initial treatments for AC joint osteoarthritis, which include non-steroidal anti-inflammatory drugs (NSAIDS) and corticosteroids, are recommended prior to surgical interventions. Distal clavicle excision, the main surgical treatment option, can be performed by various surgical approaches, such as open procedures, direct arthroscopic, and indirect arthroscopic techniques. When choosing the best surgical option, factors such as avoidance of AC ligament damage, clavicular instability, and post-operative pain must be considered. This article examines patient selection, complications, and outcomes of surgical treatment options for AC joint osteoarthritis.
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Affiliation(s)
- Salvatore Docimo
- Anatomy and Pathology Academic Medicine Fellow, New York College of Osteopathic Medline, Old Westbury, NY USA
- Department of Pathology, New York College of Osteopathic Medicine, Old Westbury, NY USA
| | | | - Bennett Futterman
- Department of Anatomy, New York College of Osteopathic Medicine, Old Westbury, NY USA
| | - David E. Elkowitz
- Department of Pathology, New York College of Osteopathic Medicine, Old Westbury, NY USA
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Jia X, Petersen SA, Khosravi AH, Almareddi V, Pannirselvam V, McFarland EG. Examination of the shoulder: the past, the present, and the future. J Bone Joint Surg Am 2009; 91 Suppl 6:10-8. [PMID: 19884407 DOI: 10.2106/jbjs.i.00534] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Xiaofeng Jia
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA
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Pennington RGC, Bottomley NJ, Neen D, Brownlow HC. Radiological features of osteoarthritis of the acromiclavicular joint and its association with clinical symptoms. J Orthop Surg (Hong Kong) 2008; 16:300-2. [PMID: 19126894 DOI: 10.1177/230949900801600306] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To determine whether increasing age is associated with increased radiological features of osteoarthritis of the acromioclavicular joint (ACJ) in a general population, and whether clinical symptoms correlate with radiological features. METHODS Anteroposterior and axillary shoulder radiographs of 240 patients aged 20 to 80 years were randomly selected. The presence of stigmata of osteoarthritis of the ACJ including sclerosis, cysts, lysis, and osteophytes were recorded, and the width of the ACJ was measured. To determine the correlation between clinical symptoms and radiological features, the same radiological features were assessed for 100 further patients who had undergone either arthroscopic subacromial decompression (ASD) alone (n=50) or ASD plus ACJ excision (n=50, age-matched controls) based on clinical examination. RESULTS Radiological features of osteoarthritis of the ACJ increased significantly with increasing age but were not related to gender or the side affected. Of the 10 features, only medial acromial sclerosis and superior clavicular osteophytes were more prevalent in patients with ASD plus ACJ excision than in those with ASD alone (p=0.016). The sensitivity, specificity, positive and negative predictive values of these features were poor. Therefore, clinical symptoms were not associated with radiological features of osteoarthritis of the ACJ. CONCLUSION Radiological features should only be used as an adjunct in the decision to excise the ACJ. A thorough clinical examination is crucial in the assessment of ACJ pathology.
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Affiliation(s)
- R G C Pennington
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, United Kingdom.
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Alyas F, Curtis M, Speed C, Saifuddin A, Connell D. MR imaging appearances of acromioclavicular joint dislocation. Radiographics 2008; 28:463-79; quiz 619. [PMID: 18349451 DOI: 10.1148/rg.282075714] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The key structures involved in dislocation of the acromioclavicular joint (ACJ) are the joint itself and the strong accessory coracoclavicular ligament. ACJ dislocations are classified with the Rockwood system, which comprises six grades of injury. Treatment planning requires accurate grading of the ACJ disruption, but correct classification can be difficult with clinical assessment. Magnetic resonance (MR) imaging has a well-established role in evaluation of ACJ pain. MR imaging performed in the coronal oblique plane parallel to the distal clavicle allows assessment of the acromioclavicular and coracoclavicular ligaments owing to its in-plane orientation in relation to these structures. This technique enables distinction between grade 2 and grade 3 injuries, which can be difficult with conventional clinical and radiographic evaluation. In addition, diagnosis of grade 1 injuries is possible by demonstration of a ruptured superiodorsal acromioclavicular ligament. Resultant thickening of the acromioclavicular or coracoclavicular ligament allows identification of chronic ACJ injuries.
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Affiliation(s)
- Faisal Alyas
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, England.
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Maquirriain J, Ghisi JP, Amato S. Is tennis a predisposing factor for degenerative shoulder disease? A controlled study in former elite players. Br J Sports Med 2006; 40:447-50. [PMID: 16632577 PMCID: PMC2653874 DOI: 10.1136/bjsm.2005.023382] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND High demands imposed to the shoulder during tennis activity can decrease the efficiency of static and dynamic constraints. Subtle or frank instability of the glenohumeral joint may occur, and long term degenerative changes may be expected. OBJECTIVE To determine and compare the prevalence of primary glenohumeral osteoarthritis in senior tennis players and matched controls. STUDY DESIGN Cross sectional controlled study. METHODS 18 asymptomatic senior tennis players were studied (17 male; mean (SD) age, 57.2 (8.8) years) with no history of shoulder surgery or major trauma. There were 18 matched controls. Radiographs were used to determine glenohumeral osteoarthritic changes: joint space narrowing, humeral and glenoid subchondral sclerosis, humeral and glenoid juxta-articular cysts, osteophytes, humeral and glenoid flattening, humeral posterior displacement and glenoid posterior erosion. Findings were classified as normal, minimal, moderate, or severe changes. RESULTS 33% of the players (95% confidence interval (CI), 13% to 59%) had osteoarthritic changes in their dominant shoulder (n = 6; five with minimal changes, one with moderate changes), and 11% of the controls (95% CI, 1% to 34%) had articular degeneration on their dominant side (n = 2; both minimal changes) (p = 0.04, Wilcoxon test). The osteoarthritic group was significantly older than the players without degenerative changes (p = 0.008). CONCLUSIONS The prevalence of glenohumeral osteoarthritis in the dominant shoulder was greater in former elite tennis players than in sedentary controls. Prolonged intensive tennis practice may be a predisposing factor for the development of mild degenerative articular changes in the dominant shoulder.
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Affiliation(s)
- J Maquirriain
- High Performance National Training Centre (CeNARD), Argentine Tennis Association, Buenos Aires, Argentina.
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