Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Apr 2018
Multimodal analgesia decreases opioid consumption after shoulder arthroplasty: a prospective cohort study.
Studies on perioperative pain control in shoulder arthroplasty focus on regional anesthesia, with little research on other approaches. Perioperative multimodal analgesia regimens decrease opioid intake and opioid-related side effects in lower-extremity arthroplasty. In this study we compare pain scores, opioid consumption, length of stay, and readmission rates in postoperative shoulder arthroplasty patients treated with a standard or multimodal analgesia regimen. ⋯ Patients undergoing shoulder arthroplasty have decreased postoperative pain and opioid consumption and shorter hospital stays when given a multimodal analgesia regimen. There is no increase in short-term complications or unplanned readmissions, indicating that this is a safe and effective means to control postoperative pain.
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J Shoulder Elbow Surg · Apr 2018
Randomized Controlled TrialThe effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position: a randomized blinded study.
Beach chair positioning for shoulder surgery is associated with measurable cerebral desaturation events (CDEs) in up to 80% of patients. Near-infrared spectroscopy (NIRS) technology allows real-time measurement of cerebral oxygenation and may minimize the frequency of CDEs. The purpose of this study was to investigate the incidence of CDEs when anesthetists were aware of and blinded to NIRS monitoring and to determine the short-term cognitive effects of surgery in the beach chair position. ⋯ In our series, the incidence of CDEs was much lower than previously reported and was not lowered by use of NIRS. Patients did not have significant cognitive deficits after arthroscopic surgery in the beach chair position, and there was a correlation between NIRS and intraoperative brachial blood pressure.
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J Shoulder Elbow Surg · Mar 2018
Psychometrics of the Patient-Reported Outcomes Measurement Information System Physical Function instrument administered by computerized adaptive testing and the Disabilities of Arm, Shoulder and Hand in the orthopedic elbow patient population.
This study evaluated the psychometric properties of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) instrument administered through computerized adaptive testing (CAT) compared with the traditional full-length Disabilities of the Arm, Shoulder and Hand (DASH). ⋯ The PROMIS PF CAT and the DASH both showed sufficient unidimensionality, good item fit, and good local independence with the exception of high levels of gender item bias, particularly for the DASH. Further scale evaluation should address item bias and item response categories for these instruments. Overall, the PROMIS PF CAT is an effective outcome instrument to measure function in patients with elbow disorders that requires significantly fewer questions than the DASH.
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J Shoulder Elbow Surg · Mar 2018
Outcomes of displaced olecranon fractures treated with the Olecranon Sled.
Tension-band wiring is largely considered the gold standard for fixation of displaced olecranon fractures despite high rates of hardware complications. The purpose of this study was to report the outcomes of displaced olecranon fractures treated with the Olecranon Sled. ⋯ The Olecranon Sled is a reliable and well-tolerated implant for the treatment of olecranon fractures. This device results in excellent functional outcomes and may obviate hardware removal.
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J Shoulder Elbow Surg · Mar 2018
Review Meta AnalysisOperative versus nonoperative treatment for the management of full-thickness rotator cuff tears: a systematic review and meta-analysis.
Rotator cuff disease is the most common pathology of the shoulder, responsible for approximately 70% of clinic visits for shoulder pain. However, no consensus exists on the optimal treatment. The aim of this study was to analyze level I and II research comparing operative versus nonoperative management of full-thickness rotator cuff tears. ⋯ There was a statistically significant improvement in outcomes for patients managed operatively compared with those managed nonoperatively. The differences in both Constant and VAS scores were small and did not meet the minimal difference considered clinically significant. Larger studies with longer follow-up are required to determine whether clinical differences between these treatments become evident over time.