Patient-reported activities after bilateral reverse total shoulder arthoplasties.

PURPOSE: Reverse shoulder arthroplasty (RSA) improves pain and function with very good satisfaction. Concerns exist about some activities of daily living (ADLs) involving internal rotation. The purpose of this study was to report how patients with bilateral RSA perform various ADLs. METHODS: Thirty-one primary bilateral RSA patients (average age 76 years; 21 women and 10 men) completed a survey to assess various outcomes. The average time between the second arthroplasty and the survey was 2.7 years (range 1.0-7.8 years). RESULTS: All clinical parameters were favorable. All patients reported being able to easily manage toileting and 87% reaching their back pocket. However, 29% found difficulty and 39% were unable to wash their back or put on bra. In comparison with various unilateral arthroplasty types, there was no statistical difference in overall activities ( p < 0.05). CONCLUSION: Bilateral RSA can provide good functional outcome and high satisfaction. Patients manage most ADLs easily with some limitations in activities requiring extreme internal rotation.

Radiographs and computed tomography scans show similar observer agreement when classifying glenoid morphology in glenohumeral arthritis.

BACKGROUND: Glenohumeral subluxation and glenoid morphology are commonly evaluated in primary osteoarthritis by use of the Walch classification. The reliability of this classification system has been analyzed only by computed tomography (CT). The purpose of this study was to determine the reliability of plain axillary radiographs compared with CT scans. METHODS: Three shoulder surgeons blindly and independently evaluated the radiographs and CT scans of 75 consecutive shoulders with primary glenohumeral osteoarthritis. Each observer classified all shoulders according to Walch in 4 separate sessions, each 6 weeks apart. There were 2 sessions using only radiographs and 2 using only CT scans. The order of shoulders evaluated was randomized. RESULTS: The first reading by the most senior observer based on CT was arbitrarily used as the "gold standard" (A1, 21; A2, 13; B1, 12; B2, 28; C, 1). The average intraobserver agreement for radiographs was 0.66 (substantial; 0.66, 0.59, and 0.74 for each observer). The average intraobserver agreement for CT scans was 0.60 (moderate; 0.53, 0.61, and 0.65). Pairwise comparisons between observers showed higher agreement for radiographs than for CT scans (0.48 vs. 0.39). The average agreement for observations on radiographs and CT scans was 0.42 (moderate; 0.40, 0.37, and 0.50). CONCLUSION: In this study, intraobserver agreement using the Walch classification based on axillary radiographs was substantial and compared favorably with agreement based on CT scans. The Walch classification provides a useful frame of reference when assessing subluxation and glenoid morphology in primary glenohumeral osteoarthritis, but not unlike other classification systems, it does not allow perfect agreement among observers.

Ultrasound-guided aspiration of wrist ganglions: a follow-up survey of patient satisfaction and outcomes.

BACKGROUND: Ganglion cysts are one of the most frequently occurring masses of the wrist, often causing pain and interfering with daily activity. Ultrasound (US)-guided aspiration is a treatment for ganglion cysts of the wrist. PURPOSE: To examine the results and patient satisfaction of US-guided aspiration of wrist ganglion cysts. MATERIAL AND METHODS: Medical records from August 2009 through December 2013 were reviewed to identify all adult patients referred to a single musculoskeletal radiologist for US-guided aspiration of a painful wrist ganglion cyst. Records were reviewed for patient demographics, cyst size, location, and morphology. Outcomes and patient satisfaction were evaluated using a telephone questionnaire at a minimum of 9 months after the procedure. RESULTS: Of 56 consecutive patients identified, follow-up data were available for 39 patients (69%) at a minimum of 9 months. There were 21 volar and 18 dorsal ganglion cysts. The overall recurrence rate was 20% (8 of 39 patients) and only five patients reported a pain score of greater than 2 out of 10. The mean age of patients with recurrence of the cyst was greater than that of patients without recurrence (52 vs. 35 years, P = 0.03). Satisfaction with the outcome was high and varied by recurrence. There were no acute complications including infection, hemorrhage, or allergic reaction. CONCLUSION: US-guided aspiration is a safe and potentially effective treatment for ganglion cysts of the wrist, with high patient satisfaction. US-guided aspiration may be particularly advantageous for volar ganglion cysts, and in patients who are poor surgical candidates.

Noninvasive buccal swab antigen sample and molecular testing provides extended antigen typing for patients with hemoglobinopathies.

OBJECTIVE: To demonstrate the feasibility of performing a noninvasive, molecular-based red blood cell (RBC) antigen test on infants and very young children with sickle cell disease as part of a statewide newborn screening follow-up program. STUDY DESIGN: A prospective pilot project was conducted using a noninvasive buccal swab and test kit to perform DNA-based, extended RBC phenotyping in 92 children participating in a newborn hemoglobinopathy screening follow-up program. Reported data include the extended panel of antigens detected by molecular analysis compared with unaffected population estimates. RESULTS: Molecular-based RBC antigen testing was successful, with extended RBC typing generated for all subjects. Molecular testing detected several rare negative or rare positive phenotypes, demonstrating the utility of obtaining an extended antigen panel. CONCLUSION: This study demonstrates the feasibility of performing antigen testing on buccal swab specimens from children with sickle cell disease as part of a newborn screening follow-up program with the aim of allowing specific unit matching to prevent alloimmunization with RBC transfusions. The general applicability of testing may be limited by a lack of uniform insurance coverage for buccal swab testing, however.

Re-rupture rate of primarily repaired distal biceps tendon injuries.

BACKGROUND: Distal biceps tendon rupture is a common injury, and primary repair results in excellent return of function and strength. Complications resulting from distal biceps tendon repairs are well reported, but the incidence of re-ruptures has never been investigated. METHODS: A search of the Mayo Clinic's Medical/Surgical Index was performed, and all distal biceps tendon repairs from January 1981 through May 2009 were identified. All patients who completed 12 months or more of follow-up were included. All charts were reviewed and patients contacted as necessary to identify a re-rupture. We also investigated the situation causing the re-rupture. RESULTS: We identified a total of 190 distal biceps tendon ruptures that underwent repair and met our inclusion and exclusion criteria. Of the 190 repairs, 172 (90.5%) were performed by the Mayo modification of the Boyd-Anderson 2-incision technique. Bilateral ruptures occurred in 13 patients (7.3%). Six primary ruptures (3.2%) occurred in women, 4 of the 6 being partial ruptures. Partial ruptures were found to be statistically more common than complete ruptures in women (P = .05). We identified 3 re-ruptures (1.5%), all occurring within 3 weeks of the index surgery. CONCLUSION: The re-rupture rate after primary repair of the distal biceps tendon is low at 1.5% and occurs within 3 weeks of index repair. This appears to be due to patient compliance and excessive force placed on repairs. We also found the incidence of women who sustain a distal biceps tendon tear to be 3.2%, with partial tears being statistically more common than complete ruptures. LEVEL OF EVIDENCE: Level IV, case series, treatment study