Arthroscopic approach controls posterior shoulder instability
Source: Medscape News
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 (see http://1.usa.gov/15g2OcX). 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.
For the current paper, the team expanded on an earlier evaluation to include 200 shoulders in 183 athletes. All had unidirectional recurrent posterior glenohumeral instability treated with arthroscopic posterior capsulolabral reconstruction.
At a mean of 36 months postoperatively, the mean American Shoulder and Elbow Surgeons (ASES) score increased from 45.9 to 85.1. There were also significant improvements in subjective measures of stability, pain, and function.
Overall, 188 shoulders (94%) had excellent or good results on the ASES scale at the latest follow-up, and similar proportions of patients had excellent or good results on subjective measures of stability, and in terms of patient-described subjective satisfactory or full range of motion.
When a subset of 117 shoulders of contact athletes was compared with the whole cohort of 200 shoulders, no significant differences were seen.
Return to play was significantly more common among the 156 patients who had anchored plications than among the 44 with anchorless intraoperative soft tissue fixation (92% versus 84%). The anchored plication group also had higher mean ASES scores
In total, 90% of patients were able to return to sports and 64% were able to return to the same level postoperatively.
Although most articles on open repair do not address sports return, Dr. Bradley pointed out, one reported that 29% of patients were unable to return to recreational sports.
Overall, he concluded, “the data clearly demonstrate that the arthroscopic approach is superior to open techniques when compared to the historic open literature.”
When Athletic Shoes Cause Injury
Source: NY times
Sometimes innovative science requires innovative machinery, like a moveable, four-legged robotic sled that can wear shoes, a contraption recently developed and deployed by researchers at the University of Calgary to test whether grippy athletic shoes affect injury risk.
It’s well known, of course, that shoe traction influences athletic performance, especially in sports that involve sprinting or cutting, meaning abrupt rapid shifts in direction. In broad terms, more traction leads to better results.
Additional oblique MRI improved diagnosis of ACL tears
The accuracy of diagnosing an ACL tear and efficacy in detecting ACL remnant tissue was improved with the additional use of oblique MRI, according to recently published study.
Better posture can help ease shoulder pain from impingement
Source: UT Sandiego
Shoulder pain from impingement occurs frequently as the rotator cuff tendons and sometimes a bursal sac get pinched under the roof of the shoulder blade or the acromion. People with a downward slope of the acromion, or who have developed bone spurs from arthritis in the adjacent acromioclavicular (AC) joint, are more susceptible to developing such impingement.
The mechanism causing this disorder may be a gradual or sudden elevation of the ball of the shoulder joint, squishing the described soft tissues against the acromion roof. The rotator cuff muscles are responsible for keeping the ball of the shoulder joint down and away from the roof as we elevate the arm.
Relief for Rotator Cuff Tears — Research Summary
The rotator cuff is made up of tendons and muscles in the shoulder. The tendons and muscles connect the upper arm bone with the shoulder blade and they hold the ball of the upper arm bone in the shoulder socket. The combination means greater range of motion of any joint in the body. A rotator cuff injury can include any type of irradiation or damage to the tendons and muscles. Causes of an injury can include lifting, falling, and repetitive arm activities (usually those that are done overhead like throwing a baseball). About 50 percent of rotator cuff injuries can heal with self-care or exercise therapy.
Neuraxial anesthesia improves outcomes in patients undergoing hip or knee replacement
A highly underutilized anesthesia technique called neuraxial anesthesia, also known as spinal or epidural anesthesia, improves outcomes in patients undergoing hip or knee replacement, according to a new study by researchers at Hospital for Special Surgery. The study, which appears in the May issue of the journal Anesthesiology, found that neuraxial anesthesia, a type of regional anesthesia, reduced morbidity, mortality, length of hospital stay and costs when compared with general anesthesia.
Using neuraxial anesthesia over general anesthesia reduced the risk of pulmonary compromise by twofold in knee replacement patients and over threefold in hip replacement patients.
Embrace the Knee Brace
It’s been established that braces for the knees can provide relief from pain and protection from injury. But until now, not much was known on whether knee braces can pinpoint pain in the kneecap.
Knee braces can ease pain from osteoarthritis specifically in the kneecap, according to a study recently presented at a conference.
The findings show that the brace is a step forward from relying on painkillers and reducing the chances of needing joint surgery, according to researchers.
Fat cells in knee secrete a protein linked to arthritis
Scientists have discovered that fat cells in the knee secrete a protein linked to arthritis, a finding that paves the way for new gene therapies that could offer relief and mobility to millions worldwide.
“We found that fat in the knee joints secretes a protein called pro-factor D which gives rise to another protein known as factor D that is linked to arthritis,” said Nirmal Banda, Ph.D., associate professor of medicine in the Division of Rheumatology at the University of Colorado School of Medicine. “Without factor D, mice cannot get rheumatoid arthritis.”
Knee osteoarthritis patients have improved knee loads when using specialized mobility shoe
Source: Daily Rx
When patients with knee osteoarthritis are walking, their knees may jut out to the side. Shoes that imitate barefoot walking can help with that.
A recently published study found that wearing a “mobility” shoe keeps the knee joint more aligned in knee osteoarthritis patients.
Using flat, flexible footwear can significantly reduce knee loading in patients with the joint condition, according to researchers.
Which knees need the knife?
Source: Daily Rx
Jeffery Katz, MD, of Orthopedic and Arthritis Center for Outcomes Research Brigham and Women’s Hospital, Boston, and colleagues led the study to determine if patients with a meniscal tear and knee osteoarthritis had better outcomes with surgery plus physical therapy or just physical therapy.