Assuntos
Artroscopia/métodos , Tratamento Conservador , Manipulação Ortopédica/métodos , Modalidades de Fisioterapia , Luxação do Ombro/terapia , Adolescente , Distribuição por Idade , Idoso , Tomada de Decisão Compartilhada , Feminino , Humanos , Imobilização/métodos , Cápsula Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Distribuição por Sexo , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/epidemiologia , Articulação do Ombro/cirurgia , Reino Unido/epidemiologia , Adulto JovemRESUMO
The radiographic appearance of calcific tendinitis of the rotator cuff varies according to the stage of the disease. We compared currently used classification systems in a large group of observers to identify the most reliable classification system. Thirty-seven orthopaedic surgeons evaluated shoulder radiographs of 25 patients to classify the stage of the calcific tendinitis according to the classifications by (1) Gärtner and (2) Molé on a Web-based study platform. Inter and intraobserver agreement among observers was measured using the Siegel and Castellan multirater κ. Both classification systems had fair interobserver agreement : κ was 0.25 for the Molé classification and 0.34 for the Gärtner classification. The Gärtner classification was significantly more reliable than the Molé classification. Currently there is no radiographic classification that can serve the purpose of guiding the treatment in a reliable way.
Assuntos
Calcinose/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Tendinopatia/classificação , Tendinopatia/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Shoulder instability is associated with decreased functioning. The associated costs could be substantial and interesting to clinicians, researchers, and policy makers. This prospective observational study aims to (1) estimate productivity losses and healthcare expenses following the nonoperative treatment of shoulder instability and (2) identify patient characteristics that influence societal costs. METHODS: One hundred and thirty-two patients completed a questionnaire regarding production losses and healthcare utilization following consecutive episodes of shoulder instability. Productivity losses were calculated using the friction cost approach. Healthcare utilization was evaluated using standard costs. analysis of variance test was used to assess which patient characteristics are related to productivity losses and healthcare expenses. Societal costs were assessed using multilevel analyses. Bootstrapping was used to estimate statistical uncertainty. RESULTS: Mean productivity losses are 1469, 881, and 728 and mean healthcare expenses are 3759, 3267, and 2424 per patient per dislocation for the first, second, and third dislocation. Productivity losses decrease significantly after the second (mean difference -1969, 95%CI= -3680 to -939) and third (mean difference -2298, 95%CI= -4092 to -1288) compared to the first dislocation. CONCLUSIONS: Nonoperative treatment of shoulder instability has substantial societal costs. LEVEL OF EVIDENCE: III, economic analysis.