Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival.

By ignoring the root causes of disease and neglecting to prioritize lifestyle measures for prevention, the medical community is placing people at harm. Advanced nations, influenced by a Western lifestyle, are in the midst of a health crisis, resulting largely from poor lifestyle choices. Epidemiologic, ecologic, and interventional studies have repeatedly indicated that most chronic illnesses, including cardiovascular disease, cancer, and type 2 diabetes, are the result of lifestyles fueled by poor nutrition and physical inactivity.In this article, we describe the practice of lifestyle medicine and its powerful effect on these modern instigators of premature disability and death. We address the economic benefits of prevention-based lifestyle medicine and its effect on our health care system: A system on the verge of bankruptcy. We recommend vital changes to a disastrous course. Many deaths and many causes of pain, suffering, and disability could be circumvented if the medical community could effectively implement and share the power of healthy lifestyle choices. We believe that lifestyle medicine should become the primary approach to the management of chronic conditions and, more importantly, their prevention. For future generations, for our own health, and for the Hippocratic Oath we swore to uphold ("First do no harm"), the medical community must take action. It is our hope that the information presented will inspire our colleagues to pursue lifestyle medicine research and incorporate such practices into their daily care of patients. The time to make this change is now.

Anterior deltoid reeducation for irreparable rotator cuff tears revisited.

BACKGROUND: A previous study introduced a method of conservative treatment of irreparable rotator cuff tears (RCTs) using a rehabilitation program (anterior deltoid reeducation [ADR]). The purposes of this study were to present our experience with ADR and to compare our results with those of the previous study. METHODS: Thirty consecutive elderly patients with irreparable RCTs were prospectively enrolled and taught how to perform the home-based ADR program for a period of 3 months. Clinical and radiographic evaluations were determined at the first visit. Clinical follow-up was available after 9 and 24 months. Failure of the ADR program was defined as abandonment of the ADR program because of pain and/or a patient's decision to undergo surgery at any time or a less than 20-point improvement in the American Shoulder and Elbow Surgeons score at last follow-up. RESULTS: Of the 30 patients, 9 did not complete the 3-month ADR program because of pain. Of the 21 patients who completed the ADR program, 3 were not satisfied with the outcome and went on to undergo surgery. Eighteen of the 30 patients completed the program and had a follow-up at 24 months. Among these 18 cases, there were significant mean improvements between pre-ADR and follow-up outcome scores among all variables (P < .005). However, 6 of these 18 patients did not have an improvement in the American Shoulder and Elbow Surgeons score by at least 20 points. Overall, the ADR program had a success rate of only 40%. CONCLUSION: A 3-month ADR program had limited success to treat irreparable RCTs. We could not reproduce the high rate of satisfactory results of 82% found in a previous study.

Incidence of symptomatic compressive peripheral neuropathy after shoulder replacement.

BACKGROUND: The incidence of post-operative compressive peripheral neuropathy (CPN) after shoulder arthroplasty is not known. We hypothesized that the likelihood following shoulder arthroplasty would be higher compared to a non-operative cohort. METHODS: Retrospective study compared the incidence of symptomatic CPN after shoulder replacement to a 1:1 age- and gender-matched non-operative control group with shoulder arthritis. Six hundred six consecutive shoulder replacements from a regional shoulder arthroplasty registry were analyzed. This included 319 primary total shoulder arthroplasties (TSR), 168 hemiarthroplasties (HA), 31 humeral resurfacings (HHR), 71 reverse arthroplasties (RTSA), and 17 revision arthroplasties. Diagnosis of post-operative CPN was obtained by documented clinical examination by a physician consistent with CPN based on patient complaints, positive nerve study results, and/or nerve decompression. Age, gender, body mass index, diabetes status, thyroid abnormalities, operative side, and anesthesiology (ASA) score were examined. RESULTS: The surgery group had 15 cases (2.5 %) of post-operative CPN (ten carpal tunnel syndrome, five cubital tunnel syndrome). This included seven TSR, six HA, one revision TSR, and one RTSA. Diagnoses included ten osteoarthritis, four rotator cuff arthropathies, and one chondrolysis. Control group had eight cases (1.3 %) of CPN (seven carpal tunnel syndrome, one cubital tunnel syndrome). In univariate analysis, age, gender, body mass index, ASA score, operative side, thyroid status, and diabetes were not predictors of post-operative CPN. CPN incidence between surgical and control groups was not statistically significant. CONCLUSION: The 1-year incidence rate of new onset clinical post-operative CPN symptoms was 2.5 %. There was no significant difference of CPN rates between surgical and non-operative groups.

Longitudinal analysis of effects of operator experience on accuracy for ultrasound detection of supraspinatus tears.

BACKGROUND: Magnetic resonance imaging (MRI) is highly accurate in diagnosing full-thickness rotator cuff tears but has the limitations of high cost and patient-based inconveniences. Diagnostic ultrasound of the rotator cuff has become popular, but its accuracy is operator dependent. We hypothesized that the incremental learning associated with initiation of shoulder ultrasonography in the orthopedic office setting could be quantified. MATERIALS AND METHODS: Ultrasound was performed by 2 surgeons in different patient populations each consisting of 200 patients within the clinical setting. Analysis of the operator learning curves based on sensitivity, specificity, positive predictive value, negative predictive value, and κ agreement scores was performed with MRI used as the reference standard. RESULTS: Surgeon 1 detected 67 (ultrasound) of 72 (MRI) full-thickness supraspinatus tears, and surgeon 2 detected 92 (ultrasound) of 95 (MRI) full-thickness tears. Agreement between ultrasound and MRI improved with increasing number of ultrasounds performed. The maximal rate of increase in sensitivity occurred by the 50th ultrasound for both surgeons. The maximal rate of increase in specificity occurred by the 75th ultrasound for both surgeons. Overall accuracy to detect full-thickness supraspinatus tears plateaued after 100 ultrasounds. CONCLUSIONS: The majority of learning to detect full-thickness supraspinatus tears by ultrasound occurred in the surgeons' first 50 cases. The ability to accurately distinguish a normal supraspinatus tendon by ultrasound took longer, occurring within the first 75 cases. The majority of learning before accuracy plateaued occurred within the first 100 ultrasounds. The recommended operator experience necessary to evaluate the supraspinatus tendon before clinical application was 100 ultrasounds. LEVEL OF EVIDENCE: Level I, Diagnostic Study.

Proximal interphalangeal joint stiffness: measurement and analysis.

PURPOSE: The purpose of this study was to quantify the stiffness of the human finger proximal interphalangeal (PIP) joint and to study its relationship to different common clinical parameters. METHODS: Eighty-nine normal adult subjects had their PIP joints of the index, middle, and ring fingers evaluated using a computer-controlled moment-angle plotter. This device was used to measure stiffness and energy absorbed at the PIP joint during passive flexion and extension. RESULTS: The average overall stiffness was 0.05 N-cm/degree. There was a weak correlation between stiffness and energy absorbed and the size of the finger: they both increased with the size of the finger. The men's fingers were stiffer and absorbed more energy than the corresponding women's fingers. No significant associations were found between the time of day when the test took place, occupation, hobbies, or age with stiffness or absorbed energy. No significant differences were associated with hand dominance. The finger on the dominant hand had a larger circumference for both genders. Heavier individuals had more stiffness and absorbed more energy than lighter individuals. CONCLUSIONS: The PIP joint stiffness was defined quantitatively and measured over a wide cross-section of a normal population. This may allow future studies to record the outcome of different treatments for finger joint stiffness objectively. The stiffness was greater in men and in larger fingers.