Outcomes following carpal tunnel release are generally favorable. Understanding factors that contribute to inferior outcomes may allow for strategies targeted at improving results in these patients. Our purpose was to determine if patients' underlying personality traits, specifically resiliency and catastrophization, impact their post-operative outcomes following carpal tunnel release.

A prospective case series was performed. Based on our power analysis, 102 patients were recruited. Patients completed written consent, the Boston Carpal Tunnel Questionnaire (BCTQ), the Pain Catastrophizing Scale (PCS) and the Brief Resiliency Scale (BRS). A single surgeon, or his resident under supervision, then performed an open carpal release under local anaesthetic. Our primary outcome measure was a repeat BCTQ at three- and six-months. Univariate and multivariate analysis was performed to assess the correlation between PCS and BRS scores and final BCTQ scores.

Forty-three and sixty-three participants completed the BCTQ at three and six months respectively. All patients showed improvement in their symptoms (p = 0.001). There was no correlation between patients PCS or BRS and the amount of improvement. There was also no correlation between PCS or BRS and the patients' raw scores at baseline or follow-up.

Patients self-assessed resiliency and degree of pain catastrophization has no correlation with the amount of improvement they have three or six months post-operatively. Most patients improved following carpal tunnel release, and patients with low resiliency and high levels of pain catastrophization should expect comparable outcomes to patients without these features.

Repetitive manual handling caused 31% of all work related musculoskeletal disorders in 2015, with the back being the site of injury 38% of the time. Despite its high resilience, studies have shown that intervertebral discs can be damaged during repetitive loading at physiological motions, causing cumulative damage and disc herniation. To understand the mechanism of disc injury resulting from repetitive lifting, it is important to measure disc deformations/strains accompanied by MRI imaging to identify disc tissue damage. Therefore, the aim of this study was to examine associations between the magnitude of 3D internal strains, tissue damage and macroscopic evidence of disc injury after simulated repetitive lifting on normal human lumbar discs. Sixteen cadaver lumbar functional spinal units (FSUs) were subjected to pre-test MRI. Eight FSUs (control) underwent 20,000 cycles or until failure (5 mm displacement) of loading under compression (1.7 MPa – to simulate lifting a 20 kg weight) + flexion (13°) + right axial rotation (2°) using a novel Hexapod Robot. The remaining eight FSUs (experimental) had a grid of tantalum wires inserted, and stereoradiographs were taken to track internal disc displacements at increasing cyclic intervals. Maximum shear strains (MSS) were calculated from the displacements using radiostereometric analysis at cycle 1 and 20,000 cycles (or failure). Post-test MRI was conducted to determine the extent of tissue damage and associated with regions of highest MSS. A repeated measures ANOVA was performed on MSS with a within–subjects factor of cycle number (cycle 1 and failure cycle) and a between subjects-factor of disc region and failure type (p < 0 .05). Pfirrmann grading revealed mostly normal discs [I (N=2), II (N=13), and III (N=1)]. No significant difference in MSS between control and experimental groups was found for number of cycles to failure (p=0.279). Pre and post-test MRI analysis revealed that 13 specimens were injured after repetitive lifting with either an endplate failure (N=9) or disc bulge (N=4), and two specimens did not fail. Failure strain was significantly greater than cycle 1 in all regions except posterior, left/right posterolateral (p>0.109). Largest MSS at failure was seen in the anterior (60%), and left/right posterolateral regions (64% and 70%, respectively). MSS at failure for the endplate failure group was significantly larger than the no injury group in all regions except right lateral and nucleus (p>0.707). Disc bulge group MSS was significantly larger than the no injury group in the anterior, right anterolateral, and left/right posterolateral regions (p < 0 .027). Simulated repetitive lifting led to largest shear strains in the anterior, left and right posterolateral regions that corresponded to annular tears or annular protrusion. The no injury group shear strain was less than 50% in all regions, indicating there may be a threshold that could be associated with tissue damage linked with injuries such as disc bulge and endplate failure. There was no evidence of disc herniation in normal discs, agreeing with current clinical knowledge. These results may be indicative of the effects of repetitive manual handling on normal discs of younger patients

Aims

As the world continues to fight successive waves of COVID-19 variants, we have seen worldwide infections surpass 100 million. London, UK, has been severely affected throughout the pandemic, and the resulting impact on the NHS has been profound. The aim of this study is to evaluate the impact of COVID-19 on theatre productivity across London’s four major trauma centres (MTCs), and to assess how the changes to normal protocols and working patterns impacted trauma theatre efficiency.

As reverse total shoulder arthroplasty (RTSA) systems expand with longer durations in vivo, so does the concern and potential complications of wear, debris and osteolysis. Despite some other profound attempts, no wear testing method has stood out to compare implants across systems and labs. The main reasons may have been the diverse sources of forces and motions used in testing, widely different wear amounts which resulted and the general lack of dedicated shoulder simulators. To add a dedicated shoulder simulator to hip and knee simulators would burden the resources of any testing lab. In this study we propose a shoulder wear test method which addresses the above. Harnessing the wealth of force-motion data from telemetrized shoulder implants from the Bergman's group in Berlin, we synthesized their results to devise a wholistic multi-axes simulation regime for reverse shoulders. The alignment and motions of the humeral cup and the glenosphere were kept anatomically correct (relative to each other) and yielded a physiologically realistic wear-inducing articulation. However, we opted for a very unusual installation/orientation of the whole implant system to allow a twelve station AMTI (hip) simulator to be adapted for this study. The shoulder constructs were aligned with novel fixtures such that the machine's vertical compressive force mimicked the average forces of the shoulder found from the in vivo telemetry data in magnitude and nominal direction. Aligned thus, a patient with a shoulder installed would neither stand, nor lie down, but be oriented in a composite angle relative the simulator original axes. Each anatomic shoulder motion would be achieved by unique computed combinations of the three simulator motion actuators, none of which would be aligned anatomically for the shoulder on its own. The maximum ranges of cyclic shoulder motion achieved with the constraints of the simulator were 38°–79° of forward elevation repeated in two separate (15°and 45°) elevation planes. The change of elevation plane inherently involved abduction-adduction motion, and simultaneously also involved variation of internal-external rotation within a 57° range. Each elevation rise (twice per cycle) was also accompanied by a sinusoidally rising and falling compressive load in the range 50N–1700N. The test method was tested (!) by simulating for 2.5 million of the above (double-elevation) cycles and gravimetrically measuring wear of twelve 36 mm size RTSA systems. We compared six systems having vitamin E-infused highly cross-linked polyethylene bearings (100 kGy radiation) to six controls with a medium cross-linked polyethylene of half the radiation dose. Significant wear resulted for the control bearing material (average 17.9 ± 0.851 mg/MC) which was no less than many hips and knees. Multiply (and statistically significantly, p < 0.001) less average wear (3.42 ± 0.22 mg/MC) resulted for the highly cross linked bearings. The above demonstrated the effectiveness of the test method. Significant wear resulted under physiologically realistic cyclic motion and forces with strong discrimination between two systems whose bearing materials were known to be different in resilience to wear. Using novel fixtures and unusual orientation to utilize a standard commercially available joint simulator promises efficacy of the test method and utility across different labs

Aims

Healthcare systems have been rapidly restructured to meet COVID-19 demand. Clinicians are working to novel clinical guidelines, treating new patient cohorts and working in unfamiliar environments. Trauma and orthopaedics (T&O) has experienced cancellation of routine clinics and operating, with redistribution of the workload and human resources. To date, no studies have evaluated the mental health impact of these changes on the T&O workforce. We report the results of a novel survey on the impact of the pandemic on the mental health of our orthopaedic workforce and the contributory factors.

The number of arthroplasties being undertaken is expected to grow year on year, and periprosthetic joint infections will be an increasing socioeconomic burden. The challenge to prevent and eradicate these infections has resulted in the emergence of several new strategies, which are discussed in this review.

Cite this article: Bone Joint J 2015;97-B:1162–9.

Treatment for osteoarthritis (OA) has traditionally focused on joint replacement for end-stage disease. An increasing number of surgical and pharmaceutical strategies for disease prevention have now been proposed. However, these require the ability to identify OA at a stage when it is potentially reversible, and detect small changes in cartilage structure and function to enable treatment efficacy to be evaluated within an acceptable timeframe. This has not been possible using conventional imaging techniques but recent advances in musculoskeletal imaging have been significant. In this review we discuss the role of different imaging modalities in the diagnosis of the earliest changes of OA. The increasing number of MRI sequences that are able to non-invasively detect biochemical changes in cartilage that precede structural damage may offer a great advance in the diagnosis and treatment of this debilitating condition.

Cite this article: Bone Joint J 2013;95-B:738–46.