Long-term effects on subscapularis integrity and function following arthroscopic shoulder stabilization with a low anteroinferior (5:30 o'clock) portal.

PURPOSE: The use of a low anteroinferior (5:30 o'clock) portal for arthroscopic shoulder stabilization allows an anatomical refixation of the capsulolabral complex. This anteroinferior portal, however, penetrates the inferior subscapularis (SSC), which is criticized. Therefore, the aim of the study was to evaluate the functional and structural properties of the SSC in patients with anteroinferior shoulder stabilization. The hypothesis was that it does not harm the SSC by demonstrating full muscular function and imaging-based normal structure at a long-term follow-up. METHODS: Twenty patients were examined (14 males and six females; mean age 37.0 years) retrospectively after a mean follow-up of 9.6 years. At final follow-up, clinical examination and clinical scores (ASES, Constant-Murley, WOSI, and Rowe score) were documented. Additionally, SSC strength was evaluated with a custom-made electronic force measurement plate. All patients underwent bilateral magnetic resonance imaging to assess structural integrity and fatty infiltration (grading according to Fuchs et al.) of the SSC. Furthermore, vertical and transversal (superior and inferior) diameters of the muscle and the muscle area in a parasagittal plane were measured. RESULTS: Clinical scores revealed good-to-excellent long-term results (ASES 92 points, Constant-Murley 82 points, WOSI 85 %, and Rowe 84 points). Force measurement in comparison with the contralateral side showed no significant (p > 0.05) differences for the 'belly-press' test (ipsilateral 102 N vs. contralateral 101 N) and the 'lift-off' test (73 vs. 69 N). There were also no significant differences between the mean diameters and the areas of the SSC muscle belly (vertical diameter ipsilateral 92 mm vs. contralateral 94 mm; superior transversal 28 vs. 29 mm; inferior transversal 34 vs. 34 mm; area 2336 vs. 2526 mm(2)). CONCLUSION: Arthroscopic labral repair with a low anteroinferior portal demonstrates no signs of structural and functional impairment of the SSC after 9.6 year follow-up. For clinical relevance, the lower part of the SSC can be penetrated for an optimal anchor placement in shoulder instabilities or Bankart fractures without concerns of a negative long-term effect on the SSC. LEVEL OF EVIDENCE: Case series, Level IV.

What Comes First, Job Burnout or Secondary Traumatic Stress? Findings from Two Longitudinal Studies from the U.S. and Poland.

This longitudinal research examined the directions of the relationships between job burnout and secondary traumatic stress (STS) among human services workers. In particular, using cross-lagged panel design, we investigated whether job burnout predicts STS at 6-month follow up or whether the level of STS symptoms explains job burnout at 6-month follow-up. Participants in Study 1 were behavioral or mental healthcare providers (N = 135) working with U.S. military personnel suffering from trauma. Participants in Study 2 were healthcare providers, social workers, and other human services professions (N = 194) providing various types of services for civilian trauma survivors in Poland. The cross-lagged analyses showed consistent results for both longitudinal studies; job burnout measured at Time 1 led to STS at Time 2, but STS assessed at Time 1 did not lead to job burnout at Time 2. These results contribute to a discussion on the origins of STS and job burnout among human services personnel working in highly demanding context of work-related secondary exposure to traumatic events and confirm that job burnout contributes to the development of STS.

Cultivating secondary traumatic growth among healthcare workers: the role of social support and self-efficacy.

OBJECTIVE: This 2-study longitudinal investigation examined the indirect effects of secondary traumatic stress (STS) on secondary traumatic growth via two mediators: perceived social support and secondary trauma self-efficacy. In particular, we tested if the 2 hypothetical mediators operate sequentially, that is, with secondary trauma self-efficacy facilitating social support (i.e., cultivation hypothesis) and/or social support enhancing self-efficacy (i.e., enabling hypothesis). METHOD: Participants in Study 1 (N = 293 at Time 1, N = 115 at Time 2) were behavioral healthcare providers working with U.S. military personnel suffering from trauma. Study 2 was conducted among Polish healthcare workers (N = 298 at Time 1, N = 189 at Time 2) providing services for civilian survivors of traumatic events. RESULTS: In both studies, multiple mediational analyses showed evidence for the cultivation hypothesis. The relationship between STS at Time 1 and secondary traumatic growth at Time 2 was mediated sequentially by secondary trauma self-efficacy at Time 1 and social support at Time 2. The enabling hypothesis was not supported. CONCLUSION: Education and development programs for healthcare workers may benefit from boosting self-efficacy with the intent to facilitate perceived social support.

Secondary traumatic stress among mental health providers working with the military: prevalence and its work- and exposure-related correlates.

Our research assessed the prevalence of secondary traumatic stress (STS) among mental health providers working with military patients. We also investigated personal, work-related, and exposure-related correlates of STS. Finally, using meta-analysis, the mean level of STS symptoms in this population was compared with the mean level of these symptoms in other groups. Participants (N = 224) completed measures of indirect exposure to trauma (i.e., diversity, volume, frequency, ratio), appraisal of secondary exposure impact, direct exposure to trauma, STS, and work characteristics. The prevalence of STS was 19.2%. Personal history of trauma, complaints about having too many patients, and more negative appraisals of the impact caused by an indirect exposure to trauma were associated with higher frequency of STS symptoms. A meta-analysis showed that the severity of intrusion, avoidance, and arousal symptoms of STS was similar across various groups of professionals indirectly exposed to trauma (e.g., mental health providers, rescue workers, social workers).