Hip Arthroscopy Complications Are Rare, but There Is Room for Improvement.

Complications are agonizing and leave feelings of inadequacy, insufficiency, or ineptitude. For these and other reasons, complications are not frequently reported in the literature. But reporting of complications is not only cathartic, it can be illuminating. Once out in the daylight, complications can be categorized, quantified, parsed, analyzed, and dissected with the scientific method to yield insight to enable us to prevent complications that we can avoid. Technical innovations have demonstrated ability to solve current problems. Standardizing the reporting of complications allows comparability between centers. Better data lead to better analysis and may decrease the complication rate. Recent investigations published in Arthroscopy and elsewhere have improved our understanding of hip arthroscopy complications, making the procedure safer, more effective, and of higher value.

Immunomodulatory effects of Pimpinella anisum L. (Aniseed) in Broiler Chicks against Newcastle disease and infectious bursal disease viruses / Efecto inmunomodulador de Pimpinella anisum L. (anís) en pollos de engorde contra la enfermedad de Newcastley la enfermedad viral de la bursitis infecciosa

Pimpinella anisum L. (Aniseed) is mostly used as an immune stimulant, growth promoter, antifungal, antibacterial in many countries for centuries. The aim of this study was to determine the immunomodulatory effect of aniseed against Newcastle Disease (ND) and infectious bursal disease (IBD) viruses. The immunomodulatory effect of aniseed against ND and IBD viruses were determined by modifying splenic cell migration inhibition assay and differential leukocyte count for cellular immunity. Haemagglutination inhibition and indirect haemagglutination were used for measurement of humoral immune response against ND and IBD viruses, respectively. The present study suggests that the aniseed addition to basal diet at the rate of 0.5 g/kg and 1 g/kg of feed had best immunomodulatory activity both for humoral and cellular immune responses. However, at higher doses aniseed had adverse effects. Aniseed possesses significant immunomodulatory activity when it is added at lower doses i.e., 0.5 g/kg and 1 g/kg.

Pimpinella anisum L. (Anís) se utiliza principalmente como un estimulante inmunológico, promotor del crecimiento, antifúngico, y antibacteriano, en muchos países durante siglos. El objetivo de este estudio fue determinar el efecto inmunomodulador de anís contra la enfermedad de Newcastle (ND) y la enfermedad de la bursitis infecciosa (IBD). El efecto inmunomodulador de anís contra los virus ND y e IBD se determinaron mediante la modificación del ensayo de inhibición de la migración de células del bazo y recuento diferencial de leucocitos de la inmunidad celular. La inhibición de la hemaglutinación y hemaglutinación indirecta se utilizaron para la medición de la respuesta inmune humoral contra el virus de ND e IBD, respectivamente. El presente estudio sugiere que la adición de anís a la dieta basal a la tasa de 0,5 g/kg y 1 g/kg de alimentación tuvo una mejor actividad inmunomoduladora tanto para las respuestas inmunes humorales como celulares. Sin embargo, a dosis más altas de anís tuvo efectos adversos. El anís posee una importante actividad inmunomoduladora cuando se añade en dosis más bajas, es decir, 0,5 g/kg y 1 g/kg.

Effects of glycemic control on prevalence of diabetic frozen shoulder.

BACKGROUND: There is controversy regarding the influence of glycemic control in diabetic patients with frozen shoulder. To determine the relationship between glycemic control and the prevalence of frozen shoulder in diabetic patients, we hypothesized that increased glycosylated hemoglobin A1c (HbA1c) levels would correlate with an increased prevalence of frozen shoulder. METHODS: A retrospective analysis with statistical review of 201,513 diabetic patients enrolled in a regional health maintenance organization in 2007 was performed. Analysis included determining the relationship between the prevalence of frozen shoulder and the following factors: HbA1c level, type of diabetes treatment, duration of diabetes treatment, and presence of end-stage diabetic manifestations. RESULTS: There were 1150 diabetic patients with a diagnosis of frozen shoulder. There was no significant relationship between HbA1c level and the prevalence of frozen shoulder. Insulin-dependent patients who used or did not use oral hypoglycemics were 1.93 times more likely than non-insulin-dependent diabetic patients to have frozen shoulder, and that rate increased to 1.96 times more likely when the results were adjusted for HbA1c level. Patients who were taking oral hypoglycemic drugs were 1.5 times more likely to develop frozen shoulder than those who did not use insulin or take oral hypoglycemic drugs. Duration of diabetes was also associated with the development of frozen shoulder, after controlling for insulin use (odds ratio: 1.85 for duration of more than ten years of use compared with less than five years of use). The prevalence of end-stage diabetic manifestations was increased in patients with frozen shoulder as compared with those without frozen shoulder (p < 0.0001). CONCLUSION: There was no association found between HbA1c level and the prevalence of frozen shoulder in this diabetic population.

Reduction of postoperative stiffness after arthroscopic rotator cuff repair: results of a customized physical therapy regimen based on risk factors for stiffness.

PURPOSE: The purpose of this study was to determine the benefits of a modified rehabilitation protocol (incorporating early closed-chain overhead stretching) in reducing the risk of postoperative stiffness after arthroscopic rotator cuff repair. METHODS: During a 17-month period, we performed primary arthroscopic rotator cuff repairs in 152 patients. After surgery, patients with risk factors identified in the previous study (calcific tendonitis, adhesive capsulitis, PASTA [partial articular surface tendon avulsion]-type rotator cuff repair, concomitant labral repair, or single-tendon cuff repair) were enrolled in a modified rehabilitation protocol that added early overhead closed-chain passive motion exercises to our standard protocol; alternatively, patients without risk factors received a standard conservative rehabilitation program. Historical controls were used and comprised patients in the senior author's practice who all received the conservative rehabilitation protocol. The prevalence of postoperative stiffness was compared between the historical cohort and current study patients by use of Fisher exact tests. RESULTS: Among the 152 patients studied, 79 were positive for at least 1 of the specified risk factors and received the modified protocol. Postoperative stiffness developed in none of the 79 patients enrolled in the modified program. This finding represented a significant improvement (Fisher exact test, P = .004) over the historical controls, in which 18 of the 231 at-risk patients had significant postoperative stiffness develop. CONCLUSIONS: In at-risk patients (with calcific tendonitis, adhesive capsulitis, PASTA repair, concomitant labral repair, and single-tendon repair), a postoperative rehabilitation regimen that incorporates early closed-chain passive overhead motion can reduce the incidence of postoperative stiffness after arthroscopic rotator cuff repair.

Bursitis, adventitious bursa, localized soft-tissue inflammation, and bone marrow edema in tibial stumps: the contribution of magnetic resonance imaging to the diagnosis and management of mechanical stress complications.

OBJECTIVE: To assess the contribution of magnetic resonance imaging (MRI) in the diagnosis of tibial stump bursitis, in the establishment of differential diagnosis, and in the therapeutic management prosthetic-stump interface, mainly by adaptation of the prosthetic device. DESIGN: Two-year, prospective, consecutive series. SETTING: University-affiliated prosthetic and rehabilitation center and university department of radiology. PARTICIPANTS: A group of 17 persons with stump problems identified from a total of 139 consecutive below-knee amputees with prosthesis problems. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical symptoms and MRI. RESULTS: Clinical symptoms (variable stump volume, fluctuating mass at palpation with or without mechanical pain) were suggestive of bursitis in 10 patients. MRI confirmed bursitis in 9 and identified 1 in whom clinical signs suggested neuroma, giving an incidence of 10 of 139 amputees (7.2%). MRI identified 13 sites of bursitis (adventitious bursa, 11; synovial bursitis, 2) and 5 localized areas of soft tissue inflammation. MRI showed diffuse muscular edema at 1 site of clinically suspected bursitis, and bursitis at another site of suspected neuroma. Calcified bursitis was observed in 1 case. Bone abnormalities associated with bursitis (n=7) included osteophytes or fracture (n=4) or bone marrow edema (n=3). Two asymptomatic neuromas were also identified. MRI-guided modifications of the prosthetic interface led to favorable outcome in all cases. CONCLUSION: Bursitis, adventitious bursae, and areas of localized soft-tissue inflammation are different aspects of the same disorder resulting from a mechanical conflict between the stump and the prosthesis socket. Besides contributing to diagnosis, MRI provides a precise assessment necessary for correcting the prosthesis-stump interface in a way that reduces mechanical stress and subsequently cures bursitis.

The 11th nerve syndrome. Accessory nerve palsy or adhesive capsulitis?

The 11th nerve syndrome classically involves the majority of patients undergoing neck dissections even when the accessory nerve is preserved. A preliminary analysis of our data of 31 of 44 patients who underwent neck dissections from a prospective study showed numerous findings of shoulder disability that are not attributable to accessory nerve palsy but are well described by the syndrome of adhesive capsulitis of the glenohumeral joint. At 1 month postoperatively, although accessory nerve palsy symptoms were common, adhesive capsulitis symptoms were significant. At 6 months, the frequency of accessory nerve palsy symptoms was less as the accessory nerve had begun to recover. At 12 and 18 months, when most of the accessory nerves had recovered, the accessory nerve palsy symptoms were comparatively uncommon while the adhesive capsulitis symptoms predominated as the remaining symptoms of the 11th nerve syndrome. We propose that adhesive capsulitis is a principal component of the 11th nerve syndrome that can significantly compound the morbidity of a neck dissection even when the accessory nerve recovers. We also propose that adhesive capsulitis accounts for the persistence and variability of shoulder symptoms after neck dissection that cannot be attributed to trapezius muscle dysfunction.