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Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 175 - 175
1 Jul 2014
Razmjou H Gunnis G Holtby R
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Summary. Data of 663 patients with three different pathologies were examined. We found that using patients with significant symptoms and functional difficulty in the opposite shoulder will not bias the results of observational studies if outcomes are based on routine disability measures such as ASES or Constant-Murley scores. Introduction. Recently, using patients with bilateral limb problems as independent cases has raised concerns in orthopaedic research due to violating the assumption of independence. If observations are too similar in characteristics, they become highly correlated which leads to lowering the variance and biasing the results. Type of pathology (impingement, cuff tear, osteoarthritis) and aging are expected to affect the incidence of bilateral shoulder complaints and should be considered when examining potential bias in this area. In addition, the impact of dominant side pathology has not been investigated primarily in patients with shoulder problems. The objectives of this study were: 1) to examine the incidence of bilateral shoulder complaints and pathology on the dominant side in patients with impingement syndrome, rotator cuff tear and osteoarthritis of the glenohumeral joint, 2) to explore the role of sex and age in developing bilateral shoulder complaints, and 3) to examine the impact of bilaterality and hand dominance on pre and one year post-operative disability. Patients and Methods. This study involved review of data of patients with a diagnosis of impingement syndrome, rotator cuff tears and osteoarthritis (OA) of the gleno-humeral joint who had undergone surgery and had returned for their one year follow-up. Two outcome measures were used; the American Shoulder & Elbow Surgeons (ASES) and the Constant Murley score (CMS). Results. Data of 663 patients (317 females; 269 impingement syndrome, 290 rotator cuff tear, 104 osteoarthritis) were included in the analysis. There was a difference in the incidence of bilateral symptoms in patients with different pathologies: osteoarthritis 46%, impingement 26%, and rotator cuff tears 23% (p<0.0001). The incidence of dominant side involvement was 70%, 68% and 50% in patients with rotator cuff tear, impingement syndrome and osteoarthritis (p=0.003). Neither bilaterality nor dominant arm pathology had a negative impact on disability (p>0.05). Discussion/Conclusion. Type of pathology and aging affect the incidence of bilateral shoulder symptoms. Rotator cuff related pathologies affect the dominant side more frequently. The most interesting finding of this study was related to lack of influence of bilateral symptoms or dominant side pathology on reported disability in three different pathology groups with different prevalence of disease


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 358 - 358
1 Jul 2014
Holtby R Razmjou H Gunnis G
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Summary. In the sample studied, reparability of large and massive tears was associated with pre-op ASES and active external rotation in neutral position. Surgical factors affecting reparability were tear size, tendon mobility and shape of the tear. Introduction. The limited literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear. 1–3. The purpose of this study was twofold, 1) to explore the predictive value of clinical and surgical factors on reparability of large and massive rotator cuff tears and 2) to examine the relationship between reparability and clinical and disability measures. Patients and Methods. This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (full or partial repair) and had returned for their two year follow-up. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (RCMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regression and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student's T-tests and non-parametric statistics. Results. One hundred and fourteen patients (40 women, mean age 64, SD=9) were included in the analysis. There were 79 large (34 fully reparable, 45 partially reparable) and 35 (10 fully reparable, 25 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p>0.05) but the fully repairable tear group showed a better pre-operative ASES score (p=0.01) and a better active external rotation in neutral (p=0.05). Reparability was associated with tear shape (p<0.0001) and size (p=0.007), and tendon mobility (p<0.0001). Discussion/Conclusion. Among demographics, clinical examination and patient-oriented outcomes, the pre-op scores of the ASES and active external rotation in neutral position were predictive of reparability of a large or massive tear. Surgical variables associated with a partial repair were the tear size, tendon mobility and shape of the tear. Patients with partial repair had a statistically significant improvement in range of motion and strength and all disability scores over time. However, they had less flexion and abduction and reported a higher level of residual disability at 2 years post-operatively


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 174 - 174
1 Jul 2014
Razmjou H Holtby R
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Summary. In the sample studied, reparability of large and massive tears was associated with pre-op ASES and active external rotation in neutral position. Surgical factors affecting reparability were tear size, tendon mobility and shape of the tear. Introduction. The limited literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear . 1-3. The purpose of this study was twofold, 1) to explore the predictive value of clinical and surgical factors on reparability of large and massive rotator cuff tears and 2) to examine the relationship between reparability and clinical and disability measures. Patients and Methods. This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (full or partial repair) and had returned for their two year follow-up. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (RCMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regression and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student's T-tests and non-parametric statistics. Results. One hundred and fourteen patients (40 women, mean age 64, SD=9) were included in the analysis. There were 79 large (34 fully reparable, 45 partially reparable) and 35 (10 fully reparable, 25 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p>0.05) but the fully repairable tear group showed a better pre-operative ASES score (p=0.01) and a better active external rotation in neutral (p=0.05). Reparability was associated with tear shape (p<0.0001) and size (p=0.007), and tendon mobility (p<0.0001). Discussion/Conclusion. Among demographics, clinical examination and patient-oriented outcomes, the pre-op scores of the ASES and active external rotation in neutral position were predictive of reparability of a large or massive tear. Surgical variables associated with a partial repair were the tear size, tendon mobility and shape of the tear. Patients with partial repair had a statistically significant improvement in range of motion and strength and all disability scores over time. However, they had less flexion and abduction and reported a higher level of residual disability at 2 years post-operatively