Pedicled Forearm Fasciocutaneous Flap for Tracheal Reconstruction: Anomalous Radial Vasculature Preventing Free-Flap.

A 61-year-old female presented with poorly differentiated thyroid carcinoma with anterior tracheal wall invasion. Following resection, the patient was to undergo anterior tracheal wall reconstruction with a radial forearm fasciocutaneous free flap and costal cartilage grafts. However, intraoperative identification of a "brachioradial artery" was identified with the deep radial and ulnar arteries completely separated from the radial artery. To maximize the chance for flap success, the fasciocutaneous flap was converted to a pedicled rotational flap with excellent results. This is the first pedicled radial forearm fasciocutaneous flap for composite reconstruction of the anterior trachea.

Seven new genera and thirty-four new species of buccinoid gastropods (Neogastropoda: Buccinidae) from the Aleutian Islands, Alaska.

Seven new genera and thirty-four new species of gastropods in the in the family Buccinidae, are described from the Aleutian Islands. The new taxa represent five subfamilies: Parancistrolepidinae Habe, 1972: Boreancistrolepis excelsus n. gen. & n. sp. Beringiinae Golikov & Starabogatov, 1975: Aleutijapelion mirandus n. gen. & n. sp.; Beringius nearensis n. sp., B. amliensis n. sp., B. bisulcatus n. sp., B. kiskensis n. sp., B. stanchfieldi n. sp., B. frausseni n. sp., B. aurulentus n. sp., B. maristempestus n. sp., B. undataformis n. sp.; Exiloberingius exiguus n. gen. & n. sp. Neptuneinae Stimpson, 1865: Aulacofusus canaliculatus n. sp., A. tanagaensis n. sp.; Neptunea aleutica n. sp., N. baxteri n. sp., N. dominator n. sp., N. petrelensis n. sp., N. quhmax n. sp., N. vesteraalen n. sp.; N. harrisoni n. sp., N. jewetti n. sp., Laevisipho galaxaios n. gen & n. sp., L. kessleri n. sp.; Volutopsiinae: Volutopsius nanus n. sp., Volutopsius gracilis n. sp.; Crebrivolutopsius labidentatus n. gen. & n. sp. Buccininae Rafinesque, 1815: Aleutibuccinum n. gen.; Castaneobuccinum orri n. gen. & n. sp., C. lauthi, n. sp., C. clinopsis n. sp., C. pagodaformis n. sp.; Sulcosinus carinatus n. sp.; Buccinum lanatum n. sp.; and Buccinum katharinae n. gen. & n. sp. The new genera and species are distinguished by the morphological characters of the shells and radulae.

Burn Pit Exposure Is Associated With Increased Sinonasal Disease.

OBJECTIVE: The aim of this study was to determine whether self-reported burn pit exposure is associated with increased subjective and objective sinus disease. DESIGN: A cross-sectional study was performed evaluating consecutive adult patients presenting to a US Military rhinology clinic. Demographics, medical histories, sinonasal quality-of-life scores, and nasal endoscopy examinations were obtained. Participants were divided into three cohorts based on self-reported exposure histories and outcomes compared. RESULTS: One hundred eighty-six patients met the inclusion criteria, the majority of whom were male. Patients with burn pit exposure had worse Sinonasal Outcome Test-22 scores (49.9) compared with those deployed without burn pit exposure (31.8) or never deployed (31.5). Endoscopic findings demonstrated worse disease within those exposed (Lund-Kennedy score, 3.3) compared with the other cohorts (1.8 and 1.7, respectively). CONCLUSIONS: These novel findings suggest that deployment-related burn pit exposure is associated with increased subjective and objective sinus disease.

Inferior angle of scapula fractures: A retrospective case series.

Background: Inferior angle of scapula fractures (IAS) are rare injuries that result from the periscapular shoulder muscles avulsing the inferior scapula tip. The aim of this study was to investigate the mechanisms of injury, investigations and treatment outcomes, as currently only case reports are available to guide management. Methods: Computered tomography (CT) images were reviewed to identify patients with an IAS fracture. Case notes were reviewed, and patients contacted to gather data relating to the injury, treatment and outcome. Results: Fourteen fractures were identified on CT. Five were missed on the initial radiograph. High energy fractures had an average age of 47.6 years, 90% were male. Low energy fractures had a mean age of 83.6 years 75% were female. All undisplaced fractures had a satisfactory outcome treated non-operatively. Three of six displaced fractures reported an unsatisfactory outcome with non-operative treatment. Subsequent surgical fixation resulted in resolution of symptoms. Conclusions: Inferior angle of scapula fractures are a rare injury that can result from high or low energy trauma. They are easy to miss on plain radiographs. Identification is important as displaced fractures can do poorly when treated non-operatively, but symptoms resolve with surgical fixation. Undisplaced fracture has a satisfactory outcome when treated non-operatively. Evidence: Level IV.

Investigation of Adult Post-Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use.

OBJECTIVES/HYPOTHESIS: Tonsillectomy is one of the most common ambulatory surgeries performed in the United States, yet the incidence of post-tonsillectomy hemorrhage (PTH) in adults remains unclear. In addition, any association between non-steroidal anti-inflammatory drugs (NSAIDs) and PTH in adults is currently unknown. The aim of this study is to examine the incidence and management of adult PTH at a single academic center and to assess for any association between NSAID use and PTH in adults. STUDY DESIGN: Retrospective chart review. METHODS: We conducted a retrospective chart review of adult tonsillectomies performed at our institution between January 1, 2012, and December 30, 2019. Demographics, past medical history, medications, NSAID use, surgical indication, bleeding events, and interventions were documented. The rate of PTH was calculated, logistic regression was performed to assess for any predictive factors, and odds ratios were calculated for NSAID use and PTH. RESULTS: A total of 1,057 adult tonsillectomies were performed within the aforementioned time period. A total of 126 patients experienced 163 bleeding events for a postoperative hemorrhage rate of 11.9%. Most were controlled with bedside interventions, while 29 (23%) bled more than once. The hemorrhage rate for those who were not prescribed NSAIDs postoperatively (n = 625) was 11.7%, compared to 12.6% for those who did receive NSAIDs postoperatively (n = 432), which was not significantly different (adjusted odds ratio 1.01, 95% confidence interval 0.69-1.49; P = .95). CONCLUSIONS: This retrospective cohort study of 1,057 adult patients found the incidence of PTH to be 11.9%. This study found no association between the use of NSAIDs and the rate of PTH, although a higher-powered study is needed. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:949-953, 2022.

The only species of Mohnia Friele, 1879 (Caenogastropoda, Buccinoidea, Buccinidae) in the North Pacific represents an unrecognized new genus of Newtoniellidae (Triphoroidea).

Mohniakurilana Dall, 1913 was described more than 100 years ago from deep waters off the Kuril Islands and remains exceedingly rare in museum collections. Originally placed in the carnivorous neogastropod family Buccinidae, fragmentary soft parts from the type lot and from several specimens belonging to allied species collected in the Aleutian Islands in the 1990s have allowed anatomical investigations for the first time. These have revealed the presence of a paucispiral operculum with an eccentric nucleus, foot with a deep propodial pedal gland and metapodial pedal gland, taenioglossate radula, short acrembolic proboscis, well-developed mid-esophageal gland, glandular prostate, and the absence of a penis; the nervous system is epiathroid with a long supra-esophageal connective and numerous statoconia in the statocysts. Analysis of the gut contents revealed abundant halichondriid sponge spicules. This evidence indicates a placement in the Triphoroidea, a diverse superfamily of specialized spongivores. Mohniakurilana is transferred to the Newtoniellidae and placed in the new genus Pseudomohnia gen. nov. Pseudomohniarogerclarki sp. nov. is established for a new species from the Aleutian Islands characterized by its narrowly turreted shell and distinctive multicuspid rachidian. A lectotype is designated for Mohniakurilana.

3-D compressed sensing optical coherence tomography using predictive coding.

We present a compressed sensing (CS) algorithm and sampling strategy for reconstructing 3-D Optical Coherence Tomography (OCT) image volumes from as little as 10% of the original data. Reconstruction using the proposed method, Denoising Predictive Coding (DN-PC), is demonstrated for five clinically relevant tissue types including human heart, retina, uterus, breast, and bovine ligament. DN-PC reconstructs the difference between adjacent b-scans in a volume and iteratively applies Gaussian filtering to improve image sparsity. An a-line sampling strategy was developed that can be easily implemented in existing Spectral-Domain OCT systems and reduce scan time by up to 90%.

Anisotropic Mechanical Properties of the Human Uterus Measured by Spherical Indentation.

The mechanical function of the uterus is critical for a successful pregnancy. During gestation, uterine tissue grows and stretches to many times its size to accommodate the growing fetus, and it is hypothesized the magnitude of uterine tissue stretch triggers the onset of contractions. To establish rigorous mechanical testing protocols for the human uterus in hopes of predicting tissue stretch during pregnancy, this study measures the anisotropic mechanical properties of the human uterus using optical coherence tomography (OCT), instrumented spherical indentation, and video extensometry. In this work, we perform spherical indentation and digital image correlation to obtain the tissue's force and deformation response to a ramp-hold loading regimen. We translate previously reported fiber architecture, measured via optical coherence tomography, into a constitutive fiber composite material model to describe the equilibrium material behavior during indentation. We use an inverse finite element method integrated with a genetic algorithm (GA) to fit the material model to our experimental data. We report the mechanical properties of human uterine specimens taken across different anatomical locations and layers from one non-pregnant (NP) and one pregnant (PG) patient; both patients had pathological uterine tissue. Compared to NP uterine tissue, PG tissue has a more dispersed fiber distribution and equivalent stiffness material parameters. In both PG and NP uterine tissue, the mechanical properties differ significantly between anatomical locations.

The Potential Effects of Burn Pit Exposure on the Respiratory Tract: A Systematic Review.

INTRODUCTION: Burn pits (BPs) have been widely used by the U.S. military for waste disposal while in conflicts abroad. Significant adverse health effects are thought to be linked to BPs, but limited data exist examining the impact on the respiratory tract. The purpose of this systematic review is to characterize these effects on both the upper respiratory tract (URT) and lower respiratory tract (LRT). MATERIALS AND METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines on articles published from January 1, 2001, through November 2020. PubMed, EMBASE, and Ovid MEDLINE databases were queried for studies examining the effect of BPs on the URT and LRT of service members. RESULTS: A total of 288 articles were identified, with nine meeting inclusion criteria. Eight of the nine articles assessed the LRT, one examined the URT alone, and two examined both the URT and LRT. Outcome measures were heterogeneous across all studies, precluding meta-analysis. Patient-reported LRT diagnoses appeared to increase as exposure to BPs increased. There are very limited data assessing the impact of BP exposure on the URT. No association between BP exposure and objective measures of LRT or URT disease was identified. CONCLUSION: Service members deployed to combat zones seem to report a significant increase in respiratory diseases following exposure to BPs, although definitive conclusions are limited by multiple airborne exposures and varied reporting methods. Self-reported LRT diagnoses appear to be more prevalent. There is a paucity of data on the effects of BPs on the URT. Objective measures of disease do not appear to correlate with patient reports. Prospective, long-term, and outcome-based studies are necessary to examine the effects of BPs, and other airborne hazards related to deployment, on the URT and LRT of service members.

Three-dimensional collagen fiber mapping and tractography of human uterine tissue using OCT.

Automatic quantification and visualization of 3-D collagen fiber architecture using Optical Coherence Tomography (OCT) has previously relied on polarization information and/or prior knowledge of tissue-specific fiber architecture. This study explores image processing, enhancement, segmentation, and detection algorithms to map 3-D collagen fiber architecture from OCT images alone. 3-D fiber mapping, histogram analysis, and 3-D tractography revealed fiber groupings and macro-organization previously unseen in uterine tissue samples. We applied our method on centimeter-scale mosaic OCT volumes of uterine tissue blocks from pregnant and non-pregnant specimens revealing a complex, patient-specific network of fibrous collagen and myocyte bundles.

High-speed collagen fiber modeling and orientation quantification for optical coherence tomography imaging.

Quantifying collagen fiber architecture has clinical and scientific relevance across a variety of tissue types and adds functionality to otherwise largely qualitative imaging modalities. Optical coherence tomography (OCT) is uniquely suited for this task due to its ability to capture the collagen microstructure over larger fields of view than traditional microscopy. Existing image processing techniques for quantifying fiber architecture, while accurate and effective, are very slow for processing large datasets and tend to lack structural specificity. We describe here a computationally efficient method for quantifying and visualizing collagen fiber organization. The algorithm is demonstrated on swine atria, bovine anterior cruciate ligament, and human cervical tissue samples. Additionally, we show an improved performance for images with crimped fiber textures and low signal to noise when compared to similar methods.

Hip Disability and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index Values in Asymptomatic and Arthritic Cohorts.

The primary aim of this study was to determine whether an electronic, multicenter data collection system could be used to establish normal population reference values for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The secondary aim was to investigate differences in asymptomatic HOOS and WOMAC values reported in 2 geographically distinct English-speaking countries and compare these with a symptomatic arthritic patient cohort. A total of 552 participants were recruited. Asymptomatic Australian and Canadian cohorts were compared; combined asymptomatic cohorts were compared with an arthritic cohort. There was a statistically significant association between age and asymptomatic HOOS (P<.0001) and WOMAC (P<.0001) values; as age increased, values worsened. Females had worse HOOS and WOMAC values (P<.0001). When compared with age- and sex-matched asymptomatic participants, arthritic participants had worse scores (P<.0001). Asymptomatic Australians had a statistically significant 3.8% better (higher) HOOS (P<.0001) in all age groups (P<.0001). When compared with age- and sex-matched asymptomatic participants, younger arthritic participants reported worse activities of daily living and sports and recreation HOOS values. This observational study established an electronic HOOS and WOMAC patient-reported outcome measures database of asymptomatic individuals in 2 geographically distinct countries. An asymptomatic control group should be sourced from the same country of origin as the proposed study. Factors that should be considered when recording the HOOS and WOMAC include age, sex, geographic location, history of an inactive hip problem, contralateral hip disease, and active knee, ankle, or foot problems. [Orthopedics. 2019; 42(2):e216-e224.].

Varus Posteromedial Rotatory Instability of the Elbow: Injury Pattern and Surgical Experience of 27 Acute Consecutive Surgical Patients.

OBJECTIVES: To identify associated injuries that occur in varus posteromedial rotatory instability (VPMRI) of the elbow and present their surgical management. DESIGN: Level II retrospective study. SETTING: Tertiary referral center. PATIENT/PARTICIPANTS: Twenty-seven patients with VPMRI injuries treated surgically over an 8-year period. INTERVENTION: Open reduction and internal fixation of anteromedial coronoid facet fracture, lateral collateral ligament repair, and associated injured soft-tissue repairs. MAIN OUTCOME MEASURED: Radiographic classification, associated medial and lateral bony and soft-tissue injuries, surgical fixation method, and complications were recorded. RESULTS: According to the O'Driscoll classification, there were 15 (55%) type 2-2, 11 (41%) type 2-3, and 1 (4%) type 3-1 fractures. Lateral and medial collateral ligament tears were found in 100% and 63%, respectively. Common extensor and flexor origin injuries occurred in 19 (70%) and 2 (7%) elbows, respectively. A marginal radial head fracture was found in 1 patient. Most patients were treated with a combination of fixation methods. Complications occurred in 7 (26%) patients. CONCLUSIONS: This study documents both associated findings and surgical fixation methods. In all cases, the lateral collateral ligament was disrupted, often in association with an injured common extensor origin. Medial collateral ligament injuries are commonly involved. Radial head fractures are rarely associated. The surgeon should have a high index of suspicion if an isolated coronoid fracture is encountered. Clinical and functional outcome scores are needed in future studies to further inform treatment of VPMRI of the elbow. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Asymptomatic reference values for the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation - electronic data collection and its clinical implications.

The purpose of this study was to establish normal asymptomatic population values for the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation in healthy, asymptomatic individuals of different age, gender, ethnicity, handedness and nationality, using electronic data collection. Two-hundred and ninety-two Australian and 293 Canadian citizens with no active wrist pain, injury or pathology in their dominant hand, were evaluated. Participants completed an electronically administered questionnaire and were assessed clinically. There was no statistically significant association between both wrist scores and nationality. There was a statistically significant association between both wrist scores and age, demonstrating that as age increased, normal wrist function declined. This study has established an electronic, asymptomatic control group for future studies using these scores. When using the Disability of Arm, Shoulder and Hand and Patient-Rated Wrist/Hand Evaluation, the control group can be sourced from a pre-established control group within a database, without necessarily being sourced from the same country of origin. Level of evidence: II.

Asymptomatic population reference values for three knee patient-reported outcomes measures: evaluation of an electronic data collection system and implications for future international, multi-centre cohort studies.

OBJECTIVES: The aim was to assess whether the Knee Society Score, Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were comparable in asymptomatic, healthy, individuals of different age, gender and ethnicity, across two remote continents. The purpose of this study was to establish normal population values for these scores using an electronic data collection system. HYPOTHESIS: There is no difference in clinical knee scores in an asymptomatic population when comparing age, gender and ethnicity, across two remote continents. METHODS: 312 Australian and 314 Canadian citizens, aged 18-94 years, with no active knee pain, injury or pathology in the ipsilateral knee corresponding to their dominant arm, were evaluated. A knee examination was performed and participants completed an electronically administered questionnaire covering the subjective components of the knee scores. The cohorts were age- and gender-matched. Chi-square tests, Fisher's exact test and Poisson regression models were used where appropriate, to investigate the association between knee scores, age, gender, ethnicity and nationality. RESULTS: There was a significant inverse relationship between age and all assessment tools. OKS recorded a significant difference between gender with females scoring on average 1% lower score. There was no significant difference between international cohorts when comparing all assessment tools. CONCLUSIONS: An electronic, multi-centre data collection system can be effectively utilized to assess remote international cohorts. Differences in gender, age, ethnicity and nationality should be taken into consideration when using knee scores to compare to pathological patient scores. This study has established an electronic, normal control group for future studies using the Knee society, Oxford, and KOOS knee scores. LEVEL OF EVIDENCE: Diagnostic Level II.

IMPROVED CLASSIFICATION IN TACTILE BCIS USING A NOISY LABEL MODEL.

Tactile BCIs have gained recent popularity in the BCI community due to the advantages of using a stimulation medium which does not inhibit the users visual or auditory senses, is naturally inconspicuous, and can still be used by a person who may be visually or auditorily impaired. While many systems have been proposed which utilize the P300 response elicited through an oddball task, these systems struggle to classify user responses with accuracies comparable to many visual stimulus based systems. In this study, we model the tactile ERP generation as label noise and develop a novel BCI paradigm for binary communication designed to minimize label confusion. The classification model is based on a modified Gaussian mixture and trained using expectation maximization (EM). Finally, we show after testing on multiple subjects that this approach yields cross-validated accuracies for all users which are significantly above chance and suggests that such an approach is robust and reliable for a variety of binary communication-based applications.

Smartphone applications for the evaluation of pathologic shoulder range of motion and shoulder scores-a comparative study.

HYPOTHESIS AND BACKGROUND: Accurate measurement of range of motion (ROM) is important in evaluating a pathologic shoulder and calculating shoulder scores. The aim of this study was to establish the reliability and validity of different smartphone applications (apps) in assessing pathologic shoulder ROM and to determine whether differences in recorded ROM measurements affect calculated shoulder scores. The authors hypothesized that there is no difference between shoulder ROM assessment methods and calculated shoulder scores. METHODS: In this nonrandomized controlled clinical trial, ROM of 75 participants with a history of shoulder disease (21 women, 54 men) was assessed using a smartphone inclinometer and virtual goniometer, a standard goniometer, and clinicians' visual estimation. Shoulder strength was assessed, and Constant-Murley (CM) and University of California-Los Angeles (UCLA) shoulder scores were calculated. RESULTS: Independent of diagnosis or operation, all cases (except for passive glenohumeral abduction of unstable shoulders) showed excellent intraclass correlation coefficients (>0.84). Interobserver reliability was excellent for all ROM measures (intraclass correlation coefficient > 0.97). All modalities had excellent agreement to values attained with the universal goniometer. There were no differences for the calculated CM or UCLA scores between the modalities employed to measure ROM. CONCLUSIONS: A smartphone inclinometer or virtual goniometer is comparable to other clinical methods of measuring pathologic shoulder ROM. Clinicians can employ smartphone applications with confidence to measure shoulder ROM and to calculate UCLA and CM scores. The apps are also available to patients and may be a useful adjunct to physiotherapy, especially in cases of limited access to health care services.

Association of Mohs Reconstructive Surgery Timing With Postoperative Complications.

IMPORTANCE: Same-day Mohs reconstructive surgery is not always possible; moreover, a delay can offer benefits such as improved surgical planning and increased blood supply to the cauterized wound bed. However, recent work found that delaying reconstruction by more than 2 days increases the postoperative complication rate. OBJECTIVE: To review the outcomes of Mohs micrographic surgery (MMS) reconstruction with respect to patient- and surgery-specific variables, especially timing of repair. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, single-institution cohort study of patients who underwent Mohs reconstructive surgery by 1 of the 2 senior authors from January 2012 to March 2017 for cutaneous squamous cell carcinoma or basal cell carcinoma. No patients had to be excluded for inadequate follow-up or incomplete medical records. MAIN OUTCOMES AND MEASURES: Postoperative complications including hematoma, infection, dehiscence, and partial or full graft or flap loss. RESULTS: A total of 633 defects in 591 patients (median [range] age, 65 [21-96] years; 333 [56.3%] female) were identified over the 5-year period. Reconstructions occurred from less than 24 hours to 32 days after MMS, with 229 (36.2%) delayed longer than 48 hours. Patient-specific variables reviewed included comorbidities, age, smoking status, and use of anticoagulant or antiplatelet medications. Surgery-specific variables analyzed included location and size of defect, time interval between MMS and reconstruction, and reconstructive modalities. Single-variable analysis was performed to determine whether each variable was associated with postoperative complications. On multivariable binary logistic regression, smoking status (odds ratio [OR], 2.46; 95% CI, 1.29-4.71; P = .007), defect size (OR exp(B), 1.04; 95% CI, 1.01-1.06; P = .006), full-thickness defects (OR, 1.56; 95% CI, 1.08-2.25; P = .02), interpolated flaps with cartilage grafting (OR, 8.09; 95% CI, 2.65-24.73; P < .001), and composite grafts (OR, 6.35; 95% CI, 2.25-17.92; P < .001) were associated with an increased risk of postoperative complications. CONCLUSIONS AND RELEVANCE: We found no association between timing of Mohs reconstructive surgery and complications, indicating that a delayed repair did not increase the risk of infection or flap failure. Variables associated with an increased risk of postoperative complications include smoking status, size of the defect, full-thickness defects, interpolated flaps with cartilage grafting, and the use of composite grafts. LEVEL OF EVIDENCE: 3.

An international, multicenter cohort study comparing 6 shoulder clinical scores in an asymptomatic population.

HYPOTHESIS: The study purpose was to assess 6 shoulder patient-reported outcome measure (PROM) values in asymptomatic, healthy, pathology-free individuals. We hypothesized that there would be no difference in PROM values in pathology-free individuals when considering sex, age, ethnicity, and geographical location. METHODS: Electronic questionnaires were completed by 635 individuals (323 Australians and 312 Canadians) without dominant shoulder pathology for the American Shoulder and Elbow Surgeons (ASES) shoulder score; Constant-Murley Shoulder Score (CSS); Oxford Shoulder Score (OSS); University of California, Los Angeles (UCLA) shoulder score; Shoulder Pain and Disability Index (SPADI); and Stanmore Percentage of Normal Shoulder Assessment (SPONSA). Shoulder range of motion and strength were assessed. RESULTS: No difference was identified between subjective-only and subjective-objective PROMs. Handedness and a current elbow or wrist problem were not associated with differences in PROM values. Poorer PROM values were associated with a history of an inactive shoulder problem and increasing age. Female participants tended to report similar or poorer PROM scores. No significant difference was found between ethnicities. Geographical location was associated with differences in the ASES shoulder score, UCLA shoulder score, and SPADI but not the CSS, SPONSA, and OSS. CONCLUSIONS: Differences in sex, age, and geographical location will affect PROM shoulder scores in pathology-free individuals and should be taken into consideration when PROMs are being used to compare patient outcomes. This study has established normative values for the ASES shoulder score, CSS, OSS, UCLA shoulder score, SPADI, and SPONSA. Future studies assessing a pathologic patient cohort should perform comparisons against a sex- and age-matched control cohort, ideally sourced from the same geographical location.