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How do SLAP-repairs compare with Bankart repairs?
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Thursday 16 October Papers / Journal of Science and Medicine in Sport 18S (2014) e23–e71
frequent extreme pain (r = 0.6, p < 0.01), with increase neovascularisation (r = 0.7, p < 0.01), counts of CD68 macrophages (r = 0.6, p < 0.04), M2 macrophages (r = 0.6, p < 0.01), mast cells (r = 0.8, p < 0.0001), and T-cells (r = 0.6, p < 0.01). Increased blood vessels positively correlated with more frequent pain during sleep (spearman correlation, r = 0.6, p < 0.01) and extreme pain (r = 0.6, p < 0.01). Discussion: To the best of our knowledge this is the first time markers for nerves and blood vessels have been evaluated in tendon from patients with calcific tendonitis. This study shows a very significant concomitant eight (8) fold increase in mast cells, macrophages, and neo-neurovascular infiltration in the tendons of patients with calcific tendonitis. These increases in neoneurovascular infiltration were strongly associated with shoulder pain.
Discussion: The lower subscapularis activates at a significantly higher muscle activity than upper subscapularis during shoulder abduction in a normal population. Greater activity was seen in lower subscapularis during flexion however this was not significant. Additionally, lower subscapularis activated significantly earlier than the upper segment in abduction. This may indicate different roles for each segment during some shoulder motions and a different functional role at that commencement of movement. http://dx.doi.org/10.1016/j.jsams.2014.11.210 21 How do SLAP-repairs compare with Bankart repairs?
http://dx.doi.org/10.1016/j.jsams.2014.11.209
P. Haen ∗ , P. Lam, A. McKeown, G. Murrell
20
Orthopaedic Research Institute, St George Hospital, Australia
Variability in upper and lower subscapularis during shoulder motion J. Wickham 2 , T. Pizzari 1 , S. Balster 3 , C. Ganderton 1,∗ , L. Watson 1,3 1 Department of Physiotherapy, La Trobe University, Victoria, Australia 2 School of Biomedical Science, Charles Sturt University, NSW, Australia 3 LifeCare Prahran Sports Medicine, Victoria, Australia
Background: The subscapularis muscle has two distinct portions, based on variable nerve supply and a broad origin. It has many roles, described as an internal rotator of the humerus, a shoulder abductor, a humeral head depressor and an anterior stabiliser. As studies have traditionally evaluated the subscapularis muscle as a single muscle unit, the aims of the study were to investigate if differences exist in the level of muscle activity between upper and lower subscapularis during seven MVIC positions and four shoulder movements, as well as temporal characteristics during abduction and flexion. Methods: Intramuscular electrodes recorded electromyographic muscle activity from the upper and lower subscapularis muscles of the dominant throwing arm of twenty-four normal subjects (mean age = 23.6 yrs, range = 18–37 yrs) with no history of shoulder pain, injury or surgery. Participants completed ten repetitions of four shoulder movements – abduction, flexion, internal rotation and external rotation and three repetitions of seven maximal voluntary isometric contractions. An accelerometer angle processor was placed on the participants’ wrist to measure the start and finish of motion and the shoulder angle during dynamic movements. Data was processed using Delsys EMGworks software package and the muscle activity was expressed as a percentage of maximum voluntary isometric contraction. Results: The lower subscapularis was found to activate at a higher level than the subscapularis during abduction, flexion and external rotation movements. However, only during abduction were differences between the two muscle components found to be significant (p = 0.018). During internal rotation, upper subscapularis muscle activity mirrored that of lower subscapularis, with a mean difference of 1.14%. Neither upper nor lower subscapularis had onset data commencing prior to the abduction movement however upper subscapularis activated significantly later than lower subscapularis (p = 0.02). Flexion temporal data were not compared due to the minimal detectable activity of subscapularis.
Background: Our uncontrolled observations were that stiffness and pain were often problematic after superior labral (SLAP) repair. The aim of this study was to determine the effect of the location of labral tear on surgical outcomes of arthroscopic labral repair, particularly with respect to pain and stiffness. Methods: Consecutive patients with a primary arthroscopic labral repair by a single surgeon using PEEK knotless anchors (Pushlock, Arthrex, Naples, FL) were assessed with the use of patient-reported pain scores, shoulder functional scores, and shoulder range of motion at the pre-operative evaluation and at six weeks, three months and six months after surgery. Our primary outcome was early postoperative examiner determined range of motion. Our secondary outcomes were patient-reported pain and function. Post-hoc the patients were divided into three groups: Bankart, SLAP, and combined SLAP and Bankart. Results: There were 53 patients in the Bankart group, 33 patients in the SLAP-group, and 40 patients in the combined Bankart-SLAP group. No differences in demographics, pre-operative range of motion and patient-reported scores, and postoperative range of motion and patient-reported scores were found between the Bankart and the combined Bankart-SLAP group. For subsequent analyses, therefore, these two groups were combined into a Bankart ± SLAP group (93 patients). There were significantly more workers compensation cases (WC) in the SLAP group compared to the Bankart ± SLAP group (49% vs 21%, p < 0.002). Pre-operative the SLAP-group had less internal (p < 0.01) and external rotation (46 ± 21 vs 59 ± 21 (mean ± SD)) compared to the Bankart ± SLAP group (p < 0.01). Postoperative internal rotation was also less in the SLAP group (p < 0.001). Postoperatively, patients in both groups improved with respect to pain and satisfaction. Patients in the SLAP-group improved to moderate regarding pain and stiffness (p > 0.01), and instability patients improved to mild-none (p < 0.001). Multiple linear regression analyses showed a loss of internal rotation correlated with postoperative pain and stiffness (r = 0.4). Workers compensation was associated with more pain, more stiffness and less satisfaction in the SLAP-group (r = 0.4), but not in the Bankart ± SLAP group. Conclusion: Labral tear location was important in the outcomes of arthroscopic stabilisation. A SLAP-repair combined with a Bankart repair had similar, excellent, outcomes as a Bankart repair. An isolated SLAP-repair performed worse than a combined repair, particularly in patients with a worker compensation claim and/or pre-operative limitation of internal rotation. http://dx.doi.org/10.1016/j.jsams.2014.11.211
Thursday 16 October Papers / Journal of Science and Medicine in Sport 18S (2014) e23–e71
frequent extreme pain (r = 0.6, p < 0.01), with increase neovascularisation (r = 0.7, p < 0.01), counts of CD68 macrophages (r = 0.6, p < 0.04), M2 macrophages (r = 0.6, p < 0.01), mast cells (r = 0.8, p < 0.0001), and T-cells (r = 0.6, p < 0.01). Increased blood vessels positively correlated with more frequent pain during sleep (spearman correlation, r = 0.6, p < 0.01) and extreme pain (r = 0.6, p < 0.01). Discussion: To the best of our knowledge this is the first time markers for nerves and blood vessels have been evaluated in tendon from patients with calcific tendonitis. This study shows a very significant concomitant eight (8) fold increase in mast cells, macrophages, and neo-neurovascular infiltration in the tendons of patients with calcific tendonitis. These increases in neoneurovascular infiltration were strongly associated with shoulder pain.
Discussion: The lower subscapularis activates at a significantly higher muscle activity than upper subscapularis during shoulder abduction in a normal population. Greater activity was seen in lower subscapularis during flexion however this was not significant. Additionally, lower subscapularis activated significantly earlier than the upper segment in abduction. This may indicate different roles for each segment during some shoulder motions and a different functional role at that commencement of movement. http://dx.doi.org/10.1016/j.jsams.2014.11.210 21 How do SLAP-repairs compare with Bankart repairs?
http://dx.doi.org/10.1016/j.jsams.2014.11.209
P. Haen ∗ , P. Lam, A. McKeown, G. Murrell
20
Orthopaedic Research Institute, St George Hospital, Australia
Variability in upper and lower subscapularis during shoulder motion J. Wickham 2 , T. Pizzari 1 , S. Balster 3 , C. Ganderton 1,∗ , L. Watson 1,3 1 Department of Physiotherapy, La Trobe University, Victoria, Australia 2 School of Biomedical Science, Charles Sturt University, NSW, Australia 3 LifeCare Prahran Sports Medicine, Victoria, Australia
Background: The subscapularis muscle has two distinct portions, based on variable nerve supply and a broad origin. It has many roles, described as an internal rotator of the humerus, a shoulder abductor, a humeral head depressor and an anterior stabiliser. As studies have traditionally evaluated the subscapularis muscle as a single muscle unit, the aims of the study were to investigate if differences exist in the level of muscle activity between upper and lower subscapularis during seven MVIC positions and four shoulder movements, as well as temporal characteristics during abduction and flexion. Methods: Intramuscular electrodes recorded electromyographic muscle activity from the upper and lower subscapularis muscles of the dominant throwing arm of twenty-four normal subjects (mean age = 23.6 yrs, range = 18–37 yrs) with no history of shoulder pain, injury or surgery. Participants completed ten repetitions of four shoulder movements – abduction, flexion, internal rotation and external rotation and three repetitions of seven maximal voluntary isometric contractions. An accelerometer angle processor was placed on the participants’ wrist to measure the start and finish of motion and the shoulder angle during dynamic movements. Data was processed using Delsys EMGworks software package and the muscle activity was expressed as a percentage of maximum voluntary isometric contraction. Results: The lower subscapularis was found to activate at a higher level than the subscapularis during abduction, flexion and external rotation movements. However, only during abduction were differences between the two muscle components found to be significant (p = 0.018). During internal rotation, upper subscapularis muscle activity mirrored that of lower subscapularis, with a mean difference of 1.14%. Neither upper nor lower subscapularis had onset data commencing prior to the abduction movement however upper subscapularis activated significantly later than lower subscapularis (p = 0.02). Flexion temporal data were not compared due to the minimal detectable activity of subscapularis.
Background: Our uncontrolled observations were that stiffness and pain were often problematic after superior labral (SLAP) repair. The aim of this study was to determine the effect of the location of labral tear on surgical outcomes of arthroscopic labral repair, particularly with respect to pain and stiffness. Methods: Consecutive patients with a primary arthroscopic labral repair by a single surgeon using PEEK knotless anchors (Pushlock, Arthrex, Naples, FL) were assessed with the use of patient-reported pain scores, shoulder functional scores, and shoulder range of motion at the pre-operative evaluation and at six weeks, three months and six months after surgery. Our primary outcome was early postoperative examiner determined range of motion. Our secondary outcomes were patient-reported pain and function. Post-hoc the patients were divided into three groups: Bankart, SLAP, and combined SLAP and Bankart. Results: There were 53 patients in the Bankart group, 33 patients in the SLAP-group, and 40 patients in the combined Bankart-SLAP group. No differences in demographics, pre-operative range of motion and patient-reported scores, and postoperative range of motion and patient-reported scores were found between the Bankart and the combined Bankart-SLAP group. For subsequent analyses, therefore, these two groups were combined into a Bankart ± SLAP group (93 patients). There were significantly more workers compensation cases (WC) in the SLAP group compared to the Bankart ± SLAP group (49% vs 21%, p < 0.002). Pre-operative the SLAP-group had less internal (p < 0.01) and external rotation (46 ± 21 vs 59 ± 21 (mean ± SD)) compared to the Bankart ± SLAP group (p < 0.01). Postoperative internal rotation was also less in the SLAP group (p < 0.001). Postoperatively, patients in both groups improved with respect to pain and satisfaction. Patients in the SLAP-group improved to moderate regarding pain and stiffness (p > 0.01), and instability patients improved to mild-none (p < 0.001). Multiple linear regression analyses showed a loss of internal rotation correlated with postoperative pain and stiffness (r = 0.4). Workers compensation was associated with more pain, more stiffness and less satisfaction in the SLAP-group (r = 0.4), but not in the Bankart ± SLAP group. Conclusion: Labral tear location was important in the outcomes of arthroscopic stabilisation. A SLAP-repair combined with a Bankart repair had similar, excellent, outcomes as a Bankart repair. An isolated SLAP-repair performed worse than a combined repair, particularly in patients with a worker compensation claim and/or pre-operative limitation of internal rotation. http://dx.doi.org/10.1016/j.jsams.2014.11.211