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Klungsøyr JA, Vagstad T, Klungsøyr PJ, Myklebust TÅ, Lund Hanssen H, Hoff SR, Drogset JO. The Arthroscopic Subscapular Sling Procedure Results in Low Recurrent Anterior Shoulder Instability at 24 Months of Follow-Up. Arthroscopy 2024:S0749-8063(24)00167-1. [PMID: 38453096 DOI: 10.1016/j.arthro.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss. METHODS Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion. RESULTS Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (P < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, P = .211). Flexion and abduction were significantly improved from 152° to 174° (P = .001) and 141° to 170° (P < .001) after 24 months. The surgical procedures were completed without any intraoperative complications. CONCLUSIONS The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Jan Arild Klungsøyr
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway.
| | - Terje Vagstad
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Peter Johannes Klungsøyr
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Tor Åge Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Håkon Lund Hanssen
- Department of Radiology and Nuclear Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jon Olav Drogset
- Department of Orthopedic Surgery, Trondheim University Hospital and Norwegian University of Science and Technology (NTNU) Trondheim, Norway
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Marigi EM, Lamba A, Boos A, Wang A, Okoroha KR, Barlow JD, Krych AJ, Camp CL. Outcomes of Shoulder Instability Surgery in Competitive Wrestlers: Outcomes, Reoperations, and Return to Play at 5 Years' Mean Follow-up. Am J Sports Med 2024; 52:586-593. [PMID: 38305257 DOI: 10.1177/03635465231218262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Wrestling is a physically demanding sport with young athletes prone to traumatic shoulder instability and a paucity of data evaluating the results of shoulder instability surgery (SIS). PURPOSE To assess reoperation rates, patient-reported outcomes, and return to wrestling (RTW) after SIS in a cohort of competitive wrestlers. STUDY DESIGN Case series; Level of evidence, 3. METHODS All competitive wrestlers with a history of shoulder instability and subsequent surgery at a single institution between 1996 and 2020 were identified. All directions of shoulder instability (anterior shoulder instability [ASI], posterior shoulder instability [PSI], and traumatic multidirectional shoulder instability [TMDI]) were analyzed. Exclusions included revision SIS and <2 years of follow-up. Athletes were contacted for determination of complications, RTW, and Western Ontario Shoulder Instability Index scores. RESULTS Ultimately, 104 wrestlers were included with a mean age at initial instability of 16.9 years (range, 12.0-22.7 years), mean age at surgery of 18.9 years (range, 14.0-29.0 years), and a mean follow-up of 5.2 years (range, 2.0-22.0 years). A total of 58 (55.8%) wrestlers were evaluated after a single shoulder instability event, while 46 (44.2%) sustained multiple events before evaluation. ASI was the most common direction (n = 79; 76.0%), followed by PSI (n = 14; 13.5%) and TMDI (n = 11; 10.6%). Surgical treatment was most commonly an arthroscopic soft tissue stabilization (n = 88; 84.6%), with open soft tissue repair (n = 13; 12.5%) and open bony augmentation (n = 3; 2.9%) performed less frequently. RTW occurred in 57.3% of wrestlers at a mean of 9.8 months. Recurrent instability was the most common complication, occurring in 18 (17.3%) wrestlers. Revision SIS was performed in 15 (14.4%) wrestlers. Across the entire cohort, survivorship rates free from recurrent instability and revision surgery were 90.4% and 92.5% at 2 years, 71.9% and 70.7% at 5 years, and 71.9% and 66.5% at 10 years, respectively. Preoperative recurrent instability was an independent risk factor for postoperative recurrent instability (hazard ratio, 3.8; 95% CI, 1.33-11.03; P = .012). CONCLUSION Competitive wrestlers with multiple dislocations before initial clinical evaluation were 3.8 times more likely to experience postoperative recurrent instability. Patients should be counseled that despite SIS, only 57.3% returned to wrestling after surgery.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhinav Lamba
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Boos
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Allen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Grossi J, Danahy P, Rosenthal OD, Ackerman GP. Management of a Failed Distal Tibial Allograft Procedure for Anterior Shoulder Instability in a Patient With Epilepsy: A Case Report. Cureus 2024; 16:e51477. [PMID: 38298280 PMCID: PMC10830132 DOI: 10.7759/cureus.51477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
Shoulder instability episodes are observed in high-energy injuries, such as seizures. In this case report, we highlight the management of a failed distal tibial allograft procedure for recurrent shoulder instability in a patient with a bony Bankart lesion and epilepsy. The patient was treated with an iliac crest autograft and a proximal humerus osteochondral allograft procedure. To our knowledge, the use of an iliac crest autograft for glenoid bone loss and a proximal humerus osteochondral allograft after several failed shoulder instability procedures in a patient with epilepsy has not been reported.
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Affiliation(s)
- John Grossi
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Paul Danahy
- Orthopaedic Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Oren D Rosenthal
- Anatomy, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - George P Ackerman
- Orthopaedic Surgery, Optum Urgent Care - Glen Oaks, Lake Success, USA
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Kanesen K, Yeak RDK, Abdul Kahar J, Mohd Nasir MN. The Successful Resolution of Bilateral Recurrent Shoulder Dislocation With the Bilateral Shoulder Open Latarjet Procedure: A Case Report. Cureus 2023; 15:e50569. [PMID: 38222191 PMCID: PMC10788047 DOI: 10.7759/cureus.50569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Recurrent shoulder dislocation is a common orthopedic condition, but bilateral involvement is rare and presents unique challenges in management. The Latarjet procedure is an effective surgical technique that addresses instability by creating a bony block on the anterior glenoid rim. This case highlights the successful management of bilateral recurrent shoulder dislocation using the bilateral shoulder open Latarjet procedure and emphasizes the importance of early intervention in such cases.
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Affiliation(s)
- Kumarendran Kanesen
- Orthopaedic Surgery, Hospital Sultan Abdul Aziz Shah, University Putra Malaysia, Serdang, MYS
| | - Raymond Dieu Kiat Yeak
- Orthopaedic Surgery, Hospital Sultan Abdul Aziz Shah, University Putra Malaysia, Serdang, MYS
| | - Johan Abdul Kahar
- Orthopaedic Surgery, Hospital Sultan Abdul Aziz Shah, University Putra Malaysia, Serdang, MYS
| | - Mohd Nizlan Mohd Nasir
- Orthopaedic Surgery, Hospital Sultan Abdul Aziz Shah, University Putra Malaysia, Serdang, MYS
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van Iersel TP, Larsen van Gastel M, Versantvoort A, Hekman KM, Sierevelt IN, Broekman BF, van den Bekerom MP. The Modified Tampa-Scale of Kinesiophobia for Anterior Shoulder Instability. Arthrosc Sports Med Rehabil 2023; 5:100768. [PMID: 37645388 PMCID: PMC10461199 DOI: 10.1016/j.asmr.2023.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/14/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To assess content validity and to modify the Tampa Scale of Kinesiophobia (TSK) to make it suitable for application in patients with anterior shoulder instability. Methods A four-round Delphi method was performed to establish expert consensus on developing the Tampa Scale of Kinesiophobia for patients with anterior shoulder instability (TSK-SI) using an expert group of Dutch shoulder-specialized orthopedic surgeons and physiotherapists. During round 1, experts were asked to score the 17 items of the original TSK on relevance and construction using the COSMIN guidelines. With this feedback, questions were reviewed and modified. During round 2, experts were asked to score the modified items. This process was repeated until consensus was established. Then, patients were asked to participate in a moderator-guided, three-step-test interview using a Web-based platform to assess the modified scale. Sessions were recorded and evaluated by the working group. The modified scale was finally adjusted on the basis of the input of these patients. Results Thirty Dutch shoulder experts were included, of which 25 completed all 4 rounds, after which consensus was established. One question was added to the modified scale based on feedback in round 1, establishing the 18-item TSK-SI. Sixteen patients with shoulder instability were included, which all completed the three-step test interview. Following this, question 4 (changed to present tense) and question 7 (hypothetical component added) were adjusted, resulting in the final TSK-SI. Conclusions This consensus modification of the TSK to TSK-SI can support the content validity of the instrument to assess kinesiophobia in patients with anterior shoulder instability. These modifications may improve the responsiveness and validity of the TSK-SI, as it does not match all the items of the original TSK. Level of evidence Level V, consensus statement.
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Affiliation(s)
- Theodore P. van Iersel
- Shoulder and elbow unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
| | | | | | - Karin M.C. Hekman
- Medical Centre Jan van Goyen, Amsterdam, The Netherlands
- ShoulderCentre IBC Amstelland, Amstelveen, The Netherlands
| | - Inger N. Sierevelt
- Department of Orthopedic Surgery, Spaarne Gasthuis, The Netherlands
- Department of Orthopedic Surgery, Xpert Clinics Orthopedics, Amsterdam, The Netherlands
| | - Birit F.P. Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
| | - Michel P.J. van den Bekerom
- Shoulder and elbow unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Xpert Clinics Orthopedics, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Calixto LF, Pedreros R, Castañeda JF. [Translated article] Translation, validation, and cultural adaptation of the HSS-ES scale (Hospital for Special Surgery's [HSS] Shoulder Surgery Expectations Survey). Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T188-T192. [PMID: 36863520 DOI: 10.1016/j.recot.2023.02.014] [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: 05/23/2022] [Accepted: 10/26/2022] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION The questionnaire Hospital for Special Surgery Shoulder Surgery Expectations Survey (HSS-ES) is a tool used to assess the preoperative expectations of patients with shoulder pathologies. The purpose of this study is to translate, culturally adapt, and validate the Spanish version of the HSS-ES questionnaire to assess preoperative expectations in Spanish-speaking patients. METHODOLOGY Questionnaire validation study, using a structured method where a survey-type tool was processed, evaluated and validated. The study involved 70 patients from the shoulder surgery outpatient clinic of a tertiary care hospital, with shoulder pathologies requiring surgery. RESULTS The version of the questionnaire translated into Spanish presented a very good internal consistency with a Cronbach's Alpha of 0.94 and a very good reproducibility with an Intraclass Correlation Coefficient (ICC) of 0.99. CONCLUSION The HSS-ES questionnaire presents an adequate intragroup validation and a strong intergroup correlation according to the internal consistency analysis of the questionnaire and the ICC. Therefore, it is considered an adequate questionnaire to use in the Spanish-speaking population.
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Affiliation(s)
- L F Calixto
- Unidad de Ortopedia y Traumatología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - R Pedreros
- Unidad de Ortopedia y Traumatología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - J F Castañeda
- Unidad de Ortopedia y Traumatología, Universidad Nacional de Colombia, Bogotá, Colombia.
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Kheradmand E, Rahimi SM, Nakhaei Amroodi M, Nejati P, Griffin S. Cross-cultural adaptation, validity and reliability of the Persian translation of the Western Ontario Shoulder Instability Index (WOSI). J Orthop Surg Res 2023; 18:174. [PMID: 36882849 PMCID: PMC9990569 DOI: 10.1186/s13018-023-03593-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 02/08/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE The Western Ontario Shoulder Instability Index (WOSI) is the most commonly used patient-reported outcome measure to record the quality of life in patients with shoulder instability. The current study aimed to translate the WOSI into the Persian language and evaluate its psychometric properties. METHODS The translation procedure of the WOSI was performed according to a standard guideline. A total of 52 patients were included in the study and responded to the Persian WOSI, Oxford shoulder score (OSS), Oxford shoulder instability score (OSIS), and disabilities of arm, shoulder and hand (DASH). A sub-group of 41 patients responded for the second time to the Persian WOSI after an interval of 1-2 weeks. The internal consistency, test-retest reliability using intraclass correlation coefficient (ICC), measurement error, minimal detectable change (MDC), and floor and ceiling effect were analyzed. The hypothesis testing method was used to assess construct validity by calculating Pearson correlation coefficient between WOSI and DASH, OSS, and OSIS. RESULTS Cronbach's alpha value was 0.93, showing strong internal consistency. Test-retest reliability was good to excellent (ICC = 0.90). There was no floor and ceiling effect. The standard error of measurement and MDC were 8.30% and 23.03%, respectively. Regarding construct validity, 83.3% of the results agreed with hypotheses. High correlations were observed between WOSI and DASH, OSS and OSIS (0.746, 0.759 and 0.643, respectively) indicating excellent validity for the Persian WOSI. CONCLUSION The current study results demonstrated that the Persian WOSI is a valid and reliable instrument and can be used in the clinic and research for Persian-speaking patients with shoulder instability.
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Affiliation(s)
- Ehsan Kheradmand
- Department of Sports and Exercise Medicine, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rahimi
- Department of Sports and Exercise Medicine, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Morteza Nakhaei Amroodi
- Department of Orthopedic Surgery, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Nejati
- Department of Sports and Exercise Medicine, Hazrat-e Rasool General Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Sharon Griffin
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, ON, Canada
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8
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Bejer A, Płocki J, Kulczyk M, Griffin S, Kotela I, Kotela A. Reliability, Validity and Responsiveness of the Polish Version of the Western Ontario Shoulder Instability Index (WOSI-PL) in Patients after Arthroscopic Repair for Shoulder Instability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14015. [PMID: 36360895 PMCID: PMC9659089 DOI: 10.3390/ijerph192114015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Apart from imaging and physical examination for shoulder instability (SI), medical history with patient feedback should be considered to assess the patient's condition and recovery. The aim of this study was to evaluate psychometric properties of the Polish version of Western Ontario Shoulder Instability Index (WOSI)-one of the most frequently used patient-reported outcome measures for SI. During examination 1, 74 patients after arthroscopic repair for SI (age x¯ = 30.01 ± 8.98) were tested. Examinations 2 and 3 involved 71 and 51 patients, respectively. They completed the Polish version of the WOSI, the shortened version of the Disabilities of Arm, Shoulder and Hand Questionnaire (QuickDASH), the Short Form-36 version 2.0 (SF-36 v. 2.0) and 7-point Global Rating Change scale (GRC). The WOSI-PL demonstrated high internal consistency (Cronbach's alpha for total = 0.94), and test-retest reliability (Total ICC2,1 = 0.99). High construct validity was found (89%) as the a priori hypotheses were confirmed. All domains and total scores of WOSI-PL showed a moderate to strong degree of responsiveness (ES = 0.37-0.44; SMR = 0.87-1.26). Minimal clinically important difference (MCID) for the Total WOSI-PL was 126.43 points/6% (95%CI 67.83-185.03) by the anchor-based method and 174.05 points/8% (95%CI 138.61-233.98) by the distribution-based method. The Polish version of the WOSI can be considered a reliable, valid and responsive PROM. It is recommended for assessing the quality of life in patients after arthroscopic repair for SI and can be applied in research and in the clinical setting for monitoring treatment and facilitating patient-centred therapeutic decisions.
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Affiliation(s)
- Agnieszka Bejer
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Rejtana 16C, 35-959 Rzeszow, Poland
- The Holy Family Specialist Hospital, Rudna Mała 600, 36-060 Głogów Małopolski, Poland
| | - Jędrzej Płocki
- Department of Physiotherapy, Collegium Medicum, University of Information Technology and Management in Rzeszow, Sucharskiego 2, 35-225 Rzeszow, Poland
| | - Marek Kulczyk
- The Holy Family Specialist Hospital, Rudna Mała 600, 36-060 Głogów Małopolski, Poland
| | - Sharon Griffin
- Fowler Kennedy Sport Medicine Clinic, Faculty of Medicine, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON N6A 3K7, Canada
| | - Ireneusz Kotela
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, IX Wieków Kielc 19a, 25-317 Kielce, Poland
- Department of Orthopaedic Surgery and Traumatology, Central Clinical Hospital of the Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland
| | - Andrzej Kotela
- Department of Orthopaedic Surgery and Traumatology, Central Clinical Hospital of the Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Woycickiego 1/3, 01-938 Warsaw, Poland
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Broida SE, Sweeney AP, Gottschalk MB, Wagner ER. Management of shoulder instability in hypermobility-type Ehlers-Danlos syndrome. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:155-164. [PMID: 37588970 PMCID: PMC10426500 DOI: 10.1016/j.xrrt.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Shoulder instability in hypermobile Ehlers-Danlos syndrome can result in lifelong pain and functional disability. Treatment in this population is complicated by the severe degree of instability as well as the underlying abnormalities of the joint connective tissue. Appropriate care for these patients requires a thorough understanding of the natural history of their disease, knowledge of the available treatment options, and certain special considerations. This article reviews the pathoanatomy, recognition, and management of shoulder instability in the patient with hypermobile Ehlers-Danlos syndrome.
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Affiliation(s)
- Samuel E. Broida
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Aidan P. Sweeney
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | - Eric R. Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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Kadantsev PM, Logvinov AN, Ilyin DO, Ryazantsev MS, Afanasiev AP, Korolev AV. [Shoulder instability: review of current concepts of diagnosis and treatment]. Khirurgiia (Mosk) 2021:109-124. [PMID: 33977706 DOI: 10.17116/hirurgia2021051109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To conduct a systematic review of modern literature data on the modern approaches in diagnosis and treatment of shoulder instability. MATERIAL AND METHODS Searching for literature data was performed using the Pubmed and Google Scholar databases. RESULTS The authors analyzed the results of conservative treatment of patients with shoulder instability and emphasized higher risk of instability recurrence, degeneration of anatomical structures and functional impairment in these patients. Surgery is advisable to restore shoulder stability and normalize its function. Several methods for stabilizing the shoulder have been proposed. The approaches to diagnosis and treatment of shoulder instability have been updated. CONCLUSION Successful treatment of shoulder instability is based on qualitative and complete assessment of soft tissues and bone structures. An individual approach considering bone tissue deficiency and individual needs of the patient is required.
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Affiliation(s)
- P M Kadantsev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia.,Peoples Friendship University of Russia, Moscow, Russia
| | - A N Logvinov
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia
| | - D O Ilyin
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia.,Peoples Friendship University of Russia, Moscow, Russia
| | - M S Ryazantsev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia
| | - A P Afanasiev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia
| | - A V Korolev
- European Clinic of Sports Traumatology and Orthopedics (ECSTO), Moscow, Russia.,Peoples Friendship University of Russia, Moscow, Russia
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Matsumura N, Kaneda K, Oki S, Kimura H, Suzuki T, Iwamoto T, Matsumoto M, Nakamura M, Nagura T. Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability. J Orthop Surg Res 2021; 16:255. [PMID: 33849594 PMCID: PMC8045245 DOI: 10.1186/s13018-021-02395-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.
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Affiliation(s)
- Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kazuya Kaneda
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroo Kimura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss. Arthroscopy 2021; 37:824-833. [PMID: 33359157 DOI: 10.1016/j.arthro.2020.11.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical and radiologic outcomes of patients undergoing arthroscopic glenoid bone allograft combined with subscapularis upper-third tenodesis for anterior shoulder instability associated with clinically relevant bone loss and hyperlaxity. METHODS Between January 2016 and December 2017, patients with recurrent anterior shoulder instability associated with bone loss and hyperlaxity were selected and treated with arthroscopic iliac crest bone graft combined with subscapularis upper-third tenodesis. The selection criteria were as follows: more than 5 dislocations; positive apprehension, anterior drawer, and Coudane-Walch test results; glenoid bone defect between 15% and 30% and humeral bone defect with an engaging Hill-Sachs lesion; and no previous shoulder surgery. All patients were followed up with the Constant score, University of California-Los Angeles (UCLA) rating, Rowe score, and visual analog scale evaluation. Assessments were performed with plain radiographs and a PICO computed tomography scan before surgery and at 2 years of follow-up. RESULTS Nineteen patients were included in the study, with a mean follow-up duration of 34.6 months (range, 24-48 months). In 17 patients (89%), excellent clinical results were recorded according to the Rowe score. The Constant score improved from 82.9 (standard deviation [SD], 5.2) to 88.9 (SD, 4.3) (P = .002); Rowe score, from 25.3 (SD, 5.3) to 89.1 (SD, 21.8) (P < .001); UCLA score, from 23.7 (SD, 3) to 31.5 (SD, 4.8) (P < .001); and visual analog scale score, from 3.2 to 1.3 (P < .001). Patients met the minimal clinically important difference 94.7%, 89.5%, and 47.3% of the time for the Rowe score, UCLA score, and Constant score, respectively. Bone graft resorption was observed in all patients: partial in 9 and complete in 10. We recorded 2 recurrent traumatic dislocations (11%), with no case of persistent anterior apprehension or other complication. CONCLUSIONS An arthroscopic glenoid bone graft combined with subscapularis upper-third tenodesis may be a valid surgical option to treat recurrent anterior instability associated with both bone loss and hyperlaxity. LEVEL OF EVIDENCE Level IV, case series.
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Zheng Y, Wang H, Wang H, Xu J, Chen P. The efficacy of a phone assistance nursing program for functional outcomes in patients after shoulder instability surgery: A protocol for randomized controlled trial. Medicine (Baltimore) 2020; 99:e22756. [PMID: 33120779 PMCID: PMC7581063 DOI: 10.1097/md.0000000000022756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE We conduct this research protocol for the assessment of the effect of phone-assisted care programs on functional outcomes in patients receiving shoulder instability surgery. METHODS This is a randomized controlled, single center trial which will be implemented from October 2020 to December 2021. This trial is conducted according to the SPIRIT Checklist of randomized researches. It was authorized via the Ethics Committee of the First People's Hospital of Xiangyang city affiliated to Hubei Medical College (XY234-026). Ninety participants who undergo shoulder instability surgery are analyzed. Patients are randomly divided into control group (standard management group, with 45 patients) and study group (the phone program group, with 45 patients). In control group, the exercises at home are not monitored. Whereas in study group, patients are asked about their at-home activities, and the extra coaching sessions are provided to patients on self-care, exercise guidance, and the importance of exercise at home, and then answers to their questions. The primary outcome is the range of motion of the shoulder joint, and the pain arcs are determined through the range of motion. The extra assessments include the shoulder functional outcome, pain, and the quality of life. All the analysis needed in this study is implemented with SPSS (IBM, Chicago, USA) for Windows Version 19.0. RESULTS The clinical outcome variables between groups are shown in Table. CONCLUSION This investigation can offer a reliable basis for the effectiveness of phone assistance nursing program in patients after shoulder instability surgery. TRIAL REGISTRATION NUMBER researchregistry6010.
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Affiliation(s)
| | | | | | | | - Ping Chen
- Department of Gynaecology and Obstetrics, the First People's Hospital of Xiangyang City Affiliated to Hubei Medical College, Hubei, China
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Antri IE, Benyass Y, Zine A. Simultaneous bilateral anterior shoulder dislocation as a result of minimal trauma. Pan Afr Med J 2020; 36:94. [PMID: 32774653 PMCID: PMC7392871 DOI: 10.11604/pamj.2020.36.94.23757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
Simultaneous bilateral anterior shoulder dislocation is rare, it often occurs after high energy trauma, we report a case of a 43-years-old male presented with bilateral anterior shoulder dislocation when he tries to stand up from the floor, shoulders in extension, abduction and external rotation. A closed reduction was performed without complications, and one month later the right shoulder was stabilized by open Laterjet technique. The evolution was favorable for both shoulders with no pain, recuperation of the range motion and no recurrence of dislocation. Through this case we underline the value of early diagnosis and appropriate treatment of bilateral anterior shoulder dislocation, to avoid complications and obtain good result.
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Affiliation(s)
- Ismail El Antri
- Department of Orthopedic Surgery, Military Training Hospital Mohamed V, University Mohamed V, Rabat, Morocco
| | - Youssef Benyass
- Department of Orthopedic Surgery, Military Training Hospital Mohamed V, University Mohamed V, Rabat, Morocco
| | - Ali Zine
- Department of Orthopedic Surgery, Military Training Hospital Mohamed V, University Mohamed V, Rabat, Morocco
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Hasebroock AW, Brinkman J, Foster L, Bowens JP. Management of primary anterior shoulder dislocations: a narrative review. SPORTS MEDICINE - OPEN 2019; 5:31. [PMID: 31297678 PMCID: PMC6624218 DOI: 10.1186/s40798-019-0203-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/24/2019] [Indexed: 01/20/2023]
Abstract
Abstract The recurrence rate following acute anterior shoulder dislocations is high, particularly in young, active individuals. The purpose of this paper is to provide a narrative overview of the best available evidence and results with regards to diagnostic considerations, comorbidities, position of immobilization, surgical versus conservative management, and time to return to play for the management of primary anterior shoulder dislocations. Three independent reviewers performed literature searches using PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials and systematic reviews meeting inclusion criteria from 1930 to April 2019 were appraised and discussed with the intent to consolidate the best available evidence with regards to lowering recurrence rates. A majority of studies support early surgical intervention for individuals between 21 and 30 years of age following primary shoulder dislocations, as this group is particularly susceptible to recurrence. Conservative treatment plans favor 1–3 weeks of immobilization in internal rotation, followed by rehabilitation. Surgical methods are associated with longer time to return to play, but lower recurrence rates. Return to play time is best determined on an individualized basis, when subjective and objective function of both shoulders is determined to be symmetric. This paper broadly summarizes the best available evidence for the management of primary anterior shoulder dislocations. There remains a need for randomized studies to determine ideal long-term treatment following conservative or surgical management, as general timelines for returning to play following injury remain vague. Level of evidence IV, Narrative Review
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Affiliation(s)
- Andrew W Hasebroock
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA
| | - Joseph Brinkman
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA
| | - Lukas Foster
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA.
| | - Joseph P Bowens
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE, 68105, USA
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