Journal of shoulder and elbow surgery
-
J Shoulder Elbow Surg · Sep 2019
Meta AnalysisEfficacy of liposomal bupivacaine in shoulder surgery: a systematic review and meta-analysis.
The aim of this meta-analysis was to compare the safety, efficacy, and opioid-sparing effect of liposomal bupivacaine (LB) vs. nonliposomal local anesthetic agents (NLAs) for postoperative analgesia after shoulder surgery. ⋯ LB is comparable to NLAs with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after arthroscopic rotator cuff repair and total shoulder arthroplasty.
-
J Shoulder Elbow Surg · Sep 2019
Sensory innervation of the subacromial bursa by the distal suprascapular nerve: a new description of its anatomic distribution.
Sensory innervation to the shoulder provided by the distal suprascapular nerve (dSSN) remains the subject of debate. The purpose of this study was to establish consensus with respect to the anatomic features of the sensory branches of the dSSN. The relevant hypothesis was that the dSSN would give off 3 sensory branches providing innervation to the posterior glenohumeral (PGH) capsule, the subacromial bursa, in addition to the coracoclavicular and acromioclavicular ligaments. ⋯ The dSSN provided 2 subacromial branches and 1 PGHb to the shoulder joint. This arrangement allowed for bipolar-MSAb and LSAb-innervation of the subacromial bursa, acromioclavicular and coracoclavicular ligaments, as well as the PGH capsule.
-
J Shoulder Elbow Surg · Sep 2019
Complications after surgical treatment of proximal humerus fractures in the elderly-an analysis of complication patterns and risk factors for reverse shoulder arthroplasty and angular-stable plating.
To date, there is a lack of consensus regarding surgical treatment recommendations for complex proximal humerus fracture (PHF) patterns, especially between joint preservation and joint replacement techniques. ⋯ RTSA led to fewer complications than ORIF and thus can be considered a valuable option in complex PHF of the elderly. Paying attention to specific prognostic factors may help to reduce the complication rate.
-
J Shoulder Elbow Surg · Sep 2019
Clinical TrialOpioid-free shoulder arthroplasty: a prospective study of a novel clinical care pathway.
Opioid therapy has been a cornerstone of perioperative pain control for decades in the United States, despite our increased understanding of the morbidity and mortality linked to opioids. The purpose of this study is to explore the safety, efficacy, and feasibility of an entirely opioid-free perioperative pathway in patients undergoing elective shoulder arthroplasty. ⋯ An opioid-free, multimodal pain management pathway is a safe and effective option in properly selected patients undergoing shoulder arthroplasty with a very low risk of requiring rescue opioids. This study is the first such study to present a surgical protocol entirely free of opioids at all portions of the patient care pathway.
-
J Shoulder Elbow Surg · Sep 2019
Screw configuration in proximal humerus plating has a significant impact on fixation failure risk predicted by finite element models.
Proximal humeral fractures occur frequently, with fixed angle locking plates often being used for their treatment. No current quantitative evidence for the effect of different screw configurations exists, and the large number of variations makes biomechanical testing prohibitive. Therefore, we used an established and validated finite element osteosynthesis test kit to quantify the effect of variations in screw configuration on predicted failure risk of PHILOS plate fixation for unstable proximal humerus fractures. ⋯ Screw configurations significantly impact predicted cutout failure risk for locking plate fixations of unstable proximal humerus fractures in low-density bone. Although requiring clinical corroboration, the result of this study suggests that additional screws reduce peri-screw strains, the distance between them should be maximized whenever possible and the calcar screws should be used.