Glenohumeral internal rotation deficit (GIRD) in young and asymptomatic elite swimmers.

CONTEXT: Glenohumeral internal rotation deficit (GIRD) may affect overhead athletes and contribute to shoulder injury. The aim of our study was to assess data on passive shoulder ROM in young elite swimmers and to determine the prevalence of anatomical and pure GIRD (aGIRD and pGIRD) in a large sample size of asymptomatic elite swimmers with a new classification method. OBJECTIVE: to assess data on passive shoulder ROM in young elite swimmers and investigate possible association with anthropometric data and competitive practice routine. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 752 asymptomatic elite swimmers were by voluntary participation (391 males, 361 females; mean age, 15.88 ± 2.31 years). Passive glenohumeral rotational ROM was measured bilaterally to investigate the prevalence of aGIRD and pGIRD. Evaluations were performed with athletes at rest before any training or competition. MAIN OUTCOME MEASURE(S): GIRD and associated aGIRD and pGIRD in elite youth swimmers by identifying a standard classification procedure. RESULTS: GIRD was found in 136 participants (18.1%); aGIRD was present in 28 cases (3.7% of all) whereas pGIRD was observed in 108 cases (14.4% of all). No significant differences were found regarding GIRD between sex, age, age group, years of training, breathing side and distance. Swimmers classified as pGIRD showed significant less dominant Internal rotation, Total range of motion and External rotation gain (P < 0.01) than aGIRD; conversely, aGIRD swimmers shows significant less non-dominant IR, ER and TROM than pGIRD (P < 0.01). CONCLUSIONS: GIRD is a relatively common condition in asymptomatic elite youth swimmers; In order to not overestimate this condition, anatomical and pure GIRD have to be distinguished. While they play a role, the respiratory side, dominant limb, and crawl did not have a significant impact when facing an elite swimmer with GIRD.

Shoulder Intra-Articular Temperature Is Higher In Patients With Small Rotator Cuff Tears Compared With Patients Who Have Larger Tears.

Purpose: The purpose of this study was to determine whether the intra-articular temperature of the shoulder correlates with the size of the tendon tear in patients with rotator cuff tears (RCTs). Methods: The shoulder intra-articular temperature of 75 consecutive (32 female, 43 male; mean age 61.12; standard deviation = 7.10) patients who underwent arthroscopic rotator cuff repair was measured with a digital thermometer, at first in 2 points (biceps anchor and glenoid labrum) during dry arthroscopy, followed by a third measurement during wet arthroscopy. A fourth measurement, represented by the patient's axillary body temperature, was taken upon admission. The RCTs were classified during surgery according to the Southern California Orthopedic Institute classification system as small, large, and massive. Data were submitted for statistical analysis. Results: The intra-articular temperature differs in patients with different-sized RCTs regardless of the location of the thermometer. A significantly higher temperature was found in patients with small RCTs (36.2°C ± 0.57°C) (P < .01). When the in-flow of the arthroscopic fluid was opened, the temperature dropped to an average of 24.5°C. Conclusions: The shoulder intra-articular temperature was significantly associated with RCT size. A significantly higher temperature was found in small RCTs. No correlation was found between age and sex, age and RCT size, sex and RCT size, or sex and temperature. Clinical Relevance: An early diagnosis and treatment of RCTs may avoid further degeneration and damage of the tendon caused by the increased temperature.

Peripheral microcirculation alteration as cause of posterosuperior rotator cuff tear: the possible indirect contribution of nailfold capillaroscopy.

BACKGROUND: Most of the recent literature regarding rotator cuff tear etiology identifies in peripheral microcirculation disorders the probable main cause of tissue degeneration, and consequently of tendon rupture. Nailfold capillaroscopy is a practical and inexpensive diagnostic technique used to evaluate the health status of peripheral microcirculation, and recently, its use has found other indications in addition to that of diagnosing connective tissue diseases and Raynaud phenomenon. We verified the possible indirect contribution of nailfold capillaroscopy in the identification of peripheral microcirculation disturbances in a group of patients with rotator cuff tear and whether these possible alterations could be related to rotator cuff tear size. MATERIALS AND METHODS: A case-control study was performed. One hundred patients (56 male, 44 female; mean age ± standard deviation [SD]: 60.46 ± 5.46 years) with different-sized posterosuperior cuff tears and 100 healthy controls (38 male, 62 female; mean age ± SD: 60.40 ± 6.34 years) were submitted to capillaroscopic examination. The following parameters were examined: capillary morphology and density, avascular areas, visibility of the subpapillary venous plexus, enlarged and giant capillaries, ectasias and microaneurysms, neoangiogenesis, hemosiderin deposits, pericapillary edema, and capillary blood flow. Severe exclusion criteria were applied. Statistical analysis was performed. RESULTS: Visibility of subpapillary venous plexus (P < .001), pericapillary edema (P < .001), capillary blood flow (P < .001), ectasias and microaneurysms (P < .001), and neoangiogenesis (P = .04) were significantly associated with presence of a rotator cuff tear. CONCLUSIONS: Our results support the hypothesis that microcirculation disorder has a relevant role in the genesis of cuff degeneration and, consequently, of tendon rupture. However, these alterations do not seem to be related to rotator cuff tear size.

Progression of Oropharyngeal Dysphagia in Amyotrophic Lateral Sclerosis: A Retrospective Cohort Study.

Little is known regarding the optimal timing of dysphagia assessment and PEG indication in amyotrophic lateral sclerosis (ALS). The study aims to investigate the progression of dysphagia in a cohort of ALS patients and to analyse whether there are variables linked to a faster progression of dysphagia and faster indication of PEG placement. A retrospective cohort study in 108 individuals with ALS. Fiberoptic endoscopic evaluation of swallowing was performed 6 monthly until PEG indication or death. Dysphagia severity and PEG indication were assessed using Penetration Aspiration Scale. Progression Index (PI) analysed the risk of disease progression (fast/slow) in relation to dysphagia onset and PEG indication. Patients were grouped based on ALS onset and PI. Person-time incidence rates were computed considering dysphagia onset and PEG indication from ALS symptoms during the entire observation period and have been reported as monthly and 6-month rates. Cox regression survival analysis assessed dysphagia and PEG risk factors depending on onset. Person-time incidence rates of dysphagia progression and PEG risk were increased based on type of ALS onset and PI. Patients with a fast progressing disease and with bulbar onset (BO) show statistically significant increased risk of dysphagia (BO 178.10% hazard ratio (HR) = 2.781 P < 0.01; fast 181.10% HR 2.811 P < 0.01). Regarding PEG risk, fast patients and patients with BO had a statistically significant increased risk (fast 147.40% HR 2.474 P < 0.01, BO 165.40% HR 2.654 P < 0.01). Fast PI predicts the likelihood of faster progression of dysphagia and PEG indication and should be included in multidisciplinary assessments and considered in the design of future guidelines regarding dysphagia management in ALS patients.Level of Evidence Level IV.

The Rare Medial-End Clavicle Fractures: Epidemiological Study on Inhabitants of a Suburban Area.

Background Variable epidemiological data are known on medial clavicle fractures (MCFs). Aim To obtain demographic information regarding the etiopathogenesis of MCFs. Materials and methods All fractures were radiographically evaluated. Age; gender; side; date of fracture; fragment dislocation; associated fractures; fracture mechanism were collected. Three age groups were distinguished. Results 1096 patients were enrolled: 29 (2.6%) had an MCF. Nineteen (66%) were males; mean age was 51.6 years (SD±24.4; range: 18-87). The right side was involved in 19 cases (66%). Nineteen fractures (66%) were un-displaced. Five patients (16.6%) had associated fractures. Accidental falls represent the main cause of fracture. In advanced age (Group III), simple fall was the only cause of fracture. On the occasion of a fall, the right side was significantly more involved (p <0.05). Sports injuries were responsible for 22.2% of fractures, but for 42.9% of fractures in younger patients (Group I). Traffic accidents were responsible for five fractures (16.7%). During the sunny seasons, the highest number of fractures occurred; the vast majority of fractures (83.3%) occurred on working days (p <0.05). Conclusions Medial clavicle fractures represent 2.6% of all clavicle fractures. Middle-aged males and the right side are more involved. Two-thirds of fractures are un-displaced. Accidental falls represent the main cause of fracture. During sunny seasons, the highest number of fractures occurred.

Shoulder Long Head Biceps Tendon Pathology Is Associated With Increasing Rotator Cuff Tear Size.

PURPOSE: To evaluate the association between rotator cuff tear (RCT) size and long head biceps tendon (LHBT) pathology. METHODS: We retrospectively enrolled 202 consecutive patients (114 women and 88 men with mean age at surgery of 62.14 years [SD, 7.73]) who underwent arthroscopic rotator cuff repair for different sized full-thickness RCTs. LHBT pathology was evaluated considering the presence of inflammation, section alteration, loss of integrity, dislocation, dynamic instability, and absence. The site of LHBT pathology was evaluated considering 3 portions: (1) the insertional element; (2) the free intra-articular portion; (3) the part that enters the intertubercular groove. Statistics were evluated. RESULTS: The LHBT was absent in 22 cases (10.9%): 2, 4, 15, and 1 patients with small, large, massive, and subscapularis RCTs, respectively. A significant correlation was found between the prevalence of LHBT absence and massive RCTs (P < .001). In 53 patients (26%), there was a healthy LHBT; a healthy LHBT was present in 47%, 20% and 8% of small, large and massive RCTs, respectively. A significant correlation between LHBT inflammation, section alteration, loss of integrity, and RCT severity was found (P < .001, P < .001, and ). The insertional portion was the most involved (57% of cases); RCT severity was significantly associated with the number of involved portions (P < .001). CONCLUSIONS: Shoulder LHBT pathology is associated with increasing rotator cuff tear size. CLINICAL RELEVANCE: Surgeons should be aware that biceps pathology is particularly prevalent in patients with larger RTCs.

Can Physical Activity Influence Human Gut Microbiota Composition Independently of Diet? A Systematic Review.

Evidence suggests that physical activity (PA) influences the human gut microbiota composition, but its role is unclear because of dietary interference. The aim of this review is to clarify this issue from this new perspective in healthy individuals. Articles analyzing intestinal microbiota from fecal samples by 16S rRNA amplicon sequencing were selected by searching the electronic databases PubMed, Scopus, and Web of Science until December 2020. For each study, methodological quality was assessed, and results about microbiota biodiversity indices, phylum and genus composition, and information on PA and diet were considered. From 997 potentially relevant articles, 10 met the inclusion criteria and were analyzed. Five studies involved athletes, three were performed on active people classified on the basis of habitual PA level, and two among sedentary subjects undergoing exercise interventions. The majority of the studies reported higher variability and prevalence of the phylum Firmicutes (genera Ruminococcaceae or Fecalibacteria) in active compared to inactive individuals, especially in athletes. The assessment of diet as a possible confounder of PA/exercise effects was completed only in four studies. They reported a similar abundance of Lachnospiraceae, Paraprevotellaceae, Ruminococcaceae, and Veillonellaceae, which are involved in metabolic, protective, structural, and histological functions. Further studies are needed to confirm these findings.

AC joint osteoarthritis: The role of genetics. An MRI evaluation of asymptomatic elderly twins.

PURPOSE: The anatomy of the articular surfaces has historically identified as major responsible for acromioclavicular joint osteoarthritis (ACJO). On the other side, the almost 100% prevalence of ACJO in subjects over 50 years old seems to suggest a multifactorial etiology. We compared ACJO between asymptomatic elderly monozygotic (MZ) and dizygotic (DZ) twins to investigate the influence of genetics and environmental factors. MATERIALS AND METHODS: Thirty pairs of twins [15MZ-15DZ; mean age (SD): 63.70 (3.31); range: 53-72] were retrospectively enrolled. ACJO was evaluated on MRI through a 4-grade severity scale and ACJ configuration was assessed. Information regarding work activity were obtained. Heritability index was calculated. RESULTS: The intraclass correlation coefficient (ICC) value of 0.868 (95% CI; 0.798 to 0.917). An ICC values of 0.889 (95% CI; 0.798 to 0.944) and 0.843 (95% CI, 0.712 to 0.920) were found in the MZ and DZ groups, respectively. The polychoric correlation was 0.857 in the MZ twins and 0.757 in the DZ twins. The calculated heritability index was 0.20 (20%), and the contribution of the shared environment (c2) and unique environment (e2) was 0.66 (66%) and 0.14 (14%), respectively. No relationship between job types and ACJO in both the total cohort (r = 0.089; p = 0.499) and in the monozygotic (r = 0.247; p = 0.187) and the dizygotic twin groups (r = -0.084; p = 0.658) was found. CONCLUSIONS: The role of genetics on ACJO accounts for only 20%; a specific anatomical configuration of the articular surfaces only partially acts on the development of joint osteoarthritis. Environmental factors have the greatest impact. LEVEL OF EVIDENCE: IV.

Scapular Dyskinesis in Young, Asymptomatic Elite Swimmers.

BACKGROUND: Overhead athletes are at a greater risk of developing scapular dyskinesis (SD). Although swimming is considered an overhead sport, information regarding SD in these athletes is scarce. PURPOSE: To determine the prevalence of SD in young, asymptomatic elite swimmers. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 661 asymptomatic elite swimmers were enrolled in this study (344 male, 317 female; mean age, 15.83 ± 2.20 years). Anthropometric characteristics, training routine, and stroke specialty were recorded. SD was assessed using a dynamic test consisting of an examination of the shoulder blades throughout synchronous forward flexion motion in the sagittal plane and was deemed to be either present or absent. Each movement was repeated 5 times. These evaluations were performed with athletes at rest, before any training or competition. Statistical analysis was performed. RESULTS: SD was detected in 56 (8.5%) participants. Type I SD was the most common (46.5%); male participants were 2 times as likely to have SD as female participants (39 male, 17 female; P < .01). No correlation was found between the dominant limb and side affected (P = .258); rather, a correlation was found between the breathing side and side affected, in that swimmers with a preferred breathing side were more prone to develop SD in the opposite shoulder (P < .05). Swimmers involved in long-distance races were found to have a greater risk of developing SD (P = .01). CONCLUSION: SD may be an asymptomatic condition in elite young swimmers and is present in 8.5% of these athletes. Early diagnosis may be useful for asymptomatic athletes with SD and to avoid its possible evolution to a symptomatic condition.