The majority of patients return to athletic activity following biceps tenodesis.

PURPOSE: Biceps tenodesis is widely used as a primary treatment for long head of the biceps brachii pathology and superior labral anterior and posterior (SLAP) lesions. However, rates and timing of full return to sports (RTSs)/duty have not been systematically analysed. This systematic review examines the literature to ascertain the rate and timing of return to athletic activity, and the availability of specific criteria for safe return to atheletic activity following the biceps tenodesis. METHODS: Based on PRISMA guidelines, this systematic review utilised the EMBASE, MEDLINE, and The Cochrane Library Databases. Eligible for inclusion were clinical studies reporting on return to athletic activity following biceps tenodesis. Statistical analysis was performed using SPSS. RESULTS: This review identified 17 studies including 374 cases meeting the inclusion criteria. The majority of patients were men 260 (69.7%), with an median age of 42.2 years (range 16-88) and a mean follow-up of 37.4 months. The overall rate of RTS was 217/269 (80.7%), with 43/59 (72.9%) returning to the same level. In overhead athletes, the overall rate of return to play was 39/49 (79.6%). Among military personnel, the overall rate of return to duty was 61/74 (82.4%). The average time to RTS was 5.4 (range 3-11) months. 10 (58.8%) Studies reported a recommended time window within which patients were allowed to return to full activity. Specific criteria for return to play were not reported in any of the identified studies. CONCLUSION: While overall rate of return to athletic activity was reportedly high following biceps tenodesis, one in four patients were not able to resume athletic activity at the same level. At present, there is no objective assessment of when patients can return to full activity reported in the literature. LEVEL OF EVIDENCE: IV.

Evaluation of the quality of information online for arthroscopic Bankart repair.

PURPOSE: The purpose of this study was to evaluate the quality and readability of information online for patients searching terms related to arthroscopic Bankart repair (ABR). METHODS: Google, Yahoo and Bing were searched with terms related to ABR. The quality of information was assessed using the Journal of the American Medical Association (JAMA) Benchmark criteria, DISCERN Score, and the Flesch-Kincaid Reading Ease & Grade Level. The presence of the HONcode marker was noted. Additionally, we used a scoring system specific to content relating to the ABR (AB score), a 1-20 Likert scale. Websites were also categorised according to the source: academic institution, physician, allied healthcare, commercial, media or social media. Statistical analysis was performed using GraphPad Prism. RESULTS: Ninety-six unique websites were evaluated, with the most common website category being physician websites (52) and academic institution websites (24). There were nine websites with the HONcode marker. The average JAMA Benchmark criteria score was 1.95 (1-4), the average DISCERN score was 48.8 (20-78), with an average Flesch-Kincaid reading ease of 50.9 (11-96) and grade level of 8 (1-18). The average AB score was 5.9 (0-18), and there was a strong correlation with a higher DISCERN score (r=0.57), but not JAMA score (r=0.18) or Flesch-Kincaid grade (r=0.16). Websites with the HONcode marker did not score higher in any criteria than those without it (p>0.05). The quality of information on physician websites was better than (statistically insignificant) non-physician websites; however, the readability of information in the former was poorer (statistically significant) than the latter. CONCLUSION: There was wide variability in the quality and readability online of the information on ABR, and the AB scoring system was shown to correlate strongly with increased quality.

Bilateral Scapulothoracic Fusions Fixed with High-Strength Suture Tapes for Facioscapulohumeral Dystrophy: A Case Report.

CASE: A 32-year-old male right-hand dominant school-bus driver with facioscapulohumeral dystrophy (FSHD) was referred to an upper limb specialist for consideration for scapulothoracic fusion (STF) because of limited upper limb function and cosmetic issues. Staged bilateral STFs were performed with seven high-strength suture tapes tensioned to secure a standard tubular plate in situ. CONCLUSION: STF may be a desirable treatment option for patients with FSHD. The use of high-strength suture tapes in cases of STF allows for secure fixation of the scapulothoracic joint. This potentially confers a reduction in operative time while ensuring adequate tensioned fixation and minimizing the risk of iatrogenic pneumothorax.

Copeland surface replacement of the shoulder. Results of an hydroxyapatite-coated cementless implant in patients over 80 years of age.

We describe the results of Copeland surface replacement shoulder arthroplasty using the mark III prosthesis in patients over 80 years of age. End-stage arthritis of the shoulder is a source of significant pain and debilitating functional loss in the elderly. An arthroplasty offers good relief of pain and may allow the patient to maintain independence. The risk-benefit ratio of shoulder replacement may be felt to be too high in an elderly age group, but there is no published evidence to support this theory. We have assessed whether the procedure was as reliable and safe as previously seen in a younger cohort of patients. Between 1993 and 2003, 213 Copeland surface replacement arthroplasty procedures were performed in our unit, of which 29 (13.6%) were undertaken in patients over the age of 80. This group of patients was followed up for a mean of 4.5 years (2.1 to 9.3). Their mean age was 84.3 years (81 to 93), the mean operating time was 40 minutes (30 to 45) and the mean in-patient stay was five days (2 to 21). There were no peri-operative deaths or significant complications. The mean Constant score adjusted for age and gender, improved from 15.1% to 77%. Copeland surface replacement shoulder arthroplasty may be performed with minimal morbidity and rapid rehabilitation in the elderly.

Adhesive capsulitis: human fibroblast response to shoulder joint aspirate from patients with stage II disease.

Abnormal fibroblast proliferation has been implicated in the pathogenesis of adhesive capsulitis. The aim of the study was to examine the effect of fluid aspirated from the glenohumeral joint of patients with adhesive capsulitis on human fibroblast cells. Shoulder aspirate from 15 patients with stage II adhesive capsulitis was obtained and diluted to concentrations of 10%, 25%, and 50%. Fifteen patients undergoing shoulder arthroscopy for instability comprised the normal control group. Human fibroblast cells were cultured from human volunteers. Cellular proliferation was determined by use of the Promega CellTiter 96 nonradioactive cell proliferation assay. Fibroblast proliferation was significantly increased in patients with adhesive capsulitis. The rate of increased fibroblast proliferation showed a dose-dependent relationship to aspirate concentration. There was a moderate increase in fibroblast apoptosis at higher aspirate concentrations (25% and 50%) as detected by the ability of apoptotic cells to bind annexin V and exclude propidium iodide. These findings demonstrate that fluid from shoulders with adhesive capsulitis contains growth factors that influence fibroblast activity.

Quantification of the coupled motion that occurs with axial rotation and lateral bending of the head-neck complex: an experimental examination.

The vertebrae of the cervical spine exhibit out-of-plane or coupled motion during axial rotation and lateral bending. Quantifying the range of motion (ROM) of this occurrence can aid the understanding of cervical spine injury mechanisms and disorders, as well as the development of new treatment methods. Previous studies have formulated ratios to describe coupled motion obtained from in-vitro examinations. The aim of the present study was to use in-vivo test data to develop mathematical relationships to quantify the coupled motion that occurs with axial rotation and lateral bending of the head-neck complex. Using a three-dimensional motion analyser it was possible to trace the coupling effect throughout the full range of unrestricted head-neck motion. Values for primary and coupled ROMs were obtained, showing no significant difference between male and female primary ROMs but a small disparity between male and female coupled ROMs. Regression equations were found to quantify coupled motion throughout the range of axial rotation and lateral bending. The present experimental study also examines the range of horizontally fixed axial rotation of the head to determine the minimum amount of coupled lateral bending that takes place, which has not been measured previously.

The use of the Zebris motion analysis system for measuring cervical spine movements in vivo.

The cervical spine exhibits the greatest range of motion among the spinal segments due to the complex interaction of its triplanar components of movement. As a result, measurement of movements of the cervical spine and of the various orthoses used in cervical spine injuries has proved difficult with no one method proving satisfactory. This paper uses the Zebris ultrasonic three-dimensional motion analysis system to measure flexion, extension, range of lateral bending, and range of axial rotation in five similar male and five similar female subjects with no history of neck injuries. The subjects were tested unrestrained and in soft and hard collars, as well as in Philadelphia, Miami J, and Minerva orthoses. Results show that the Minerva is the most stable construct for restriction of movement in all planes in both groups. Looking at these results allows ranking of the measured orthoses in order of their three-dimensional stability. Furthermore, by presenting reproducible data incorporating the composite triplanar movements of the cervical spine, thus allowing comparative analysis of the studied orthoses, they propose the Zebris as a reliable, repeatable, and safe method of measurement of cervical spine motion with low intersubject variability.

Acupuncture-associated arthritis in a joint with an orthopaedic implant.

Viral infection is a well-recognized complication of acupuncture therapy. Bacterial infection however is rare. We report a rare case of intra-articular bacterial knee infection due to inadvertent acupuncture needle penetration.

Outcome measures following metacarpophalangeal joint replacement.

We used the Jebsen-Taylor hand function assessment system to prospectively study the effect of metacarpophalangeal joint replacement on overall hand function in 29 hands. In addition pain relief, subjective improvement in hand function, appearance and overall patient satisfaction were assessed. There was modest improvement in the number of Jebsen-Taylor tasks performed (1.8 to 3. 1), and pain relief was good or excellent in 18 of 24 patients. Eleven patients felt their hand function had improved by more than 50%, and the majority of patients (22 of 24) were very satisfied with the procedure. This study demonstrates that despite limited improvements in objective outcome measures, this procedure is reliable in producing a very high rate of patient satisfaction.

Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a plaster cast.

Sixty-six adult patients with minimally displaced distal radial fractures were randomly assigned to treatment with either a plaster cast or a lightweight removable wrist splint. Outcome assessment was by clinical and radiological evaluation and an independent physiotherapy assessment. There were significant differences between the treatments for cast satisfaction, cast problems and the functional assessment score at 6 weeks, with the removable splint scoring better in all cases.

Development of a model for occipital fixation--validation of an analogue bone material.

Several implant systems may be used to fuse the skull to the upper cervical spine (occipitocervical fusion). Current biomechanical evaluation is restricted by the limitations of human cadaveric specimens. This paper describes the design and validation of a synthetic testing model of the occipital bone. Data from thickness measurement and pull-out strength testing of a series of human cadaveric skulls was used in the design of a high-density rigid polyurethane foam model. The synthetic occipital model demonstrated repeatable and consistent morphological and biomechanical properties. The model provides a standardized environment for evaluation of occipital implants.

Occupational noise levels in orthopaedic surgery.

Prolonged exposure to potentially damaging noise levels in the workplace has been the subject of much recent litigation. The occupational risk of noise induced hearing loss among orthopaedic surgeons is unknown. Continuous readings of air-powered instruments routinely used in orthopaedic surgery were made in a regional trauma unit at standard distance from the noise source. All instruments generated noise levels greater than the threshold for routine monitoring of hearing loss under health and safety legislation.

Irish orthopaedic patients' attitudes to blood transfusion.

This study was designed in response to perceived increased public anxiety about the risks of allogenic blood transfusion. A questionnaire was completed by 203 patients attending an elective orthopaedic hospital. The questionnaire examined patients' factual knowledge about various aspects of transfusion, their attitudes to blood transfusion and confidence in the safety of blood products. Despite recent publicity, only 124 patients (61%) regarded blood transfusion as a risk for hepatitis transmission while 172 patients (85%) knew of the risk of blood transmission of HIV. 22 patients (11%) reported that they would have no concerns about receiving a blood transfusion, while at the other extreme, 9 (5%) would not be willing to receive blood under any circumstances. 162 patients (80%) felt that allogenic blood transfusion was either entirely safe or that there was an acceptable small risk associated with it. A majority of responders (109 patients, 54%) reported they would favour autologous transfusion if available. Current practices and alternatives to traditional allogenic blood transfusion are discussed in the context of elective orthopaedic surgery.

Computerized dynamic posturography analysis of balance in individuals with a shoulder stabilization sling.

INTRODUCTION: Sling immobilization of the upper limb may affect balance. Computerized dynamic posturography (CDP) provides a validated, objective assessment of balance control and postural stability under dynamic test conditions. We tested the balance of individuals with a shoulder stabilization sling (SSS) using an EquiTest machine to objectively assess imbalance while wearing a sling. METHODS: Forty-two right hand dominant (RHD) adults (16 females, 26 males; average age 22 years; range 20-35 years) were included in the study, comprising six controls and two SSS groups with 18 dominant hands (DH) and 18 non dominant hands (NDH). CDP assessed balance by the Sensory Organization Test (SOT), Motor Control Test (MCT), and Adaptation Test (ADT). RESULTS: The composite equilibrium scores (CES) were as follows: controls 80.8 %, sling DH 71.1 versus sling NDH 69.6 %. Sling use has lower CES compared to controls (p = 0.025). The use of a sling caused 31 % of subjects to have decreased CES. 22.9 % of sling users had imbalances. Among sling users, the DH group had 19.1 % imbalances compared to 26.8 % for the NDH group (p = 0.044). There were six absolute falls in the DH group versus 12 in the NDH group. CONCLUSIONS: Wearing a sling causes balance decompensation in almost one-third of healthy volunteers, and this is greater when worn in the non dominant hand, with double the number of falls. This has significant implications for patients having prolonged use of a sling. Consideration should be given to operative procedures or conservative management of shoulder pathology where sling use is required and promotion of the early discontinuation of sling use can be considered.

Day case shoulder surgery: satisfactory pain control without regional anaesthesia. A prospective analysis of a perioperative protocol.

BACKGROUND: Pain control is an issue which may limit patients' acceptance of day case shoulder surgery. This study prospectively examined the outcome of a protocol for day case shoulder surgery to determine if satisfactory pain relief could be achieved without regional anaesthesia. METHODS: Patients attended for pre-assessment and were informed about the procedure and day case protocol. Anaesthesia used was either a regional anaesthetic block or subacromial bursal block. Patients were discharged with a standard pain pack. All 117 operations were performed arthroscopically. Patients were contacted 24 h following surgery by an independent observer. RESULTS: Based on 90 completed surveys, all patients were satisfied. Pain was well controlled in 85% of patients but 50% of the remaining patients did not take the prescribed pain pack. Problems other than pain were seen in only 4% of patients. No patients required overnight admission. CONCLUSION: Our study indicates a very high level of patient satisfaction and good pain relief without the use of regional anaesthesia for patients undergoing shoulder surgery as a day case.

Arthroscopic treatment of lateral epicondylitis: clinical and cadaveric studies.

Clinical and cadaveric studies were done to investigate the role of a degenerative fringe of the radiocapitellar complex subluxating in the radiocapitellar joint in patients with lateral epicondylitis. In the clinical study, arthroscopic resection of this capsular complex was done. Thirty patients with recalcitrant symptoms of lateral epicondylitis for a minimum of 9 months had surgery. In all patients at arthroscopy, a collar-like band of radiocapitellar capsular complex was found to impinge on the radial head and subluxate into the radiocapitellar joint with manipulation under direct vision. Histologic analyses of the resected tissue showed hyaline degeneration and fibrosis. There were no complications in this series. Twenty-eight patients had complete relief of symptoms by this procedure within 2 weeks of surgery. The average time until return to work was 7 days. Elbow arthroscopy was done in 34 cadaveric elbows to examine the relationship of the annular ligament, the lateral joint capsule, and the radial head. A degenerative capsular fold impinging on the radial head was seen in 15 elbows. A classification system, based on the relationship of the capsular fold to the radial head is described. In Type 1 (19 elbows), the radial head is completely exposed. In Type 2 (six elbows), there is partial coverage of the radial head by the capsuloligamentous complex without interposition into the joint in any position. In Type 3 elbows (six elbows), there is subluxation of the capsular edge into the joint, whereas in Type 4 elbows (three elbows), the radial head is completely obscured throughout the range of motion. The lesion was equally prevalent in men and women. The arthroscopic findings at the time of surgery in the clinical group were the same as the Grade 2 and Grade 3 changes that were seen in cadaveric specimens.

Non-union of the capitate with associated triangular fibrocartilage tear.

We report a case of a 19-year-old boy who presented with a painful wrist 3 months after a fall. Plain radiographs demonstrated a non-union of a capitate fracture which was unrecognised at the time of injury. Magnetic resonance imaging confirmed the diagnosis and also demonstrated a tear of the triangular fibrocartilage complex. This combination of injuries has not been previously described.

Outcome of compartment syndrome following intramedullary nailing of tibial diaphyseal fractures.

Seventeen cases of compartment syndrome were treated in a group of 626 consecutive patients with tibial diaphyseal fractures. Clinical and radiological follow-up was performed at an average of 24 months (range 8-54 months). Functional outcome was assessed using Edward's classification. All patients who developed compartment syndrome had fracture stabilisation with a reamed intramedullary nail using skeletal traction. The average interval between the nailing procedure and fasciotomy was 11 h. Results were good in 10 cases, fair in four cases and poor in the remaining three cases. Patients who had decompression within 12 h had a good functional outcome. Patients with poor results were all treated at an interval greater than 24 h.