Outcomes of Bilateral Shoulder Arthroplasties: A Comparison of Bilateral Total Shoulder Arthroplasties and Bilateral Reverse Shoulder Arthroplasties
Ryan M. CoxTyler J. BrolinEric M. PadegimasMark D. LazarusCharles L. GetzMatthew L. RamseyGerald R. WilliamsJoseph A. Abboud
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Abstract:
][3][4][5][6] TSA is most commonly performed for degenerative shoulder conditions such as glenohumeral osteoarthritis (OA).Reverse shoulder arthroplasty (RSA) has been used in Europe since the 1980s and was approved by the Food and Drug Administration in 2004. 7)RSA is a treatment option for patients with cuff tear arthropathy (CTA), which has yielded consistent results.The number of TSA and especially RSA procedures performed each year continues to increase. 8)The cause of the increase in RSAs performed is multifactorial, butKeywords:
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Background: Rotator cuff tears are treated surgically when conservative treatment methods fail. Since osteoporosis is common and the cuff is degenerative in nature, it may be a challenge to treat the tears surgically in the elderly. The objective of this study was to evaluate the results rotator cuff repair with double row two anchors (one medial and one lateral) for middle sized tears in patients over 65years old.Methods: 18 patients who are over 65years old treated arthroscopically for medium sized rotator cuff tear were included in the study. Inclusion criteria were patients with MR findings and physical findings consistent with medium sized (1-3cm) rotator cuff tears, patients with follow up period of at least 2years. All of the patients were repaired using (two anchors, one medially and one laterally placed) double row technique arthroscopically. The patients were evaluated with constant Murley score and ASES scores. All these measurements (both ROM and functional tests) were performed preoperatively and at postoperative third sixth months, first year and after second year.Results: Mean age of the patients was 69.3 (±2.6). The mean follows up period was 34months (±4.1) Preoperative mean forward flexion and external rotation were 127.3±25.3º and 48.9±14.6º respectively. The preoperative mean internal rotation was 9.1±6.9º. Preoperative mean ASES score was 59.1º (±9.6) and mean constant score was 53.7º (±11.2). At the last follow up mean forward flexion was 158.3º (±17.9), external rotation was 63.2º (±11.4) and internal rotation was 9.3º (±7.3). Mean ASES score and constant score of the patients were 84.3 (±9.1) and 77.3 (±10.8) in the last follow up.Conclusions: It is possible to obtain good results in medium sized rotator cuff tears in patients over 65years old particularly if fatty degeneration over grade II has not prevailed.
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[Purpose] This study aimed to clarify the relationship between scapular dyskinesis and shoulder external rotation strength and muscle activity. [Subjects and Methods] Both shoulders of 20 healthy males were evaluated. They were classified into 19 normal, 8 subtly abnormal, and 13 obviously abnormal shoulders using the scapular dyskinesis test. Subtly abnormal shoulders were subsequently excluded from the analysis. Shoulder external rotation strength and muscle activity (infraspinatus, serratus anterior, upper, middle, and lower trapezius) were measured in 2 positions using a handheld dynamometer and surface electromyography while sitting in a chair with shoulder 0° abduction and flexion (1st position), and while lying prone on the elbows with the shoulders elevated in the zero position (zero position). The strength ratio was calculated to quantify the change in strength between the positions (zero position / 1st position). [Results] In the obviously abnormal shoulder group, the strength in the 1st position was significantly stronger, the strength ratio was significantly smaller, and the serratus anterior in the zero position showed significantly lower activity than the normal shoulder group. [Conclusion] In shoulder external rotation in the zero position, in obviously abnormal shoulders, the serratus anterior is poorly recruited, weakening the shoulder external rotation strength.
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We describe the first reported case of a tumour deposit within the rotator cuff presenting as a bizarre, progressive, and fixed external rotation deformity of the shoulder. It is also the first reported case to our knowledge of an oesophageal primary metastasising to the rotator cuff.
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〔目的〕膝前十字靭帯損傷の既往の有無による股関節内旋筋力,外旋筋力およびこれらの比の差異を明らかにすることとした.〔対象と方法〕対象は,健常成人女性22名および膝前十字靭帯損傷の既往のある女性9名とした.ハンドヘルドダイナモメータにより計測される股関節内旋筋力と外旋筋力,およびこれらの比をマン・ホイットニーのU検定を用い,群間で比較した.〔結果〕股関節外旋筋力は有意差を示さなかったが,股関節内旋筋力および内外旋筋間の筋力比はACL群で有意に大きかった.〔結語〕ACL損傷の既往がある者には,股関節内外旋筋の筋力比に不均衡が生じていることから,損傷患者ではこの筋力比を健常者の水準値に近づけることは,有益な理学療法介入となる可能性がある.
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The aim of this paper was to evaluate ultrasonographic picture of rotator cuff integrity after surgical reconstruction performed in 34 patients with mean follow-up 17.2 months (range 6-45 months). The lack of rotator cuff echo or hypoechogenic area were the criteria for diagnosis of re-tear. This occurred in 16% of shoulders with isolated supraspinatus tear and in 33.3% of shoulder with 2 tendons involved. Hyperechogenic changes were noted in 35.3% of shoulders, some thinning of the rotator cuff in 23.5%, while both of these changes in 14.7%. The thinning of the rotator cuff was classified as pathologic if there was difference between diameter of rotator cuff measured in 6th to 8th postoperative week and diameter measured at the time of follow-up. Ultrasonographic examination offers critical evaluation of both surgical result and postoperative physical therapy protocol.
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A retrospective study was performed on twenty shoulders in nineteen patients who had been managed for severe loss of external rotation of the glenohumeral joint after a previous anterior capsulorrhaphy for recurrent instability. All patients had noted a restricted range of motion, and seventeen shoulders had been painful. In seven shoulders, the humeral head had been subluxated or dislocated posteriorly, and sixteen shoulders had been affected by mild to severe glenohumeral osteoarthrosis. All twenty shoulders were treated with a reoperation, which consisted of a release of the anterior soft tissue. In addition, eight shoulders had a total arthroplasty and one had a hemiarthroplasty. At an average duration of follow-up of forty-eight months, all shoulders had an improvement in the ratings for pain and range of motion. The average increase in external rotation was 45 degrees (range, 25 to 65 degrees). Patients who have a major loss of external rotation following anterior capsulorrhaphy of the shoulder may be at risk for the development of posterior subluxation and glenohumeral osteoarthrosis. The performance of an anterior release should be considered for these patients.
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Muscle training usually plays an important role in the treatment of shoulder disorders. Clinicians traditionally predict the pre-injury strength of an injured shoulder by using the contralateral uninjured side as the baseline data.The primary purpose of the present study was to determine the difference in isokinetic peak torque of dominant and nondominant shoulders.Both shoulders of 39 healthy subjects (24 men, 15 women) were tested isokinetically by using the CON-TREX MJ dynamometer at two angular velocities (60 and 180 degrees/sec) during abduction, adduction, flexion, extension, internal rotation and external rotation.There were statistical differences of contralateral peak torque in almost all directions of shoulder muscle contractions except in shoulder flexion at both speeds. Peak torque of shoulder adduction, extension, and internal rotation were greater in the dominant side. Shoulder abduction and external rotation peak torque were greater in the nondominant side.Therefore, clinicians should not directly use the isokinetic strength of the contralateral shoulder as normal baseline data for an injured side without consideration.
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