RESUMO
BACKGROUND: Without surgical repair, flexor tendon injuries do not heal and patients' ability to bend fingers and grip objects is impaired. However, flexor tendon repair surgery also requires optimal rehabilitation. There are currently three custom-made splints used in the rehabilitation of zone I/II flexor tendon repairs, each with different assumed harm/benefit profiles: the dorsal forearm and hand-based splint (long), the Manchester short splint (short), and the relative motion flexion splint (mini). There is, however, no robust evidence as to which splint, if any, is most clinical or cost effective. The Flexor Injury Rehabilitation Splint Trial (FIRST) was designed to address this evidence gap. METHODS: FIRST is a parallel group, superiority, analyst-blind, multi-centre, individual participant-randomised controlled trial. Participants will be assigned 1:1:1 to receive either the long, short, or mini splint. We aim to recruit 429 participants undergoing rehabilitation following zone I/II flexor tendon repair surgery. Potential participants will initially be identified prior to surgery, in NHS hand clinics across the UK, and consented and randomised at their splint fitting appointment post-surgery. The primary outcome will be the mean post-randomisation score on the patient-reported wrist and hand evaluation measure (PRWHE), assessed at 6, 12, 26, and 52 weeks post randomisation. Secondary outcome measures include blinded grip strength and active range of movement (AROM) assessments, adverse events, adherence to the splinting protocol (measured via temperature sensors inserted into the splints), quality of life assessment, and further patient-reported outcomes. An economic evaluation will assess the cost-effectiveness of each splint, and a qualitative sub-study will evaluate participants' preferences for, and experiences of wearing, the splints. Furthermore, a mediation analysis will determine the relationship between patient preferences, splint adherence, and splint effectiveness. DISCUSSION: FIRST will compare the three splints with respect to clinical efficacy, complications, quality of life and cost-effectiveness. FIRST is a pragmatic trial which will recruit from 26 NHS sites to allow findings to be generalisable to current clinical practice in the UK. It will also provide significant insights into patient experiences of splint wear and how adherence to splinting may impact outcomes. TRIAL REGISTRATION: ISRCTN: 10236011.
Assuntos
Artropatias , Traumatismos dos Tendões , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Pragmáticos como Assunto , Qualidade de Vida , Contenções , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Resultado do Tratamento , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
INTRODUCTION: Hand lacerations are common injuries seen by the primary care physician. Even seemingly small cuts carry a high risk of injury to flexor tendons of the hand which requires surgical treatment by a specialist. Elucidation of the relevant history, along with a dedicated and focused physical examination is imperative for an early intervention which, along with a meticulous surgical technique and dedicated rehabilitation by occupational therapists, will lead to a much improved functional prognosis for the patient. This is a brief review of the anatomy and physiology of flexor tendons injury and repair, with historical milestones of developments in the approach to the injury. The article also highlights the surgical procedure brought forth by the late Professor Isidor Kessler, one of the founders of surgery of the hand in Israel, presented here as an overview and guidance to the primary care physician.
Assuntos
Traumatismos da Mão , Lacerações , Traumatismos dos Tendões , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/etiologia , Traumatismos da Mão/cirurgia , Humanos , Lacerações/cirurgia , Técnicas de Sutura , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Tendões/cirurgiaRESUMO
BACKGROUND: Given the similar outcomes of various fixation constructs for single-incision distal biceps repair, a critical evaluation of the factors that drive the cost of the procedure is the key to optimizing treatment value. The purpose of this study was to quantify variation in costs for surgical treatment of complete distal biceps ruptures, as well as identify factors affecting costs. METHODS: We retrospectively identified adult patients consecutively treated surgically for complete distal biceps ruptures between July 2011 and January 2018 at a single academic medical center. Using our institution's information technology value tool, we recorded the surgical encounter total direct costs (SETDCs) for each patient. Univariate and multivariate gamma regression models were used to determine factors affecting SETDCs. RESULTS: Of 121 included patients, 102 (86%), 7 (6%), and 12 (10%) underwent primary repair, revision, and reconstruction. SETDCs varied widely, with a standard deviation of 40% and a range of 58% to 276% of the average SETDC. The main contributors to SETDCs were facility utilization costs (53%) and implant costs (29%). Implant costs also varied, with a standard deviation of 16%, ranging up to 121% of the mean SETDC. Multivariate analysis demonstrated that reconstructions were 72% more costly than primary repairs (P < .001). No significant cost differences were found between cortical button and dual-suture anchor fixation (P = .058). American Society of Anesthesiologists class, body mass index, revision surgery, time to surgery, location, administration of postoperative block, and surgeon performing the procedure did not significantly affect the SETDC. CONCLUSION: Surgical encounter and implant costs vary widely for distal biceps rupture treatment. However, no significant difference in SETDC was identified between repair with a cortical button vs. dual-suture anchor repair. The greater costs associated with reconstruction surgery should be taken into consideration.
Assuntos
Custos Diretos de Serviços , Músculo Esquelético/lesões , Traumatismos dos Tendões/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Ruptura/cirurgia , Âncoras de Sutura/economia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/economia , Resultado do Tratamento , CicatrizaçãoRESUMO
PURPOSE: Flexor tendon lacerations are a common and debilitating injury for thousands of Americans annually. Despite this, no study has attempted to estimate the economic impact of these injuries. The objective of this study was to estimate the economic impact of flexor tendon lacerations in America. METHODS: The cost of flexor tendon lacerations to society was estimated using a validated prevalence-based cost of illness model. The primary cohort was defined as all patients in the United States presenting with complete flexor tendon lacerations who underwent surgical repair. The secondary cohort was defined by all patients who required reoperation within 1 year of their initial operation. For these groups, both direct and indirect costs (lost income, missed workdays, and disability payments) were measured. RESULTS: Flexor tendon lacerations incur an estimated cost of between US $240.8 and US $409.1 million annually to the American medical system. The total direct cost per injury is estimated to be US $13,725, whereas estimates to the indirect costs range from US $60,786 to US $112,888. CONCLUSIONS: Flexor tendon lacerations represent an important economic burden to our health care system, even when compared with other common hand conditions. Specifically, indirect costs, such as missed workdays, are the major contributor toward the total cost these injuries incur on society, accounting for upward of 89% of the total cost. This suggests that we should focus our efforts to improve treatments and rehabilitation protocols which decrease these indirect costs.
Assuntos
Traumatismos da Mão/economia , Gastos em Saúde , Reembolso de Seguro de Saúde/estatística & dados numéricos , Procedimentos Ortopédicos/economia , Traumatismos dos Tendões/economia , Traumatismos dos Tendões/cirurgia , Adulto , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Bases de Dados Factuais , Feminino , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/reabilitação , Traumatismos da Mão/cirurgia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/reabilitação , Estados UnidosRESUMO
BACKGROUND: Achilles tendon rupture (ATR) is a common sports injury, with a rising incidence and significant impairments. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment (non-surgical or surgical) and rehabilitation. It is hypothesized that this lack of consensus and guidelines leads to sub-optimal recovery and higher societal costs. The primary aim of this study is to give a broad insight into the recovery after ATR. Secondarily this study aims to explore factors contributing to recovery and gain insight into the cost-effectiveness of ATR management. METHODS: This multicenter prospective cohort study will include all adult (≥ 18 years) patients with an ATR treated at the three main hospitals in the Northern Netherlands: University Medical Center Groningen, Martini Hospital Groningen and Medical Center Leeuwarden. All subjects will be invited for three visits at 3, 6 and 12 months post-injury. The following data will be collected: patient-reported outcome measures (PROMs), physical tests, imaging and economic questionnaires. At 3 months post-injury personal, injury, and treatment data will be collected through a baseline questionnaire and assessment of the medical file. The PROMs concern the Dutch version of the Achilles Tendon Total Rupture Score, EQ-5D-5 L, Oslo Sport Trauma Research Center Overuse Injury Questionnaire, Injury Psychological Readiness Return to Sport Scale, Tampa Scale of Kinesiophobia, Expectations, Motivation and Satisfaction questionnaire and a ranking of reasons for not returning to sport. The administered physical tests are the heel-rise test, standing dorsiflexion range of motion, resting tendon length and single leg hop for distance. Ultrasound Tissue Characterization will be used for imaging. Finally, economic data will be collected using the Productivity Cost Questionnaire and Medical Consumption Questionnaire. DISCUSSION: This prospective cohort study will contribute to optimal decision making in the primary treatment and rehabilitation of ATRs by providing insight into (1) ATR recovery (2) novel imaging for monitoring recovery (3) (barriers to) return to sport and (4) cost-effectiveness of management. The analysis of these data strives to give a broad insight into the recovery after ATR as well as provide data on novel imaging and costs, contributing to individualized ATR management. TRIAL REGISTRATION: Trialregister.nl. NTR6484 . 20/06/2017. 20/07/2017.
Assuntos
Tendão do Calcâneo/lesões , Projetos de Pesquisa , Traumatismos dos Tendões/terapia , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/fisiopatologia , Tomada de Decisão Clínica , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Estudos Multicêntricos como Assunto , Países Baixos , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Exame Físico , Valor Preditivo dos Testes , Estudos Prospectivos , Recuperação de Função Fisiológica , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/economia , Traumatismos dos Tendões/fisiopatologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The FASH (Functional Assessment Scale for Acute Hamstring Injuries) questionnaire has been recently developed as a disease-specific self-administered questionnaire for use in Greek, English, and German languages. Its psychometric qualities (validity and reliability) were tested only in Greek-speaking patients mainly representing track and field athletes. As hamstring injuries represent the most common football injury, we tested the validity and reliability of the FASH-G (G = German version) questionnaire in German-speaking footballers suffering from acute hamstring injuries. METHODS: The FASH-G questionnaire was tested for reliability and validity, in 16 footballers with hamstring injuries (patients' group), 77 asymptomatic footballers (healthy group), and 19 field hockey players (at-risk group). Known-group validity was tested by comparing the total FASH-G scores of the injured and non-injured groups. Reliability of the FASH-G questionnaire was analysed in 18 asymptomatic footballers using the intra-class coefficient. RESULTS: Known-group validity was demonstrated by significant differences between injured and non-injured participants (p < 0.001). The FASH-G exhibited very good test-retest reliability (intra-class correlation coefficient = 0.982, p < 0.001). Internal consistency was excellent (α = 0.938). Compared with the results presented in the original publication, no statistical differences were found between healthy athletes (p = 0.257), but patients' groups and at-risk groups presented scoring differences (p = 0.040 and <0.001, respectively). CONCLUSIONS: The FASH-G is a valid and reliable instrument to assess and determine the severity of hamstring injuries in German footballers.
Assuntos
Músculos Isquiossurais/lesões , Tendões dos Músculos Isquiotibiais/lesões , Futebol/lesões , Traumatismos dos Tendões/diagnóstico , Índices de Gravidade do Trauma , Adolescente , Adulto , Teste de Esforço/métodos , Estudos de Viabilidade , Feminino , Alemanha , Humanos , Idioma , Masculino , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto JovemAssuntos
Traumatismos da Mão/diagnóstico , Traumatismos da Mão/terapia , Queimaduras/diagnóstico , Queimaduras/terapia , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/terapia , Humanos , Paroniquia/diagnóstico , Paroniquia/terapia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/terapia , Tenossinovite/diagnóstico , Tenossinovite/cirurgiaRESUMO
Accurate assessment of partial-thickness flexor tendon lacerations in the hand is difficult owing to the subjectivity of evaluation. In this study, we created 12 partial-thickness flexor tendon lacerations in a cadaveric hand, evaluated the accuracy of 6 orthopedic residents and 4 fellowship-trained hand surgeons in estimating the percentage thickness of each laceration, and assessed the groups' interobserver and intraobserver agreement. The 10 participants estimated each laceration independently and on 2 separate occasions and indicated whether they would repair it. The actual thickness of each laceration was calculated from measurements made with a pair of digital microcalipers. Overall estimates differed significantly from calibrated measurements. Estimates grouped by residents and fellowship-trained hand surgeons also differed significantly. Third-year residents were the most accurate residents, and fellowship-trained hand surgeons were more accurate than residents. Overall interobserver agreement was poor for both readings. There was moderate overall intraobserver agreement. Fellowship-trained hand surgeons and first-year residents had the highest intraobserver agreement. These results highlight the difficulty in accurately assessing flexor tendon lacerations. Accuracy appears not to improve with surgeon experience.
Assuntos
Traumatismos da Mão/diagnóstico , Traumatismos dos Tendões/diagnóstico , Cadáver , Bolsas de Estudo , Traumatismos da Mão/cirurgia , Humanos , Internato e Residência , Lacerações/diagnóstico , Lacerações/cirurgia , Variações Dependentes do Observador , Ortopedia/educação , Reprodutibilidade dos Testes , Traumatismos dos Tendões/cirurgiaRESUMO
Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937.
Assuntos
Traumatismos em Atletas/diagnóstico , Ligamento Patelar/lesões , Inquéritos e Questionários , Adulto , Comparação Transcultural , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Traumatismos dos Tendões/diagnóstico , TraduçãoRESUMO
BACKGROUND: Assessments used to measure outcomes associated with rotator cuff pathology and after repair are varied. This lack of standardization leads to difficulty drawing comparisons across studies. We hypothesize that this variability in patient-reported outcome measures and objective metrics used in rotator cuff studies persists even in high-impact, peer reviewed journals. METHODS: All studies assessing rotator cuff tear and repair outcomes in 6 orthopedic journals with a high impact factor from January 2010 to December 2014 were reviewed. Cadaveric and animal studies and those without outcomes were excluded. Outcome measures included range of motion (forward elevation, abduction, external rotation, and internal rotation), strength (in the same 4 planes), tendon integrity imaging, patient satisfaction, and functional assessment scores. RESULTS: Of the 156 included studies, 63% documented range of motion measurements, with 18% reporting range of motion in all 4 planes. Only 38% of studies reported quantitative strength measurements. In 65% of studies, tendon integrity was documented with imaging (38% magnetic resonance imaging/magnetic resonance anrhrogram, 31% ultrasound, and 8% computed tomography arthrogram). Finally, functional score reporting varied significantly, with the 5 most frequently reported scores ranging from 16% to 61% in studies, and 15 of the least reported outcomes were each reported in ≤6% of studies. CONCLUSIONS: Significant variability exists in outcomes reporting after rotator cuff tear and repair, making comparisons between clinical studies difficult. Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management and allow comparisons across the literature.
Assuntos
Artroscopia/métodos , Diagnóstico por Imagem/métodos , Avaliação de Resultados em Cuidados de Saúde , Lesões do Manguito Rotador , Traumatismos dos Tendões/diagnóstico , Animais , Artrografia , Humanos , Imageamento por Ressonância Magnética , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: Few studies define the clinical signs to evaluate the integrity of teres minor in patients with massive rotator cuff tears. CT and MRI, with or without an arthrogram, can be limited by image quality, soft tissue density, motion artifact, and interobserver reliability. Additionally, the ill-defined junction between the infraspinatus and teres minor and the larger muscle-to-tendon ratio of the teres minor can contribute to error. Therefore, we wished to determine the validity of clinical testing for teres minor tears. QUESTION/PURPOSES: The aim of this study was to determine the accuracy of commonly used clinical signs (external rotation lag sign, drop sign, and the Patte test) for diagnosing the teres minor's integrity. METHODS: We performed a prospective evaluation of patients referred to our shoulder clinic for massive rotator cuff tears determined by CT arthrograms. The posterosuperior rotator cuff was examined clinically and correlated with CT arthrograms. We assessed interobserver reliability for CT assessment and used three different clinical tests of teres minor function (the external rotation lag sign, drop sign, and the Patte test). One hundred patients with a mean age of 68 years were available for the analysis. RESULTS: The most accurate test for teres minor dysfunction was an external rotation lag sign greater than 40°, which had a sensitivity of 100% (95% CI, 80%-100%) and a specificity of 92% (95% CI, 84%-96%). External rotation lag signs greater than 10° had a sensitivity of 100% (95% CI, 80%-100%) and a specificity of 51% (95% CI, 40%-61%). The Patte sign had a sensitivity of 93% (95% CI, 70%-99%) and a specificity of 72% (95% CI, 61%-80%). The drop sign had a sensitivity of 87% (95% CI, 62%-96%) and a specificity of 88% (95% CI, 80%-93%). An external rotation lag sign greater than 40° was more specific than an external rotation lag sign greater than 10° (p < 0.001), and a Patte sign (p < 0.001), but was not more specific than the drop sign (p < 0.47). There was poor correlation between involvement of the teres minor and loss of active external rotation. CONCLUSIONS: Clinical signs can predict anatomic patterns of teres minor dysfunction with good accuracy in patients with massive rotator cuff tears. This study showed that the most accurate test for teres minor dysfunction is an external rotation lag sign and that most patients' posterior rotator cuff tears do not lose active external rotation. Because imaging is not always accurate, examination for integrity of the teres minor is important because it may be one of the most important variables affecting the outcome of reverse shoulder arthroplasty for massive rotator cuff tears, and the functional effects of tears in this muscle on day to day activities can be significant. Additionally, teres minor integrity affects the outcomes of tendon transfers, therefore knowledge of its condition is important in planning repairs. LEVEL OF EVIDENCE: Level III, diagnostic study.
Assuntos
Exame Físico/métodos , Manguito Rotador/fisiopatologia , Articulação do Ombro/fisiopatologia , Traumatismos dos Tendões/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Artrografia/métodos , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador , Lesões do Ombro , Articulação do Ombro/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: The purpose of this study was to determine the feasibility and the value of percutaneous ultrasound-guided subacromial bursography (PUSB) with contrast-enhanced ultrasound (CEUS) for assessment of rotator cuff tears. METHODS: Between January 2012 and September 2014, 2-D US and PUSB were prospectively performed in 135 patients with suspected rotator cuff tears from among 2,169 patients with clinically diagnosed subacromial impingement syndrome. Sixty-three patients who had undergone arthroscopy were included. The PUSB findings were compared with those from 2-D US using the McNemar test, with arthroscopy as a standard. RESULTS: Of a total of 19 full-thickness tears (FTTs), 2-D US correctly diagnosed 12 and PUSB correctly diagnosed 18 (P = 0.031). With regard to partial-thickness tears, 2-D US correctly diagnosed 31 and PUSB 35 of a total of 41 tears (P = 0.375).Accuracy in diagnosing FTTs was 81.0 % for 2-D US and 98.4 % for PUSB. 2-D US and PUSB yielded sensitivity of 63.2 % and 94.7 %, respectively, for full-thickness tears, with specificity of 88.6 % and 100.0 %, respectively. CONCLUSIONS: PUSB is a safe and feasible procedure, with greater sensitivity and specificity than 2D US in diagnosing FTTs As such, PUSB improves the value of ultrasound for assessing rotator cuff pathology. KEY POINTS: ⢠PUSB allows new application of CEUS and offers a new form of bursography. ⢠PUSB appears to facilitate diagnosis of full -thickness rotator cuff tears. ⢠PUSB outlines the rotator cuff tears more clearly than 2-D US.
Assuntos
Microbolhas , Lesões do Manguito Rotador , Síndrome de Colisão do Ombro/diagnóstico por imagem , Adulto , Idoso , Artroscopia/métodos , Bolsa Sinovial/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Manguito Rotador/diagnóstico por imagem , Sensibilidade e Especificidade , Traumatismos dos Tendões/diagnóstico , Ultrassonografia de Intervenção/métodosRESUMO
Although pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 ± 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p = .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques.
Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/patologia , Imagem de Tensor de Difusão/métodos , Interpretação de Imagem Assistida por Computador , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/cirurgia , Adulto , Anisotropia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Cuidados Pós-Operatórios/métodos , Controle de Qualidade , Valores de Referência , Estudos Retrospectivos , Ruptura/cirurgia , Traumatismos dos Tendões/diagnóstico , Resultado do TratamentoRESUMO
HYPOTHESIS: The purpose of this study was to determine the minimal detectable change (MDC) for the Constant score in patients with impingement, a supraspinatus tear, or a massive rotator cuff (RC) tear as observed changes smaller than the MDC might be the result of measurement error. METHODS: The Constant score was recorded in a total of 180 patients, including 34 patients with impingement, 105 with supraspinatus tears, and 41 with massive RC tears. We assessed the MDC in the 3 subgroups and total group using the samples standard deviation (SD), internal consistency (Cronbach α), and standard error of the measurement. Floor and ceiling effects were also reported. RESULTS: The absolute mean Constant score was 72 (SD, 11.2) in the impingement group, 44 (SD, 14.7) in the supraspinatus tear group, and 46 (SD, 18.9) in the massive RC tear group. There were no floor and ceiling effects for the absolute Constant score. In the total group, the internal consistency was 0.8 and the standard error of the measurement was 8. The MDC was 23 points on the Constant score in the total group and 17, 18, and 23 points on the Constant score for impingement, RC tears, and massive RC tears, respectively. CONCLUSION: This study demonstrates that the MDCs of the Constant score are different in patients with impingement, supraspinatus tears, and massive RC tears. Studies reporting the Constant score should be interpreted by use of the population-specific MDC and minimal clinical important change.
Assuntos
Indicadores Básicos de Saúde , Artropatias/diagnóstico , Lesões do Manguito Rotador , Síndrome de Colisão do Ombro/diagnóstico , Traumatismos dos Tendões/diagnóstico , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Manguito Rotador/cirurgia , RupturaRESUMO
OBJECTIVE: To develop a condition-specific patient-reported outcome measure, the Functional Assessment Scale for Acute Hamstring Injuries (FASH), de novo in three languages, following distinct and rigorous methodology for content generation, analysis and validation and to assess its psychometric properties. BACKGROUND: To our knowledge, there is no patient-reported functional scale specific for acute hamstring injuries. METHODS: The development of the scale followed specific guidelines, as well as de novo construction in three languages (Greek, English and German). Item generation was accomplished by selecting three different sources of items: literature review, focus group and key informant interviews. Content analysis was conducted by an expert committee. The 21 items selected as appropriate were tested through a structured content analytic method and item-content validity coefficient, and 10 were retained for the FASH. The validation and assessment of its psychometric properties followed theConsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) recommendations to ensure quality, in a convenience sample of 140 participants. RESULTS: The face validity was adequate and tested by expert committees, authors and participants. Content validity was characterised as well addressed and conducted independently by experts and through specific content validation procedures. The dimensionality analysis indicated a one-factor solution explaining the 95.8% of total variance. Known group validity was demonstrated by significant differences between patients and controls (p<0.001). The FASH exhibited very good test-retest reliability (intraclass correlation coefficient=0.9, p<0.001), internal consistency (α=0.98) and responsiveness (3.81 and 5.23 using baseline and pooled SD, respectively; standardised response mean (SRD)=4.68). CONCLUSION: This study provides initial evidence for psychometric properties of the first scale assessing hamstring injuries.
Assuntos
Traumatismos em Atletas/diagnóstico , Escala de Gravidade do Ferimento , Inquéritos e Questionários/normas , Traumatismos dos Tendões/diagnóstico , Traumatismos em Atletas/fisiopatologia , Humanos , Psicometria , Adulto JovemRESUMO
BACKGROUND: This study was designed to perform conventional ultrasonography, magnetic resonance arthrography (MRA) and arthrosonography exams after rotator cuff repair to compare the results of conventional ultrasonography and arthrosonography with those of MRA as the gold standard. METHODS: We prospectively studied 42 consecutive patients (14 males, 28 females; average age, 59.4 years) who received arthroscopic rotator cuff repair due to full-thickness tears of the supraspinatus tendon from 2008 to 2010. The integrity assessment of the repaired rotator cuff was performed 6 months postoperatively using conventional ultrasonography, MRA, and arthrosonography. RESULTS: The diagnostic accuracy of the conventional ultrasonography compared to MRA was 78.6% and the McNemar test results were 0.016 in full-thickness tear and 0.077 in partial-thickness tear. The diagnostic accuracy of arthrosonography compared to MRA was 92.9% and the McNemar test results were 0.998 in full-thickness tear and 0.875 in partial-thickness tear. CONCLUSIONS: It was found that the integrity assessment of the repaired rotator cuff by ultrasonography must be guarded against and that arthrosonography is an effective alternative method in the postoperative integrity assessment. Also, an arthrosonography seems to be a suitable modality to replace the conventional ultrasonography.
Assuntos
Manguito Rotador/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrografia , Artroscopia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Manguito Rotador/fisiopatologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgia , Ultrassonografia , CicatrizaçãoRESUMO
BACKGROUND: In many areas of orthopaedics, patients with greater levels of psychological distress report inferior self-assessments of pain and function. This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales, even those not traditionally considered to have a psychological component. QUESTIONS/PURPOSES: This study attempts to answer the following questions: (1) Are higher levels of psychological distress associated with clinically important differences in baseline scores on the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair? (2) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled? METHODS: Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire. Patients completed baseline self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Age, sex, BMI, smoking status, American Society of Anesthesiologists classification, tear size, and tear retraction were recorded for each patient. Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function. RESULTS: Distressed patients reported higher baseline VAS scores (6.7 [95% CI, 4.4-9.0] versus 2.9 [95% CI, 2.3-3.6], p = 0.001) and lower baseline Simple Shoulder Test (3.7 [95% CI, 2.9-4.5] versus 5.7 [95% CI 5.0-6.4], p = 0.001) and American Shoulder and Elbow Surgeons scores (39 [95% CI, 34-45] versus 58 [95% CI, 53-63], p < 0.001). Distress remained associated with higher VAS scores (p = 0.001) and lower Simple Shoulder Test (p < 0.001) and American Shoulder and Elbow Surgeons scores (p < 0.001) when age, sex, BMI, American Society of Anesthesiologists classification, smoking status, tear size, and tear retraction were controlled. CONCLUSIONS: Higher levels of psychological distress are associated with inferior baseline patient self-assessment of shoulder pain and function using the VAS, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score. Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes after arthroscopic rotator cuff repair. LEVEL OF EVIDENCE: Level I, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
Assuntos
Autoavaliação Diagnóstica , Lesões do Manguito Rotador , Lesões do Ombro , Dor de Ombro/diagnóstico , Estresse Psicológico/psicologia , Traumatismos dos Tendões/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia , Fenômenos Biomecânicos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição da Dor , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Manguito Rotador/fisiopatologia , Manguito Rotador/cirurgia , Ombro/fisiopatologia , Ombro/cirurgia , Dor de Ombro/fisiopatologia , Dor de Ombro/psicologia , Dor de Ombro/cirurgia , Estresse Psicológico/diagnóstico , Inquéritos e Questionários , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/psicologia , Traumatismos dos Tendões/cirurgiaRESUMO
BACKGROUND: Rotator cuff tears are a common cause of shoulder pain. There is an absence of information about symptomatic rotator cuffs from the patients' perspective; this limits the information clinicians can share with patients and the information that patients can access via sources such as the internet. This study describes the experiences of people with a symptomatic rotator cuff, their symptoms, the impact upon their daily lives and the coping strategies utilised by study participants. METHODS: An interpretive phenomenological analysis approach was used. 20 participants of the UKUFF trial (The United Kingdom Rotator Cuff Surgery Trial) agreed to participate in in-depth semi-structured interviews about their experiences about living with a symptomatic rotator cuff tear. Interviews were digitally recorded and fully transcribed. Field notes, memos and a reflexive diary were used. Data was coded in accordance with interpretive phenomenological analysis. Peer review, code-recode audits and constant comparison of data, codes and categories occurred throughout. RESULTS: The majority of patients described intense pain and severely disturbed sleep. Limited movement and reduced muscle strength were described by some participants. The predominantly adverse impact that a symptomatic rotator cuff tear had upon activities of daily living, leisure activities and occupation was described. The emotional and financial impact and impact upon caring roles were detailed. Coping strategies included attempting to carry on as normally as possible, accepting their condition, using their other arm, using analgesics, aids and adaptions. CONCLUSIONS: Clinicians need to appreciate and understand the intensity and shocking nature of pain that may be experienced by participants with known rotator cuff tears and understand the detrimental impact tears can have upon all areas of patient's lives. Clinicians also need to be aware of the potential emotional impact caused by cuff tears and to ensure that patients needing help for conditions such as depression are speedily identified and provided with support, explanation and appropriate treatment.
Assuntos
Adaptação Psicológica , Efeitos Psicossociais da Doença , Lesões do Manguito Rotador , Dor de Ombro/psicologia , Traumatismos dos Tendões/psicologia , Atividades Cotidianas , Idoso , Fenômenos Biomecânicos , Emoções , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Medição da Dor , Pesquisa Qualitativa , Manguito Rotador/fisiopatologia , Índice de Gravidade de Doença , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Dor de Ombro/fisiopatologia , Transtornos do Sono-Vigília/etiologia , Transtornos do Sono-Vigília/fisiopatologia , Transtornos do Sono-Vigília/psicologia , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/fisiopatologia , Fatores de TempoRESUMO
BACKGROUND: This study compared ultrasound and magnetic resonance imaging (MRI) evaluation of the repaired rotator cuff to determine concordance between these imaging studies. METHODS: We performed a concordance study using the data from a prospective nonrandomized multicenter study at 13 centers. A suture bridge technique was used to repair 113 rotator cuff tears that were between 1 and 4 cm wide. Repairs were evaluated with MRI and ultrasound at multiple time points after surgery. The MRI scans were read by a central radiologist and the surgeon, and the ultrasounds were read by a local radiologist or the surgeon who performed the ultrasound. RESULTS: The concordance between the central radiologist's MRI reading and the investigator's MRI readings at all time points was 89%, with a κ coefficient of 0.60. The concordance between the central radiologist's MRI and ultrasound readings at all time points was 85%, with a κ coefficient of 0.40. The concordance between the investigator's MRI and ultrasound readings was 92%, with a κ coefficient of 0.70. CONCLUSIONS: In the community setting, ultrasound may be used to evaluate the integrity of a repaired rotator cuff tendon and constitutes a comparable alternative to MRI when evaluating the integrity of a rotator cuff repair. Clinical investigators should compare their postoperative ultrasound results with their postoperative MRI results for a certain time period to establish the accuracy of ultrasound before relying solely on ultrasound imaging to evaluate the integrity of their rotator cuff repairs.