Pectoralis major rupture repair with Achilles tendon allograft in 22 bodybuilding athletes.

BACKGROUND: Pectoralis major tendon rupture rate is increasing due to increased tendency to bodybuilding exercises, specially the bench press workout, and weight-lifting. The aim of this study was to determine the results of pectoralis major rupture repair with Achilles tendon allograft in bodybuilding athletes. METHODS: In this case series study, 22 bodybuilding athlete patients (24 pectoralis major ruptures) were undergone open surgical repair during January 2016 till December 2020. 21 ruptures were chronic (2 ruptures were revision) and 3 ruptures were acute. Surgical method was based on Achilles tendon allograft used to augment the ruptured site for lengthening the shortened tendon.The results were analyzed using Bak's criteria and Constant score in pre operation visit and 6th and 12th months and in the last follow up. RESULTS: All cases were male with the mean age of 32.1 ± 5.4. The mean duration time between injuries to surgery was 37 ± 46 month (1-182 months). Return to professional sport began at 10.9 ± 2.8 months after surgery in which 16 cases (66.7%) have returned to their pre surgery bench press workout records. No infection or hematoma occurred. At the final follow-up, Bak criteria demonstrated excellent, good and fair in 4, 18 and 2 shoulders respectively. The constant score increased from 87.9 ± 7.9 in pre operation visit to 92.7 ± 6.4 in the last follow up (P < 0.001). CONCLUSIONS: It seems that our surgical method is an effective approach in cases with acute or chronic pectoralis major ruptures. LEVEL OF EVIDENCE: Level IV.

Transfer of the Long Head Biceps Tendon to Conjoined Tendon in Proximal Humerus Fractures with Cleavage or Comminution at the Bicipital Groove.

Objective: To evaluate the clinical and radiographic findings of long head biceps tendon (LHBT) transfer in traumatic proximal humeral fractures with the biceps groove breakage or comminution. Methods: In this interventional study, subjects surveyed in terms of shoulder function, clinical signs of LHBT tendinitis, radiographic signs of transferred biceps as a possible depressor of the shoulder, and mechanical changes of the scapula. Data were analyzed in SPSS version 21. Results: Fifteen patients were included in the case group (tendon transfer to the conjoined tendon), and 10 patients were evaluated in the control group (non-transfer or non-manipulation of the exposed tendon in the fracture callus of biceps groove). The mean age of the study population was 46.56±14.31 years, and the majority of patients (14.56%) were men. The differences between two groups were not significant in terms of the American Society of Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score, and constant shoulder score (CSS) (p=0.535, p=0.419, and p=0.266, respectively). Also, there was no significant differences between the case and control groups regarding the biceps muscle involvement (Popeye sign: p=1.00; tenderness: p=0.477; pain: p=1.00; speed test: p=1.00; Yergason's test: p=1.00). Conclusion: LHBT transfer to the conjoined tendon in proximal humerus fractures with cleavage or comminution at the bicipital groove showed no advantages.

Horizontal instability after acromioclavicular joint reduction using the two-hole technique is preferred over the loop technique: a single-blind randomized clinical trial.

BACKGROUND: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique. METHODS: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery. RESULTS: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups. CONCLUSIONS: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

Can indirect magnetic resonance arthrography be a good alternative to magnetic resonance imaging in diagnosing glenoid labrum lesions?: a prospective study.

BACKGROUND: This study was designed to evaluate and compare the diagnostic value of magnetic resonance imaging (MRI) and indirect magnetic resonance arthrography (I-MRA) imaging with those of arthroscopy and each other. METHODS: This descriptive-analytical study was conducted in 2020. All patients who tested positive for labrum lesions during that year were included in the study. The patients underwent conservative treatment for 6 weeks. In the event of no response to conservative treatment, MRI and I-MRA imaging were conducted, and the patients underwent arthroscopy to determine their ultimate diagnosis and treatment plan. Imaging results were assessed at a 1-week interval by an experienced musculoskeletal radiologist. Image interpretation results and arthroscopy were recorded in the data collection form. RESULTS: Overall, 35 patients comprised the study. Based on the kappa coefficient, the results indicate that the results of both imaging methods are in agreement with the arthroscopic findings, but the I-MRA consensus rate is higher than that of MRI (0.612±0.157 and 0.749±0.101 vs. 0.449±0.160 and 0.603±0.113). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI in detecting labrum tears were 77.77%, 75.00%, 91.30%, 50.00%, and 77.14%, respectively, and those of I-MRA were 88.88%, 75.00%, 92.30%, 66.66%, and 85.71%. CONCLUSIONS: Here, I-MRA showed higher diagnostic value than MRI for labral tears. Therefore, it is recommended that I-MRA be used instead of MRI if there is an indication for potential labrum lesions.

Role of suprascapular nerve block in idiopathic frozen shoulder treatment: a clinical trial survey.

BACKGROUND: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy. METHODS: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention. RESULTS: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001). CONCLUSIONS: Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

Epidemiology of Generalized Ligamentous Laxity in Iran: A National Study Including Different Iranian Ethnic Groups and its Relationship with Musculoskeletal Disorders.

Background: Ligamentous laxity is a condition that leads to joints' hypermobility beyond their average and normal range of motion. It can cause musculoskeletal and joint injuries. This national multi-centered study investigated the epidemiology of generalized ligamentous laxity and its relationship with musculoskeletal disorders among Iranian adults with different ethnic backgrounds. Methods: A total of 1,488 people (age range: 17-40 years) were selected from eight cities and six different ethnicities of Iran and included in this cross-sectional study. The presence of ligamentous laxity with clinical examinations was searched according to Beighton score criteria. They were also examined for any kind of musculoskeletal disorders that might accompany ligamentous laxity. The Chi-square test was used to compare the frequency of ligamentous laxity based on gender and ethnicity; moreover, the t-test was utilized to compare the frequency of ligamentous laxity based on age. Results: In total, 280 (18.8%) participants had generalized ligamentous laxity, and it was more prevalent in women (22.7%), compared to men (14.4%). Regarding ethnicity, the highest and lowest prevalence rates were in Gilak (37.9%) and Persian-Arab (6%) ethnicities, respectively (P<0.001). Ligamentous laxity showed a significant relationship with sports injury, joint complaint, joint dislocation, ligament sprain, sciatica and back pain, Baker's cyst, and varicose veins (P<0.001). Most participants with generalized ligamentous laxity (93.6%) had no knowledge of their problem and its importance in choosing an appropriate sports activity. Conclusion: The prevalence of generalized ligamentous laxity seems to be relatively high among the 17-40-year-old population of Iran, especially in women. It seems to be significantly related to ethnicity. It is strongly recommended that examinations, screening, and information be provided at an early age in schools or at least in areas with a high prevalence as national programs.

Rotator cuff repair with or without proximal end detachment for long head of the biceps tendon tenodesis.

BACKGROUND: Rotator cuff tears cause pathologies of the long head of the biceps tendon (LHBT). One of the surgical treatments for such a tear is LHBT tenodesis to the humerus. This study aims to compare simultaneous rotator cuff repair and LHBT tenodesis with or without detachment of the proximal end of the LHBT (PELHBT) from its site of adhesion to the glenoid. METHODS: This retrospective study involved patients affected by LHBT pathology with rotator cuff tear. The patients were divided into two groups, with or without PELHBT detachment from the glenoid. Therapeutic outcomes were investigated by evaluation of patient satisfaction, pain based on visual analog scale, shoulder function based on Constant score and simple shoulder test, and biceps muscle strength based on the manual muscle testing grading system before surgery, at 6 months, and at the final visit after surgery. RESULTS: Groups 1 and 2 comprised 23 and 26 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). Shoulder function, biceps muscle strength, pain, and satisfaction rate improved over time (p<0.05) but were not significantly different between the two groups (p>0.05). No post-surgical complication was found in either group. CONCLUSIONS: There was no difference in final outcomes of tenodesis with or without detachment of the PELHBT from the supraglenoid tubercle. Such tendon detachment is not necessary.

Outcome of open reduction and Kirschner wire fixation in pediatric radial neck fracture.

BACKGROUND: Radial neck fracture in children is rare. This study attempted to evaluate the outcome of surgically treated patients and any associated complications. METHODS: This study evaluated 23 children under 15 years of age with radial neck fracture who were treated with open reduction between 2006 and 2016 to determine their range of motion, postoperative complications, and radiographic outcomes. The results were assessed clinically using the Mayo clinic elbow performance score. RESULTS: The mean follow-up duration for patients was 34.6 months. The average postoperative angulation was 3.6°. Hypoesthesia was reported in only 9% of patients, and none of the patients complained of postoperative pain. The postoperative X-ray results were excellent in 60% and good in 40%. No radiographic complications were identified. The elbow score was excellent in 87% and good in 13% (mean score, 96.74). There was a statistical relationship between range of motion limitations and age, degree of fracture, initial displacement, and surgical pin removal time. CONCLUSIONS: Although most patients accept the closed reduction method as a primary treatment, the present study suggests that an open-reduction approach has been associated with optimal therapeutic outcomes for patients in whom closed reduction was not satisfactory or indicated.

Arthroscopic release in adhesive capsulitis of the shoulder: a retrospective study with 2 to 6 years of follow-up.

BACKGROUND: This study aimed to evaluate the response rate to arthroscopic release treatment in adhesive capsulitis of the shoulder (ACS) for patients with refractory to conservative treatment. METHODS: In this retrospective study, 51 patients (age mean, 49.1±5.6 years) with unilateral adherent capsule underwent arthroscopic releasing surgery for the shoulder capsule. Etiologies of the ACS in 30 patients were idiopathic: 10 patients were affected after surgery and 11 patients following trauma. The patients were evaluated in terms of shoulder function, satisfaction rate, pain intensity, and joint range of motion (ROM) based on a Constant score, a Simple Shoulder Test, the visual analog scale, and four movements, respectively. RESULTS: The mean Constant score before surgery was 48.2±3.5 and reached 74.4±6 and 77.0±6.3 at 6 months and the final follow-up, respectively (p<0.001). The mean scores of pain intensity, a Simple Shoulder Test, and ROM showed significant improvement at all follow-ups (p<0.001). Sex, age, and diabetes did not have any significant effect on patient recovery. However, patients who experienced ACS after surgery had poorer results than others at all follow-up points. CONCLUSIONS: Arthroscopic releasing surgery of the shoulder in patients with ACS refractory to conservative treatment produces rare complications and an effective injury response. It seems that patients suffering ACS following surgery have a weaker response to the treatment.

Bilateral total knee arthroplasty: Simultaneous versus staging in the same or in twice hospitalization.

BACKGROUND AND OBJECTIVE: Arthroplasty is the main treatment in patients with advanced knee osteoarthritis. In bilateral lesions, it is frequently performed in two simultaneous or separate surgical procedures. In this regard, the present study aimed to compare the results of knee arthroplasty in two joints simultaneously at two different times. METHOD: In general, all 40-70 years old patients in need of complete bilateral total knee arthroplasty (BTKA) were enrolled in this descriptive cross-sectional study during 2009-2016. They were included in three groups of BTKA as simultaneously (n = 272), staging in the same hospitalization (146), and staging in different hospitalizations (245). To assess the quantitative and qualitative function of the knees, patients' knees were evaluated before the surgery, and one month, three months, and two years after the surgery using the Knee Society Score (KSS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). Finally, hospitalization time, anesthesia duration, and medical costs were compared between the three groups. RESULTS: Based on the results, knee function improved based on WOMAC and KSS scales in all groups after arthroplasty although no significant differences were observed between the three groups. Patients' satisfaction in simultaneous BTKA was significantly higher compared to the other two groups (P = 0.013). Eventually, complications demonstrated no significant differences between the three groups except for pulmonary and cerebral embolism which were more prevalent in old patients with a high body mass index in the simultaneous BTKA group (P = 0.035 and P = 0.043, respectively). CONCLUSION: Overall, simultaneous BTKA is a useful approach for reducing costs while increasing patients' function and satisfaction although it has certain complications such as embolism in older overweight patients.

Return to sports activity in the revision of anterior cruciate ligament reconstruction: A 2-6 Year follow-up study.

INTRODUCTION: and Objective: The risk of an anterior cruciate ligament (ACL) injury in young patients and those with sports activity is increasing. Regarding the need of athletes with ACL re-rupture to return to sports, ACL revision surgery has received great importance. This study was conducted to evaluate the outcome of ACL reconstruction revision surgery in athletes. METHOD: In general, 62 patients with primary surgery and 62 patients with revision ACL surgery were investigated in this study. The study subjects were matched in terms of age, gender, involved leg, injury mechanism, sports group, time of surgery, and the degree of cartilage injury and ankle meniscus rupture. The studied variables included age, gender, body mass index (BMI), sports group, infection, meniscus injuries, chondral lesion, time to return to sports, quality of return to sports, range of motion, Lachman's test, and knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee score, Lysholm, and Marx scores. They were obtained through the information in the patients' medical records and the questionnaire filled out by the participants and the examiner's physician through the follow-ups. Then, the collected data were imported into the SPSS software and underwent analysis. RESULTS: The mean follow-up of patients was 49 months (in the range of 2-6 years). None of the patients had a chronic infection. The mean time to return to sports was 29.2 ± 3.2 and 35.3 ± 4.3 weeks in the primary surgery and revision surgery groups, respectively. In addition, 34 (54.8%) and 25 (40.3%) patients of the primary surgery and the revision surgery groups returned to the same level before injury, respectively. On the latest follow-up, the results of the Lachman test showed no significant difference between the two groups (P = 0.222) whereas Lysholm, IKDC, MARX, and KOOS scores on the latest follow-up in primary surgery were significantly higher than those of revision surgery (P < 0.001). CONCLUSION: The rate of return to sports in revision surgery was 14.5% lower than that of primary surgery, and the average time of return to sports was six weeks. The rate of return to sports, similar to before the injury, was significantly lower in the revision group, females, the age group of over 25 years, and contact sports activity, and patients with a chondral lesion. All knee performance scores were also poorer in the revision surgery.

Return to sport activity after anterior cruciate ligament reconstruction: A 6-10 years follow-up.

BACKGROUND: Nowadays, patients widely accept anterior cruciate ligament (ACL) reconstructive surgery. However, its long-term complications are still under investigation in athletes. Therefore, the aim of this study was to evaluate long-term ACL reconstruction especially in athletes. METHODS: A total of 426 patients with ACL injury were studied during 2008-2012. Demographic characteristics (gender, age, BMI), graft type, chondral lesion, osteoarthritis, meniscus tear, exercise activity, and pain intensity were noted. The effects of these factors on the return to sport activity after ACL reconstruction were also investigated. Lachman test, KT-1000, ACL quality of life (ACL-QOL), KOOS score, IKDC, and LKS were assessed at 2 years post-operation and at final follow-up. Repeated ACL rupture on the same and contralateral sides were also evaluated.Results: knee stability (based on Lachman and KT-1000), knee function (according to KOOS, LKS, and IKDC scores) and ACL-QOL were improved during the 2 years follow-up. The rate of return to sport activity similar to preinjury in patients was 64.08% in final follow-up. Chondral lesion was a limiting factor among the variables that affected the return to sport activity. It caused a return to sport activity similar to pre injury just in 21.24% of the patients. However, meniscus rupture did not affect return to sport activity similar to pre injury. Also, the rate of return to sport activity similar to pre injury was higher in men, patients under 30 years and those who had BMI of 20-25 kg/m2. In final follow-up, risk of ACL rupture in the injured knee and contralateral knee was 4.22% and 10.57%, respectively. CONCLUSION: Despite the recovery of patients after ACL reconstruction during long-term follow-up in athletes, return to sport activity similar to pre-injury in female, older peoples, overweight patients and athletes with chondral lesion were lower. However, these conditions do not apply to the meniscus rupture.

Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique.

PURPOSE: The aims of the present study were to evaluate and report the therapeutic outcomes of double-plate fixation in combination with autogenous bridging bone grafting in treatment of nonunion fractures of femur. METHODS: In this retrospective case series study, 41 patients with nonunion fracture of femur who underwent surgery by double-plate fixation and autogenous bridging bone grafting in academic referral center from July 2010 to July 2015 were enrolled. Totally, 32 males and 9 females with mean age of 35 years were evaluated. They were evaluated for related risk factors, previous therapeutic methods, time interval between injury to nonunion surgery and surgery to full clinical and radiological union, duration of follow-up, levels of postoperative limb shortening, and movement limitations. RESULTS: Ten patients had open fractures and eight patients had infected nonunion in the femoral supracondylar, subtrochanteric, and shaft fractures. Nailing was the most common used method as the primary treatment of femoral shaft fractures. In addition, the mean follow-up time was 37 months. Full union was obtained even in infected cases. Deep vein thrombosis was found in one patient and pulmonary thromboembolism in another patient, and both patients were treated successfully. Moreover, limitations of articular movements were seen in seven patients. CONCLUSION: Double-plate fixation in combination with bridging bone grafting is an effective method in the treatment of nonunion of femoral supracondylar, subtrochanteric, and shaft fractures even in the infected cases.

Contralateral and siblings' knees are at higher risk of ACL tear for patients with a positive history of ACL tear.

PURPOSE: Recent studies have shown that several genetic factors can cause susceptibility to anterior cruciate ligament (ACL) rupture. The aim of the present study was to evaluate certain underlying factors that increase the risk of ACL rupture. METHODS: Eight hundred thirty-six patients with ACL rupture who underwent ACL reconstructive surgery from 2010 to 2013 at an academic center completed a minimum of 5 years post-operation follow-up. The collected variables included sex, age, height, weight, exercise level, time interval between ACL rupture in the first knee and contralateral ACL rupture, dominant leg, side of the involved knee and sibling history of ACL rupture. RESULTS: The median follow-up duration was 6.5 (range: 5-8) years. Eighty-three patients (9.9%) had a contralateral ACL rupture, and 155 patients (18.5%) had siblings with a history of ACL rupture. The rate of contralateral ACL rupture was three times higher in women than in men and in patients with siblings with a history of ACL rupture than in those without such history. In addition, the risk of contralateral ACL rupture was higher in those younger than 30 years of age, those with a BMI of 20-25 kg/m2 and those who participated in regular sports activity. However, whether the involved knee was on the dominant or nondominant side had no effect on the incidence of contralateral ACL rupture. The results of the study showed that 69 (83.1%) of the contralateral ACL ruptures occurred within the first 2 years after the primary operation. CONCLUSION: In a 5- to 8-year follow-up, one out of every ten patients had a contralateral ACL rupture, and two out of every ten patients had siblings with a history of ACL rupture. The findings suggest that having a sibling with a history of ACL rupture and being female are important risk factors for ACL rupture of the contralateral knee. LEVEL OF EVIDENCE: III.

Simultaneous arthroscopic ACL and PCL reconstruction using allograft Achilles tendon.

BACKGROUND: Multi-ligamentous injuries to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) are uncommon but debilitating injuries. They mostly lead in functional disabilities and further surgeries. HYPOTHESIS: The aim of the present study was to evaluate the outcomes of simultaneous arthroscopic reconstruction of ACL and PCL using allograft Achilles tendon. STUDY DESIGN: Case-series study. MATERIALS AND METHODS: This study was performed on patients with combined ACL-PCL injuries which attended for treatment to a referral center from January 2010 to January 2014. All of them underwent simultaneous arthroscopic reconstruction of ACL and PCL using allograft Achilles tendon. Range of motion (flexion and extension loss), giving way, anterior and posterior knee stability, proximal tibia step off, subjective assessment of knee function and patients satisfaction were evaluated at 3, 6, 12, 24 months and final follow-up. Data were analyzed by SPSS version 21 with consideration of P < 0.05 as significant difference. RESULTS: Among 28 included patients, 21 patients (75%) were male. Mean age of patients was 30.86 ±â€¯7.25 years (range: 18-49 years). The mean follow-up time was 35.7 ±â€¯6.8 months (range: 26-50 months). Our results demonstrated that knee function, stability, and range of motion were improved along the follow-up periods. At final follow-up none of the patients had giving way and all of them were completely satisfied from the surgery. CONCLUSION: Simultaneous reconstruction of injured cruciate ligaments using allograft Achilles tendon resulted in appropriate functional outcomes and acceptable range of motion. LEVEL OF EVIDENCE: IV.

Rotator cuff tear with concomitant long head of biceps tendon (LHBT) degeneration: what is the preferred choice? Open subpectoral versus arthroscopic intraarticular tenodesis.

BACKGROUND: Lesions associated with the biceps tendon are commonly detected during arthroscopic repair of rotator cuff tears. Acquiring a preferable technique to repair both cuff and long head of biceps tendon (LHBT) lesions was the aim of several recent studies. This study aimed to compare clinical and functional outcomes of open subpectoral versus arthroscopic intraarticular tenodesis in patients with repairable rotator cuff tear associated with LHBT degeneration. PATIENTS AND METHODS: In this randomized clinical trial, 60 eligible candidates for arthroscopic rotator cuff repair (mean age 55.7 ± 6.9 years) were allocated to a control group (open subpectoral, SP) or intervention group (intraarticular, IA). In the IA group, an anchor suture was used for both rotator cuff repair and LHBT tenodesis. In the SP group, after arthroscopic repair of the rotator cuff, subpectoral tenodesis of LHBT was performed using an interference screw. Patients were evaluated for 2 years follow-up regarding pain intensity using the visual analogue scale (VAS) and shoulder function using the Constant Score and Simple Shoulder Test. RESULTS: The two groups were similar with regard to demographic characteristics and preoperative evaluations (all P > 0.05). The functional status of both groups was improved, but not significantly differently so between the two groups (P = 0.1 and P = 0.4, respectively). Pain intensity decreased during the 2-year follow-up period, similarly so in the two groups. Patient satisfaction was also similar in the two groups. CONCLUSION: Large and massive rotator cuff tears (tears > 3 cm) associated with LHBT pathologies benefited from intraarticular or subpectoral tenodesis similarly, with no differences in short- or mid-term results between these two techniques. LEVEL OF EVIDENCE: II.

Wet-Cupping Is Effective on Persistent Nonspecific Low Back Pain: A Randomized Clinical Trial.

OBJECTIVE: To compare the possible effects of wet-cupping therapy with conventional therapy on persistent nonspecific low back pain (PNSLBP). METHODS: In this randomized clinical trial, 180 participants with the mean age of 45±10 years old, who had been suffering from PNSLBP were randomly assigned to wet-cupping and conventional groups. The wet-cupping group was treated with two separate sessions (4 weeks in total) on the inter-scapular and sacrum area. In the conventional group, patients were conservatively treated using rest (6 weeks) and oral medications (3 weeks). The primary and the secondary outcome were the quantity of disability using Oswestry Disability Index (ODI), and pain intensity using Visual Analogue Scale (VAS), respectively. RESULTS: There was no significant difference in demographic characteristics (age, gender, and body mass index) between the two groups (P>0.05). Therapeutic effect of wet-cupping therapy was comparable to conventional treatment in the 1st month follow-up visits (P<0.05). The functional outcomes of wet-cupping at the 3rd and 6th month visits were significantly increased compared to the conventional group. Final ODI scores in the wet-cupping and conventional groups were 16.7 ± 5.7 and 22.3 ± 4.5, respectively (P<0.01). CONCLUSION: Wet-cupping may be a proper method to decrease PNSLBP without any conventional treatment. The therapeutic effects of wet-cupping can be longer lasting than conventional therapy. (Registration No. IRCT2013021672741)).

A Comparison between Single and Double Tourniquet Technique in Distal Upper Limb Orthopedic Surgeries with Intravenous Regional Anesthesia.

BACKGROUND: Several studies have put an effort to minimize the tourniquet pain and complications after conventional double tourniquet intravenous regional anesthesia (IVRA). We expressed in our hypothesis that an upper arm single wide tourniquet (ST) may serve a better clinical efficacy rather than the conventional upper arm double tourniquet (DT) in distal upper extremity surgeries. METHODS: In this randomized controlled trial, 80 patients undergoing upper limb orthopedic surgeries were randomized into two groups. IVRA was administered using lidocaine in both groups. Tourniquet pain was recorded based on visual analogue scale (VAS). In case of pain (VAS>3) in the DT group, the proximal tourniquet was replaced with a distal tourniquet while fentanyl 50µg was injected in the ST group. The onset time of tourniquet pain, time to reach to maximum tourniquet pain and the amount of fentanyl consumption were compared between the two groups. RESULTS: No significant difference was seen in demographic characteristics. The onset time of tourniquet pain (VAS=1) in the ST group (26.9±13.2 min) was longer than that of the DT group (13.8±4.8 min) (P<0.0001). The median of time to reach to maximum tourniquet pain (VAS>3) in DT and ST groups were 25 and 40 minutes, respectively; indicating that the patients in ST group reached to pain level at a significantly later time (P<0.0001). The total opioid consumption in the DT group (61 µg) was significantly lower than the ST group (102 µg) (P<0.0001); however, both groups were similar regarding fentanyl consumption before 40 minutes of surgeries. CONCLUSION: It seems that in upper limb orthopedic surgeries with less than 40-minute duration, a single tourniquet may serve as a proper alternative opposed to the conventional double tourniquet technique.Level of evidence: II.

Intra-sheath versus extra-sheath ultrasound guided corticosteroid injection for trigger finger: a triple blinded randomized clinical trial.

OBJECTIVE: The aim of this study is to compare clinical results of ultrasound-guided corticosteroid injection, intra-sheath versus extra-sheath of the finger flexor tendon. METHODS: A total of 166 patients with trigger finger were evaluated in a triple blind randomized clinical trial study. All the patients were injected with 1ml of 40mg/ml methyl prednisolone acetate, under the guidance of ultrasound. Half the patients were injected extra sheath, while the other half were injected intra sheath at the level of first annular pulley. RESULTS: The two groups were comparable in baseline characteristics (age, gender, dominant hand, involved hand and finger, and the symptoms duration). No significant difference was observed in the two groups with regards to Quinnell grading. In the final visit, 94% of patients from each group were symptom free. CONCLUSION: Results of corticosteroid injection intra-sheath or extra-sheath of the finger flexor tendon under ultrasound guidance in patients with trigger finger are comparably alike. Extra-sheath injection at the level of A1 pulley is as effective as an Intra-sheath administration.

Is Spinal Anesthesia with Low Dose Lidocaine Better than Sevoflorane Anesthesia in Patients Undergoing Hip Fracture Surgery.

BACKGROUND: To evaluate general anesthesia with sevoflurane vs spinal anesthesia with low dose lidocaine 5% on hemodynamics changes in patients undergoing hip fracture surgery. METHODS: In this randomized double blind trial 100 patients (50 patients in each group) older than 60 years under hip surgery were randomized in general anesthesia with sevoflurane and spinal anesthesia with lidocaine 5%. Hemodynamic changes including mean arterial pressure (MAP) and heart rate, blood loss, pain severity, nausea and vomiting and opioids consumption were compared in two groups. RESULTS: During surgery, difference between two groups regarding changes in mean arterial pressure was not significant, but the changes in heart rate were significantly different. Mean arterial pressure changes during recovery between two groups were significantly different. But there was no significant difference in heart rate changes. Bleeding in the sevoflurane group was significantly more than spinal group (513.ml vs. 365 ml). Moreover, AS Score, opioid consumption, and the nausea and vomiting in spinal anesthesia group was significantly lower than the sevoflurane group. CONCLUSION: We showed that general anesthesia with sevoflurane and spinal anesthesia with low dose lidocaine 5% have comparable effects on hemodynamics changes in patients undergoing hip fracture surgery. However postoperative pain score, vomiting and morphine consumption in patients with spinal anesthesia were lower than general anesthesia.