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1.
PLoS One ; 17(5): e0267943, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35511770

RESUMO

Proper placement of suture anchors is an important step in Bankart repair as improper placement can lead to failure. Concern surrounding suture anchor placement inspired the use navigation systems in shoulder arthroscopy. We aimed to demonstrate the technological advantage of using the O-arm (Medtronic Navigation, Denver, CO, USA) image guidance system to provide real-time images during portal and anchor placements in shoulder arthroscopy. Consecutive patients (from July to October 2014) who were admitted for arthroscopic capsulolabral repair surgeries were included. Ten patients were randomly enrolled in the navigation group and 10 in the traditional group. The glenoid was divided into four zones, and the penetration rates in each zone were compared between the two groups. In zone III, the most inferior region of the glenoid, the penetration rate was 40.9% in the traditional group and 15.7% in the navigation group (P = 0.077), demonstrating a trend toward improved accuracy of anchor placement with the aid of the navigation system; however, this was not statistically significant. Average surgical time in the navigation and traditional groups was 177.6±40.2 and 117.7±17.6 mins, respectively. American Shoulder and Elbow Surgeons Shoulder Scores showed no difference before and 6 months after surgery. This pilot study showed a trend toward decreased penetration rate in O-arm-navigated capsulolabral repair surgeries and decreased risks of implant misplacement; however, possibly due to the small sample size, the difference was not statistically significant. Further large-scale studies are needed to confirm the possible benefit of the navigation system. Even with the use of navigation systems, there were still some penetrations in zone III of the glenoid. This penetration may be attributed to the micro-motion of the acromioclavicular joint. Although the navigation group showed a significant increase in surgical time, with improvements in instrument design, O-arm-navigated arthroscopy will gain popularity in clinical practice.


Assuntos
Instabilidade Articular , Articulação do Ombro , Cirurgia Assistida por Computador , Artroscopia/métodos , Humanos , Imageamento Tridimensional , Instabilidade Articular/cirurgia , Projetos Piloto , Ombro/cirurgia , Articulação do Ombro/cirurgia , Âncoras de Sutura , Tomografia Computadorizada por Raios X
3.
Arthroscopy ; 38(5): 1420-1421, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35501010

RESUMO

Massive, retracted rotator cuff tears with poor tissue quality continue to pose a problem for the shoulder surgeon. Augmentation of such repairs with grafts, patches, spacers, or biologics is being closely investigated to help improve clinical outcomes and healing rates. Specifically, superior capsule reconstruction augmentation of such rotator cuff tears may lead to good outcomes. However, we do not truly understand how much native cuff tissue or graft healing is actually taking place. Clinically, superior capsule reconstruction augmentation of rotator cuff repair may simply be serving as a spacer.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões do Manguito Rotador , Articulação do Ombro , Artroplastia , Humanos , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Articulação do Ombro/cirurgia
4.
Arthroscopy ; 38(5): 1454-1456, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35501012

RESUMO

Since the introduction of superior capsular reconstruction (SCR) for the treatment of irreparable rotator cuff tears nearly 10 years ago, we have witnessed widespread adoption by the arthroscopic shoulder community alongside an exponential increase in use within North America. To date, more than 42,000 acellular dermal allografts have been implanted in the United States alone, and our indications and surgical technique have been progressively refined in response to the evolving body of clinical outcomes research. However, with P values set aside, the real question still remains: how do our patients actually do after SCR? With the advent of clinically significant outcomes such as the patient acceptability symptomatic state and substantial clinical benefit, investigators have sought to establish more practical, patient-centered benchmarks for success after an intervention. Rather than just seeking the baseline expectations via the minimally clinically important difference (i.e., "I am better"), substantial clinical benefit (i.e., "I am so much better") and patient acceptability symptomatic state (i.e., "I am 'okay' with how I feel") truly clarify patient satisfaction and provide measurable units of patient improvement. These must be assessed on an individual basis, as aggregated averages introduce outliers that can distort the outcomes. Based on these end points, prognostic factors may allow a more concrete assessment of surgical risk while equipping physicians with appropriate information to guide ideal patient selection and optimize chances of success. Patients of female sex, older age, worker's compensation status, and those with subscapularis involvement are less likely to achieve clinically significant outcomes at minimum 1-year follow-up after SCR. Based on the current study, surgeons should exercise caution in recommending SCR for patients of advancing chronological age and significant subscapularis involvement, particularly if irreparable or untreated.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Artroscopia/métodos , Feminino , Humanos , Manguito Rotador , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Articulação do Ombro/cirurgia
5.
Acta Med Okayama ; 76(2): 173-177, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35503445

RESUMO

To the best of our knowledge, no previous studies have reported a relationship between osteoarthritis (OA) of the lower limbs and OA of the shoulder joints. We evaluated the correlation between shoulder OA and hip OA. We collected contrast-enhanced computed tomography (CECT) images of the shoulder joints of 159 patients with hip OA who underwent primary total hip arthroplasty (THA). The images, taken 1 week after THA to monitor venous thromboembolism (VTE), were used to examine the prevalence of shoulder OA. They were compared with those of 103 controls who underwent CECT during the same period to monitor VTE. Shoulder OA was observed in 15% of the controls and 24% of the THA patients. Although the rate was somewhat higher in the THA group, the difference was not significant. However, in the THA group, significantly more patients with bilateral hip OA (33%) had shoulder OA than those with unilateral hip OA (17%). In summary, the prevalence of shoulder OA was significantly higher in patients with bilateral hip OA. In these patients, pain and instability in the hip joints require them to use arm support to stand up or walk, putting the weight-bearing shoulder at risk of developing OA.


Assuntos
Artroplastia de Quadril , Osteoartrite do Quadril , Tromboembolia Venosa , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Articulação do Quadril/cirurgia , Humanos , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Ombro/cirurgia
6.
Spine (Phila Pa 1976) ; 47(9): E385-E389, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35533295

RESUMO

STUDY DESIGN: Retrospective review. OBJECTIVE: To analyze if shoulder balance continues to change in the postoperative period in patients undergoing selective lumbar fusion for adult spinal deformity (ASD), and secondarily, analyze if shoulder balance correlates with health-related quality of life (HRQOL) outcomes. SUMMARY OF BACKGROUND DATA: Shoulder balance in patients with ASD is poorly understood and has largely been extrapolated from adolescent scoliosis literature. MATERIALS AND METHODS: Adult patients who underwent selective lumbar fusion (upper instrumented vertebra: Τ9-Τ12, lower instrumented vertebra: L4-Pelvis) for thoracolumbar or lumbar scoliosis (cobb angle > 30°) or sagittal plane deformity with thoracic compensatory curves (cobb angle > 10°) were identified. The clavicular angle (CA) was used to quantify shoulder balance. Shoulder balance was categorized into three groups postoperatively (balanced: CA <2°, mild imbalance: CA 2°-4°, severe imbalance: CA >4°). The average CA and proportion of patients in each shoulder balance group were compared at each postoperative period. Patients with 1-year postoperative HRQOL scores were identified. RESULTS: Eighty-six patients were included. The preoperative CA was 2.7 ±â€Š2.3° and did not significantly change at discharge (2.9 ±â€Š2.4°), 6-weeks (2.5 ±â€Š2.1°), 6-months (2.4 ±â€Š2.2°), 1-year (2.4 ±â€Š2.5°), or 2-years (2.3 ±â€Š1.5°) postoperatively. The proportion of patients in each shoulder balance group did not significantly change from discharge to 6-weeks, 6-months, 1-year or 2-years postoperatively (P > 0.1). At 1-year follow-up, the CA demonstrated no significant correlation with Oswestry Disability Index, Scoliosis Research Society (SRS)-22 score, or SRS-22 subscores. There was no significant association between shoulder balance group and Oswestry Disability Index, SRS-22 score, or SRS-22 subscores. CONCLUSIONS: In patients with ASD undergoing selective lumbar fusion, shoulder balance did not change over the postoperative period. From a functional standpoint, shoulder balance demonstrated no correlation with HRQOL scores. In patients undergoing selective lumbar fusion for ASD, shoulder balance may not spontaneously correct over the postoperative period, but this may not be of functional consequence.Level of Evidence: 4.


Assuntos
Escoliose , Fusão Vertebral , Adolescente , Adulto , Humanos , Vértebras Lombares/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Escoliose/cirurgia , Ombro/cirurgia , Vértebras Torácicas/cirurgia , Resultado do Tratamento
7.
Am J Sports Med ; 50(6): 1503-1511, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35442106

RESUMO

BACKGROUND: Patients undergoing shoulder stabilization surgery have been shown to have elevated activity levels. Factors associated with shoulder activity in this patient population at baseline and after surgery are unknown. HYPOTHESIS: Patient-specific variables are associated with shoulder activity level at baseline and at 2-year follow-up in a cohort of patients undergoing shoulder stabilization surgery. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing shoulder stabilization surgery were prospectively enrolled. As part of the data collection process, patients completed a previously validated Shoulder Activity Scale. A regression analysis was performed to assess the association of patient characteristics with baseline and 2-year follow-up shoulder activity levels. RESULTS: A total of 764 (n = 612 men, n = 152 women) out of 957 patients (80%) undergoing shoulder stabilization surgery with a median age of 25 years had baseline and 2-year follow-up data and were included in the current analysis. The baseline shoulder activity level was associated with race ( P < .0001) and preoperative duration of instability (P < .0001). At 2 years, 52% of the cohort had returned to the same or higher activity level after surgery. Predictors of higher shoulder activity level at 2-year follow-up included higher baseline activity level (P < .0001), male sex (P < .0001), younger age (P = .004), higher body mass index (BMI) (P = .03), more dislocations (P = .03), nonsmokers (P = .04), and race (P = .04). CONCLUSION: A longer duration of preoperative symptoms was associated with a lower baseline activity in this cohort. High baseline preoperative shoulder activity, younger age, male sex, higher BMI, number of dislocations, and nonsmoking status predicted higher shoulder activity 2 years after shoulder stabilization surgery. REGISTRATION: NCT02075775 (ClinicalTrials.gov identifier).


Assuntos
Luxações Articulares , Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Adulto , Artroscopia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Instabilidade Articular/epidemiologia , Instabilidade Articular/cirurgia , Masculino , Ombro/cirurgia , Luxação do Ombro/epidemiologia , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia
8.
J Ayub Med Coll Abbottabad ; 34(1): 3-7, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35466617

RESUMO

BACKGROUND: Forequarter amputation (FQA) is the surgical treatment of choice for tumours in the upper extremity and shoulder girdle that infiltrate the neurovascular bundle, shoulder joint and muscles of the shoulder girdle in non-salvageable cases. In both curative and palliative settings, FQA can serve as an effective oncological treatment for local control of tumour. METHODS: All patients who underwent FQA in our unit from January 2016 till August 2019 for oncological indications were included in our study and their clinical outcomes were calculated. RESULTS: Thirteen patients were included in the study including 8 male patients. Mean age of patients at surgery was 20 years (Range 10-53 years) with a minimum follow up of 6 months or till patient was deceased earlier. Six patients had primary osteosarcoma, 4 had Ewing's sarcoma, 2 had Spindle cell sarcoma while 1 had Giant cell tumour. Six patients underwent surgery with curative intent. No major per operative complication was encountered in any of the cases with a mean blood loss of 350 ml and mean duration of surgery being 75 minutes. At last, follow up only 6 patients were alive, with 2 patients alive with disease (Metastasis) and undergoing palliative treatment. None of our patients had local recurrence. Mean survivorship for the whole cohort was 9.2 months (Range 3-18 months) with a mean survivorship for the deceased group was 7.1 months (Range 3-16 months) and mean survivorship for alive patients was 11.6 months (range 9-18 months). All the alive patients had phantom limb sensations and only one had a prosthesis in place only for cosmetic reasons, at last follow up. CONCLUSIONS: Although FQA is a significantly body disfiguring procedure, but in large tumours of shoulder girdle, this is a viable option for local control of the disease. Based on our study, although relatively small sample size, we propose the combined anteroposterior approach to be safe and reliable for advanced shoulder girdle tumours.


Assuntos
Neoplasias Ósseas , Neoplasias , Articulação do Ombro , Amputação , Neoplasias Ósseas/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Ombro/cirurgia , Extremidade Superior/cirurgia
9.
J Hand Surg Asian Pac Vol ; 27(2): 285-293, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35404203

RESUMO

Background: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used patient-reported outcome measure (PROM) for assessment of upper extremity disability assessment. However, DASH is a multidimensional measurement with different difficulty levels and ratio apportionment of the items categorised by ordinal scale. This has caused a misinterpretation of the total disability scores. We created a modified DASH adapted to the Rasch model. The aim of this study is to compare the functional recovery and quality of life (QOL) improvement and to assess the validity of the original DASH and modified DASH between C56/C567, C5-8 and total types of brachial plexus injury (BPI) following surgical reconstruction. Methods: A total of 183 BPI patients who underwent reconstructive surgery were evaluated for functional recovery using the range of motion and power of the affected limb, and improvement in QOL with DASH. The collected data were analysed using Rasch measurement theory to detect the misfit items. The original and modified DASH were compared under the three different types of BPI after item reduction by removing the misfit items. Results: There were significant differences in functional recovery between three types of palsy. However, PROM using DASH score with or without misfit items (12 items) did not show any significant differences. Conclusions: DASH is not suitable for comparison of upper extremity disabilities even after being corrected mathematically due to the inclusion of items from many different domains unequally. Therefore, each item of the function (with or without compensation of the uninjured hand), pain and impact to the patients should be evaluated separately. Level of Evidence: Level IV (Prognostic).


Assuntos
Plexo Braquial , Ombro , Braço , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Humanos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Ombro/cirurgia , Inquéritos e Questionários , Extremidade Superior
10.
Artigo em Inglês | MEDLINE | ID: mdl-35389922

RESUMO

INTRODUCTION: We aimed to describe the demographic and professional backgrounds of current shoulder and elbow fellowship directors. METHODS: The American Shoulder and Elbow Surgeons (ASES) 2021 to 2022 Fellowship Directory was reviewed to identify the 31 ASES-recognized US fellowship programs. Demographic and other data were obtained through an electronic survey and publicly available online resources from February 28, 2021, to March 5, 2021. RESULTS: Of the 31 fellowship directors, 97% (30) identified as male and 74% (23) as White, the mean age was 53 ± 7 years, and the mean Scopus h-index was 24.2 ± 13. Almost all (95%) held ASES committee leadership appointments in at least one committee. The mean time from completion of most recent fellowship to fellowship director appointment was 7.3 ± 6 years. About two-thirds of fellowship directors trained at one of five fellowship programs: Columbia University (n = 7), California Pacific Orthopaedics (n = 4), Washington University in St. Louis (n = 3), Mayo Clinic (n = 3), and Hospital for Special Surgery (n = 2). DISCUSSION: ASES fellowship directors share similar demographic and professional characteristics with high levels of research productivity and involvement in orthopaedic societies. There is a lack of diversity in shoulder and elbow fellowship directors, highlighting a need for priority consideration of this disparity by leaders in the field.


Assuntos
Bolsas de Estudo , Internato e Residência , Estudos Transversais , Cotovelo/cirurgia , Humanos , Liderança , Masculino , Pessoa de Meia-Idade , Ombro/cirurgia , Estados Unidos
11.
J Orthop Surg (Hong Kong) ; 30(1): 10225536221088633, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35392727

RESUMO

Background: Inferior angle of scapula fractures (IAS) are rare injuries that result from the periscapular shoulder muscles avulsing the inferior scapula tip. The aim of this study was to investigate the mechanisms of injury, investigations and treatment outcomes, as currently only case reports are available to guide management. Methods: Computered tomography (CT) images were reviewed to identify patients with an IAS fracture. Case notes were reviewed, and patients contacted to gather data relating to the injury, treatment and outcome. Results: Fourteen fractures were identified on CT. Five were missed on the initial radiograph. High energy fractures had an average age of 47.6 years, 90% were male. Low energy fractures had a mean age of 83.6 years 75% were female. All undisplaced fractures had a satisfactory outcome treated non-operatively. Three of six displaced fractures reported an unsatisfactory outcome with non-operative treatment. Subsequent surgical fixation resulted in resolution of symptoms. Conclusions: Inferior angle of scapula fractures are a rare injury that can result from high or low energy trauma. They are easy to miss on plain radiographs. Identification is important as displaced fractures can do poorly when treated non-operatively, but symptoms resolve with surgical fixation. Undisplaced fracture has a satisfactory outcome when treated non-operatively. Evidence: Level IV.


Assuntos
Fraturas Ósseas , Fraturas do Ombro , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Escápula/diagnóstico por imagem , Escápula/cirurgia , Ombro/cirurgia , Resultado do Tratamento
12.
J Orthop Surg (Hong Kong) ; 30(1): 10225536221094259, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35393908

RESUMO

PURPOSE: This study aims to identify predictors of postoperative pain and opioid consumption after shoulder surgery to help optimize postoperative pain protocols. STUDY DESIGN: Observational cohort study. METHODS: One thirty-four patients undergoing arthroscopic shoulder repair were included. Variables related to the patient, surgery and anesthesia were collected and correlated with postoperative pain intensity, analgesic consumption, and functionality up to 1-month post-surgery. We used mixed-effect linear models to estimate the association of gender, interscalene block (ISB), preoperative shoulder pain, non-steroidal anti-inflammatory drugs (NSAIDs) consumption before surgery, and type of surgery with each of the following outcomes: postoperative pain scores, opioid consumption, and functionality. We further analyzed the data for pain scores and opioid consumption per body weight using the multiple linear regression analysis to demonstrate the aforementioned associations specifically at 1 h, 6 h, 12 h, 24 h, 72 h, 1 week and 1 month after surgery. RESULTS: Omitting the ISB was associated with higher postoperative pain and cumulative opioid consumption over the first 24 h after surgery. Rotator cuff repair and stabilization surgeries were found to be predictive of higher postoperative pain at 24 h, 72 h, and 1 week and lower functionality at 1 week after surgery. Preoperative shoulder pain and NSAIDs consumption were also predictive of postoperative pain and cumulative opioid consumption. CONCLUSION: Omitting a single shot ISB is a strong predictor of postoperative pain and opioid consumption in the early postoperative phase, beyond which the type of surgery, particularly rotator cuff repair and stabilization surgery, emerges as the most important predictor of postoperative pain and functionality.


Assuntos
Analgésicos Opioides , Lesões do Manguito Rotador , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia/métodos , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Dor de Ombro/etiologia
15.
Zhongguo Gu Shang ; 35(3): 203-8, 2022 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-35322607

RESUMO

OBJECTIVE: To compare the effect of two different arthroscopic procedures, threading lasso fixation and full-thickness conversion, for repairing articular-sided partial-thickness supraspinatus tendon tear. METHODS: From July 2015 to November 2018, 21 patients with articular-sided partial-thickness supraspinatus tendon tears underwent arthroscopic modified threading lasso fixation repair(group A). There were 12 males and 9 females in the group, with an average age of(53.2±6.4)years old. Twenty-four patients with articular-sided partial-thickness supraspinatus tendon tears received arthroscopic full-thickness conversion repair(group B). In this group, there were 14 males and 10 females, with an average age of (55.7±5.2) years old. The American Shoulder and Elbow Surgeons (ASES) score and University of California Los Angeles (UCLA) shoulder score were used to evaluate preoperative and postoperative clinical function. MRI was used to examine the healing status of the reconstructed rotator cuff. RESULTS: All patients were followed up, and the duration ranged from 20 to 27 months, with a mean of (23.7±3.1) months. In threading lasso fixation group, ASES score and UCLA score increased from 50.6±6.4 and 15.6±2.7 preoperatively to 87.3±5.2 and 31.6±2.4 postoperatively. In full-thickness conversion group, ASES score and UCLA score increased from 52.3±5.6 and 16.8±2.4 scores to 90.1±4.8 and 32.1±2.8. There were also no significant differences in ASES score and Constant score between the two groups before and after operation. There were no significant differences in rotator cuff healing between the two groups(χ2=2.374, P=0.128). CONCLUSION: For the treatment of articular-sided partial-thickness supraspinatus tendon tears both arthroscopic repairs employing threading lasso fixation and full-thickness conversion could achieve satisfactory clinical results, and there are no significant differences in clinical outcomes between the two techniques. Arthroscopic repair with threading lasso fixation is a novel transtendinous procedure in which integrity of the tendon can be preserved.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Ombro/cirurgia , Tendões
16.
BMC Anesthesiol ; 22(1): 55, 2022 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-35227219

RESUMO

BACKGROUND: Forced-air warming (FAW) is an effective method of preventing inadvertent perioperative hypothermia (IPH). However, its warming effects can be influenced by the style and position of the FAW blanket. This study aimed to compare the effects of underbody FAW blankets being placed under or over patients in preventing IPH. METHODS: Patients (n=100) undergoing elective arthroscopic shoulder surgery in the lateral decubitus position were randomized into either under body (UB) group or the over body (OB) group (50 per group). The body temperature of the patients was recorded from baseline to the end of anesthesia. The incidences of postoperative hypothermia and shivering were also collected. RESULTS: A steady decline in the body temperature was observed in both groups up to 60 minutes after the start of FAW. After 60 minutes of warming, the OB group showed a gradual increase in the body temperature. However, the body temperature still decreased in UB group until 75 minutes, with a low of 35.7℃ ± 0.4℃. Then the body temperature increased mildly and reached 35.8℃ ± 0.4℃ at 90 minutes. After 45 minutes of warming, the body temperature between the groups was significantly different (P < 0.05). The incidence of postoperative hypothermia in the UB group was significantly higher than that in the OB group (P = 0.023). CONCLUSIONS: The body temperature was significantly better with the use of underbody FAW blankets placed over patients than with them placed under patients. However, there was not a clinically significant difference in body temperature. The incidence of postoperative hypothermia was much lower in the OB group. Therefore, placing underbody FAW blankets over patients is recommended for the prevention of IPH in patients undergoing arthroscopic shoulder surgery. TRIAL REGISTRATION: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 13/1/2021 with the registration number ChiCTR2100042071 . It was conducted from 14/1/2021 to 30/10/2021 as a single, blinded trial in Sichuan Provincial Orthopedic Hospital.


Assuntos
Hipotermia , Roupas de Cama, Mesa e Banho/efeitos adversos , Temperatura Corporal , Humanos , Hipotermia/etiologia , Hipotermia/prevenção & controle , Estudos Prospectivos , Ombro/cirurgia
17.
Pain Physician ; 25(2): E285-E292, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35322983

RESUMO

BACKGROUND: Chronic postsurgical pain remains a major hurdle in postoperative management, especially in patients undergoing shoulder surgery, for whom persistent pain rates are higher than for any other surgical site. Little is known about pain beliefs and attitudes as preoperative predictors of postoperative pain following nonarthroplasty shoulder surgery. OBJECTIVES: We evaluated predictors of pain following nonarthroplasty shoulder surgery, hypothesizing that preoperative kinesiophobia, pain catastrophizing, and neuropathic pain scores are predictive of greater postoperative pain. STUDY DESIGN: Case control study. SETTING: Division of Sports Medicine at the University of Wisconsin School of Medicine and Public Health. METHODS: Consecutive patients aged 18 and older undergoing a nonarthroplasty  shoulder operation were selected. At the preoperative appointment and 3 months postoperative, patients completed the Short-Form McGill Pain Questionnaire-2 to assess severity and quality of pain, the painDetect Questionnaire to screen for neuropathic pain, the Tampa Scale of Kinesiophobia to assess fear of movement and fear-avoidance beliefs, and the Pain Catastrophizing Scale  to gauge rumination, magnification, and pessimism. A univariable negative binomial regression model was used to identify associations between preoperative predictors and postoperative  scores, reporting risk ratios and 95% confidence intervals. RESULTS: Eighty-one patients completed the preoperative surveys and 43 patients completed at least one postoperative survey. The median pain score decreased from 3 out of 10 (interquartile range [IQR] = 2-5) in the preoperative group to one (IQR = 0-2) in the postoperative group (P < 0.001). Mean kinesiophobia scores decreased from 40.44 (standard deviation [SD] = 5.94) preoperatively to 35.40 (SD = 6.44) postoperatively (P < 0.001). Median pain catastrophizing scores decreased from 7 (IQR = 2-17]) preoperatively to 2 (IQR = 0-11]) postoperatively (P = 0.005). No significant changes in neuropathic pain scores were observed. Higher baseline kinesiophobia scores were associated with greater postoperative pain (risk ratio = 1.09, 95% confidence interval [CI] = 1.01 to 1.18), P = 0.03), as were higher pain catastrophizing scores (risk ratio = 1.05, 95% CI = 1.01 to 1.08), P = 0.01). No association between baseline neuropathic pain and degree of postoperative pain was identified. LIMITATIONS: Limitations of the study include a single institution with multiple surgeons and types of surgery. The study drop-out rate was relatively high. CONCLUSION: This study suggests that greater baseline kinesiophobia and pain catastrophizing are predictive of greater postoperative pain following nonarthroplasty shoulder surgery in an adult population.


Assuntos
Catastrofização , Neuralgia , Adulto , Estudos de Casos e Controles , Humanos , Dor Pós-Operatória/diagnóstico , Ombro/cirurgia , Dor de Ombro
18.
Comput Methods Programs Biomed ; 219: 106751, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35306286

RESUMO

BACKGROUND: The number of Total Shoulder Arthroplasties (TSA) has increased in these last years with significant increase of clinical success. However, glenoid component loosening remains the most common cause of failure. OBJECTIVE: In this study we evaluated the critical conditions to predict short and medium-term performance of the uncemented anatomical Comprehensive® Total Shoulder System using a finite element model that was validated experimentally. METHODS: The finite element models of an implanted shoulder analysed included total shoulder components with pegs. The models were simulated in 3 phases of adduction: 45°, 60° and 90° to determine the most critical situation. Two different bone-implant fixation conditions were considered: post-surgery and medium term (2 years). RESULTS: These show that the critical condition is for the shoulder in 90° adduction were the highest contact stress (70 MPa) was observed in the glenoid component. Relatively to the interface implant-bone strains, the maximum (-16000 µÎµ) was observed for the short-term in the lateral region of the humerus. The highest micromotions were observed in the central fixation post of the glenoid component, ranging from 20 to 25 µm, and 325 µm in the lateral plane of the humeral component. CONCLUSION: The predicted results are in accordance with clinical studies published and micromotions of the humeral component can be used to predict loosening and to differentiate shoulder implant designs.


Assuntos
Artroplastia do Ombro , Articulação do Ombro , Artroplastia do Ombro/métodos , Análise de Elementos Finitos , Desenho de Prótese , Ombro/cirurgia , Articulação do Ombro/cirurgia
20.
Clin Sports Med ; 41(2): 219-231, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35300836

RESUMO

Shoulder surgery introduces important anesthesia considerations. The interscalene nerve block is considered the gold standard regional anesthetic technique and can serve as the primary anesthetic or can be used for postoperative analgesia. Phrenic nerve blockade is a limitation of the interscalene block and various phrenic-sparing strategies and techniques have been described. Patient positioning is another important anesthetic consideration and can be associated with significant hemodynamic effects and position-related injuries.


Assuntos
Bloqueio Nervoso , Ombro , Humanos , Bloqueio Nervoso/métodos , Posicionamento do Paciente , Ombro/cirurgia
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