Return-to-work following shoulder arthroplasty in adults with osteoarthritis.

BACKGROUND: Anatomic total shoulder arthroplasty (aTSA) and hemiarthroplasty (HA) have demonstrated significant improvement in shoulder function and pain relief. Work-related outcomes have become increasingly important, while the current literature lacks evidence related to return-to-work (RTW) and which factors might have an influence on it. AIMS: This study aimed to assess RTW in patients who have received aTSA or HA at a minimum of 1-year follow-up after surgery, and secondary to evaluate possible prognostic factors associated with RTW. METHODS: We performed a retrospective query in employed patients diagnosed with primary osteoarthritis of the shoulder, who received either an aTSA or HA between February 2006 and February 2021. Preoperative and post-operative work and sports participation were assessed. RESULTS: Forty-four patients participated in this study (98% compliance), of which 40 patients (91%) were able to RTW at a median time of two (interquartile range: 2-4) months post-operatively. Patients with a medium-/high-demand occupation demonstrated RTW at a significantly lower rate (79%) than those with light-demand occupations (100%; P = 0.03). There was a statistically significant association between return to full employment and patients' expectation to fully return, absence of preoperative work adjustments and preoperative sick leave (odds ratio: 16.9 [3.1-93.5]; 18.3 [2.1-160.4]; 0.1 [0.0-0.6]). CONCLUSIONS: aTSA and HA facilitate excellent RTW rates. Patients with a medium-/high-demand occupation return at a significantly lower rate. The ability to RTW seems to be multifactorial and the results found might not be attributed to shoulder arthroplasty alone.

How to Treat Musicians with Frozen Shoulder: A Narrative Review.

Musicians comprise a specific occupational group with high musculoskeletal loads as well as demands. A frozen shoulder, or adhesive capsulitis, is a common musculoskeletal condition characterized by pain and loss of function of the glenohumeral joint. Despite being described as a generally self-limiting condition, the clinical course of the disease is unclear. A frozen shoulder can be a career-threatening diagnosis for musicians who need a wide range of motion of the shoulder to play their instruments. The aim of this narrative review is to provide healthcare providers and musicians with an overview of treatment principles for instrumental musicians with frozen shoulder. In this review, both general treatment principles as well as instrument-specific ergonomic tools are discussed. The aim is to provide an overview of the available tools to preserve a musician's playing capabilities and to enable early return to playing the instrument.

['You tell me, you are the doctor'; patients on long-term psychiatric residences about their medication]. / 'Zegt u het maar, u bent de dokter'; patiënten op langdurige psychiatrische verblijfsafdelingen over hun medicatie.

BACKGROUND: In an era of patient centered care, the question rises whether practitioners of these patients are sufficiently aware of their treatment preferences.
AIM: To study the opinion and knowledge of older, long-term psychiatric patients about their medication and health priorities.
METHOD: Patients were interviewed with the Patient's Attitudes Towards Deprescribing questionnaire. Furthermore patients were asked to name their medication by heart, their health priorities and preferences in medication changes. These preferences were compared with those of their practitioners.
RESULTS: 47 patients (median age 67 years, median 11 drugs) were interviewed. The mean percentage of spontaneously recalled drugs was 37%. Though 64% believed all used drugs were necessary, 77% would like to deprescribe if the doctor said it was possible. Preferences in deprescribing of patients and doctors didn't correspond in about 80%.
CONCLUSION: Most of old psychiatric patients are willing to deprescribe, but await initiative of their doctor. They can recall little of their currently used drugs. Preferences in deprescribing of the patient and doctor do often not match. We recommend to include a patient interview about the need for education and treatment preferences in the annual medication reviews in order to deprescribe and deliver more patient centered care.

Functional treatment for acute ankle sprains: Softcast wrap versus MOK-cast. A prospective randomized single-center trial.

BACKGROUND: The outcome of a removable (MOK-cast) versus a non-removable polyester wrap for acute lateral ankle ligament injury is unknown. METHODS: Patients with grade II-III lateral ankle ligament injuries were randomized between treatment with a MOK-cast and a wrap. Primary outcome is the Karlsson score for function. Secondary outcomes are patient satisfaction and pain at 4 months follow-up. RESULTS: Randomisation resulted in 53 and 54 patients per arm. Four month follow up was completed by 92% (n=100). The mean Karlsson score improved from 20 to 87 (p<0.01) in the wrap group and 20 to 90 (p<0.01) in the MOK-cast group. In the MOK-cast group treatment satisfaction was higher (8.2 vs 7.8 p 0.04). Reported pain was higher in the first thirty days after injury (p<0.01). CONCLUSIONS: Both wrap and MOK-cast are effective functional treatment options in acute lateral ankle ligament injury. MOK-cast is associated with increased patient satisfaction but higher VAS pain scores. LEVEL OF EVIDENCE: I.

Acute syndesmotic instability in ankle fractures: A review.

Ankle fractures are among the most common fracture types, and 10% of all ankle fractures lead to accessory syndesmotic injury. An injury that is challenging in every respect is syndesmotic instability. Since the range of diagnostic techniques and the therapeutic options is extensive, it still is a controversial subject, despite the abundance of literature. This review aimed to summarize the current knowledge on syndesmotic instability in ankle fractures and to formulate some recommendations for clinical practice. Chronic instability and the operative osseous treatment of ankle fractures are not part of this review.

Outcome and revision rate of uncemented glenohumeral resurfacing (C.A.P.) after 5-8 years.

BACKGROUND: Resurfacing of the glenohumeral joint for patients with glenohumeral arthritis has gained popularity since the first introduction. We report the mid-term results of the Global C.A.P. uncemented resurfacing shoulder prosthesis (DePuy Synthes). METHODS: From January 2007 to December 2009, 48 humeral cementless resurfacing prostheses in 46 patients were performed. All patients were diagnosed with primary glenohumeral osteoarthritis. Patients were contacted for review; the Constant Score, visual analog pain scale, Dutch Simple Shoulder Test, SF-12 scores and physical examination were assessed both preoperatively and yearly postoperatively. Complications and revision surgery were documented. Radiographs were evaluated for component size, offset, inclination, height, loosening and subluxation. RESULTS: Forty-six patients (12 males) with a mean age of 72 years old (range 59-89) were included. At a mean 6.4-year follow-up (range 5-8), the Constant Score, visual analog pain scale and the Dutch Simple Shoulder Test scores improved significantly (p < 0.05) from baseline. Three patients were lost to follow-up. One patient died and two patients were not able to attend the follow-up appointments, due to other health-related issues. Eleven patients (23%) had a revision operation. CONCLUSIONS: The most important findings of this study of the Global C.A.P. shoulder resurfacing arthroplasty were an increase of range of motion, a reduction of pain complaints, but a concerning high rate of revision after mid-term follow-up. LEVEL OF EVIDENCE: Therapeutic Level IV.

[Recognition of psychiatric disorders with a religious content by members of the clergy of different denominations in the Netherlands]. / De herkenning van psychische problemen met religieuze inhoud door pastores: een vignetstudie.

BACKGROUND: Clergy members (CMS) frequently provide support and counselling for people with psychological and psychiatric disorders. There is evidence in the literature that CMS consider themselves to be inadequately trained to recognise psychiatric disorders. AIM: To investigate to what extent CMS are able to recognise psychiatric symptoms. METHOD: CMS were recruited in the south-west of the Netherlands among various denominations (Roman Catholic, strict (orthodox) Protestant, moderate Protestant and Evangelical; n = 143) by means of a regional sampling method. The participating CMS (n = 143) and a control group consisting of mental health care professionals MPHS; n = 73) evaluated four vignettes of psychiatric problems with a religious content: two were about a psychiatric disorder (a psychotic state and a psychotic depression/melancholic state), and two concerned non-psychiatric states (a spiritual/religious experience and a mourning reaction with a religious dilemma). For each vignette the respondents scored the suitability of psychiatric medication, the desirability of mental health care, the severity of the disorder and whether there was a religious or spiritual aetiology. RESULTS: Some CMS were able to recognise psychiatric problems almost as well as the MHPS, but among the CMS the degree of recognition varied according to the denomination. Recognition was relatively poor among Evangelical CMS, but was best among the strict Protestant CMS. Evangelical pastors and strict Protestant CMS tended to interpret the non-psychiatric states as pathological. CONCLUSION: The findings of this study emphasise the need for collaboration between MHPS and CMS and stress the importance of consultation.

Alignment of particles in sheared viscoelastic fluids.

We investigate the shear-induced structure formation of colloidal particles dissolved in non-Newtonian fluids by means of computer simulations. The two investigated visco-elastic fluids are a semi-dilute polymer solution and a worm-like micellar solution. Both shear-thinning fluids contain long flexible chains whose entanglements appear and disappear continually as a result of Brownian motion and the applied shear flow. To reach sufficiently large time and length scales in three-dimensional simulations with up to 96 spherical colloids, we employ the responsive particle dynamics simulation method of modeling each chain as a single soft Brownian particle with slowly evolving inter-particle degrees of freedom accounting for the entanglements. Parameters in the model are chosen such that the simulated rheological properties of the fluids, i.e., the storage and loss moduli and the shear viscosities, are in reasonable agreement with experimental values. Spherical colloids dispersed in both quiescent fluids mix homogeneously. Under shear flow, however, the colloids in the micellar solution align to form strings in the flow direction, whereas the colloids in the polymer solution remain randomly distributed. These observations agree with recent experimental studies of colloids in the bulk of these two liquids.

The floating shoulder.

Ipsilateral scapular neck and clavicular shaft fractures comprise the so-called "floating shoulder". This rare injury, which is, in general, caused by a high-energy trauma, is perceived to be an unstable injury with the considerable risk of significant displacement of scapular neck and/or the clavicular fracture. An understanding of the patho-anatomy is important in identifying a floating shoulder and to offer rational treatment for this injury. The current status of the anatomical, biomechanical and clinical aspects of a floating shoulder is reviewed in this article. Recommendations for treatment of particularly displaced ipsilateral fractures of the scapular neck and clavicular shaft cannot be derived from the reported clinical studies. The possible correlation between functional outcome and malunion of the scapular neck is called into doubt.

Fractures of the scapula surgical neck: outcome after conservative treatment in 13 cases.

BACKGROUND: Conservative treatment of fractures of the scapular neck does not uniformly lead to a success. The purpose of this retrospective study was to analyze the occurrence of glenoid displacement in conservatively treated patients with a scapular neck fracture without concomitant shoulder girdle injury in relation with the clinical outcome. METHODS: Between 1991 and 2001, 177 patients with a fracture of the scapula were treated in two Dutch clinics. Twenty-four patients sustained a scapular neck fracture, who all, with the exception of one, were treated non-operatively. At follow-up, 13 patients had a functional evaluation and were assessed clinically at an average of 5.5 years after the injury. RESULTS: All fractures healed uneventfully. At final radiographic evaluation, four patients were found with significant translational displacement of fracture fragments (>1 cm); however, no angular displacement of the glenoid was found (no GPA < 20 degrees ). The functional outcome of the 13 patients was excellent (Constant score: 90). No correlation was found between functional outcome and malunion. There was no significant difference between the SF-36 scores in the follow-up group and the scores for age-matched controls in the general population. CONCLUSIONS: Non-operative treatment of a surgical neck fracture of the scapula in absence of an ipsilateral shoulder injury and associated permanent neurological impairment leads to a good to excellent functional outcome, with or without significant translational displacement.

Biomechanical analysis of scapular neck malunion--a simulation study.

OBJECTIVE: To explain loss of shoulder function following scapular neck malunion in terms of biomechanical changes around the gleno-humeral joint. DESIGN: Biomechanical modelling study. BACKGROUND: Residual rotation of the scapular neck after fracture can lead to pain and loss of function, and the indications for surgical intervention are contested. METHODS: A 3D, large-scale, musculo-skeletal model of the upper limb was used to compare shoulder biomechanics in the case of scapular neck malunion with normal anatomy. Abduction of the humerus was simulated with three models: normal anatomy, 24 degrees and 40 degrees inferior scapular neck rotation. RESULTS: Predicted muscle activation differed greatly between the control and the fracture cases. The motion required additional muscle effort for the maintenance of gleno-humeral stability in the fracture cases. Higher moments in the plane of abduction were generated by the teres major, pectoralis major and biceps brachii muscles with high humeral elevation angles. The rotator cuff muscles were severely shortened in the post-fracture cases and the forces in these muscles were greatly reduced in a test of loaded abduction with the humerus at 90 degrees. CONCLUSIONS: Given the function of the rotator cuff muscles as stabilisers of the gleno-humeral joint, it is concluded that the loss of force in these muscles, together with other changes in muscle activation, will lead to loss of arm function in patients with scapular neck malunion. RELEVANCE: These findings will contribute to the improved treatment of patients with scapular neck malunion by identifying important factors in the consideration of surgical intervention.

Limited posterior approach for internal fixation of a glenoid fracture.

We present the case of a patient who was treated by open reduction and internal fixation for a displaced glenoid fracture using a limited posterior approach.

The floating shoulder. A multicentre study.

The aim of this retrospective study was to review a series of patients with ipsilateral fractures of the neck of the scapula and of the clavicle. Between 1991 and 1996 a total of 79 general and orthopaedic surgeons treated 46 patients with a floating shoulder in The Netherlands. The records and radiographs of these patients were studied. Of the 35 patients available for follow-up, 31 had initially been treated conservatively and four by operation; three underwent secondary reconstructive surgery. The mean Constant score for the 28 patients treated conservatively was 76 and for the seven treated operatively it was 71 at a mean follow-up of 35 months. In six of the 28 patients treated conservatively the glenoid was dislocated caudally at the end of treatment; they had a score of 42. In the 22 patients without this dislocation the score was 85. We conclude that this rare injury is not inherently unstable and, in the absence of caudal dislocation of the glenoid, conservative treatment gives a good functional outcome.

The correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease.

We studied the effect of comorbidities on function of the shoulder and health status in a group of eighty-five consecutive patients who had glenohumeral degenerative joint disease of sufficient severity to meet one surgeon's criteria for the performance of shoulder arthroplasty. A questionnaire was used to identify the comorbidities, such as other diseases, social factors, or a work-related injury, for each patient. The number of functions on the Simple Shoulder Test that the patient could perform had a significant negative correlation with the number of comorbidities (r = -0.32, intercept = 4.6 per cent, slope = -0.6, and p = 0.0031). Each parameter on the Short Form-36 (except for physical role function) had a significant negative correlation with the number of comorbidities (p < 0.05). This negative relationship was strongest for general health perception (r = -0.42) and vitality (r = -0.35). We concluded that the number of comorbidities has a quantitative effect on function of the shoulder. In the evaluation of the functional status of patients and the effectiveness of treatment, the effects of comorbidity must be controlled. The results of the present study demonstrate that the scores on the Short Form-36 are quantitatively related to the number of comorbidities. The six parameters that are unrelated to function of the shoulder (physical function, social function, emotional role function, mental health, vitality, and general health perception) may provide a practical way to integrate the effects of all potential comorbidities on individual patients. Future clinical research will be strengthened by efforts to measure the impact of comorbidities and by strategies to control for their effects.

Lowered motor conduction velocity of the peroneal nerve after inversion trauma.

To analyze the effect of inversion trauma on peroneal nerve function, motor conduction velocity was measured in 22 patients. In the injured leg, 4-8 d post trauma motor nerve conduction velocity in the knee-caput fibulae segment of the superficial peroneal nerve was significantly smaller when compared with the contralateral leg and the control group. Five weeks post trauma these values were normal again. For three segments of the deep peroneal nerve, the motor conduction velocity was significantly reduced, 4-8 d post trauma, when compared with the control group. In the caput-ankle and knee-ankle segment, motor conduction velocity was still significantly lowered 5 wk post trauma. Lowered amplitudes of the Compound Motor Action Potentials of the extensor digitorum brevis muscle were found 4-8 d post trauma. No correlation was found between motor nerve conduction velocities and subjective clinical tests (anterior drawer sign and (manually performed) talar tilt test). The results of this study support the hypothesis that inversion trauma is frequently accompanied by lesions of the peroneal nerve. Motor conduction velocity measurements can be a valuable tool in assessing more objectively functional instability of the ankle joint induced by inversion trauma.

Properties of turnip yellow mosaic virus in cesium chloride solutions: the formation of high-density components.

The bottom component B1a of TYMV with a buoyant density of 1.42-1.43 g/ml, is converted to a more dense particle B2a following CsCI density gradient centrifugation. This conversion is complete after a prior incubation of the virus in the CsCl solution at elevated temperatures. It is shown that the formation of B28 is accompanied with a loss from the virion of polyvalent cations like spermidine and Mg2+. The exchange of the latter ions for Cs ions is responsible for the occurrence of the higher-density particles. The more dense component B2a can be converted back to B,; like particles upon incubation in the presence of 0.1 M M9Cl2. If TYMV or component B1a is centrifuged in the presence of Mg2+, the conversion into B2a is prevented. The latter phenomenon allowed the isolation and characterization of the minor components B1b and B1c, previously postulated (Mellema et al. (1979), Virology 96, 38-46). The phenomenon of conversion appeared to be restricted to the components of the B series of TYMV; indicating that the class of light minor components does not contain artefacts of the CsCl gradient centrifugation. The formation of B2a is accompanied by degradation of RNA, which might be due to some conformational change in the virion, rendering the RNA vulnerable to RNases.

Translational studies with turnip yellow mosaic virus RNAs isolated from major and minor virus particles.

The major and minor nucleoprotein components in turnip yellow mosaic virus (TYMV) preparations have been fractionated by four cycles of CsCl gradient equilibrium centrifugations. RNAs isolated from the various fractions were translated in a rabbit reticulocyte cell-free system. Three classes of RNAs were studied: genomic RNA with an Mr of 2.0 x 10(6), the subgenomic coat protein messenger with an (r) of 2.4 x 10(5) (H. Guilley and J. P. Briand, 1978, Cell15, 113-122) and RNA molecules of intermediate sizes. Genomic RNA is found in the major TYMV components. These particles do not contain the coat protein messenger. The latter messenger has mainly been detected in two types of minor components, those which have an RNA content exceeding that of the major TYMV virions and particles which contain the coat protein messenger as their sole RNA constituent. RNAs of intermediate sizes are found in minor components less dense than the major particles; the full-length translational products of these RNAs and of genomic RNA overlap with one another and share a common NH2 terminus. It is concluded that a number of intermediate-sized RNAs and the genomic RNA have a common site for initiation of translation located close to their 5'-termini.