The Thrower's Shoulder

Brazilian version of the Kerlan-Jobe orthopedic clinic shoulder and elbow score: translation and cross-cultural adaptation

BACKGROUND

The Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Score is commonly used to assess the functional status of athletes with conditions affecting the shoulder and elbow. However, a Brazilian Portuguese version of the KJOC questionnaire is currently unavailable.

OBJECTIVES

This study aimed to develop a Brazilian Portuguese version of the KJOC questionnaire.

DESIGN AND SETTING

This translation and cultural adaptation study was conducted at the Federal University of Paraíba, Brazil.

METHODS

The procedures adopted in this study followed guidelines recommending translation by two independent translators, synthesis of the translations, back-translation performed by two native English-speaking translators, analysis by an expert committee, and pre-testing. The Portuguese version was tested with 32 athletes to assess their understanding of the assessment tool. Items were deemed adequate if they were understood by at least 90% of the athletes.

RESULTS

The terms and expressions of some original items were modified to achieve better comprehensibility in the Brazilian context. No further modifications were necessary after the pre-test; all terms were comprehensible to over 90% of athletes.

CONCLUSION

The translation and cultural adaptation of the KJOC questionnaire into Portuguese were completed, resulting in a Brazilian version of the scale. Further studies are needed to evaluate the reliability and validity of this scale.

Glenohumeral internal rotation deficit: insights into pathologic, clinical, diagnostic, and therapeutic characteristics

Overhead throwing athletes undergo significant biomechanical adaptations due to repetitive overhead movements, primarily affecting the glenohumeral joint. These adaptations can lead to glenohumeral internal rotation deficit (GIRD), which is characterized by posterior capsule stiffness that results in glenohumeral joint translation and a shift in the center of gravity. The severity of GIRD is dependent upon the presence of asymmetry between gained external and lost internal rotation, which is defined clinically as an asymmetry exceeding 20º; this reduces the total range of motion compared to the unaffected limb or baseline measurements. Diagnosis is challenging, as it can be mistaken for chronic scapular adaptations. To mitigate misdiagnosis, a high clinical suspicion is crucial in overhead athletes, especially those who began performing forceful overhead movements before closure of growth plates. Periodic physical examinations should establish baseline values for glenohumeral rotation and track changes in glenohumeral motion to aid in diagnosis. Symptoms of GIRD include shoulder pain, stiffness, and decreased force exertion. Magnetic resonance imaging is the preferred imaging method for evaluating GIRD and assessing concomitant soft tissue pathologies. Untreated GIRD can lead to rotator cuff strength imbalances. Treatment mainly involves conservative measures, such as physical therapy, to improve internal rotation and alleviate posterior tightness. Surgical interventions.

Arthroscopically Assisted Pectoralis Minor Transfer for Anterosuperior Massive Rotator Cuff Tear With Irreparable Subscapularis Tears Leads to Significant Improvement in Pain and Function at Short-Term Follow-Up

PURPOSE

To report the results of an arthroscopically assisted pectoralis minor transfer with an expanded indication to include Lafosse type 4 cases. In addition, prognostic factors for pectoralis minor transfer, including the Lafosse classification, were explored.

METHODS

Outcomes of arthroscopically assisted pectoralis minor tendon transfer for anterosuperior massive rotator cuff tear with irreparable subscapularis tears with a minimum follow-up of 24 months were retrospectively reviewed. Severe pseudoparesis with flexion of less than 30° was not indicated. All patients were evaluated preoperatively and postoperatively using a modified University of California Los Angeles (UCLA) score, active range of motion, and the visual analog pain scale. Multiple regression models were used to determine predictors for UCLA score and elevation.

RESULTS

Seventy-four consecutive patients (mean, 69.4 years; 65 men) were evaluated. The mean UCLA score increased from 15.3 preoperatively to 30.9 postoperatively (P < .001). The mean active elevation increased from 104° preoperatively to 148° postoperatively (P < .001). The mean active external rotation increased from 47° preoperatively to 57° postoperatively (P < .001). The visual analog pain scale improved from 62 to 11 mm postoperatively (P < .001). There were no serious complications, but 1 was revised with reverse shoulder due to ongoing pain. In multiple regression analysis, the positive predictors of UCLA and elevation were the preoperative external rotation angle (P = .0028) and elevation angle (P = .00067), respectively. Lafosse classification was not a significant factor.

CONCLUSIONS

Arthroscopically assisted pectoralis minor transfer led to significant improvement in overall shoulder pain and function. Better preoperative range of motion was a significant predictor of better clinical outcomes; Lafosse classification was not significant as a prognostic factor.

LEVEL OF EVIDENCE

Level IV, retrospective therapeutic case series.

Management of Shoulder Instability in the Overhead Athletes

Overhead athletes with anterior, posterior, and multidirectional shoulder instability present with a wide range of symptoms, especially considering the injury mechanism and affected supportive structures. As such, the management of shoulder instability is widely variable and relies on rehabilitation, operative management, and sport-specific considerations, such as positional and seasonal demands on the athlete. Biomechanical analysis may further aid in the recovery process or serve as a predictive tool to identify an increased risk for injury.

Overhead athletes have comparable intraoperative injury patterns and clinical outcomes to non-overhead athletes following surgical stabilization for first-time anterior shoulder instability at average 6-year follow-up

BACKGROUND AND HYPOTHESIS

Anterior shoulder instability is a common problem affecting young, athletic populations that results in potential career-altering functional limitations. However, little is known regarding the differences in clinical outcomes after operative management of overhead vs. non-overhead athletes presenting with first-time anterior shoulder instability. We hypothesized that overhead athletes would have milder clinical presentations, similar surgical characteristics, and diminished postoperative outcomes when compared with non-overhead athletes after surgical stabilization following first-time anterior shoulder instability episodes.

METHODS

Patients with first-time anterior shoulder instability events (subluxations and dislocations) undergoing operative management between 2013 and 2020 were included. The exclusion criteria included multiple dislocations and multidirectional shoulder instability. Baseline demographic characteristics, imaging data, examination findings, and intraoperative findings were retrospectively collected. Patients were contacted to collect postoperative patient-reported outcomes including American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index score, Brophy activity index score, and Subjective Shoulder Value, in addition to return-to-work and -sport, recurrent dislocation, and revision rates.

RESULTS

A total of 256 patients met the inclusion criteria, of whom 178 (70%) were non-overhead athletes. The mean age of the entire population was 23.1 years. There was no significant difference in concomitant shoulder pathology, preoperative range of motion, or preoperative strength between cohorts. A greater proportion of overhead athletes presented with instability events not requiring manual reduction (defined as subluxations; 64.1% vs. 50.6%; P < .001) and underwent arthroscopic surgery (97% vs. 76%, P < .001) compared with non-overhead athletes. A smaller proportion of overhead athletes underwent open soft-tissue stabilization compared with non-overhead athletes (1% vs. 19%, P < .001). Outcome data were available for 60 patients with an average follow-up period of 6.7 years. No significant differences were found between groups with respect to recurrent postoperative instability event rate (13.0% for overhead athletes vs. 16.8% for non-overhead athletes), revision rate (13.0% for overhead athletes vs. 11.1% for non-overhead athletes), American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index score, Brophy score, Subjective Shoulder Value, or rates of return to work or sport.

CONCLUSION

Overhead athletes who underwent surgery after an initial instability event were more likely to present with subluxations compared with non-overhead athletes. With limited follow-up subject to biases, this study found no differences in recurrence or revision rates, postoperative patient-reported outcomes, or return-to-work or -sport rates between overhead and non-overhead athletes undergoing shoulder stabilization surgery following first-time instability events. Although larger prospective studies are necessary to draw firmer conclusions, the findings of this study suggest that overhead athletes can be considered in the same treatment pathway for first-time dislocation as non-overhead athletes.

A Comparative Analysis Between Conservative Treatment, Arthroscopic Repair, and Biceps Tenodesis in Superior Labral Anterior-Posterior (SLAP) Lesions

Background "Throwing shoulder" hinders athletes' shoulder functions, causing pain, weakness, and performance reduction due to anatomical, physiological, and biomechanical factors. Anatomical issues include superior labral anterior-posterior (SLAP) injuries, rotator cuff injuries, and glenohumeral instability. Methods This study compared arthroscopic labral repairs in patients under 40 years old with shoulder injuries between 2015 and 2017. Sixty eligible patients were divided into three groups: conservative treatment, arthroscopic repair, and tenodesis. Measures included pain, functional scores, and the range of motion pre-/post-operation. Results At the last follow-up, pain relief and functional improvement were most significant with tenodesis (97% pain relief, 95% functional improvement), followed by repair (85% pain relief, 70% functional improvement), and least in conservative treatment (45% pain relief, 40% functional improvement). While all treatments significantly reduced pain and improved function (p<0.001), tenodesis demonstrated the highest effectiveness, suggesting it as a potentially preferred method. Significant improvements in pain relief and function were observed across all methods; however, surgical options suggested improved outcomes. Conclusion Our study compares conservative treatment, arthroscopic labral repair, and biceps tenodesis (BT) for SLAP lesions, highlighting significant pain relief and functional improvement across all. Conservative treatment suits patients with milder symptoms, while arthroscopic repair addresses larger tears. As the effectiveness of arthroscopic treatment is not inferior to conservative one, BT excels in cases of substantial bicep involvement.

Advances in the Treatment of Rotator Cuff Tears: Management of Rotator Cuff Tears in the Athlete

Unique biomechanical factors in the overhead and throwing athlete lead to a spectrum of rotator cuff pathology, usually with progressive lateralization of the supraspinatus footprint. Initial comprehensive nonoperative management is indicated for all athletes. Progression to arthroscopic debridement, repair of concomitant injuries, and possible rotator cuff repair with a transosseous equivalent technique are the current management strategies for athletes when nonoperative management fails.

In Vivo Anatomical Research by 3D CT Reconstruction Determines Minimum Acromiohumeral, Coracohumeral, and Glenohumeral Distances in the Human Shoulder: Evaluation of Age and Sex Association in a Sample of the Chinese Population

Accurate measurement of the minimum distance between bony structures of the humeral head and the acromion or coracoid helps advance a better understanding of the shoulder anatomical features. Our goal was to precisely determine the minimum acromiohumeral distance (AHD), coracohumeral distance (CHD), and glenohumeral distance (GHD) in a sample of the Chinese population as an in vivo anatomical analysis. We retrospectively included 146 patients who underwent supine computed tomography (CT) examination of the shoulder joint. The minimum AHD, CHD, and GHD values were quantitatively measured using three-dimensional (3D) CT reconstruction techniques. The correlation between minimum AHD, CHD, and GHD value and age with different sexes was evaluated using Pearson Correlation Coefficient. The mean value of minimum AHD in males was greater than that in females (male 7.62 ± 0.98 mm versus female 7.27 ± 0.86 mm, p = 0.046). The CHD among different sexes differed significantly (male 10.75 ± 2.40 mm versus female 8.76 ± 1.38 mm, p < 0.001). However, we found no statistical differences in GHD with different sexes (male 2.00 ± 0.31 mm versus female 1.96 ± 0.36 mm, p > 0.05). In terms of age correlation, a negative curve correlation existed between age and AHD among the different sexes (male R2 = 0.124, p = 0.030, female R2 = 0.112, p = 0.005). A negative linear correlation was found in CHD among the different sexes (male R2 = 0.164, p < 0.001, female R2 = 0.122, p = 0.005). There were no differences between age and minimum GHD in both sexes. The 3D CT reconstruction model can accurately measure the minimum AHD, CHD, and GHD value in vivo and is worthy of further investigation for standard clinical anatomical assessment. Aging may correlate with AHD and CHD narrowing for both sexes.