Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Oct 2013
Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment.
Minimally displaced (<3 mm) and non-displaced fractures of the proximal humerus are a common source of disability; nevertheless, there is no agreement on the recommended rehabilitation program in these patients. The purpose of this study was to evaluate the outcome of this group of patients and describe the rehabilitation protocol we have used for the treatment of this injury. ⋯ When the diagnosis of a minimally displaced fracture of the proximal humerus is made, the patient can be reassured that a favorable outcome is anticipated with a staged rehabilitation protocol. Nevertheless, clinicians and patients should be aware that full recovery from the injury may take an average of 8 months.
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J Shoulder Elbow Surg · Sep 2013
Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects.
Patients undergoing shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications due to cerebral ischemia. We sought to define the incidence, patient risk factors, and clinical sequelae of intraoperative cerebral desaturation events. ⋯ The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with NIRS allows prompt identification and treatment of decreased cerebral perfusion decreasing the risk of this event. Increased BMI was found to be a statistically significant patient risk factor for the development of intra-operative CDE. The transient intra-operative CDEs were not associated with postoperative cognitive dysfunction in our patient series. We believe protocols aimed at detecting and reversing CDE minimize the risk of neurocognitive dysfunction and improve patient safety.
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J Shoulder Elbow Surg · Sep 2013
Geometry of the proximal humeral articular surface in young children: a study to define normal and analyze the dysplasia due to brachial plexus birth palsy.
Little is known regarding the morphology of the proximal humerus in growing children. This study reports bilateral magnetic resonance imaging measurements in children with internal rotation contractures from birth palsy, hypothesizing that dysplasia alters normal humeral sphericity and symmetry. ⋯ Posterior displacement of the humeral head center of rotation beyond 50% of the calculated head radius warrants vigilance and possibly surgical intervention because there is a high likelihood for development of a pseudoglenoid.
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J Shoulder Elbow Surg · Sep 2013
ReviewAn assessment of the quality of rotator cuff randomized controlled trials: utilizing the Jadad score and CONSORT criteria.
The AAOS's Clinical Practice Guideline on "Optimizing Care of Rotator Cuff Problems" suggested a lack of high-quality data. Our purpose is to quantify the quality of randomized controlled trials of rotator cuff disorders via the Jadad score, and to apply the 2010 Consolidated Standards of Reporting Trials CONSORT Criteria to determine factors associated with high Jadad scores and areas for improvement. ⋯ The majority of randomized controlled trials of rotator cuff pathology are high-quality studies based on the Jadad score. Adherence to CONSORT criteria is linked to high-quality scores. Future studies should use full CONSORT Criteria.