Perioperative Outcomes, Comorbidities, and Complications following Total Shoulder Arthroplasty in Wheelchair Users: A Retrospective Cohort Analysis of a Nationwide Database.

Impaired shoulder function hinders the ability of wheelchair users to maintain independence. The current state of the literature delineates the risks and benefits of surgical techniques for the management of shoulder pathologies. To the best of our knowledge, there is no study that has investigated complications following total shoulder arthroplasty (TSA) in wheelchair users. Utilizing the PearlDiver Mariner national administrative database, 72,108 patients were identified who underwent TSA with a concurrent diagnosis of a rotator cuff tear. Two matched cohorts, one of wheelchair users and one of non-wheelchair users, were created. Due to limitations within PearlDiver, one-year outcomes, including comorbidity and complication rates and readmission statistics, were compared between the two cohorts. Each matched cohort of 869 patients underwent TSA with a concurrent diagnosis of a rotator cuff tear. The rate of readmission in wheelchair users was greater than in non-wheelchair users (24.05% vs. 9.55%, OR: 3.00, CI: 2.279, 3.946). Patients in the wheelchair cohort exhibited higher rates of complications and comorbidities (p < 0.001). Among the most likely to be readmitted after TSA were patients with osteoarthritis, pulmonary heart disease, rheumatoid arthritis, and hypertension (p < 0.05). Significant differences in surgical outcomes existed between wheelchair and non-wheelchair users in terms of preoperative comorbidities, postoperative complications, and readmission rates.

Is the King-Devick Test a Reliable Tool in Wheelchair Athletes? A Preliminary Prospective Study in Wheelchair Basketball.

OBJECTIVE: (1) To determine the reliability of the King-Devick (KD) test among wheelchair basketball athletes across a season and (2) to compare the KD test time changes among those with and without a clinically suspected concussion. DESIGN: Prospective, observational study. SETTING: Division 3 college athletics department. PARTICIPANTS: Twenty-nine intercollegiate wheelchair basketball athletes. INTERVENTIONS: Athletes were prospectively monitored for concussions throughout the 2018 to 2019 season. King-Devick testing was completed preseason, midseason, postseason, and after clinically suspected concussions. MAIN OUTCOME MEASURES: Two-way random effects intraclass correlation coefficient (ICC) was calculated. Friedman's test and pairwise comparison with Bonferroni correction were used to compare for change over time. Mean KD times and changes were compared between athletes with and without suspected concussion. RESULTS: The KD test demonstrated good test-retest reliability (ICC = 0.826). Among participants without a concussion, there was a significant decrease in the mean KD test time from preseason to midseason (-3.3 seconds; P = 0.0167) and preseason to postseason (-3.3 seconds; P = 0.0167). No change was seen from mid-to-post season. Six athletes had 7 suspected concussions. Each demonstrated an increase in the KD test time, with a mean increase from 44.3 ± 9.5 seconds to 53.7 ± 12.8 seconds. King-Devick test times returned to or below baseline by postseason. CONCLUSIONS: The KD test shows good reliability among wheelchair basketball athletes without a concussion. A learning effect is demonstrated initially but plateaus on subsequent testing. Unlike athletes without a concussion, players with a clinically suspected concussion showed an increase in the KD test time.

Physical Examination and Patellofemoral Pain Syndrome: an Updated Review.

PURPOSE OF REVIEW: Patellofemoral pain syndrome (PFPS) accounts for 25 to 40% of all knee disorders. Diagnosis of PFPS is primarily based on history and physical examination, but the findings on physical examination are often subtle and do not consistently correlate with symptoms described. Yoon and Fredericson published a review article in 2006 detailing the physical examination maneuvers most frequently used to assist clinicians in the accurate diagnosis and treatment of PFPS, and our aim in this review is to provide an update on this previous article focusing on the literature published over the past 15 years regarding the topic. RECENT FINDINGS: Since publication of Fredericson's original review article, there have been studies building on the literature specifically surrounding Q angle, patellar tilt, crepitus, strength and functional testing, and physical examination maneuver clustering. Additionally, multiple studies have been conducted on the use of musculoskeletal ultrasound (US) as a diagnostic tool for PFPS. Recent literature has further supported Q angle (when measured utilizing a standardized protocol), crepitus, weakness of hip abductors and extensors, and weakness detected in functional testing as predictors of PFPS while finding inconsistent evidence behind lateral patellar tilt as a predictor of PFPS. The reliability of most physical examination tests alone remain low, but clustering physical examination findings may provide better sensitivities and specificities in diagnosing PFPS. Musculoskeletal US is rapidly gaining popularity, and decreased vastus medialis obliquus (VMO) volume, asymmetry in gluteus medius thickness, intra-articular effusions, and quadriceps and patellar tendon thicknesses have shown value in diagnosing those with PFPS. Additionally, US has the advantage of providing dynamic examination as well as evaluation of the patellofemoral joint in newborns and infants as a predictor of future patellofemoral instability. Further studies are needed to establish the gold standard for diagnosing PFPS and what US findings are truly predictive of PFPS.

Health-Related Incidents among Intercollegiate Wheelchair Basketball Players.

BACKGROUND: Studies have revealed a higher incidence of injury and illness among elite adaptive athletes when compared to non-disabled athletes in the Paralympics and Olympics. However, sport-specific health care incidence rates and patterns outside of the Paralympics have been poorly described. To date, there are no prospective studies focused on injury or illness rates among intercollegiate wheelchair basketball players. OBJECTIVE: To determine the incidence of sports-related injuries and illnesses among men's and women's intercollegiate wheelchair basketball teams throughout a season. We hypothesized that injury rates among the intercollegiate wheelchair basketball players would be similar to or greater than those of previously published National Collegiate Athletic Association (NCAA) nondisabled basketball players and that injuries would most commonly affect the upper extremities. DESIGN: Prospective surveillance study. SETTING: Men's and women's intercollegiate wheelchair basketball teams in Arlington, Texas. PARTICIPANTS: Twenty-eight (14 male, 14 female) of the 29 (15 male, 14 female) eligible adult athletes playing on an intercollegiate men's or women's wheelchair basketball team during the 2018-2019 season. INTERVENTIONS: Completion of a repeatable, electronic, web-app injury and illness survey during the season, as well as separate pre- and post-season injury and illness surveys. MAIN OUTCOME MEASURES: Injury rates throughout the season based on athlete-exposures and relative risk (RR) of injury of intercollegiate wheelchair basketball players compared to NCAA nondisabled basketball players. Description of onset, location, diagnosis, medical evaluation, and missed time from sport related to injuries and illnesses. RESULTS: Sixty-two health-related incidents, including 48 injuries and 14 illnesses, were prospectively reported during the season. Overall injury incidence rates were 12.2 (95% confidence interval [95% CI] 7.4 to 17.4) and 13.1 (95% CI 7.8 to 18.4) injuries per 1000 athlete-exposures among male and female athletes, respectively. These equated to RRs of 1.53 (95% CI 1.03 to 2.27) (male) and 2.01 (95% CI 1.34 to 3.02) (female) when compared to the rates published previously on NCAA nondisabled basketball players, indicating a statistically significant increase in injury risk. Injuries most commonly involved the upper extremities (56.3%). Illnesses commonly involved the gastrointestinal (35.7%) or respiratory (21.4%) systems. CONCLUSIONS: This is the first prospective study to report incidence of sports-related injuries and illnesses throughout an intercollegiate wheelchair basketball season. Overall injury rates reported were higher than prior NCAA nondisabled intercollegiate basketball reports. This reinforces the need to establish an accessible network of health care support and injury prevention strategies for these athletes.

Apps and Mobile Health Technology in Rehabilitation: The Good, the Bad, and the Unknown.

Although there is disparity in access to mobile health (mHealth) services among people with disabilities, several smartphone and tablet-based mHealth applications are available that may affect the care of patients in rehabilitation medicine. This article reviews the current evidence for and breadth of application-based mHealth interventions in rehabilitation medicine, including comprehensive self-management mHealth services; weight management mHealth services; diagnosis-specific mHealth services for individuals with brain, spinal cord, musculoskeletal, or other injury types; and nonmedical services to improve community and social integration.

Dropping the Hammer: An Uncommon Case of Right-Hand Pain in a Professional Hockey Player.

A 26-year-old, right-handed male professional hockey player presented for a second opinion with dysesthesia of the tips of his right third, fourth, and fifth fingers after 2 previous incidents of hyperextension injuries to his right wrist while holding his hockey stick. Radiographs and computed tomography scans were negative for fracture. After magnetic resonance angiography and Doppler ultrasound imaging, the athlete was diagnosed with hypothenar hammer syndrome (HHS) with ulnar artery aneurysm and thrombosis. He underwent successful surgery with ligation and excision of the aneurysmal, thrombosed ulnar artery and was able to return to hockey 4 weeks after surgery. HHS is thought to be a rare posttraumatic digital ischemia from thrombosis and/or aneurysm of the ulnar artery and was traditionally considered an occupational injury but has been reported more frequently among athletes. There have only been 2 previous case reports of hockey players diagnosed with HHS, and in the previous 2 case reports, both involved repetitive trauma from the hockey stick, which resulted in thrombotic HHS. We present a case of a professional hockey player diagnosed with HHS also due to repetitive trauma from the hockey stick, but this time resulting in aneurysmal HHS with thromboembolism. This case report highlights the importance of keeping HHS in the differential diagnosis in athletes with pain, cold sensitivity, and paresthesia in their fingers with or without a clear history of repetitive trauma to the hypothenar eminence, as HHS is a condition with good outcomes after proper treatment.