Reason for Seeking Treatment Influences Preoperative Expectations of Arthroscopic Shoulder Surgery
Researchers from the Steadman Philippon Research Institute analyzed patient expectations before arthroscopic shoulder surgery and found that while the main expectation of all patients was return to sport, secondary expectations varied in importance depending on the reason why patients sought treatment.
“Elevated importance of specific expectation questions did not universally correlate with worse preoperative subjective scoring systems,” Ryan J. Warth, MD, and colleagues from the Steadman Philippon Research Institute in Vail, Colo., wrote in the study. “Whereas return to sport was the most important expectation overall, the importance of other expectations varied by patients’ reasons for seeking treatment. The current questionnaire may have limited use in patients with shoulder instability.”
Hours spent in Organized Sports may Predict Young Athlete Injury
Source: Medical News Today
Athletes ages 8 to 18 who spend twice as many hours per week in organized sports than in free play, and especially in a single sport, are more likely to be injured, according to an abstract presented at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando.
Pain Processes in Tennis Elbow Illuminated by PET Scanning
Source: Science Daily
Physiological processes in soft tissue pain such as chronic tennis elbow can be explored using diagnostic imaging methods. This is demonstrated by researchers from Uppsala University and the results are now being published in the prestigious journal PLOS ONE. The pain physician and researcher Magnus Peterson is presenting a new use of positron emission tomography (PET) and a tracer for the signal receptor NK1 for visualising a physiological process associated with pain.
Combating Sports-Related Concussions: New Device Accurately and Objectively Diagnoses Concussions from the Sidelines
Source: Science Daily
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.
Lower degrees of dominant humeral torsion results in severe upper extremity injuries for pitchers
Major League Baseball pitchers with lower degrees of dominant humeral torsion had more severe upper extremity injuries, and pitchers with lower side-to-side differences in torsion experienced more severe dominant upper extremity injuries, according to results of this recently published study.
In the study, 25 professional pitchers from a single Major League Baseball organization underwent CT on dominant and nondominant humeri. Image data were processed with a 3-D volume-rendering post-processing program. Researchers then modified the software program to model a simplified throwing motion to measure potential internal impingement distances in number of days missed from pitching as a measure of injury severity and incidence.
Overall, the mean dominant humeral torsion was 38.5°, while the mean nondominant humeral torsion was 27.6°. Overall, 45% of pitchers were injured during follow-up. Five players had shoulder injuries, seven players had elbow injuries and two players had finger injuries.
According to the study results, dominant humeral torsion was a statistically significant predictor of severe injuries, but not of milder injuries. Researchers found a strong correlation between a high number of days missed because of injury and lower degrees of dominant humeral torsion and smaller differences between dominant and nondominant humeral torsions. Study results showed no significant association between the incidence of shoulder injury and minimum glenoid-tuberosity distance in the dominant or nondominant shoulder or degree of dominant glenoid version.
As these results show, the interplay of dominant humeral torsion, torsion difference and shoulder injury is complex,” the researchers wrote.
Contact-sport brain trauma may affect personality and cognition
Source: Medical News Today
Scientists have discovered that repeated brain trauma, which commonly occurs in athletes, may affect behavior, mood and thinking abilities, according to a study published in the journal Neurology.
All athletes had been diagnosed with chronic traumatic encephalopathy (CTE) following death. CTE is a brain disease linked to repeated brain trauma – most commonly found in athletes.
Knee osteoarthritis risk unaffected by moderate exercise
Source: Medical News Today
A new study suggests that the risk of middle-aged and older adults developing knee arthritis is unaffected by doing up to 150 minutes per week of moderate physical activity, the level recommended by the US government.
Osteoarthritis occurs when the cartilage and underlying bone in a joint break down, leading to bony overgrowth, pain, swelling and stiffness. The joints most affected are the knees, hips and those of the hands and spine. The condition, for which there is currently no cure, develops gradually, usually in the over-40s.
Women more likely to tear ACL due to ‘knock knees’
Source: Medical News Today
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.
Painful frozen shoulder generally resolves, but return to mobility takes time
Source: The Vancouver Sun
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.
Frozen shoulder — also known as adhesive capsulitis — is a condition in which the capsule of connective tissue that encases the shoulder thickens and tightens around the joint. The process is extremely painful and results in a virtual immobilization of the joint, leaving the sufferer with an arm that barely functions. On average, about two-to-three per cent of people will develop frozen shoulder at some point in their lives, says orthopedic surgeon Dr. Stephen Thompson.
How to Know If Shoulder Pain Might Be Rotator Cuff Disease
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.
The studies they included involved patients referred to a specialist (orthopedist, rheumatologist, or sports medicine physician) for evaluation of shoulder pain. As a result, the prevalence of RCD was high – 33% to 81%, compared to a general population prevalence of 2.8% to 15%, they noted in JAMA August 28. Among five studies with level 1-2 quality scores, a positive painful arc test result was the only finding with a positive likelihood ratio (LR) greater than 2.0 for RCD (LR 3.7). A normal painful arc test result had the lowest negative LR (0.36).
Among strength tests, a positive external rotation lag test and internal rotation lag test had the highest positive LRs (7.2 and 5.6) for full-thickness tears.
With an LR of 3.3, a positive drop arm test result “might help identify patients with RCD,” the investigators say, whereas a normal internal rotation lag test result was most accurate for identifying patients without a full-thickness tear (LR 0.04).
There is a lack of data from primary care settings for findings that could be used to diagnose RCD among patients with shoulder pain,” Dr. Hermans and colleagues say.
And they caution, “Because specialists performed all the clinical maneuvers for RCD in each of the included studies with no finding evaluated in more than three studies, the generalizability of the results to a nonreferred population is unknown.”
Also, they say, it’s unclear whether examinations performed by generalist physicians would have the same results as those performed by specialists, because differences may be attributable to the skill of the examiner as well as to the patient populations. Yet, they believe the tests “could be mastered with practice by the generalist physician.”
“The approach we present of pain provocation tests, strength tests, and composite tests provides a framework for thinking about the physical examination findings and for interpreting the results,” the researchers conclude.
For a patient with shoulder pain, they suggest the physician could perform a single pain provocation test (painful arc test), three strength tests (internal rotation lag test, external rotation lag test, and drop arm test), and one composite test (external rotation resistance test).
Using the general population prevalence of RCD, which increases with age, the posterior probability of disease would be 9.6% (for patients older than 30 years) to more than 40% (for patients 70 years and older), the investigators say. Among patients referred to shoulder specialists, the presence of pain during the painful arc test confers a more than 60% probability of disease.
On the other hand, general medical patients with no pain during the painful arc test would have a low probability of RCD (1%-6%). Because of the high probability of disease among patients referred to shoulder specialists, the absence of pain during a painful arc test in a referred patient does not rule out RCD, because the probability could still be as high as 13%, the investigators say. They did not respond to request for comment by press time.