Structural alterations and pain perception at the ankle joint in patients with haemophilia.

BACKGROUND: Patients with haemophilia (PwH) suffer from chronic pain due to joint alterations induced by recurring haemorrhage. OBJECTIVES: This study aimed to investigate the relationship between structural alterations and pain perception at the ankle joint in PwH. PATIENTS/METHODS: Ankle joints of 79 PwH and 57 healthy controls (Con) underwent ultrasound examination (US) and assessment of pain sensitivity via pressure pain thresholds (PPT). US discriminated between joint activity (synovitis) and joint damage (cartilage and/or bone degeneration) applying the HEAD-US protocol. Based on US-findings, five subgroups were built: PwH with activity/damage, PwH with activity/no damage, PwH with no activity/no damage, controls with activity/no damage and controls with no activity/no damage. RESULTS: Joint activity and joint damage were significantly increased in ankles of PwH compared to Con (p ≤.001). Subgroup analysis revealed that structural alterations negatively impact pain perception. This is particularly evident when comparing PwH with both activity/damage to PwH with no activity/no damage at the tibiotalar joint (p = .001). At the fibulotalar joint, no significant differences were observed between PwH subgroups. Further analysis showed that both joint activity and joint damage result in an increase in pain sensitivity (p ≤.001). CONCLUSION: The data suggest a relation between joint activity, joint damage and pain perception in PwH. Even minor changes due to synovitis appear to affect pain perception, with the effect not intensifying at higher levels of inflammation. In terms of joint damage, severe degeneration leads to a sensitised pain state most robustly, whereas initial changes do not seem to significantly affect pain perception.

Long-term outcome of arthroscopic debridement of massive irreparable rotator cuff tears.

OBJECTIVES: To evaluate the clinical and radiographic outcome of low-demand patients with massive rotator cuff tears undergoing arthroscopic debridement in mid- and long-term follow-up, as well as the rate of conversion to reverse shoulder arthroplasty. METHODS: We performed a retrospective analysis of 19 patients with a mean age at surgery of 68 years (range, 55-80 years) from a previously described consecutive cohort and after a mean follow up of 47 month (FU1) and 145 month (FU2). The functional outcome was evaluated with the VAS score, the American Shoulder and Elbow Surgeons (ASES) score, and the age- and gender-adjusted Constant (aCS) score. The radiographic outcome was classified according to the Hamada classification. Non-parametric analyses were carried out with the Mann-Whitney U for independent samples and the Wilcoxon signed-rank test for related samples. RESULTS: Five patients (26%) developed symptomatic cuff tear arthropathy and underwent reverse shoulder arthroplasty after a mean time of 63 months (range, 45-97 months). These patients were excluded from further analyses. The mean VAS score of the remaining 14 patients at FU1 was significantly lower compared to preoperatively (P = .041), while there were no significant differences between the VAS score at FU1 and FU2 (P = 1.0). The ASES score of the affected shoulder at FU1 was significantly higher compared to prior to surgery (P = .028), while there were no significant differences between the scores of the affected shoulder between FU1 and FU2 (P = .878). While the ASES score of the contralateral shoulder at FU1 was significantly higher than the score of the affected shoulder (P = .038), there were no significant differences in the ASES scores of the affected and the healthy shoulder at FU2 (P = .575). The evaluation of the aCS produced similar results. A progression of the Hamada grade was documented in 6 patients. CONCLUSIONS: Arthroscopic debridement is a safe and valid option for low-demand middle-age or elderly patients with symptomatic massive rotator cuff tears, leading to a significant pain relief and significantly improved functional outcome at mid- and long-term follow up. However, about a quarter of the patients in our cohort had to undergo reverse shoulder arthroplasty due to symptomatic cuff tear arthropathy. Furthermore, some of the remaining patients continued to undergo radiographic progression. This might be due to the natural history of their disease and/or the surgical procedure, and the clinical relevance of this finding should be evaluated in further studies.

Gorham-Stout disease: good results of bisphosphonate treatment in 6 of 7 patients.

Background and purpose - Gorham-Stout disease (GSD) is a rare mono- or polyostotic condition characterized by idiopathic intraosseous proliferation of angiomatous structures resulting in progressive destruction and resorption of bone. Little is known about the course of disease and no previous study has evaluated patients' quality of life (QoL).Patients and methods - This is a retrospective analysis of 7 consecutive patients (5 males) with a median age at diagnosis of 14 years and a median follow-up of 7 years who were diagnosed with GSD in our department between 1995 and 2018. Data regarding clinical, radiographic, and histopathological features, and treatment, as well as sequelae and their subsequent therapy, were obtained. QoL was assessed by Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), and Reintegration to Normal Living (RNL) Index.Results - 3 patients had a monoostotic and 4 patients a polyostotic disease. Besides a diagnostic biopsy, 4 of the 7 patients had to undergo 8 surgeries to treat evolving sequelae. Using an off-label therapy with bisphosphonates in 6 patients, a stable disease state was achieved in 5 patients after a median of 20 months. The median MSTS, TESS, and RNL Index at last follow-up was between 87% and 79%.Interpretation - Due to its rare occurrence, diagnosis and treatment of GSD remain challenging. Off-label treatment with bisphosphonates appears to lead to a stable disease state in the majority of patients. QoL varies depending on the individual manifestations but good to excellent results can be achieved even in complex polyostotic cases with a history of possibly life-threatening sequelae.

Adaptive Changes on the Dominant Shoulder of Collegiate Handball Players-A Comparative Study.

Vogler, T, Schorn, D, Gosheger, G, Kurpiers, N, Schneider, K, Rickert, C, Andreou, D, and Liem, D. Adaptive changes on the dominant shoulder of collegiate handball players-A comparative study. J Strength Cond Res 33(3): 701-707, 2019-Handball players are susceptible to adaptive bony and soft-tissue changes of the dominant shoulder. Our goal was to compare the glenohumeral range of motion and posterior capsule thickness between the dominant and nondominant arm of throwing athletes and between the dominant arm of nonthrowers and throwing athletes. Twenty-three collegiate handball players and 23 nonthrowing athletes underwent an examination of the dominant and the nondominant shoulder. Humeral retroversion and posterior capsule thickness were assessed with an ultrasound examination, whereas external rotation and internal rotation were determined with a digital inclinometer. The dominant shoulder of handball players had a significantly higher external rotation compared with their nondominant shoulder and the dominant shoulder of nonthrowing athletes. Furthermore, the dominant shoulder of handball players had a significantly lower internal rotation compared with their nondominant shoulder, with no differences compared with the dominant shoulder of the nonthrowing athletes. There was a trend for an increased posterior capsule thickness and an increased humeral retroversion between the dominant and the contralateral shoulder of handball players. Moreover, we found a significant increase in the capsule thickness of the dominant shoulder of throwing athletes compared with the dominant shoulder of nonthrowers. However, there were no differences in humeral retroversion. Our analysis suggests that a comparison of the dominant shoulder of overhead throwing athletes with the dominant shoulder of nonthrowing athletes might be more appropriate than the comparison of the dominant and the nondominant shoulder to evaluate the adaptive changes on the dominant side.

Probing the band gap of liquid ammonia with femtosecond multiphoton ionization spectroscopy.

The electronic band gap, i.e. the energy difference between the top of the valence band and the bottom of the conduction band, is widely recognized as the key property characterizing the electronic structure of bulk liquids and liquid solvents like water or ammonia. Here, the band gap of liquid ammonia at 270 K and 300 bar was studied with 2-photon ionization spectroscopy using the solvated electron primary yield as a near-infrared action-spectroscopic probe. The experimentally determined escape probability, which is the fraction of solvated electrons that is able to avoid geminate recombination within the first nanosecond after ionization, was used to extract a value of -(1.27 ± 0.03) eV for the vertical electron affinity of the liquid.

Risk factors for acute injuries and overuse syndromes of the shoulder in amateur triathletes - A retrospective analysis.

OBJECTIVES: To investigate the prevalence of shoulder-related acute and overuse injuries in triathletes and examine the role of possible risk factors, in order to identify potential preventive measures. METHODS: We performed a retrospective epidemiologic study of 193 amateur triathletes between June and August 2013 and evaluated their competition and training habits, as well as the presence of acute and overuse injuries of the shoulder sustained during the past 12 months. Contingency tables were analyzed using Pearson's chi-squared test. Normally distributed data were compared with the independent samples t-test, while non-parametric analyses were performed with the Mann-Whitney U test. Binary logistic regression was used to identify important predictors of injuries. RESULTS: 12 participants (6%) sustained acute injuries and 36 athletes experienced an overuse injury. The acute injury rate amounted to 0.11 per 1000 hours of training and the overuse injury rate to 0.33 per 1000 hours of training. There was no association between athletes' age, height, weight, BMI, a history of shoulder complaints or triathlon experience in years and acute or overuse injuries. Male athletes had a trend for sustaining more acute injuries then female athletes (8% vs. 2%, p = 0.079). Athletes with acute injuries spent a significantly higher amount of time per week doing weight training (p = 0.007) and had a trend for a higher weekly duration of cycling training (p = 0.088). Athletes with overuse injuries participated in a significantly higher number of races compared to athletes without overuse injuries (p = 0.005). The regular use of paddles was associated with a significantly higher rate of overuse injuries (24% vs. 10%, p = 0.014). CONCLUSION: The regular use of paddles during swimming training appears to be a risk factor for the development of overuse injuries, while an increased duration of weight and cycling training seems to be associated with a higher rate of acute injuries.

Long-term outcomes after combined arthroscopic medial reefing and lateral release in patients with recurrent patellar instability - a retrospective analysis.

BACKGROUND: There is currently no consensus regarding the optimal surgical treatment method for patients with recurrent patella instability. Our goal was to evaluate the long-term results of combined arthroscopic medial reefing and lateral release, to identify possible risk factors for recurrent dislocations and residual complaints after surgical treatment and to assess functional outcome. METHODS: We performed a retrospective study of 38 patients (43 knees) treated with all-inside technique between 2001 and 2010. The functional outcome was evaluated with the Kujala score, while pain intensity was scored on a visual analogue scale (VAS). Contingency tables were analysed with Fisher's exact test. Non-parametric analyses were carried out with the Mann-Whitney U and the Wilcoxon signed-rank test. Survival curves were calculated with the Kaplan-Meier method and compared with the log-rank test. RESULTS: The median age at surgery was 16 years (range, 9-44 years) and the median follow-up amounted to 9.7 years (range, 4.7-14.7 years). Residual complaints were present in 34 cases (79%). Patients with residual complaints had a trend for a higher body mass index (BMI) at surgery (25.7 vs. 21.6, P = .086). Twenty-two cases had recurrent dislocation after a median interval of 30 months. The probability of recurrent dislocations amounted to 16% after 1 year and 52% after 10 years. There were no significant differences in the presence of residual complaints (P = .721) and median VAS score (P = .313) between patients with or without recurrent dislocation. Patients with recurrent dislocations had a trend towards younger age at surgery (15 vs. 18 years, P = .076). The median Kujala score of the affected knee was 81. Patients with recurrent dislocations had a significantly lower score compared to patients without recurrent dislocations (67 vs. 91, P < .001). CONCLUSIONS: The combined arthroscopic lateral release with medial reefing does not appear to be an adequate treatment for patients with chronic patellar instability in long-term follow-up. Younger patients might be at a higher risk for recurrent dislocations, while a higher BMI at surgery might be associated with residual complaints.

Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial.

PURPOSE: Purpose of the present study was to investigate the acute effects of a cold compression bandage on pain, swelling and skin-surface temperature after the first 24 h after arthroscopic surgery of the shoulder in a stationary setting and to compare it with cold therapy using only a cold pack. It was hypothesized that using the bandage is more effective in reducing pain and swelling after 24 h compared with using only a cold pack. METHODS: Fifty-two patients (53 ± 12.2 years) were randomly assigned to two groups after arthroscopic surgery. The first group wore a cold compression bandage, and the second group a conventional frozen cold pack. Pain, swelling and skin-surface temperature were measured 2, 8 and 24 h after surgery. Differences within and between groups were analysed. RESULTS: Both groups showed a significant reduction of the circumference of the arm 15 and 20 cm proximal of the lateral epicondyle 24 h after surgery (cold compression: p = 0.003; p < 0.001; cold: p < 0.001). Pain at rest was significantly reduced with cold compression bandage 24 h after surgery (p = 0.001). Skin temperature increased in both groups 24 h after surgery (bandage: p < 0.001; cold pack: p = 0.002). After 24 h, pain during activity was significantly decreased in the group wearing the bandage compared with the group using the cold pack (p = 0.026). CONCLUSIONS: Based on the results of this study, no recommendation can be made with respect to the question whether cold compression therapy or cold therapy should be preferred immediately after arthroscopic surgery of the shoulder. Clinicians should question the need of expensive cold compression bandages in the short-term post-operative treatment after arthroscopic surgery of the shoulder. LEVEL OF EVIDENCE: II.

The prevalence of rotator cuff tears: is the contralateral shoulder at risk?

BACKGROUND: Rotator cuff tears are a common cause of pain and disability of the shoulder. Information on the prevalence and identification of potential risk factors could help in early detection of rotator cuff tears and improve treatment outcome. HYPOTHESIS: Patients treated for a symptomatic rotator cuff tear on one side have a higher prevalence of rotator cuff tears and decreased shoulder function on the contralateral side compared with an age- and sex-matched group of healthy individuals. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: One group consisted of 55 patients who had been arthroscopically treated on one shoulder for rotator cuff tear (tear group). In this group, the nonoperated contralateral shoulder was examined. For comparison, the matching shoulder in a control group consisting of 55 subjectively healthy individuals matched by age (±1 year) and sex to the tear group was included. Diagnosis of a rotator cuff tear was made by ultrasound. Outcomes were measured using the Constant score. RESULTS: The prevalence of supraspinatus tears was significantly higher (P < .0001) in the tear group (67.3%) compared with the control group (11.0%). The Constant score for the activities of daily living subscale, however, was significantly lower (18.4) in the tear group compared with the control group (19.9; P = .012). No other subcategory score nor the overall score showed a significant difference. There was a significantly higher tear prevalence in the tear group of patients aged between 50 and 59 years (P < .001) and 60 and 69 years (P = .004). No tear was diagnosed in the control group in individuals younger than 60 years. CONCLUSION: Patients treated for partial and full-thickness rotator cuff tears have a significantly higher risk of having a tear on the contralateral side and have noticeable deficits in their shoulder function regarding activities of daily living even if the tear is otherwise asymptomatic.

Acromial morphology in patients with calcific tendinitis of the shoulder.

PURPOSE: The purpose of this study was to evaluate whether the morphology of the acromion in calcific tendinitis differs from controls without subacromial pathology and matches subacromial impingement. METHODS: Digital radiographs of 150 shoulders were evaluated with the open source DICOM-Viewer OsiriX. 50 patients had symptomatic calcific tendinitis of the shoulder, 50 had subacromial impingement without calcifications or rotator cuff tears, 50 with bruised shoulder that were previously asymptomatic served as controls. Acromial shape according to Bigliani et al. acromial tilt (AT) according to Kitay et al. and Aoki et al. acromion index (AI) according to Nyffeler et al. and lateral acromial angle (LAA) according to Banas et al. were measured. RESULTS: Both calcific (0.72; P = 0.001) and impingement groups (0.73; P = 0.008) were significantly different from controls (0.67) using AI measure, while only the calcific group (79.5°) was different from controls (84.1°) using LAA (P < 0.001), and only the impingement group (32.9°) was different from controls (29.2°) using AT (P < 0.001). An LAA <70° only occurred in two patients with calcific tendinitis. CONCLUSION: The hypothesis of this study was that the morphology of the acromion in calcific tendinitis differs from controls without subacromial pathology and matches subacromial impingement was only confirmed for the AI. The AI of shoulders with calcific tendinitis is comparable to that of shoulders with subacromial impingement.