Shared mental healthcare and somatization: changes in patient symptoms and disability.

AIM: To describe the symptoms and functional changes in patients with high levels of somatization who were referred to an outpatient, multidisciplinary, shared mental healthcare (SMHC) service that primarily offered cognitive behavioural therapy. Second, we wished to compare the levels of somatization in this outpatient clinical sample with previously published community norms. BACKGROUND: Somatization is common in primary care, and it can lead to significant impairment, disproportionate resource use, and poses a challenge for management. METHODS: All the patients (18+ years, n=508) who attended three or more treatment sessions in SMHC primary care over a seven-year period were eligible for inclusion to this pre-post study. Self-report measures included the Patient Health Questionnaire's somatic symptom severity scale (PHQ-15) and the World Health Organization Disability Assessment Schedule (WHODAS II). Normative comparisons were used to assess the degree of symptoms and functional changes. FINDINGS: Clinically significant levels of somatization before treatment were common (n=138, 27.2%) and were associated with a significant reduction in somatic symptom severity (41.3% reduction; P<0.001) and disability (44% reduction; P<0.001) after treatment. Patients' levels of somatic symptom severity and disability approached but did not quite reach the community sample norms following treatment. Multidisciplinary short-term SMHC was associated with significant improvement in patient symptoms and disability, and shows promise as an effective treatment for patients with high levels of somatization. Including a control group would allow more confidence regarding the conclusions about the effectiveness of SMHC for patients impaired by somatization.

Morphologic analysis of the proximal ulna with special interest in elbow implant sizing and alignment.

A better understanding of the morphology of the proximal ulna should permit the development of ulnar component designs which have an improved fit to the native bone, thus leading to more accurate implant positioning. Computed-tomography (CT) scans of 31 cadaveric proximal ulnae were analyzed using computer aided design software to determine the shape of the medullary canal relative to the articular surface. The diameter, curvature, cross-sectional centroid position, and coronal and sagittal angulation of the ulnar canal were all calculated with respect to the center of the greater sigmoid notch. Posterior and lateral offsets increased distally from the articulation center, and the mean diameter of the canal was larger in males than in females (P < .05). The average valgus angulation was 8.0 +/- 4.0 degrees for males and 7.2 +/- 3.1 degrees for females (P = .6). Longer stemmed ulnar implants may require a modular design to meet anatomic constraints during implant positioning.

Chronic posttraumatic elbow disorders treated with metallic radial head arthroplasty.

BACKGROUND: Metallic radial head arthroplasty is a proven technique for the treatment of complex radial head fractures. The purpose of this study was to evaluate the functional outcomes of a metallic radial head arthroplasty in patients with chronic posttraumatic elbow disorders. METHODS: The results of thirty-two metallic radial head arthroplasties in thirty-two consecutive patients were retrospectively reviewed. The indications for the radial head arthroplasty included posttraumatic nonunion and malunion of the radial head, elbow instability following previous excision of the radial head, and failure of a silicone radial head implant used to treat an acute radial head fracture. The study included thirteen male and nineteen female patients followed for a minimum of two years. The radial head arthroplasties were performed at an average of 2.4 years after the injury. Analysis included chart review, personal interview, physical examination, radiographic examination, and strength testing as well as the administration of general and region-specific questionnaires. RESULTS: The mean duration of follow-up was eight years. The average Mayo Elbow Performance Score was 83 of 100 points, with seventeen (53%) of the thirty-two results rated as excellent; four (13%), as good; seven (22%), as fair; and four (13%), as poor. The average score for subjective patient satisfaction was 8.5 points on a 10-point scale. Patients had significantly less motion and strength in the affected elbow than in the unaffected elbow. Seventy-four percent of the patients demonstrated some degree of posttraumatic arthritis. There were no significant differences in ulnar variance and the ulnohumeral joint space between the affected and unaffected arms. Over the course of the study, no metallic radial head arthroplasties required revision. CONCLUSIONS: Metallic radial head arthroplasty for the treatment of posttraumatic elbow disorders appears to be a safe and durable procedure that can provide a functional range of motion and pain relief for at least five to ten years. However, longer follow-up is needed to evaluate progression of lucencies adjacent to stems and osteoarthritis.