Aim

Synovial calprotectin point-of-care test (POC) has shown promising clinical value in diagnosing periprosthetic joint infections (PJIs). However, limited data are available in unclear cases. Moreover, cut-off values for calprotectin lateral flow assay (LFA) and enzyme-linked immunosorbent assay (ELISA) need to be adapted. The aim of this study was to evaluate the performance of an upgraded and more sensitive version of a synovial calprotectin LFA along with ELISA immunoassay in patients with septic, aseptic, and unclear cases.

Introduction: Musculoskeletal injuries of the shoulder in paraplegic patients can result from overuse and/or incorrect use of wheelchairs. With improved long-term survival of these patients who exclusively depend on their upper extremities for weight-bearing activities such as transfers and wheelchair propulsion, they are particularly susceptible for shoulder pathologies. The purpose of this study was to compare the functional and structural changes in weight-bearing shoulders of paraplegic patients who are wheelchair dependent for more than 30 years with able-bodied volunteers.

Methods: This was a randomized study with 80 (160 shoulders) patients who had been paraplegic and wheelchair dependent for a mean of 33 years. These patients were matched for gender, age, occupation, and hobbies to a group of 80 (160 shoulders) able-bodied volunteers. The mean age for the paraplegic patients was 54 years and 51 years for the matched volunteers. Shoulders from both groups were prospectively evaluated using MRI. All films were analyzed by two board-certified radiologists who were blinded to the study. Prospectively collected outcome measures included a standardized clinical examination protocol, the Constant score, and visual analog scale (VAS) pain scores.

Results: The shoulder function according to the Constant score was significantly worse in paraplegic patients compared to able-bodied volunteers (p< 0.001). Similarly, the VAS scores were significant greater in the paraplegic patients (three-fold higher pain intensity, p< 0.001). Comparison of the MRI films of the paraplegic patients and the volunteers revealed the following significant differences: rotator cuff tears 67% (108/160) vs 5.6% (9/160); tendonitis 50% (80/160) vs 23% (37/160); tendonitis of the long head of the biceps 25% (40/160) vs 3.7% (6/160); rupture of the long head of the biceps 10% (16/160) vs 2.5% (4/160); subacromial subdeltoid bursitis 71% (113/160) vs 34% (55/160); acromioclavicular osteoarthritis 33% (53/160) vs 15% (24/160); and glenohumeral osteoarthritis 15% (24/160) vs 8% (13/160).

Conclusion: This is the first study comparing the long-term effect on shoulder pathologies of paraplegic wheelchair users to a cohort of able-bodied volunteers. The complications of weight-bearing activities in these patients require appropriate prevention including wheelchair and/or home modification, physical therapy, pharmacological pain management, surgical intervention, and patient education.