Cross-Sectional study with control group, Level II.
PurposeThe purpose of the study was clinical and advanced biomechanical evaluation of shoulder function with respect to rotator cuff (RC) integrity following repair.MethodsThis was a retrospective study of 111 cases with solid single row rotator cuff repair and a minimal one-year follow-up. The RC repair was performed as an open procedure in 42 patients, arthroscopically assisted in 34 and fully arthroscopic in 48 cases. Evaluation protocol included ultrasound evaluation of the RC integrity, clinical evaluation using shoulder scores and advanced biomechanical evaluation (isometric and the isokinetic strength testing).ResultsUltrasound evaluation revealed complete retear in 16 %, partial retear in 10 % and intact repair in 74 % of the cases.Isometric testing of flexion and abduction had shown that shoulders with complete retear were weaker by 45 % compared to those with full tendon healing.Isokinetic testing revealed 29–43 % deficits in peak external rotation torque comparing complete retear vs. normal healing. Patients’ ability to generate shoulder power and withstand a load proved to be lower in circumstances of a complete lack of healing (40–43 % and 34–55 %, respectively). Partial retears did not have a negative impact on the biomechanical properties of shoulders. Surprisingly, there were no significant differences in the shoulder scores related to the quality of healing. In terms of patient satisfaction the results were good and the patients declared themselves better in all cases, no matter what quality of healing had been recorded ultimately.ConclusionsAccording to the results of this research rotator cuff integrity after open or arthroscopic repair does not seem to affect clinical scores. Recurrent tears may result in lower muscle performance in terms of active motion, strength and endurance. Advanced shoulder testing may be essential in assessing the patients’ ability to return to sports or heavy labour.
Purpose The main purpose of this study is to establish which of two methods is more reliable in glenoid assessment for instability in pre-operative planning. Accordingly, we have studied the intra-and inter-observer reliability of glenoid parameters with the use of two-dimensional (2D) and three-dimensional (3D) reconstructed computed tomography (CT) images. Methods One hundred glenoids were measured with the use of 2D-CT and 3D-CT (in 3D orientation) by two independent observers (one experienced and one inexperienced). Measurements were repeated after one week for 30 randomly selected glenoids. Results The intra-class correlation coefficient (ICC) for interobserver reliability was significantly greater for 3D-CT (0.811 to 0.915) than for 2D-CT (0.523 to 0.925). All intra-observer reliability values for 3D-CT were near perfect (0.835 to 0.997), while those for 2D-CT were less reliable (0.704 to 0.960). A dependent t-test showed that, for both observers, almost all glenoid parameters (except R and d) differed significantly (p < 0.05) between 2D and 3D measurement methods. Conclusions Therefore, it can be concluded that 3D glenoid reconstructions are more reliable for glenoid bone loss assessment than 2D-CT. The results suggest that quantifying a glenoid defect with the use of 2D image only-even if performed by an experienced orthopaedic surgeon-is prone to errors. Differences in measurements between and within observers can be explained by plane setting and identifying glenoid rim in 2D -C T. Accordingly, we recommend that glenoid measurements should be performed in 3D orientation using 3D reconstruction obtained from CT images for pre-operative assessments, which are crucial for surgical planning.
A synovial plica (fold) is normal anatomic finding, and occurs in 86–100% of cases; however, symptomatic plica is much less common (7.2–8.7% of all elbow arthroscopies). Synovial plica syndrome is a painful elbow condition related to symptomatic synovial plica. Synovial plica syndrome is diagnosed by clinical examination (lateral elbow pain) commonly accompanied by local tenderness, pain at terminal extension and/or painful snapping. Synovial plica syndrome may be mimicked by other elbow conditions, commonly tennis elbow, loose bodies, and degenerative arthritis. Magnetic resonance imaging or ultrasound scan may support diagnosis in correlation with clinical findings, but symptomatic plica may also be diagnosed as unexpected during elbow arthroscopy. The arthroscopic resection is effective and safe if conservative treatment fails. Cite this article: EFORT Open Rev 2020;5:549-557. DOI: 10.1302/2058-5241.5.200027
Background GIRD is a condition resulting in the loss of internal rotation of the glenohumeral joint as compared to the contralateral side. Mechanism of GIRD is caused by repetitive throwing such as a handball throw. Difference between total shoulders range of motion (ROM) more than 25°is considered as GIRD positive sign. Objective To compare glenohumeral rotation motion between dominant and non-dominant shoulder in handball players. Design Cross sectional study. Setting Elite handball division players. Participants The pilot studies included 48 professional handball players of average age 24.0±4.5 years, height 187.1±5.9 cm, weight 91.0±11.6 kg.Interventions All handball players were tested for internal (IR) and external (ER) glenohumeral rotation range of motion. Mean values, minimum, maximum and standard deviation were calculated. Differences between the dominant (D) and non-dominant (ND) shoulder were determined. T-Test for two independent samples was used to analyze differences between D and ND shoulder. Statistical significance was set at P<.05. Main OutcomesROM. Results We obtained:for ER_D 60.63°±13.23°and for ED_ND 58.65°±13.98°, respectively; for IR_D: 92.60°±6.92°and for IR_ND 88.96°±6.99°. Total ROM values were 153.23°±17.79°f or D and 147.60°±18.76°for ND shoulder. Differences between D and ND shoulders was statistically significant only for IR: 3.65°± 4.34°; P=.0118. For ER: 1.98°±4.92°and Total ROM: 5.63°± 7.76°there was no significant differences (P>.05). Conclusions However there are some cases with glenohumeral internal rotation deficit there is more evidence that such a deficit does not exists in handball players. To verify this results further study with grater sample size should be conducted in comparison to other professional overhead athletes.
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Background Muscle strength and endurance of the shoulder rotators is important for overhead throwing performance and dynamic glenohumeral stability. Isokinetic assessment of shoulder internal and external rotators is commonly used by clinicians to assess muscle performance. Objective To evaluate the external (ER) and internal rotator (IR) muscles isokinetic peak torque, total work and strength ratios in handball players. Design Prospective study with control group and descriptive analysis. Setting Elite division handball players. Participants The pilot studies included 48 professional handball players of average age 24.0 (±4.5 years), height 187.1 (±5.9) and weight 9.0 (±11.6). Interventions Isokinetic tests were performed concentrically at 180 and 270 deg/s using Biodex System 3 PRO in standard sitting position. Main outcome measurements Isokinetic peak torque, total work and strength ratios. Results: The differences between the athletes and controls regarding the peak torque at 180 deg/s and total work at 270 deg/s of the ER and IR muscles for dominant and non dominant shoulder were statistically significant. The control group presented higher ratios (D 85.8±26.9; ND 82.8±23.4) than handball players (D 65.4±13.3; ND 63.0±16.0)–differences were statistically significant. There were statistical differences between dominant and non dominant shoulder in both group for total work of the ER muscles. There were no statistical differences between dominant and non dominant shoulder in both group for peak torque of the ER and IR muscles. Conclusions Handball players present higher isokinetic parameters comparing to normal population. The study establishes additional normative data on ER and IR muscle torque and total work on high-level male handball players.
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