Objective assessment of sleep quality in patients with rotator cuff tears.

INTRODUCTION: Sleep dysfunction in patients with rotator cuff tears has been previously evaluated only using subjective measures. Objective parameters of sleep quality amongst rotator cuff tear patients are scarce in the literature. The aim of this study is to compare objective sleep data to historical controls and to subjective patient-reported sleep quality in patients with rotator cuff tears. HYPOTHESIS: We hypothesized that patients with rotator cuff tears would demonstrate objectively poor sleep quality based on actigraphy when compared to a historical control group. Secondarily, we hypothesize that objective sleep quality measures will correlate poorly with traditionally used questionnaires and other subjective assessments. MATERIALS AND METHODS: Twenty patients with full-thickness rotator cuff tears wore a highly validated activity monitor for 2 consecutive weeks for objective assessment and completed a sleep diary during the same period. Patients completed multiple questionnaires pertaining to their shoulder function and subjective assessment of sleep quality. Objective sleep assessments were compared to patients' sleep diary data and to subjective sleep data from a historical cohort of 969 healthy adults aged 57-97 years. RESULTS: Mean total sleep time, sleep onset latency, wake after sleep onset (WASO), and sleep efficiency were all significantly worse in the study cohort compared to the historical cohort (p=0.0338, p=0.0040, p<0.0001, and p=0.0474, respectively). Pittsburgh Sleep Quality Index (PSQI) scores did not correlate with sleep efficiency (r=0.3143, p=0.2040) or WASO (r=-0.3068, p=0.2153). Visual analog scale scores correlated with PSQI scores (r=0.5260, p=0.0249) and Epworth Sleepiness Scale scores (r=0.4863, p=0.0407). Patients tended to overreport their time spent asleep via a sleep diary compared to objective time asleep (p=0.0050). DISCUSSION: This study of objective sleep measures demonstrated poor sleep quality in patients with rotator cuff tears with shorter sleep duration, frequent awakenings, and decreased efficiency. Subjective assessments of sleep did not correlate with objective findings. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study.

HYPOTHESIS: Our hypothesis was that seasonal adaptive changes in the ulnar collateral ligament (UCL), ulnohumeral joint space (UHJS), and glenohumeral internal rotation deficit (GIRD) of the pitching extremity would subsequently resolve with off-season rest. METHODS: Eleven collegiate pitchers underwent preseason, postseason, and off-season evaluations including physical examination; dynamic ultrasound imaging of the UCL and UHJS; and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Ultrasound images were evaluated by 2 fellowship-trained musculoskeletal radiologists. RESULTS: All 11 pitchers were included in the final analysis, with an average age of 20.1 years and with 14.1 years of playing experience. After a season of pitching, we found significant increases in GIRD (P = .004) and UCL thickness (P = .033) and nonsignificant increases in both unloaded (P = .069) and loaded (P = .122) UHJS. Preseason GIRD correlated with this increase in loaded UHJS (r = 0.80, P = .003). The increase in UCL thickness was significantly greater in pitchers with GIRD greater than 10° (P < .05). After the off-season, UCL thickness returned to baseline and significant decreases were noted in both unloaded (P = .004) and loaded (P = .041) UHJS, but a progression in GIRD was found (P = .021). Pitchers with GIRD of 10° or less showed greater improvement in UHJS after the off-season (P < .05). CONCLUSIONS: The pitching season produced adaptive changes in the throwing elbow that subsequently resolved after off-season rest. However, shoulder range-of-motion deficits were progressive and did not resolve. Ultrasound adaptations of the pitching elbow were significantly related to GIRD.

Facet Sparing Foraminal Decompression Using the Flexible Shaver Foraminotomy System: Nerve Safety, Pain Relief, and Patient Satisfaction.

BACKGROUND: A number of surgical options exist for decompressing lumbar foraminal stenosis. Flexible shaver foraminotomy is a recent addition to this armamentarium. While the foraminotomy device has been incorporated into clinical practice, the literature on its safety and efficacy remain limited. We aimed to evaluate nerve safety, pain relief, and patient satisfaction in a series of patients treated with the iO-Flex shaver system (Amendia, Inc., Marietta, Georgia). METHODS: Thirty-one consecutive patients with lumbar foraminal stenosis underwent foraminal decompression using the flexible microblade shaver system at 62 neuroforamina. The shavers were inserted into each foramen using an open hemilaminotomy and fluoroscopic guidance. Nerve mapping via mechanomyography (MMG) was used to ensure nerve safety. Perioperative charts were reviewed to find the incidence of neurologic complications and to quantify pain relief. Average office-based follow-up was 5.3 months. A 3-item questionnaire was administered to assess patient satisfaction during late follow-up, which occurred at an average of 21 months. RESULTS: No planned iO-Flex foraminotomies were aborted. Neurologic complications included transient dysesthetic pain in 1 patient (3.2%, n = 31), and transient numbness in 3 patients (9.7%, n = 31). There were no motor deficits. The composite nerve complication rate was 12.7%. Preoperative visual analog scale scores decreased from a mean of 7.1 (n = 31, standard deviation [SD] 2.0) to a mean of 3.5 (n = 30, SD 2.5). If asked to repeat their decision to do surgery, 81% of patients would redo the procedure. The rate of patient dissatisfaction was 19%. CONCLUSIONS: Decompression of lumbar foramina using the flexible shaver system and MMG nerve mapping is safe and effective, although the short-term sensory complication with this technique may be higher than previously reported. Patient satisfaction with iO-Flex foraminotomy is comparable to reported satisfaction outcomes for traditional lumbar decompression. LEVEL OF EVIDENCE: 4.

Optimal management of glenohumeral osteoarthritis.

Glenohumeral osteoarthritis (OA) is defined as progressive loss of articular cartilage, resulting in bony erosion, pain, and decreased function. This article provides a gross overview of this disease, along with peer-reviewed research by experts in the field. The pathology, diagnosis, and classification of this condition have been well described. Treatment begins with non-operative measures, including oral and topical anti-inflammatory agents, physical therapy, and intra- articular injections of either a corticosteroid or a viscosupplementation agent. Operative treatment is based on the age and function of the affected patient, and treatment of young individuals with glenohumeral OA remains controversial. Various methods of surgical treatment, ranging from arthroscopy to resurfacing, are being evaluated. The roles of hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty are similarly reviewed with supporting data.