Importance of the Topic Rotator cuff disease accounts for more than 70% of referrals for shoulder complaints. Nonoperative therapy such as physical therapy or injections remains the mainstay of initial treatment, but various other local pain control modalities with less supportive evidence are used by this patient population [6]. Conventional rigid taping, which is applied over joints to immobilize and provide stability, has been largely replaced by elastic therapeutic tape, commonly referred to as kinesiology taping [9]. Therapeutic kinesiology taping involves lightly stretched tape over targeted muscles; its purported goals are to support mobilization and ostensibly to provide benefits related to early controlled motion. Patented woven cotton-thread designs [10, 17] and heat-activated acrylic adhesives [11] aim to replicate the elastic properties of human skin. Imaging findings suggests micro-convolutions at the skin caused by kinesiology taping alter the length and shape of superficial and deep tissues [3, 16], increase local skin temperature [14], and improve peripheral venous blood flow [1, 4]. But studies on healthy individuals have not demonstrated enhanced neuromuscular performance [5, 13, 18] and joint proprioception [20]. Despite a lack of evidence of clinical efficacy, kinesiology tape has been popularized by star athletes such as Kerri Walsh-Jennings, a three-time Olympic gold medalist in beach volleyball, who donned kinesiology tape during her matches at multiple summer Olympics. Gianola et al. [6] reviewed almost 2000 articles to retrieve the highest quality evidence from randomized and quasirandomized controlled trials using kinesiology tape for treatment of subacromial impingement, primary degenerative rotator cuff tendinitis, or calcific tendinopathy. The authors excluded possible confounding factors such as full- or partial-thickness rotator cuff tears, cervical pain, adhesive capsulitis, inflammatory conditions, instability, and osteoarthritis. Key outcomes included pain at rest and with motion, function, ROM, improvement in quality of life, and adverse events. We have seen access of timely surgical care severely impacted by the global pandemic. Effective pain management is essential—it is not suprising that North Americans have recorded a more than 30% increase in opioid-related overdoses and opioid-related deaths during the current healthcare crisis [2, 8, 12, 15]. Research on improving nonsurgical and nonpharmacological management is critical, and as such, a robust assessment of kinesiology tape is warranted. Upon Closer Inspection The authors investigated the efficacy of therapeutic elastic kinesiology tape as a stand-alone treatment (versus sham treatment with blinded participants; nine studies, 312 participants) and as an adjuvant treatment to cointerventions (exercise, steroid injection, physiotherapy) versus co-intervention(s) alone (14 studies, 742 participants). Given that pooled outcomes for pain, function, ROM, and quality of life did not include all available studies, presented results in this review are underpowered. The title of this review is also potentially misleading. While the pooled studies randomized participants presenting with shoulder pain, which may include the entire spectrum of rotator cuff disease from subacromial impingment to complete rotator cuff tears, it is important to note that all but one study specifically excluded complete rotator cuff tears. As such, the primary focus of this review is on shoulder pain resulting from subacromial impingment syndrome. Essentially, due to very low quality evidence, no conclusions can be drawn from this review. There is currently no evidence able to guide the use of elastic kinesiology tape for shoulder pain from rotator cuff disease. The lack of standardization of the kinesiology taping method is potentially responsible for the substantial heterogeneity observed in the results presented in this study. Kinesiology taping compared to sham treatment did not demonstrate evidence of a clinically important reduction in overall pain (three studies), pain at motion (four studies), or function (six studies) in patients with shoulder pain from rotator cuff disease. Kinesiology taping method with or without cointervention(s) compared to cointervention(s) alone did not clinically improve pain or pain at motion. Because the authors found only two studies that compared kinesiology taping treatment in the context of shoulder pain caused by rotator cuff disease (excluding rotator cuff tears) to subacromial injection, a meta-analysis could not be performed. Still, both studies reported improved pain control with subacromial injection compared to kinesiology taping method alone [7, 19]. Additionally, this review did not retrieve any publications supporting the use of kinesiology taping in athletes who play overhead sports. Take-home Messages This review is the result of an immense effort to extract and pool the most reliable evidence to provide sufficiently powered clinical recommendations. The key finding of this review is that none of the clinical endpoints evaluated by the authors achieved the required sample size to reliably detect a difference between treatment groups, and as such, current evidence does not support or recommend against the use of kinesiology tape for treatment of shoulder pain caused by rotator cuff disease. As Gianola et al. [6] note, it is reasonable to believe that there is no lasting muscular effects from kinesiology taping, and that any impact will largely occur when used or very shortly after. We recommend investing in adequately powered trials and standardization of the use of kinesiology taping method, or at least to follow similar methodology to previously published studies. It is unclear why participants with complete rotator cuff tears were excluded from almost all studies presented in this review. It may be of interest to assess the effect of kinesiology taping, which is mainly supportive, on patients with complete rotator cuff tears. While current evidence is underpowered and of low quality, the available evidence is not favorable for kinesiology taping. Still further, adequately powered research is required to identify the impact of kinesiology taping in the subset of patients with complete rotator cuff tears.
Distal biceps tendon (DBT) injuries are relatively uncommon. Controversies exist regarding the best approach, leading to variations in treatment. This study aims to understand the preferences and practices of orthopedic surgeons regarding management of DBT injuries, as well as assess the feasibility of a future pilot randomized controlled trial (RCT) to evaluate the impact of various surgical factors on patient outcomes.
Emerging evidence suggests preoperative opioid use may increase the risk of negative outcomes following orthopedic procedures. This systematic review evaluated the impact of preoperative opioid use in patients undergoing shoulder surgery with respect to preoperative clinical outcomes, postoperative complications, and postoperative dependence on opioids.EMBASE, MEDLINE, CENTRAL, and CINAHL were searched from inception to April, 2021 for studies reporting preoperative opioid use and its effect on postoperative outcomes or opioid use. The search, data extraction and methodologic assessment were performed in duplicate for all included studies.Twenty-one studies with a total of 257,301 patients were included in the final synthesis. Of which, 17 were level III evidence. Of those, 51.5% of the patients reported pre-operative opioid use. Fourteen studies (66.7%) reported a higher likelihood of opioid use at follow-up among those used opioids preoperatively compared to preoperative opioid-naïve patients. Eight studies (38.1%) showed lower functional measurements and range of motion in opioid group compared to the non-opioid group post-operatively.Preoperative opioid use in patients undergoing shoulder surgeries is associated with lower functional scores and post-operative range of motion. Most concerning is preoperative opioid use may predict increased post-operative opioid requirements and potential for misuse in patients.Level IV, Systematic review.
