Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Dec 2021
Randomized Controlled TrialPeriarticular Liposomal Bupivacaine Mixture Injection versus Single Shot Interscalene Block for Post-operative Pain in Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Trial.
The pain control efficacy, postoperative opioid requirements, and costs among patients undergoing major shoulder surgery using different perioperative analgesia modalities have been topics of active debate. Several studies have compared periarticular injection (PAI) to interscalene block (ISB) in shoulder arthroplasty, but there is a paucity of data comparing them in arthroscopic rotator cuff repair. ⋯ Both ISB and PAI provide acceptable pain control following arthroscopic rotator cuff repair. Patients have less pain on the day of surgery with ISB, but rebound pain is significant after the block wears off, resulting in substantially increased opioid use in the first 2 PODs. However, cumulative opioid use between groups was similar. There were also no significant differences at the end of the 12-week episode of care in any of the other variables studied. The charge per patient for PAI is approximately $300 less than ISB. Thus, PAI may offer surgeons and patients an effective postoperative analgesic modality as an alternative to ISB.
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J Shoulder Elbow Surg · Dec 2021
The future of healthcare service in orthopedic practice: Telemedicine or in-person visits?
The objective of this study was to assess patient satisfaction and preference for telemedicine vs. in-person visits for outpatient shoulder and elbow musculoskeletal consultation during the coronavirus disease 2019 (COVID-19) pandemic and in the future. ⋯ COVID-19 has provided a boost to the use of our telemedicine platform, with a high satisfaction rate among patients with shoulder and elbow musculoskeletal complaints, largely owing to safety reasons and limited access to in-person doctor visits. However, a considerable number of patients would have preferred in-person visits for similar health complaints if there were no pandemic. Further research on optimizing the selection of patients for telemedicine visits and addressing their expectations and concerns regarding their visits will improve patients' preference for future telemedicine visits.
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J Shoulder Elbow Surg · Nov 2021
Pain management in shoulder arthroplasty: a systematic review and network meta-analysis of randomized controlled trials.
Postoperative pain management after total shoulder arthroplasty (TSA) can be challenging. Given the variety of pain management options available, the purpose of this investigation was to systematically review the literature for randomized controlled trials reporting on pain control after shoulder arthroplasty. We sought to determine which modalities are most effective in managing postoperative pain and reducing postoperative opioid use. ⋯ Interscalene blocks are superior to local injections alone at managing pain after TSA. Single-shot interscalene blocks are optimal for reducing early postoperative pain (< 24 hours), whereas pain at 24-48 hours after surgery may be best managed with cISBs or a combination of an ssISB with a local LB injection.
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J Shoulder Elbow Surg · Oct 2021
Complications and reoperations related to tension band wiring and plate osteosynthesis of olecranon fractures.
Olecranon fractures are common and usually treated operatively either by tension band wiring (TBW) or plate fixation (PF). The aim of this study was to assess early complications and reoperations and their predictive factors related to those operative methods. ⋯ There is a high risk of early complications and reoperations associated to both TBW and PF. Transcortical positioning of K-wires may reduce the rate of complications in TBW.
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J Shoulder Elbow Surg · Aug 2021
PROMIS Global-10 Performs Poorly Relative to Legacy Shoulder Instruments in Patients undergoing Total Shoulder Arthroplasty for Glenohumeral Arthritis.
The PROMIS Global-10 is a 10-item questionnaire that assesses general health-related quality of life. There is a paucity of research on the utility of the PROMIS Global-10 in the evaluation of orthopedic conditions. The aim of this study is to compare PROMIS Global-10 and legacy shoulder-specific patient-reported outcome measures (PROMs) in patients undergoing total shoulder arthroplasty (TSA) for shoulder arthritis. ⋯ PROMIS Global-10 had limited correlation with legacy PROMs and was less responsive at 1-year follow-up in patients following TSA. The Global-10 appears to have limited utility in the evaluation of patients with shoulder arthritis both preoperatively and after TSA.