Biceps sheath fluid on shoulder ultrasound as a predictor of rotator cuff tear: analysis of a consecutive cohort.

BACKGROUND: Ultrasound provides evaluation of rotator cuff disease with accuracy comparable to that of magnetic resonance imaging. Fluid in the sheath of the long head of the biceps tendon (LHB), identified on ultrasound scan, has been associated with disease of the rotator cuff, LHB, and glenohumeral joint. Prior literature has compared ultrasound findings only with arthrography, and results have been conflicting. Arthroscopy remains the reference standard in assessing accuracy of imaging modalities. We present the first study investigating the significance of fluid in the LHB on ultrasound in predicting subsequent rotator cuff disease identified on arthroscopy. METHODS: Records were reviewed of 175 patients undergoing ultrasound and subsequent arthroscopy under 1 shoulder surgeon. Experienced musculoskeletal radiologists and sonographers performed ultrasound. Ultrasound examination and operating records were collected and analyzed. Data were analyzed using descriptive statistics, correlation, and logistic regression modeling. RESULTS: Highly significant correlation (P < .001; ρ = 0.354) was found between fluid in the LHB sheath and rotator cuff tears on arthroscopy. Statistically significant but weak correlation (P < .05; rho = 0.187) was found between fluid in the LHB sheath and both biceps tendon disease and glenohumeral joint disease. Fluid around the LHB was shown to increase the likelihood of having rotator cuff tear (odds ratio, 2.641; 95% confidence interval, 1.229-5.674) and biceps tendon disease (odds ratio, 2.698; 95% confidence interval, 1.216-5.987). CONCLUSION: This is the first report identifying significant correlation between fluid in the LHB sheath identified on ultrasound and subsequent rotator cuff disease identified at arthroscopy. We recommend routine reporting of fluid in the LHB sheath as it is likely to improve the accuracy of detecting rotator cuff and biceps tendon diseases.

Does preoperative psychologic distress influence pain, function, and quality of life after TKA?

BACKGROUND: Preoperative psychologic distress is considered to be a risk factor for clinical dissatisfaction stemming from persistent pain and physical limitations after elective orthopaedic procedures such as lower-extremity arthroplasty. However, the degree to which psychologic distress, specifically in the form of anxiety and depression, influences surgical results has been poorly characterized. QUESTIONS/PURPOSES: We analyzed the effect of preoperative psychologic distress on changes in pain, function, and quality of life 1 year after elective TKA. METHODS: In this prospective cohort study, we assessed patients who underwent TKAs in 2009 and 2010. Before surgery, patients completed the Folstein Mini Mental Test, the Hospital Anxiety and Depression Scale (HAD), The Knee Society Score(©), the WOMAC quality-of-life questionnaire, and the VAS for pain. The patients were divided into two groups based on the degree of psychologic distress on the HAD Scale, and the groups were compared in terms of the above-listed clinical outcomes tools 1 year after surgery using multivariate linear models. Two hundred sixty-three patients met the inclusion criteria, and 202 (77%) completed the study protocol. RESULTS: The presence of preoperative psychologic distress did not influence 1-year postoperative pain assessment (average reduction in pain, 40.33; 95% CI, 36.9-43.8; p = 0.18). The only factor influencing change in pain experienced by patients was the preoperative pain recorded (R(2) = 0.31; ß = -0.82; p < 0.001). The patients experiencing preoperative psychologic distress obtained poorer outcomes in function (R(2) = 0.16; ß = -5.62; p = 0.001) and quality of life (R(2) = 0.09; ß = -0.46; p < 0.001) 1 year after receiving TKA. CONCLUSIONS: The presence of preoperative psychologic distress is associated with worse 1-year outcomes for function and quality of life in patients undergoing TKA. Interventions designed to reduce psychologic distress may be indicated for patients to undergo this type of surgery, and incorporation of these data into discussions with patients may facilitate informed and shared decision making regarding the surgical treatment of knee osteoarthritis. LEVEL OF EVIDENCE: Level II, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Necrotizing Dermatosis of the Arm Following Cubital Tunnel Release: Pyoderma Gangrenosum, the Great Mimic: A Case Report.

CASE: We report the case of a fifty-one-year-old woman who underwent an uneventful cubital tunnel release and was admitted five days after surgery with a diagnosis of infection. Despite multiple surgical debridements and prolonged intravenous antibiotic treatment, the wound edges continued to slough and necrose. A delayed diagnosis of postsurgical pyoderma gangrenosum (PG) was made, and corticosteroid and immunosuppressive treatment was administered, with immediate clinical improvement. CONCLUSION: When apparent postoperative infections fail to improve with debridement and antimicrobial treatment, and when accompanied by a fever and severe local pain, nonspecific histopathological findings, and negative microbiological cultures, postsurgical PG should be considered.