Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability

OBJECTIVE

Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department.

MATERIALS AND METHODS

This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland-Altman plots, or intraclass coefficients.

RESULTS

A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81).

CONCLUSION

Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.

Supporting patients in reducing postoperative constipation: fundamental nursing care - a quasi-experimental study

BACKGROUND

The prevalence of constipation in the general population is 2-28%. Patients with constipation report symptoms of abdominal pain, bloating, nausea, straining to defecate and general discomfort. Strategies for preventing constipation include laxatives, exercise and increased fluid and fibre intake, but life style adjustments, such as exercise, eating more fibres and drinking more fluids, were not considered a solution by older patients. Previous studies have shown that actively involving patients through individualised care and support increases patients' outcome.

AIM

To test the efficacy of a nursing intervention based on active patient involvement including individualised nursing care plans and daily dialogues for patients with hip fractures in preventing constipation after surgery.

METHODS

A quasi-experimental design was applied. Inclusion criteria hip fracture needing surgery, understand Danish. Exclusion criteria dementia, gastrointestinal disease. A total of 186 patients were included and 155 completed. An admission interview including Constipation Risk Assessment Scale was undertaken. On that basis an individualised nursing care plan was made. At admission, discharge and 30 days after surgery constipation, intake of fibres and fluid were measured. The Bristol Stool Scale and Rasmussen's scale were used to measure constipation. Patients in the control group received standard care of the ward.

RESULTS

After 30 days constipation rates for patients in the intervention group were significantly lower than for patients in the control group (p = 0.042). The fibre intakes and fluid intakes were significantly higher in the intervention group (p ≤ 0.001). The effect of liquid intake was statistically significant (OR = 1.1, 95% CI: 1.0-1.2). Likewise, the effect of fibre intake was statistically significant; the odds of constipation decreased with increasing fibre intake (OR = 0.4, 95% CI: 0.2-0.8).

CONCLUSION

Patients with hip fractures that were actively involved in their own care in preventing constipation were significantly less constipated 30 days after surgery than control patients. Increases in fluid and fibre intakes had significant effects on reducing the risk of developing constipation.

[Pronator teres syndrome is a rare but important cause of pain in the forearm]

Pronator teres syndrome is a rare but clinically important condition which can cause pain in the forearm. It is a com-pression neuropathy due to compression of the median nerve proximal in the forearm. In this case report we de-scribe a 69-year-old male patient with pain in both forearms in more than ten years. After surgical decompression of the median nerve in both arms he experienced almost complete relief of his symptoms.

Proteomics perspectives in rotator cuff research: a systematic review of gene expression and protein composition in human tendinopathy

BACKGROUND

Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other tendinopathies, and to evaluate perspectives of proteomics--the comprehensive study of protein composition--in tendon research.

MATERIALS AND METHODS

We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue.

RESULTS

We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy. Most of the included studies quantified prespecified mRNA molecules and proteins using polymerase chain reactions and immunoassays, respectively. There was a tendency towards an increase of collagen I (11 of 15 studies) and III (13 of 14), metalloproteinase (MMP)-1 (6 of 12), -9 (7 of 7), -13 (4 of 7), tissue inhibitor of metalloproteinase (TIMP)-1 (4 of 7), and vascular endothelial growth factor (4 of 7), and a decrease in MMP-3 (10 of 12). Fourteen proteomics studies of tendon tissues/cells failed inclusion, mostly because they were conducted in animals or in vitro.

CONCLUSIONS

Based on methods, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although proteomics technologies may be a way to identify protein profiles (including non-prespecified proteins) that characterise specific tendon disorders or stages of tendinopathy. Thus, our results suggested an untapped potential for proteomics in tendon research.

Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children

PURPOSE

Missed Monteggia fracture dislocation in children is a serious condition. The treatment of this rare condition is controversial and reports on the long-term outcome are sparse. We present a series of patients treated with open reduction and ulnar osteotomy with a mean long-term follow-up of 8 years (range 3-17).

METHODS

All 16 patients had Bado type 1 (anterior radial head) dislocation. The mean delay from injury to surgery was 17 months (range 1-83). Bilateral radiographs, Oxford Elbow Score, strength measurements, and range of motion were obtained in all patients.

RESULTS

There were no major complications to surgery. The radiographic results showed ten patients with reduction of the radial head and with no arthrosis, four patients with arthrosis or subluxation, and two patients with a dislocated radial head. We found a significant correlation between radiographic outcome and delay to ulnar osteotomy (P = 0.03). Typical clinical findings were a small but significant extension deficit and mean loss of supination of 10° (range 0-90, P < 0.01). Ligament reconstruction or transfixation of the radial head did not influence the radiographic or clinical outcome.

CONCLUSIONS

Case reports of similar patients treated conservatively demonstrate high morbidity, and, therefore, open reduction and ulnar osteotomy seemed justified. However, this study underlines the importance of minimizing the delay between injury and ulnar osteotomy. If surgery is performed within 40 months after injury, good to fair long-term radiographic results can be obtained. Open reduction and ulnar osteotomy were performed because patients treated conservatively demonstrate high morbidity.

Laxity of the elbow after experimental excision of the radial head and division of the medial collateral ligament

We studied the stabilising effect of prosthetic replacement of the radial head and repair of the medial collateral ligament (MCL) after excision of the radial head and section of the MCL in five cadaver elbows. Division of the MCL increased valgus angulation (mean 3.9 ± 1.5°) and internal rotatory laxity (mean 5.3 ± 2.0°). Subsequent excision of the radial head allowed additional valgus (mean 11.1 ± 7.3°) and internal rotatory laxity (mean 5.7 ± 3.9°). Isolated replacement of the radial head reduced valgus laxity to the level before excision of the head, while internal rotatory laxity was still greater (2.8 ± 2.1°). Isolated repair of the MCL corrected internal rotatory laxity, but a slight increase in valgus laxity remained (mean 0.7 ± 0.6°). Combined replacement of the head and repair of the MCL restored stability completely.

We conclude that the radial head is a constraint secondary to the MCL for both valgus displacement and internal rotation. Isolated repair of the ligament is superior to isolated prosthetic replacement and may be sufficient to restore valgus and internal rotatory stability after excision of the radial head in MCL-deficient elbows.

Muscular performance and fatigue in primary hyperparathyroidism

The purpose of this study was to evaluate changes in muscular strength and endurance, work capacity, and subjective fatigue following surgical treatment of primary hyperparathyroidism (pHPT), and to assess whether changes in muscular function were due to changes in activation of the muscles. A prospective consecutive study design was used, and patients surgically treated for nontoxic goiter served as controls. Nineteen female patients with mild to moderate pHPT and 20 controls were included. Maximal isometric handgrip and quadriceps strength, quadriceps endurance (intermittent stimulation), and quadriceps activation (superimposed twitch technique) were used for evaluation of muscular function. All patients were operated on successfully. Knee extension strength increased by 17 +/- 17% (mean +/- SD; p = 0.0004) in the patients, whereas no change was observed in the controls. The relative strength increase correlated positively to patient age at operation (r = 0.52, p = 0.02). Handgrip strength, quadriceps endurance, and general work capacity did not change in any group after operation. Subjective fatigue was preoperatively higher in patients than in controls (p = 0.01), and decreased postoperatively to the level of controls. In conclusion, women with pHPT increase knee extension force after parathyroidectomy as a result of increased force generation capacity of the muscle. If change in physical performance is a determinant for change in subjective fatigue in pHPT after operation, then change in strength of the quadriceps muscle seems to be of primary importance, whereas handgrip strength, muscular endurance, and work capacity do not seem to be important. The cause of the increasing strength benefit with increasing age at operation as found in this study needs further investigation.