OBJECTIVES: The primary objective was to compare sensory processing measures in people attending specialist orthopaedic consultation for management of persistent shoulder pain with control participants. The secondary objective was to compare the groups’ sociodemographic, clinical, general health and lifestyle, and psychological characteristics. DESIGN: Observational cross-sectional. METHODS: Participants with shoulder pain for ≥3 months, who attended a public hospital orthopaedic department (n = 119), and community participants without shoulder pain (n = 44) underwent a standardized quantitative sensory testing protocol, measuring pressure pain threshold, temporal summation, and conditioned pain modulation. Sociodemographic, clinical, general health and lifestyle, and psychological characteristics were also collected. RESULTS: Participants with shoulder pain had significantly lower pressure pain thresholds at all sites (ie, local and widespread mechanical hyperalgesia) and significantly decreased conditioned pain modulation effect (ie, descending inhibition of nociception) than control participants. There was no significant difference between groups for temporal summation. Participants with shoulder pain had decreased general health and function, less healthy lifestyles, and poorer psychological health compared with controls. CONCLUSION: People referred to specialist orthopaedic care for management of persistent shoulder pain had clinical signs of altered sensory processing and poor health outcomes. J Orthop Sports Phys Ther 2024;54(10):1-10. Epub 25 July 2024. doi:10.2519/jospt.2024.12512
Spinal dural arterio venous fistulas (SDAVFs) are the commonest type of spinal vascular malformations and are encountered mostly among adult patients. Magnetic Resonance Imaging (MRI) in patients with SDAVFs demonstrates features like spinal cord swelling and signal changes. Cord signal changes are believed to be due to venous stasis.Treatment of a spinal vascular malformation may result in complete or partial resolution of MR findings with associated clinical improvement. The earliest documentation of reduction or disappearance of cord signal changes on post treatment MR images, was one month later in one series in the literature.We present and discuss disappearance of cord signal changes on MRI within 72 hours following endovascular treatment by liquid glue injection in a patient with SDAVF.
Background The present study reports a retrospective case series detailing our experience of the use of Copeland surface replacement hemiarthroplasty (CSRA) for the treatment of rheumatoid arthritis (RA) of the shoulder. Methods Fifty-three CSRAs were performed in 45 patients between 1994 and 2004. Forty-six shoulders were followed up at a mean of 62.5 months (range 24 months to 150 months). Assessment included a Constant score, patient satisfaction score, and plain radiographs. Results The Constant score improved in all shoulders, from a pre-operative mean of 15.2 to 46.3. Mean abduction improved from 27° to 78°, mean flexion from 47° to 92°, and mean external rotation from 9° to 34°. Fifty-two percent of shoulders showed superior subluxation on plain radiographs. Seven shoulders had over 2 mm of glenoid erosion, of which one underwent reoperation. No implants were loose or required revision. One humeral neck fracture was successfully treated non-operatively. Four shoulders required arthroscopic subacromial decompression. Discussion CSRA provides satisfactory results in RA compared to more conventional stemmed implants and total shoulder arthroplasty.
Fractures of the distal radius are common. Closed reduction and moulded casting is often the first line treatment. Malunion after casting is not uncommon and can lead to discussion on acute surgical fixation versus delayed corrective osteotomy if symptomatic. However, it is unclear if late surgery will provide similar outcomes as early intervention.We performed a single centre, age matched, case series comparison study, comparing outcomes of patients who had undergone early fixation (ORIF) versus those who had undergone late corrective osteotomy (CO) following distal radius fracture.Twenty-six patients were available for review, 13 in each group. Fracture patterns were similar. Reviewing CO versus ORIF; patients achieved a mean DASH; 22 versus 18 (P = 0.355), PRWE; 35 versus 26 (P = 0.237), and VAS 2 versus 2 (P = 0.490). Grip strength was significantly better in those who had undergone ORIF; 2% versus -22% (P ≤ 0.001). Range of motion was generally better with primary fixation but of doubtful clinical importance, reviewing CO versus ORIF; Flexion 46° versus 60° (P = 0.045), extension 55° versus 64° (P = 0.137), pronation 73° versus 85° (P = 0.078), supination 84° versus 84° (P = 0.747), flexion/extension arc 101 versus 124 (P = 0.017), ulnar/radial deviation arc 42° versus 59° (P = 0.01), pronation/supination arc 157° versus 168° (P = 0.118). Ulnar variance was significantly improved in the ORIF group; +0.5 mm versus +2 mm in the CO group (P = 0.023). Radial inclination, radial height and volar tilt were not significantly different between either group.Our findings suggest that patient measured outcome of corrective osteotomy is not inferior to early internal fixation.III (Case Series Comparison).
The early management of orthopaedic outpatients by physiotherapists may be useful in reducing public hospital waiting lists. Physiotherapists in Australia are prevented by legislation and funding models from investigating, prescribing, injecting and referring autonomously. This gap in service is particularly noticeable in the management of shoulder pain in early-access physiotherapy services, as patients needing corticosteroid injection face delays or transfer to other services for this procedure. This trial will investigate the clinical (decision making and outcomes) and economic feasibility of a physiotherapist prescribing and delivering corticosteroid and local anaesthetic injections for shoulder pain in an Australian public hospital setting. A double-blinded (patient and assessor) non-inferiority randomised controlled trial will compare an orthopaedic surgeon and a physiotherapist prescribing and delivering corticosteroid injections to the shoulder. Agreement in decision making between the two clinicians will be investigated, and economic information will be obtained for estimating disease burden and an economic evaluation. The surgeon and the physiotherapist will independently assess patients, and 64 eligible participants will be randomised to receive subacromial injection of corticosteroid and local anaesthetic from either the surgeon or the physiotherapist. Post-injection, all participants will receive physiotherapy. The primary outcome measure will be the Shoulder Pain and Disability Index measured at baseline, and at 6 and 12 weeks post-injection. Analysis will be conducted on an intention-to-treat basis and compared to a per-protocol analysis. A cost-utility analysis will be undertaken from the perspective of the health funder. Findings will assist policy makers and services in improving access for orthopaedic patients. Australia and New Zealand Clinical Trials Registry: 12612000532808 First registered: 21 May 2012. First participant randomized: 16 January 2013.
BackgroundDistal radius fractures are among the most common fractures encountered in the clinical setting, with a reported incidence of 17%. Of these common fractures, it has been said 60% are intra-articular in nature. Intra-articular or unstable and comminuted fractures represent severe, high energy injuries. There is a considerable amount of controversy as to which fixation method is superior. Even the OA concludes; “comparing external fixation (EF) with open reduction and internal fixation (ORIF) for the treatment of intra-articular distal radius fractures described no consistent benefit of one treatment over another”. There are only a few randomised control trials that go beyond one year to cover the long-term follow up (over two years). There has yet to be a meta-analysis of the long-term outcomes of open reduction internal fixation (ORIF) versus external fixation. We aim to show from this meta-analysis if there is any significant difference in the outcomes of either fixation method in the long-term...
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