Determinants of pain intensity and magnitude of incapability more than two years after arthroscopic Bankart repair for anterior shoulder instability.

Background: Individuals treated with arthroscopic Bankart repair after anterior shoulder dislocations experience varied discomfort and incapability. The aim of this study was to determine the relative association of mental health and physical health factors with 1) magnitude of capability and 2) pain intensity 2 or more years after surgery. Methods: This cross-sectional study evaluated 80 military patients that experienced one or more traumatic anterior shoulder dislocations a minimum of 2 years after arthroscopic Bankart repair without remplissage. We measured capability (Oxford Shoulder Instability Score), pain intensity using an 11-point ordinal scale, symptoms of anxiety (Generalized Anxiety Disorder-2 questionnaire), symptoms of depression (Patient Health Questionnaire-2), catastrophic thinking (Pain Catastrophizing Scale-4), and kinesiophobia (Tampa scale for kinesiophobia-4). We also identified preoperative presence of a Hill-Sachs lesion on radiographs and postoperative occurrence of subluxation or a dislocation episode. A negative binominal regression analysis sought factors associated with magnitude of incapability and pain intensity. Results: Greater incapability was strongly associated with both greater kinesiophobia (Regression Coefficient [RC] = -0.50; 95% confidence interval [CI] = -0.73 to -0.26; P ≤ .01) and repeat surgery (RC = -0.27; 95% CI = -0.41 to -0.13; P ≤ .01). Greater pain intensity was only strongly associated with greater kinesiophobia (RC = 0.25; 95% CI = 0.039 to 0.46; P = .021). Conclusion: The observation that greater unhelpful thinking is associated with greater pain intensity and greater magnitude of incapability after a Bankart repair for anterior shoulder instability, whereas pathophysiological factors such as glenoid bone loss were not, emphasizes the degree to which mindset is associated with musculoskeletal health.

Is the feeling of 'weakness' associated with unhelpful thoughts or distress regarding symptoms?

This cross-sectional study looked for factors associated with feelings of weakness, level of capability and pain intensity in people seeking musculoskeletal speciality care for non-traumatic upper extremity conditions. A survey was conducted in 139 English-speaking adults, with 135 participants completing it. We found that greater intensity of feelings of weakness correlated with higher distress regarding symptoms and with older age. Lower level of capability was associated with greater intensity of feelings of weakness, greater distress regarding symptoms and older age. Higher pain intensity was associated with greater distress regarding symptoms and greater intensity of feelings of weakness. These findings suggest that the symptom of weakness may be a cue to explore potential distress about symptoms in addition to examining for actual weakness. This understanding could be a guide to a more compassionate approach to alleviate distress rather than focusing on neuromuscular pathophysiology alone, with the potential to reduce unnecessary tests and treatments.Level of evidence: IV.

Magnitude of Incapability and Pain Intensity are Associated More with Unhelpful Thoughts Than Stressful Life Events.

Prior studies show that stressful life events are associated with greater magnitude of incapability and symptom intensity. We sought to understand the association of such events (i.e., both adverse childhood experiences and recent difficult life events [DLEs]) alongside feelings of worry or despair and unhelpful, on the magnitude of incapability and symptom intensity in musculoskeletal patients. One hundred and thirty-six patients presenting for musculoskeletal specialty care completed measures of incapability, pain intensity, adverse childhood experiences, DLEs in the last year, unhelpful thoughts, symptoms of anxiety and depression, and sociodemographic factors. Factors associated with the magnitude of incapability and pain intensity were sought in multivariable analysis. Accounting for potential confounders, greater incapability was associated with greater unhelpful thoughts (RC = -0.81; 95% CI = -1.2 to -0.42; P ≤ .001), but not with stressful life events (either during childhood or more recently). Greater pain intensity was associated with greater unhelpful thoughts(RC = 0.25; 95% CI = 0.16 to 0.35; P ≤ .001) and being divorced or widowed (RC = 1.8; 96% CI = 0.43 to 3.2; P = .011), but again, not with stressful life events. The strong association of unhelpful thoughts with magnitude of incapability and pain intensity can motivate musculoskeletal specialists to anticipate patients expressing negative pain thoughts and behaviors. Future studies might account for social and environmental context behind stressful life events and the influence of resiliency and pain-coping strategies on these interactions. Level of Evidence: Level III, prognostic study.

Treatment of acromioclavicular dislocations with a concomitant coracoid fracture: a systematic review of 37 patients.

Background: Acromioclavicular (AC) dislocations with a concomitant fracture of the coracoid process (CP) are rare and there is ambiguity on treatment options. This systematic review was performed to address the clinically relevant question: what are the shoulder functions, union rates, and expected time until return to daily life in patients with a dislocation of the AC joint with a concomitant CP fracture after (1) nonsurgical treatment, (2) sole fixation of the AC joint, and (3) fixation of both the AC joint and the coracoid process? Methods: Studies were identified by conducting an online. Thirty records met the inclusion criteria and were suitable for data extraction. Results: A total of 37 shoulders from 37 patients were included. Surgical treatment was provided to 22 out of 37 patients, and 15 patients had nonsurgical treatment. Out of the surgically treated patients, 12 patients were treated with a fixation of both the AC joint and the CP, 9 patients with a sole fixation of the AC joint, and 1 patient with a sole fixation of the CP. Conclusion: Existing literature does not indicate that one treatment option is superior, and more data are needed to guide evidence-based decisions on this rare injury.