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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 197 - 197
1 Sep 2012
Fraser BP Chant CB Lawendy AR Manjoo A Badhwar A Ang LC Bihari R Sanders DW
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Purpose

Compartment syndrome is a limb threatening condition. Prior research has been limited by an inability to assess functional and histologic changes in muscle over time. This study was designed to assess and quantify functional deficits and histologic changes following acute compartment syndrome of the lower limb in a novel rat model.

Method

Twenty-three male Wistar rats were trained to perform an incentive-based standard task on an optical gait tracking system. Animals were then randomized to three groups: Control (n=4), Sham (n=4) and Compartment Syndrome (CS, n=15). Control and sham animals had no elevation of intracompartmental pressure, while CS animals had elevated intracompartmental pressure to 30mmHg for 180 minutes in the anterior compartment of the left hind limb using a saline infusion technique. Following intervention, gait analysis was performed at 2hrs, 24hrs, 48hrs, 72hrs and 7days following injury. Several parameters for the injured hind limb were analyzed including: print area, print intensity, maximum contact timing, duty cycle and stance phase time. A 2-way ANOVA with Bonferroni post-hoc analysis was performed. The EDL muscle was harvested (n=17), fixed in formalin and prepared with an H&E stain. Mid-muscle sections were analyzed by a blinded senior pathologist for cell infiltration, necrosis and regeneration.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 570 - 570
1 Nov 2011
Chant CB MacDermid J Drosdowech DS Faber KJ Athwal G
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Purpose: The purpose of this study was to identify if preoperative pain scores predict postoperative pain and functional outcomes in patients following rotator cuff surgery and if a threshold where increased risk occurs could be established. Establishing a risk threshold may help identify patients who need increased follow-up or rehabilitation.

Method: One hundred six subjects with rotator cuff pathology requiring operative intervention were prospectively followed. The pain subscale of the Shoulder Pain and Disability Index (SPADI) was used as an indicator of pre-operative pain. Postoperative function one year following surgery was determined using the Simple Shoulder Test (SST). Scores with 40% or more deficit (compared to age matched controls) were classified as poor outcomes. The relative risk (RR) of poor SST scores was calculated across different cutoffs for preoperative pain scores.

Results: Having a high preoperative pain score was associated with a poor outcome following rotator cuff surgery at both the six month and one year followup. Preoperative pain scores did predict postoperative functional scores. As preoperative pain levels increased there was a higher risk of poor functional outcomes. The RR of having a poor SST at 1-year was 2.3, if preoperative pain score was greater than 35/50.

Conclusion: The current study indicates that those patients with high preoperative pain scores (> 35/50 or > 70%) are more than twice as likely to have a poor outcome following rotator cuff surgery. This should inform patients and surgeons for postoperative expectations. Whether closer follow-up, pre-rehabilitation, more intensive postoperative rehabilitation or enhanced pain management can alter this prognosis warrants investigation.