Musculoskeletal pain among Finnish orchestra musicians versus core workforce.

BACKGROUND: Professional musicians show a high prevalence of musculoskeletal pain, but information is limited about prevalence of pain compared to the general populations. AIMS: Our cross-sectional epidemiological study compared the prevalence of musculoskeletal pain between professional orchestra musicians and the working population in Finland. METHODS: Musicians with a permanent contract with all domestic professional symphony and philharmonic orchestras and a population sample of the workforce in Finland completed questionnaires including the same questions on musculoskeletal pain and on various other issues. Cross-sectional data from two population-based and two orchestra-musician studies were analysed by logistic regression model adjusting for confounding factors. RESULTS: In 2002, 345 musicians completed questionnaires (40% response rate), and in 2010, 195 (23%). The Health 2000 study sample comprised 5956 employed participants and in 2011, 5942. Musicians reported, in 2002 and in 2010, back pain during the past 30 days more often than did controls, 39% versus 27%, adjusted odds ratio (95% confidence interval, CI) 1.5 (1.2-1.9); shoulder pain, 21% versus 9%, 2.6 (1.9-2.5); elbow pain, 14% versus 5%, 2.9 (2.0-4.2); wrist pain 14% versus 7%, 2.2 (1.5-3.1); and finger pain 13% versus 9%, 2.8 (2.0-3.9). Prevalence of musculoskeletal pain increased with age in controls but not in musicians. CONCLUSIONS: Professional orchestra musicians reported more pain in the back and upper extremity than other working people. Future research should focus on explaining differences in the occurrence of musculoskeletal disorders between musicians and the general population.

The importance of radiological results in distal radius fracture operations: Functional outcome after long-term (6.5 years) follow-up.

BACKGROUND AND AIMS: Whether or not radiological results correlate with functional outcome after operative treatment of distal radius fractures still remains controversial. We carried out a retrospective study to analyse the long-term (6.5 year) outcome of radius fractures treated by means of surgery in our hospital. The aim of the study was to explore whether step-off on radius joint surface, shortening of the radius versus ulnar height and dorsal or volar tilt of the radius correlate with long-term Patient-Rated Wrist Evaluation or Quick Disability of the Arm, Shoulder and Hand scores among 100 consecutive patients after surgical treatment. MATERIALS AND METHODS: Of these, 60 patients (63 wrists) participated. They were examined radiologically, clinically and by means of a questionnaire. RESULTS: Shortening of the radius correlated significantly with both Patient-Rated Wrist Evaluation and Quick Disability of the Arm, Shoulder and Hand scores. Step-off on the radius joint surface correlated significantly with worse PRWE scores, with no difference in Quick Disability of the Arm, Shoulder and Hand evaluation. Dorsal or volar tilt showed no statistical correlation (though it was mild in this group). The age of the patients (below 60 years vs 60 years or above) did not affect the PRWE or Quick Disability of the Arm, Shoulder and Hand results. CONCLUSION: Our results indicate that when it comes to conserving the radial height and congruence of the joint surface, the more precise the reduction of the fracture achieved by surgical means, the better the functional outcome.

Initial Electromyography Fails to Predict Long-Term Outcome of Isolated Serratus Palsy.

BACKGROUND AND AIMS:: The course of isolated serratus palsy is difficult to predict, especially if, in initial electromyographic examination, long thoracic nerve function is totally absent. How initial electromyography correlates with long-term outcome of isolated serratus palsy is unknown. We evaluated initial electromyographic examinations of isolated serratus palsy patients and compared these to their long-term outcome. We hypothesized that long-term outcome after electromyographic examination-verified partial nerve injuries is better than that seen in cases of total nerve injuries. PATIENTS AND METHODS:: We retrospectively reviewed 90 patients with isolated serratus palsy and with initial electromyographic examination treated by brace or observation only, by determining pain, range of motion, and degree of scapular winging after a mean follow-up of 17.8 years. RESULTS:: Initial electromyographic examination showed total denervation in 21 cases (22%), partial severe denervation in 30 (33%), and partial moderate or slight denervation in 39 (44%). Recovery of serratus muscle function occurred in 17/21 cases (81%) of total denervation and in 47/69 cases (68%) of partial denervation, p = 0.247. Mean flexion in total denervation recovered to 152° and in partial to 157°, p = 0.301, and abduction to 173° and 174°, p = 0.970. In total denervation, 60% of patients were pain-free, in partial, 48%, p = 0.338. The duration of scapular winging among those 42 who subjectively recovered averaged 15.1 months, in 13 patients with total denervation 15.9 months, and in 29 patients with partial denervation 14.7 months (p = 0.599). CONCLUSION:: Initial electromyographic examination does not predict clinical outcomes: ROM, pain, scapular winging and strength, but partial denervation may negatively predict subjective outcome.

Optimal time for manipulation of frozen shoulder may be between 6 and 9 months.

BACKGROUND AND AIMS: Idiopathic frozen shoulder can be successfully treated conservatively. Manipulation under anesthesia, in randomized controlled studies, has proven to bring no additional benefit to other treatments. However, manipulation under anesthesia still is a used method mainly among patients with unbearable pain or too longstanding restriction of shoulder motion. Manipulation under anesthesia may lead to significant improvement in shoulder motion and function. However, the best timing for manipulation under anesthesia is still unclear. We therefore investigated whether timing of manipulation under anesthesia has influence on the results of manipulation under anesthesia, concerning range of motion, pain, and function. MATERIAL AND METHODS: We followed 57 patients (65 shoulders; 31 in women) at 2-14 years after manipulation under anesthesia evaluating range of motion, pain, and function. Their mean age at manipulation under anesthesia was 54.0 years. A total of 10 patients had diabetes. The time between the onset of symptoms and manipulation averaged 8.8 months. We formed two groups, those mobilized between 6 and 9 months after the onset of symptoms (Group A, 25 shoulders), and the others (Group B, 40 shoulders). We recorded visual analog scale pain, range of motion, Simple Shoulder Test, and Constant-Murley scores. RESULTS: Patients manipulated between 6 and 9 months after the onset of symptoms had significantly better abduction and external rotation, less pain at rest and at night, and better Simple Shoulder Test than the others. CONCLUSIONS: It seems that timing has statistically significant influence on results of manipulation of the idiopathic frozen shoulder. The best time for manipulation under anesthesia, if non-operative treatment has failed to alleviate pain or limitation of shoulder motion is too cumbersome, might be between 6 and 9 months from the onset of the symptoms. However, the clinical importance of results can be questioned.

Postoperative stiff shoulder after open rotator cuff repair: a 3- to 20-year follow-up study.

BACKGROUND AND AIMS: Stiffness after a rotator cuff tear is common. So is stiffness after an arthroscopic rotator cuff repair. In the literature, however, postoperative restriction of passive range of motion after open rotator cuff repair in shoulders with free passive range of motion at surgery has seldom been recognized. We hypothesize that this postoperative stiffness is more frequent than recognized and slows the primary postoperative healing after a rotator cuff reconstruction. We wondered how common is postoperative restriction of both active and passive range of motion after open rotator cuff repair in shoulders with free passive preoperative range of motion, how it recovers, and whether this condition influences short- and long-term results of surgery. We also explored factors predicting postoperative shoulder stiffness. MATERIAL AND METHODS: We retrospectively identified 103 postoperative stiff shoulders among 416 consecutive open rotator cuff repairs, evaluating incidence and duration of stiffness, short-term clinical results and long-term range of motion, pain relief, shoulder strength, and functional results 3-20 (mean 8.7) years after surgery in 56 patients. RESULTS: The incidence of postoperative shoulder stiffness was 20%. It delayed primary postoperative healing by 3-6 months and resolved during a mean 6.3 months postoperatively. External rotation resolved first, corresponding to that of the controls at 3 months; flexion and abduction took less than 1 year after surgery. The mean summarized range of motion (flexion + abduction + external rotation) increased as high as 93% of the controls' range of motion by 6 months and 100% by 1 year. Flexion, abduction, and internal rotation improved to the level of the contralateral shoulders as did pain, strength, and function. Age at surgery and condition of the biceps tendon were related to postoperative stiffness. CONCLUSIONS: Postoperative stiff shoulder after open rotator cuff repair is a common complication resolving in 6-12 months with good long-term results.