Shoulder Check: Investigating Shoulder Injury Rates, Types, Severity, Mechanisms, and Risk Factors in Canadian Youth Ice Hockey.

OBJECTIVE: To describe shoulder-related injury rates (IRs), types, severity, mechanisms, and risk factors in youth ice hockey players during games and practices. DESIGN: Secondary analysis of data from a 5-year prospective cohort study, Safe-to-Play (2013-2018). SETTING: Canadian youth ice hockey. PARTICIPANTS: Overall, 6584 player-seasons (representing 4417 individual players) participated. During this period, 118 shoulder-related games and 12 practice injuries were reported. ASSESSMENT OF RISK FACTORS: An exploratory multivariable mixed-effects Poisson regression model examined the risk factors of body checking policy, weight, biological sex, history of injury in the past 12 months, and level of play. MAIN OUTCOME MEASURES: Injury surveillance data were collected from 2013 to 2018. Injury rates with 95% confidence interval (CI) were estimated using Poisson regression. RESULTS: The shoulder IR was 0.35 injuries/1000 game-hours (95% CI, 0.24-0.49). Two-thirds of game injuries (n = 80, 70%) resulted in >8 days of time-loss, and more than one-third (n = 44, 39%) resulted in >28 days of time-loss. An 83% lower rate of shoulder injury was associated with policy prohibiting body checking compared with leagues allowing body checking (incidence rate ratio [IRR], 0.17; 95% CI, 0.09-0.33). A higher shoulder IR was observed for those who reported any injury in the last 12-months compared with those with no history (IRR, 2.00; 95% CI, 1.33-3.01). CONCLUSIONS: Most shoulder injuries resulted in more than 1 week of time-loss. Risk factors for shoulder injury included participation in a body-checking league and recent history of injury. Further study of prevention strategies specific to the shoulder may merit further consideration in ice hockey.

Differences in Situational Patterns During Change of Direction Movements Greater than 90° in Youth Male and Female Soccer Players.

Change of direction (COD) maneuvers in soccer create tactical advantages, but also expose the player to an increased risk of injury. COD ability is commonly tested with pre-planned drills including cuts greater than 90°. These tests do not take into consideration positional differences players encounter during games. This case-series study used principal component analysis (PCA) to examine situational differences during COD movements between playing positions in youth soccer games. For each of the four teams included (26 females, 27 males), one game was analyzed using video-analysis. Two independent reviewers identified situational patterns and a PCA was used to examine differences between playing positions. Three principal components explained 89% of the variation in the data and were categorized as the total quantity of CODs, attacking/goal-scoring and defensive reacting types of CODs. One-way ANOVA on the individual principal component (PC) scores showed significant differences (p < 0.05) between centre midfielders, goalkeepers, and centrebacks in the quantity of CODs (PC1), and between wingers and fullbacks and centre backs in attacking/goal-scoring CODs (PC2), whereas PC3 was not different between playing positions. Differences between playing positions suggest that training and testing protocols in soccer could be enhanced to better match the individual and playing position-based needs.

The Epidemiology of Youth Sport-Related Shoulder Injuries: A Systematic Review.

Background: Youth around the globe place their shoulders at risk for injury when participating in sports. Shoulder injuries may vary in severity, produce the potential for time-loss from sport, and result in functional disability. We sought to explore sport-related shoulder injuries in youth by identifying injury rates, risk factors, injury mechanisms, and injury prevention strategies. Methods: All relevant full-text articles were identified by searching MEDLINE, EMBASE, CINAHL, Sport Discus, and the Cochrane Controlled Trials Registry. No date restrictions were used. All full-text studies reporting original research describing sport-related shoulder injury among female and/or male youth from 5 to 18 years old were included. Results: Of 3,889 studies screened, 97 described shoulder injury in youth sports. Shoulder injuries were identified in 24 unique sports. The median seasonal prevalence of shoulder injury was 10.9% (range 1.2-28.2%). The most common injury mechanisms identified were contacted with another player, contact with the playing environment, and falling to the ground. Risk factors for shoulder injury identified were side-to-side strength imbalances, weak external rotator muscles, and scapular dyskinesia. One study evaluated a successful training strategy to prevent shoulder injuries, but two other interventions demonstrated no effect. Conclusions: Sport-related shoulder injuries are prevalent among youth athletes. Injury risk factors identified included modifiable intrinsic factors such as strength, range of motion, and training load. The most common injury mechanism was direct contact with either another person or an object in the playing environment. Innovative shoulder-specific strategies are needed to reduce shoulder injuries in this population. Trial Registration: PROSPERO ID: CRD42020189142.

Prior mood disorder diagnoses do not relate to current mood disorder symptoms or patient-reported disease severity in rotator cuff patients.

BACKGROUND: Surgery for rotator cuff syndrome does not always produce symptom improvement. Biological factors may explain some symptoms, but mood disorder symptoms may also contribute. The purpose of this study is to examine the interaction between disease severity, prevalence of mood disorder diagnoses, and current mood disorder symptoms in preoperative rotator cuff patients. METHODS: A prospective cohort of patients aged 35-75 years with unilateral rotator cuff disease awaiting surgery participated. Demographics, psychiatric history, the Hospital Anxiety & Depression Scale, and the Western Ontario Rotator Cuff index were collected. Descriptive and univariate statistical testing was performed. RESULTS: Of 140 participants (75M:65W) aged 55 ± 8 years, 34 reported a prior diagnosis of a mood disorder. There was a moderate positive relationship between disease severity and current depression and anxiety scores. Women were more likely to carry a diagnosis of a mood disorder, but there were no differences in current symptom levels between genders. No differences were found in patient-reported outcome measure scores between patients with and without a mood disorder diagnosis. DISCUSSION: Current mood disorder symptoms were associated with greater disease severity, whereas the presence of a past mood disorder diagnosis was not. Awareness of this relationship may reduce bias about past mood disorder diagnoses during decision-making.

A rare case of Haemophilus parainfluenzae septic knee following prolotherapy injections.

Prolotherapy injections are becoming increasingly popular as a non-surgical treatment option for many chronic musculoskeletal conditions. Proposed benefits include reduced pain, reduced joint laxity and increased tendon strength. While a number of studies report that prolotherapy reduces pain and increases function for many conditions, the academic evidence remains extremely weak. Here, we discuss a case of a complex intra-articular knee infection in a young, previously healthy, female following prolotherapy injections for management of a partial-thickness anterior cruciate ligament (ACL) tear. To the best of our knowledge, this is the first report of its kind describing a potential complication of intra-articular prolotherapy injections.

Intersection of catastrophizing, gender, and disease severity in preoperative rotator cuff surgical patients: a cross-sectional study.

HYPOTHESIS AND BACKGROUND: Surgical outcomes are dependent on multiple clinical and patient factors. One patient factor is pain catastrophizing, which is associated with poorer outcomes in other surgical populations. Our purpose was to examine relationships between gender, patient-reported disease severity, and catastrophizing in patients in whom rotator cuff surgery is planned. We hypothesized that patients with more catastrophizing would report greater disease severity. METHODS: Patients undergoing surgery for unilateral symptomatic rotator cuff disease aged 35 to 75 years were prospectively evaluated. Data collected included demographic characteristics; imaging characteristics; range of motion; and Western Ontario Rotator Cuff Index (WORC), Pain Catastrophizing Scale (PCS), and Short Form 36 scores. RESULTS: A total of 156 patients (87 men and 69 women) aged 54 ± 8 years participated. The mean WORC score was similar between men and women (1286 ± 343 vs. 1327 ± 370, P = .38). The mean PCS score was 14.7 ± 10.6 for men and 17.9 ± 12.4 for women (P = .08). A moderate positive correlation was found between the WORC and PCS scores (r = 0.59, P < .001). Women had poorer WORC-Lifestyle subscale scores (P = .012). Range of motion, Short Form 36 scores, and tear severity were not related to measures of either the WORC or PCS. DISCUSSION AND CONCLUSIONS: The direct relationship between the WORC and PCS scores is consistent with research in other patient populations. Contrary to other work, no gender-based PCS score differences were observed. Differences on the WORC-Lifestyle subscale suggest that women may experience greater functional impacts to specific lifestyle elements than men. Catastrophizing is related to patient-reported disease severity in preoperative rotator cuff patients. Further research will clarify whether this relationship leads to poorer outcomes following surgery.

Can pain catastrophizing be changed in surgical patients? A scoping review

Background: Catastrophizing, a coping style characterized by an exaggerated negative affect when experiencing or anticipating pain, is an important factor that adversely affects surgical outcomes. Various interventions have been attempted with the goal of reducing catastrophizing and, by extension, improving treatment outcomes. We performed a systematic review to determine whether catastrophizing can be altered in surgical patients and to present evidence for interventions aimed at reducing catastrophizing in this population. Methods: Using a scoping design, we performed a systematic search of MEDLINE and Embase. Studies reporting original research measuring catastrophizing, before and after an intervention, on the Pain Catastrophizing Scale (PCS) or Coping Strategies Questionnaire (CSQ) were selected. Studies were assessed for quality, the nature of the intervention and the magnitude of the effect observed. Results: We identified 47 studies that measured the change in catastrophizing score following a broad range of interventions in surgical patients, including surgery, patient education, physiotherapy, cognitive behavioural therapy, psychologist-directed therapy, nursing-directed therapy and pharmacological treatments. The mean change in catastrophizing score as assessed with the PCS ranged from 0 to ­19, and that with the CSQ, from +0.07 to ­13. Clinically important changes in catastrophizing were observed in 7 studies (15%). Conclusion: Catastrophizing was observed to be modifiable with an intervention in a variety of surgical patient populations. Some interventions produced greater reductions than others, which will help direct future research in the improvement of surgical outcomes.

Contexte: Le catastrophisme est un mode d'adaptation caractérisé par un affect démesurément négatif chez la personne qui éprouve ou s'attend à éprouver de la douleur et c'est un facteur important qui peut influer négativement sur les résultats chirurgicaux. Diverses interventions ont été tentées pour atténuer le catastrophisme et par extension, améliorer les résultats des traitements. Nous avons procédé à une revue systématique afin de déterminer s'il est possible de modifier le catastrophisme chez les patients de chirurgie et présenter des données probantes concernant les interventions visant à atténuer le catastrophisme chez cette population. Méthodes: En utilisant un plan de délimitation de la portée, nous avons procédé à une interrogation systématique de bases de données MEDLINE et Embase. Les études portant sur des recherches originales d'évaluation du catastrophisme, avant et après une intervention, au moyen de l'échelle PCS (Pain Catastrophizing Scale) ou du questionnaire CSQ (Coping Strategies Questionnaire) ont été sélectionnées et elles ont été évaluées aux plans de la qualité, de la nature des interventions et de l'ampleur de l'effet observé. Résultats: Nous avons recensé 47 études qui ont mesuré un changement au score du catastrophisme après un vaste éventail d'interventions chez des patients de chirurgie, notamment : chirurgie, enseignement au patient, physiothérapie, thérapie cognitivocomportementales, thérapie sous la supervision d'un psychologue, thérapie sous la supervision du personnel infirmier et traitements pharmacologiques. Le changement moyen au score du catastrophisme évalué à l'aide de l'échelle PCS était de 0 à ­19, et à l'aide du questionnaire CSQ, de 0,07 à ­13. Des changements cliniquement importants du catastrophisme ont été observés dans 7 études (15 %). Conclusion: Le catastrophisme s'est révélé modifiable à l'aide d'interventions chez divers types de patients de chirurgie. Certaines interventions ont généré des réductions plus marquées, ce qui guidera la recherche future pour améliorer les résultats chirurgicaux.

Periprosthetic total knee fracture after remote reconstruction of the anterior cruciate ligament: a case report.

BACKGROUND: Distal femoral fracture is a rare, but significant, postoperative complication of anterior cruciate ligament reconstruction. However, there has not been a reported case of periprosthetic total knee arthroplasty fracture associated with a previous anterior cruciate ligament repair. CASE PRESENTATION: We report the case of a 51-year-old white man with a history of total knee arthroplasty and remote anterior cruciate ligament reconstruction, who presented with a distal femoral periprosthetic fracture at the site of a previous anterior cruciate ligament augmentation staple. CONCLUSIONS: Based on these findings, it may be important to consider removal of previous anterior cruciate ligament hardware prior to total knee arthroplasty to reduce risk of periprosthetic fracture, which should be determined on a patient-specific basis.

Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome.

AIMS: More than half of infants exposed to opioids in utero develop neonatal abstinence syndrome (NAS) of severity to require pharmacological therapy. Current treatments are associated with prolonged hospitalization. We sought to optimize the dose of sublingual buprenorphine in the treatment of NAS. DESIGN: Randomized, Phase 1, open-label, active-control clinical trial comparing sublingual buprenorphine to oral morphine. SETTING: Large, urban, tertiary care hospital. PARTICIPANTS: Twenty-four term infants requiring pharmacological treatment for NAS. MEASUREMENTS: Outcomes were neonatal safety, length of treatment and length of hospitalization. FINDINGS: Sublingual buprenorphine was safe and effective. Infants treated with buprenorphine had a 23-day length of treatment compared to 38 days for those treated with morphine (P = 0.01), representing a 40% reduction. Length of hospital stay in the buprenorphine group was reduced 24%, from 42 to 32 days (P = 0.05). CONCLUSIONS: Sublingual buprenorphine was safe in NAS, with a substantial efficacy advantage over standard of care therapy with oral morphine.

Assessment of radiographic progression in the spines of patients with ankylosing spondylitis treated with adalimumab for up to 2 years.

INTRODUCTION: Ankylosing spondylitis (AS) is a chronic rheumatic disease associated with spinal inflammation that subsequently leads to progression of structural damage and loss of function. The fully human anti-tumor necrosis factor (anti-TNF) antibody adalimumab reduces the signs and symptoms and improves overall quality of life in patients with active AS; these benefits have been maintained through 2 years of treatment. Our objective was to compare the progression of structural damage in the spine in patients with AS treated with adalimumab for up to 2 years versus patients who had not received TNF antagonist therapy. METHODS: Radiographs from patients with AS who received adalimumab 40 mg every other week subcutaneously were pooled from the Adalimumab Trial Evaluating Long-Term Efficacy and Safety for Ankylosing Spondylitis (ATLAS) study and a Canadian AS study (M03-606). Radiographic progression from baseline to 2 years in the spine of adalimumab-treated patients from these two studies (adalimumab cohort, n = 307) was compared with an historic anti-TNF-naïve cohort (Outcome in AS International Study [OASIS], n = 169) using the modified Stoke AS Spine Score (mSASSS) method. RESULTS: mSASSS results were not significantly different between the adalimumab cohort and the OASIS cohort, based on baseline and 2-year radiographs. Mean changes in mSASSS from baseline to 2 years were 0.9 for the OASIS cohort and 0.8 for the adalimumab cohort (P = 0.771), indicating similar radiographic progression in both groups. When results for patients in the OASIS cohort who met the baseline disease activity criteria for the ATLAS and Canadian studies (OASIS-Eligible cohort) were analyzed, there was no significant difference in mean change in mSASSS from baseline to 2 years between OASIS-Eligible patients and adalimumab-treated patients; the mean changes in mSASSS were 0.9 for the OASIS-Eligible cohort and 0.8 for the adalimumab cohort (P = 0.744). CONCLUSIONS: Two years of treatment with adalimumab did not slow radiographic progression in patients with AS, as assessed by the mSASSS scoring system, when compared with radiographic data from patients naïve to TNF antagonist therapy.

Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial.

OBJECTIVE: In utero exposure to drugs of abuse can lead to neonatal abstinence syndrome, a condition that is associated with prolonged hospitalization. Buprenorphine is a partial mu-opioid agonist used for treatment of adult detoxification and maintenance but has never been administered to neonates with opioid abstinence syndrome. The primary objective of this study was to demonstrate the feasibility and, to the extent possible in this size of study, the safety of sublingual buprenorphine in the treatment of neonatal abstinence syndrome. Secondary goals were to evaluate efficacy relative to standard therapy and to characterize buprenorphine pharmacokinetics when sublingually administered. METHODS: We conducted a randomized, open-label, active-control study of sublingual buprenorphine for the treatment of opiate withdrawal. Thirteen term infants were allocated to receive sublingual buprenorphine 13.2 to 39.0 mug/kg per day administered in 3 divided doses and 13 to receive standard-of-care oral neonatal opium solution. Dose decisions were made by using a modified Finnegan scoring system. RESULTS: Sublingual buprenorphine was largely effective in controlling neonatal abstinence syndrome. Greater than 98% of plasma concentrations ranged from undetectable to approximately 0.60 ng/mL, which is less than needed to control abstinence symptoms in adults. The ratio of buprenorphine to norbuprenorphine was larger than that seen in adults, suggesting a relative impairment of N-dealkylation. Three infants who received buprenorphine and 1 infant who received standard of care reached protocol-specified maximum doses and required adjuvant therapy with phenobarbital. The mean length of treatment for those in the neonatal-opium-solution group was 32 compared with 22 days for the buprenorphine group. The mean length of stay for the neonatal-opium-solution group was 38 days compared with 27 days for those in the buprenorphine group. Treatment with buprenorphine was well tolerated. CONCLUSIONS: Buprenorphine administered via the sublingual route is feasible and apparently safe and may represent a novel treatment for neonatal abstinence syndrome.

Comparative safety of atorvastatin 80 mg versus 10 mg derived from analysis of 49 completed trials in 14,236 patients.

Atorvastatin has been shown to reduce coronary events and revascularization procedures in patients with multiple risk factors for coronary heart disease. Recent studies with atorvastatin 80 mg support the overall safety of this dose during long-term treatment. However, physicians appear reluctant to use high doses of statins. A retrospective analysis of pooled data from 49 clinical trials of atorvastatin in 14,236 patients treated for an average period of 2 weeks to 52 months was conducted. The study compared the safety of atorvastatin 10 mg (n = 7,258), atorvastatin 80 mg (n = 4,798), and placebo (n = 2,180) and included analyses on treatment-associated adverse events; nonserious and serious adverse events related to the musculoskeletal, hepatic, and renal systems; the incidence of elevations of creatine kinase >10 times the upper limit of normal (ULN); and hepatic transaminases >3 times ULN. Percentages of patients experiencing > or =1 adverse event were similar across all 3 groups. Withdrawals due to treatment-related adverse events were observed in 2.4%, 1.8%, and 1.2% of patients in the atorvastatin 10 mg, atorvastatin 80 mg, and placebo groups, respectively. Serious adverse events were rare and seldom led to treatment withdrawal with any dose. Treatment-associated myalgia was observed in 1.4%, 1.5%, and 0.7% of patients in the atorvastatin 10 mg, atorvastatin 80 mg, and placebo groups, respectively. No cases of rhabdomyolysis were reported in any group. Persistent elevations in hepatic transaminases >3 times ULN were observed in 0.1%, 0.6%, and 0.2% of patients in the atorvastatin 10 mg, atorvastatin 80 mg, and placebo groups, respectively. The incidence of treatment-associated adverse events for atorvastatin 80 mg was similar to that of atorvastatin 10 mg and placebo. In conclusion, the results of this analysis support the positive safety profile of atorvastatin at the highest dose.