Magnetic Resonance Imaging (MRI) and Ultrasound (US) imaging are both routinely used in the assessment of rotator cuff pathology. Factors influencing the frequency of use of the respective technologies include access to equipment, provider preference, and cost. The purpose of our study was to compare the accuracy of in clinic ultrasound with that of MRI in diagnosing pathology of the rotator cuff in a large sample size with limited exclusionary criteria. 500 patient profiles assessed by each imaging type, MRI and ultrasound, who then proceeded to arthroscopic surgery were gathered and analyzed for interobserver agreement between the image interpretation and the surgical observations. While ultrasound displayed slightly higher sensitivity and specificity ratings in the diagnosis of full tears (0.90 and 0.92 vs. 0.86 and 0.91), MRI had a higher sensitivity (0.87 vs. 0.80) and Ultrasound had a higher specificity (0.86 vs. 0.76) for general cuff damage. The Weighted Kappa Values for both MRI (0.699) and Ultrasound (0.668) both indicate a substantial strength of agreement between the image interpretation and surgical findings. While there was a balanced distribution of errors observed in the MRI category, the most common error made in the Ultrasound assessment was a false negative assessment of a partial tear. The data indicate that in a clinical setting Ultrasound imaging is a cost-effective and accurate alternative to MRI and can be a valuable addition to the diagnostic assessment of rotator cuff injury and pathology.
Intra-articular glenohumeral joint injections are commonly performed in the clinical setting for diagnostic and therapeutic purposes. Multiple approaches are described, including the anterior and posterior approaches and the less studied superomedial (Neviaser) approach. The purpose of this study was to determine the length of needle required to enter the shoulder joint via the Neviaser approach by radiography and magnetic resonance imaging (MRI) measurements. Additionally, the authors sought to identify any correlation between needle length and body mass index (BMI). They performed a retrospective review of 101 consecutive patients evaluated by one faculty member at their institution. Inclusion criteria were age older than 50 years, no previous shoulder surgery, no history of acromioclavicular joint injury, and having a true anteroposterior radiograph and MRI within 1 year of each other. Using a digital imaging system, the Neviaser approach needle path was drawn for both images, and the lengths were measured. Correlation coefficients for needle length and BMI were calculated. The images of 58 (57.4%) male patients and 43 (42.6%) female patients were evaluated (average BMI, 31.2 kg/m
2
). The average needle length measurement was 4.27 cm on radiograph and 3.9 cm on MRI. Correlation coefficients were
r
=0.36 (
P
=.0002) using radiographs and
r
=0.53 (
P
<.0001) using MRIs. When using the Neviaser approach, there is a moderate positive correlation between BMI and the measured distance between skin and the glenohumeral joint when assessed on MRI, and a weak positive correlation on radiographs. The authors conclude that an injection needle of 2 inches or greater is required to reliably access the shoulder joint, and this length may increase with increasing BMI. [
Orthopedics
. 2020;43(4):e215–e218.]
Background: Although lower extremity biomechanics has been correlated with traditional metrics among baseball players, its association with advanced statistical metrics has not been evaluated. Purpose: To establish normative biomechanical parameters during the countermovement jump (CMJ) among Major League Baseball (MLB) players and evaluate the relationship between CMJ-developed algorithms and advanced statistical metrics. Study Design: Cohort study; Level of evidence, 3. Methods: MLB players in 2 professional organizations performed the CMJ at the beginning of each baseball season from 2013 to 2017. We collected ground-reaction force data including the eccentric rate of force development (“load”), concentric vertical force (“explode”), and concentric vertical impulse (“drive”) as well as the Sparta Score. The advanced statistical metrics from each baseball season (eg, fielding independent pitching [FIP], weighted stolen base runs [wSB], and weighted on-base average) were also gathered for the study participants. The minimal detectable change (MDC) was calculated for each CMJ variable to establish normative parameters. Pearson coefficient analysis and regression trees were used to evaluate associations between CMJ data and advanced statistical metrics for the players. Results: A total of 151 pitchers and 138 batters were included in the final analysis. The MDC for “load,” “explode,” “drive,” and the Sparta Score was 10.3, 8.1, 8.7, and 4.6, respectively, and all demonstrated good reliability (intraclass correlation coefficient > 0.75). There was a weak but statistically significant correlation between the Sparta Score and wSB ( r = 0.23; P = .007); however, there were no significant correlations with any other advanced metrics. Regression trees demonstrated superior FIP with higher Sparta Scores in older pitchers compared with younger pitchers. Conclusion: There was a positive but weak correlation between the Sparta Score and base-stealing performance among professional baseball players. Additionally, older pitchers with a higher Sparta Score had statistically superior FIP compared with younger pitchers with a similar Sparta Score after adjusting for age.
Background: Anterior shoulder instability is a common complaint of young athletes. Posterior instability in this population is less well understood, and the standard of care has not been defined. The purpose of the study is to compare index frequency, treatment choice, and athlete disability following an incident of anterior or posterior shoulder instability in high school and collegiate athletes. Methods: A total of 58 high school and collegiate athletes (n¼30 athletes with anterior instability; n¼28 athletes with posterior instability) were included. Athletes suffering from a traumatic sport-related shoulder instability episode during a team-sponsored practice or game were identified by their school athletic trainer. Athletes were referred to the sports medicine physician or orthopedic surgeon for diagnosis and initial treatment choice (operative vs. nonoperative). Athletes diagnosed with traumatic anterior or posterior instability who completed the full course of treatment and provided pre-and post-treatment patient-reported outcome measures were included in the study. The frequency of shoulder instability was compared by direction, mechanism of injury (MOI), and treatment choice through c 2 analyses. A repeated measures analysis of variance was used to compare the functional outcomes by treatment type and direction of instability (a ¼ 0.05). Results: Athletes diagnosed with anterior instability were more likely to report a chief complaint of instability (70%), whereas those diagnosed with posterior instability reported a primary complaint of pain interfering with function (96%) (P ¼ .001). The primary MOI classified as a contact event was similar between anterior and posterior instability groups (77% vs. 54%, P ¼ .06) as well as the decision to proceed with surgery (60% vs. 72%, P ¼ .31). In patients with nonoperative care, athletes with anterior instability had significantly more initial disability than those with posterior instability (32AE6.1 vs. 58AE8.1, P ¼ .001). Pre-and post-treatment Penn Shoulder Scores for athletes treated with early surgery were similar (P > .05). There were no differences in functional outcomes at discharge in those treated nonoperatively regardless of direction of instability (P ¼ .24); however, change in Penn score was significantly greater in those with anterior (61AE18.7) than those with posterior (27 AE 25.2) instability (P ¼ .002).
Conclusion:Athletes with anterior instability appear to have different mechanisms and complaints than those with posterior instability. Among those that receive nonoperative treatment, athletes with anterior instability have significantly greater initial disability and change in disability than those with posterior disability during course of care.Institutional review board approval for this project was received from Prisma Health (no. Pro00054926).
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