The relationship between neuropathic pain and the outcomes of minimally invasive pain management in rotator cuff ruptures.

This study aimed to investigate how the presence of neuropathic pain related to partial rotator cuff tears affects the short-term results of subacromial injection and suprascapular nerve blockade therapy in patients with chronic shoulder pain. In this prospective observational study, shoulder pain via verbal numeric pain rating (VNPR, 0-10) and functional status through simple shoulder test (SST) were evaluated before and second week after procedure. After dividing as neuropathic pain and non-neuropathic pain groups, pre-procedural and follow-up scores concerning pain intensity, functional status, and whether there were those of patients with minimal clinically important change (MCIC) in areas of pain and function were evaluated. Between the groups including 140 patients, while there was no statistical difference in baseline pain intensity and functional status (P = .14,.11, respectively), outcomes of those without neuropathic pain were favored at the follow-up (P = .02,.01, respectively). Given baseline pain scores, the reduction (%) was significantly lower in neuropathic pain group (P = .03). There was no significant difference in patients with MCIC in pain intensity and functional status between the groups (P = .08,.59, respectively). An improvement was determined in pain intensity and functional status at the follow-up in both groups (P < .001). The improvement in pain intensity and functional status is poorer in patients with partial rotator cuff rupture-related neuropathic pain than in those without neuropathic pain. However neuropathic pain has no negative effect on the response to treatment.

DO THE CHANGES OF SCAPULOTHORACIC ANGLE AFFECT WINGED SCAPULA DEVELOPMENT AND FUNCTIONAL SCORES DURING CLAVICLE FRACTURE TREATMENT?

Introduction: To compare surgical and conservative management of midshaft clavicle fractures according with scapulothoracic joint angle change, considering clinical, functional, and radiological outcomes. Methods: A total of 95 midshaft clavicle fracture patients aged between 18-70 years with a minimum follow-up duration of 12 months were included in this study. Patients were treated either conservatively (Group I) or surgically (Group 2). Plane deformities, scapulothoracic joint angle, shortness and isokinetic muscle strength were measured. Shoulder Pain, Disability Index (SPADI) and Short Form-36 (SF36) were assessed. Results: Scapulothoracic joint angles were higher in the conservative treatment group than in surgery group (p=0.036). Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Surgical treatment was associated with significantly better SF-36 physical scores and with SPADI pain and disability scores. However, the two groups did not differ in terms of isokinetic muscle strength. Negative anteroposterior plane deformity (p<0.001) and negative axial plane deformity (p=0.004) were more frequent in the conservative treatment group. Clavicle shortness was more common in the conservative treatment group. Conclusion: According to our findings scapulothoracic joint angle changes were seen in the conservative treatment group more than in the surgery group. Consequently, winged scapula was seen more commonly in the conservative treatment group than in the surgery group (p=0.001). Level of Evidence III; Retrospective comparative study .

Introdução: Comparar o manejo cirúrgico e conservador das fraturas da diáfise da clavícula conforme alteração do ângulo escapulotorácico, considerando resultados clínicos, funcionais e radiológicos. Métodos: Um total de 95 pacientes com fratura do terço médio da clavícula com idade entre 18-70 anos, com um tempo mínimo de seguimento de 12 meses, foram incluídos neste estudo. Os pacientes foram tratados conservadoramente (Grupo I) ou cirurgicamente (Grupo 2). Deformidades planas, ângulo escapulotorácico, encurtamento e força muscular isocinética foram medidos. O Índice de Dor e Incapacidade do Ombro (SPADI) e a Short Form-36 (SF36) foram avaliados. Resultados: Os ângulos da articulação escapulotorácica foram maiores no grupo de tratamento conservador do que no grupo de cirurgia (p=0,036). Consequentemente, a escápula alada foi vista mais comumente no grupo de tratamento conservador do que no grupo de cirurgia (p=0,001). O tratamento cirúrgico foi associado a escores físicos SF-36 significativamente melhores e escores SPADI de dor e incapacidade. No entanto, os dois grupos não diferiram em termos de força muscular isocinética. A deformidade no plano anteroposterior negativo (p<0,001) e a deformidade no plano axial negativo (p=0,004) foram mais frequentes no grupo de tratamento conservador. O encurtamento da clavícula foi mais comum no grupo de tratamento conservador. Conclusão: De acordo com nossos achados, as alterações do ângulo escapulotorácico foram mais observadas no grupo de tratamento conservador do que no grupo de cirurgia. Consequentemente, a escápula alada foi vista mais comumente no grupo de tratamento conservador do que no grupo de cirurgia (p=0,001). Nível de Evidência III; Estudo comparativo retrospectivo .

Clinical and Radiological Results of Microsurgical Posterior Lumbar Interbody Fusion and Decompression without Posterior Instrumentation for Lateral Recess Stenosis.

STUDY DESIGN: A single-center, retrospective patient review of clinical and radiological outcomes of microsurgical posterior lumbar interbody fusion and decompression, without posterior instrumentation, for the treatment of lateral recess stenosis. PURPOSE: This study documented the clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression of the lateral recess using interbody cages without posterior instrumentation for the treatment of lateral recess stenosis. OVERVIEW OF LITERATURE: Although microsurgery has some advantages, various complications have been reported following microsurgical decompression, including cage migration, pseudoarthrosis, neurologic deficits, and persistent pain. METHODS: A total of 34 patients (13 men, 21 women), with a mean age of 56.65±9.1 years (range, 40-77 years) confirmed spinal stability, and preoperative radiological findings of lateral recess stenosis, were included in the study. Interbody polyetheretherketone cages and auto grafts were used in all patients. Posterior instrumentation was not used because of limited resection of the posterior lumbar structures. Preoperative and postoperative radiographs, computed tomography scans, and magnetic resonance imaging were assessed and compared to images taken at the final follow-up. Functional recovery was also evaluated according to the Macnab criteria at the final follow-up. RESULTS: The average follow-up time was 35.05±8.65 months (range, 24-46 months). The clinical results, operative time, intraoperative blood loss, and duration of hospital stay were similar to previously published results; the fusion rate (85.2%) was decreased and the migration rate (5.8%) was increased, compared with prior reports. CONCLUSIONS: Although microsurgery has some advantages, migration and pseudoarthrosis remain challenges to achieving adequate lumbar interbody fusion.

Extension Block Pinning Versus Hook Plate Fixation for Treatment of Mallet Fractures.

PURPOSE: To compare the outcomes and associated costs of the treatment of mallet fractures with either extension block pinning or open reduction and hook plate fixation. METHODS: We treated 22 patients for a mallet fracture that involved at least 25% of the distal phalanx articular surface. Three joints demonstrated concomitant volar subluxation. Extension block pinning was used to treat 16 fractures (group 1) and 6 were treated with open reduction and hook plate fixation (group 2). All patients were evaluated at the second, fourth, and sixth weeks after surgery. Collected data included range of motion, extensor lag, and pain status. Patients were asked to grade preoperative and postoperative pain levels on a visual analog scale. Functional outcomes were determined by Crawford criteria. We retrospectively performed a cost analysis using our institutional records. RESULTS: Mean follow-up was 12.7 months. Visual analog scale pain scores improved by a similar amount for both groups. Preoperative pain scores were 7.0 for group 1 and 7.5 for group 2. Postoperative levels were 2.0 and 2.0, respectively. Mean extensor lag was identical for both groups, 5°. Mean flexion was 70° for group 1 and 80° for group 2. Based on the Crawford criteria, group 1 had 5 patients rated as excellent, 6 as good, 3 as fair, and 2 as poor. Group 2 outcomes were 2 excellent, 2 good, and 2 fair. Five complications occurred in group 1, and 1 in group 2. Differences noted between groups were not statistically significant. Extension block pinning was more cost-effective than hook plate fixation. CONCLUSIONS: We find extension block pinning to be an equally effective but more cost-efficient treatment than open reduction and hook plate fixation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.