Pain After Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty.

As anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) become increasingly common, differences between the 2 procedures are of importance. The purpose of this study was to determine differences in acute pain levels between patients undergoing aTSA and rTSA. Sixty patients undergoing aTSA or rTSA were assessed for participation. The primary outcome was postoperative daily visual analog scale scores, which were initially collected for 4 days postoperatively. Secondary outcomes included opioid consumption, length of stay, and complications. Comparisons between the 2 groups were assessed using a multivariable analysis, which controlled for sex, age, body mass index, and type of anesthetic. A total of 57 patients consented and were analyzed. No significant differences were found in postoperative visual analog scale scores in the first 4 days following surgery or at 1 year postoperatively. Patients undergoing aTSA had a higher mean opioid requirement in the first 4 hours postoperatively (1.0±0.7 vs 0.4±0.6 morphine milligram equivalents, P<.01). Forty percent of patients undergoing shoulder arthroplasty were prescribed narcotics within the 3 months prior to surgery. Patients who were prescribed narcotics prior to surgery were more likely to continue to require narcotics at extended time periods postoperatively. Patients undergoing aTSA required more opioid medication in the immediate postoperative period. However, after 4 hours postoperatively, no significant differences in pain scores or opioid consumption were found. These findings suggest that patients undergoing aTSA or rTSA have similar postoperative pain profiles. Patients who are prescribed narcotics before shoulder arthroplasty are at an increased risk for postoperative opioid demand. [Orthopedics. 2019; 42(2):e247-e252.].

Predictors of outcome after nonoperative and operative treatment of adhesive capsulitis.

BACKGROUND: Few studies regarding adhesive capsulitis have concurrently evaluated nonoperative and operative treatment. PURPOSE: The objectives were to evaluate the efficacy of operative and nonoperative treatment of adhesive capsulitis and to determine predictors of clinical outcome. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: At minimum 24 months' follow-up, 85 patients underwent self-assessment using the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) score, including 24 patients treated operatively. RESULTS: Mean number of yes responses on the SST improved from 4.0 ± 2.7 at initial presentation to 9.9 ± 2.8 at final follow-up (P < .0001). Patients who received nonoperative treatment and patients who underwent surgery demonstrated similar improvements on the SST. For the entire cohort, forward elevation and external rotation at the side improved from 119° ± 20° to 152° ± 15° and from 29° ± 18° to 46° ± 11° (P < .0001), respectively, between initial presentation and discharge from treatment. Internal rotation to the back improved from the gluteal area to the thoracolumbar junction (P < .0001). Improvements in forward elevation and external rotation were greater for patients undergoing surgery. After nonoperative treatment, patients with diabetes had a lower final SST than patients without diabetes (P < .05). For the entire cohort, initial SST predicted final SST (P < .05), and a shorter duration of symptoms predicted a higher final ASES score (P < .05). Younger patients (P < .001) and those with a lower initial SST (P < .05) were more likely to undergo surgery. CONCLUSIONS: A multimodal nonoperative treatment program is effective for most patients with adhesive capsulitis. Patients who do not improve, including those with diabetes, respond well to manipulation and arthroscopic release. Residual motion deficits at discharge from treatment do not appear to affect longer-term clinical outcome.