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Broken bones may seem like a normal part of an active childhood. About 1 in 3 otherwise healthy children suffers a bone fracture. Breakage of the bone running from the elbow to the thumb side of the wrist (distal forearm fracture) is the most common. It occurs most often during the growth spurt that children typically undergo in early adolescence.
Placing leukocyte- and platelet-rich fibrin between the tendon and the bone during arthroscopic rotator cuff repair was linked to a higher vascularization response at 6 weeks compared to repair without the biologic, according to the results of this pilot study.
“Arthroscopic rotator cuff repair with the application of [leukocyte- and platelet-rich fibrin] L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose [patients] to an increased and earlier cellular response and an increased healing rate,” the investigators wrote in their study abstract.
They randomly assigned 20 patients with chronic rotator cuff tears to either a test or control group. The test group had L -PRF added during arthroscopic rotator cuff repair, while the control group received the same arthroscopic treatment without biologic augmentation. The groups were assessed using the Visual Analog Scale, Constant and Simple Shoulder Test Scores and power Doppler ultrasonography.
The investigators found comparable clinical results between the groups at 6 weeks and 12 weeks. The L-PRF group had a significantly higher mean vascularization index of the surgical tendon-to-bone insertions compared with their contralateral healthy shoulders. Although the L-PRF group showed a higher vascularization at 6 weeks compared with the control group, researchers found no difference after 12-weeks follow-up.
According to study results, there have been no postoperative complications and 89% of the repaired cuffs had watertight healing.
Placing leukocyte- and platelet-rich fibrin between the tendon and the bone during arthroscopic rotator cuff repair was linked to a higher vascularization response at 6 weeks compared to repair without the biologic, according to the results of this pilot study.
“Arthroscopic rotator cuff repair with the application of [leukocyte- and platelet-rich fibrin] L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose [patients] to an increased and earlier cellular response and an increased healing rate,” the investigators wrote in their study abstract.
They randomly assigned 20 patients with chronic rotator cuff tears to either a test or control group. The test group had L -PRF added during arthroscopic rotator cuff repair, while the control group received the same arthroscopic treatment without biologic augmentation. The groups were assessed using the Visual Analog Scale, Constant and Simple Shoulder Test Scores and power Doppler ultrasonography.
The investigators found comparable clinical results between the groups at 6 weeks and 12 weeks. The L-PRF group had a significantly higher mean vascularization index of the surgical tendon-to-bone insertions compared with their contralateral healthy shoulders. Although the L-PRF group showed a higher vascularization at 6 weeks compared with the control group, researchers found no difference after 12-weeks follow-up.
According to study results, there have been no postoperative complications and 89% of the repaired cuffs had watertight healing.
One of the first studies to analyze the outcomes of arthroscopic repair according to lesion size suggests small-sized bony Bankart lesions should be treated with a different procedure than lesions measuring 12.5% to 25% of the inferior glenoid width.
“In small Bankart lesions, restoration of capsulolabral soft tissue tension alone may be enough,” whereas in medium lesions, the osseous architecture of the glenoid should be reconstructed for more functional improvement and less pain,” Young-Kyu Kim, MD, and colleagues wrote in their study.
The researchers conducted a minimum 24-month follow-up of 34 patients with small- and medium-sized lesions that were measured by CT and treated arthroscopically. Surgeons performed capsulolabral repair using suture anchors without excision of the bony fragment for 16 small-sized lesions (<12.5% of the inferior glenoid width) and anatomic reduction and fixation using suture anchors for 18 medium-sized lesions (12.5% to 25% of the inferior glenoid width).
Overall, the investigators found the Visual Analog Scale score improved from 1.7 preoperatively to 0.5 at final follow-up (24 months). The mean modified Rowe score also improved from 59 to 91. In the medium-sized lesion group, the mean postoperative Rowe scores increased from 60 to 95 in cases of anatomic reduction compared with an increase from 56 to 76 in cases of nonanatomic reduction. – by Christian Ingram
One of the first studies to analyze the outcomes of arthroscopic repair according to lesion size suggests small-sized bony Bankart lesions should be treated with a different procedure than lesions measuring 12.5% to 25% of the inferior glenoid width.
“In small Bankart lesions, restoration of capsulolabral soft tissue tension alone may be enough,” whereas in medium lesions, the osseous architecture of the glenoid should be reconstructed for more functional improvement and less pain,” Young-Kyu Kim, MD, and colleagues wrote in their study.
The researchers conducted a minimum 24-month follow-up of 34 patients with small- and medium-sized lesions that were measured by CT and treated arthroscopically. Surgeons performed capsulolabral repair using suture anchors without excision of the bony fragment for 16 small-sized lesions (<12.5% of the inferior glenoid width) and anatomic reduction and fixation using suture anchors for 18 medium-sized lesions (12.5% to 25% of the inferior glenoid width).
Overall, the investigators found the Visual Analog Scale score improved from 1.7 preoperatively to 0.5 at final follow-up (24 months). The mean modified Rowe score also improved from 59 to 91. In the medium-sized lesion group, the mean postoperative Rowe scores increased from 60 to 95 in cases of anatomic reduction compared with an increase from 56 to 76 in cases of nonanatomic reduction. – by Christian Ingram
As an emphasis on competitive success in youth sports has led to intense training, frequent competition and early single sport specialization, overuse injuries and burnout have become common. Given these concerns, the American Medical Society for Sports Medicine (AMSSM) has released a new clinical report that provides guidance to physicians and healthcare professionals who provide care for young athletes.
With the coming of the new year, many people will vow to get in shape after overindulging during the holidays. However, not knowing the proper way to work out might do more harm than good.
Nearly 500,000 workout-related injuries occur each year. One reason is people want to do too much too fast and overuse their muscles. These injuries occur gradually and are often hard to diagnose in the bones, tendons and joints. Another reason is poor technique during weight and other training.
Researchers say that women are nearly four times more likely to suffer from a tear to the ACL (anterior cruciate ligament) in the knee than men, but that it may be prevented by a different “landing strategy.”
ACL injuries are defined as a tearing of the anterior cruciate ligament inside the knee joint. The injury causes the knee to swell, and the joint becomes too painful to bear weight.
These injuries are very common in sports where the participants are required to do many “jump stops and cuts.” This includes basketball, soccer, tennis and volleyball.
In the United States there are millions of sports-related concussions each year, but many go undiagnosed because for some athletes, the fear of being benched trumps the fear of permanent brain damage, and there is no objective test available to accurately diagnose concussions on the sidelines.
Balance tests are a primary method used to detect concussion. The current means of scoring these tests relies on the skill of athletic trainers to visually determine whether or not a concussion has occurred.
A positive painful arc test and a positive external rotation resistance test in a patient with shoulder pain has a high likelihood of being rotator cuff disease (RCD). And a positive lag test (external or internal rotation) likely means a full-thickness rotator cuff tear.
That’s according to a meta-analytic review of relevant studies. Dr. Job Hermans from Erasmus Medical Center, Rotterdam, the Netherlands and colleagues say they did the analysis to identify the most accurate clinical examination findings for RCD.
This Update looks at the anatomy, assessment and management of rotator cuff tears.
The rotator cuff is a set of tendons that surround the humeral head and seat the head in the glenoid which in turn allows overhead function. They are crucial tendons and commonly injured. The most commonly injured of the four tendons is the supraspinatus, particularly, at its insertion into the greater tuberosity on the humeral head.
Nearly a decade has passed since Lynne Robson’s first encounter with frozen shoulder. But she remembers in exquisite detail the limitations it imposed and the pain it caused her.
Pulling on a winter coat was excruciating. Robson could only wear clothing with front closures, because reaching behind her back to hook a bra, for instance, required a range of movement she no longer had.
Blow-drying her hair — pretty much a requirement for a TV reporter, which Robson was at the time — was impossibility.
A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively.
Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence.
“Vegetarian athletes can meet their dietary needs from predominantly or exclusively plant-based sources when a variety of these foods are consumed daily and energy intake is adequate,” Ghosh wrote in his presentation.
Vegetarians should find non-meat sources of iron, creatine, zinc, vitamin B12, vitamin D and calcium because the main sources of these typically are animal products and could be lacking in their diets. Vegetarian women, in particular, are at increased risk for non-anemic iron deficiency, which may limit endurance performance. In addition, vegetarians as a group have lower mean muscle creatine concentrations, which may affect high-level exercise performance.
Almost everyone who runs (or has shopped for running shoes) has heard that how your foot pronates, or rolls inward, as you land affects your injury risk. Pronate too much or too little, conventional wisdom tells us, and you’ll wind up hurt. But a provocative new study shows that this deeply entrenched belief is probably wrong and that there is still a great deal we don’t understand about pronation and why the foot rolls as it does.
The incidence rate for stress fracture injuries among females was nearly three times greater when compared to males. Knee rotation and abduction angles when landing were both associated with the rates of lower-extremity stress fractures, as were reduced knee and hip flexion angles, and increased vertical and medial ground reaction forces.
“Lower extremity movement patterns and strength have previously been associated with stress fractures and overuse injuries; however, our study is one of the first to identify dynamic knee rotation and frontal plane angles as important prospective risk factors for lower extremity stress fractures.
Arthroscopic capsulolabral posterior reconstruction offers advantages in posterior shoulder instability, according to researchers.
More than 90% of athletes treated for the condition in this manner are able to return to sports, Dr. James P. Bradley told Reuters Health by email.
While glenohumeral instability is relatively common, affecting 2% of the general population, posterior instability is much rarer, affecting 2% to 10% of all unstable shoulders, according to a 2011 paper in Sports Medicine. Posterior glenohumeral instability is mainly seen in athletes.
In a June 26 online paper in The American Journal of Sports Medicine, Dr. Bradley of the University of Pittsburgh Medical Center and colleagues observe that there are few reports of arthroscopic treatment of unidirectional posterior shoulder instability.
Postmenopausal women may develop full thickness rotator cuff tears and not know it.
In a study of pre- and postmenopausal women, investigators from Italy found a nearly three-fold increase in asymptomatic rotator cuff full-thickness tears in the older women.
“Because asymptomatic tears have a great potential to evolve into symptomatic painful shoulder, a precocious discovery of this pathology may allow the planning of preventive and therapeutic measures,” they point out in a report online June 10 in Menopause.
Rotator cuff tendon tears increase with age, but no study until now has specifically addressed prevalence changes in women from premenopause to postmenopause.
Existing rehabilitation used for people undergoing tendon-bone repairs like rotator cuff repair perhaps partially to blame for the high rates of failed healing post-surgery suggests study by a new Hospital for Special Surgery. Experiments in a rat model of this injury suggest that immobilizing the limb for four to six weeks after surgery, rather than quickly starting physical therapy, improves healing.
“Before we did this study, we thought that delaying motion for a short period of time, seven to ten days, and then starting physical therapy would be the most beneficial to tendon healing. However, from the data in this study, it appears we should be immobilizing our patients for longer periods of time,” said Scott Rodeo, M.D., principal investigator of the study and co-chief of the Sports Medicine and Shoulder Service at Hospital for Special Surgery (HSS) in New York City.
For many people who have fibromyalgia, even the thought of exercising is painful.
“For many people with fibromyalgia, they will exercise for a week or two and then start hurting and think that exercise is aggravating their pain, so they stop exercising,” Ang said. “We hope that our findings will help reduce patients’ fear and reassure them that sustained exercise will improve their overall health and reduce their symptoms without worsening their pain.”
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