In a prospective randomised study we compared the results of arthroscopic subacromial bursectomy alone with debridement of the subacromial bursa followed by acromioplasty. A total of 57 patients with a mean age of 47 years (31 to 60) suffering from primary subacromial impingement without a rupture of the rotator cuff who had failed previous conservative treatment were entered into the trial. The type of acromion was classified according to Bigliani. Patients were assessed at follow-up using the Constant score, the simple shoulder test and visual analogue scores for pain and functional impairment. One patient was lost to follow-up. At a mean follow-up of 2.5 years (1 to 5) both bursectomy and acromioplasty gave good clinical results. No statistically significant differences were found between the two treatments. The type of acromion and severity of symptoms had a greater influence on the clinical outcome than the type of treatment. As a result, we believe that primary
Aims. The primary aim of this study was to assess the feasibility of recruiting and retaining patients to a patient-blinded randomized controlled trial comparing corticosteroid injection (CSI) to autologous protein solution (APS) injection for the treatment of subacromial shoulder pain in a community care setting. The study focused on recruitment rates and retention of participants throughout, and collected data on the interventions’ safety and efficacy. Methods. Participants were recruited from two community musculoskeletal treatment centres in the UK. Patients were eligible if aged 18 years or older, and had a clinical diagnosis of
The conservative management of Sub-Acromial Impingement Syndrome (SAIS) of the shoulder includes both physiotherapy treatment and subacromial injection with local anaesthetic and steroids. The outcome from injection treatment has rarely been evaluated scientifically. Patients attending a designated shoulder clinic and diagnosed by an experienced shoulder surgeon as having a SAIS between January 2009 and December 2011 were considered for inclusion in the study. 67 of 86 patients screened completed the study (3 did not meet inclusion criteria; 9 declined to participate; 3 lost to follow-up; 4 developed frozen shoulder syndrome). Each patient had a pre-injection Oxford Shoulder Score (OSS) and was given one subacromial injection of 10ml 0.25% levobupivacaine(Chirocaine) + 40 mg triamcinolone(Kenalog) through the posterior route. Radiograph imaging was also assessed. Follow-up was carried out at 6 to 12 weeks post injection when OSS was repeated. A 6 month follow-up assessment to assess if the patient's improvement in functionality and absence of symptoms indicated that a subacromial decompression operation was not necessary. The percentage of patients showing improvement in OSS was calculated and the difference in OSS pre- and post-injection assessed using a Wilcoxon Signed Rank test.Introduction
Methods
Subacromial corticosteroid injection has been shown to be effective in treating impingement syndrome. The exact mechanism of action is not clear but it may be due to its anti-inflammatory properties. However, there are potential side effects of steroid injection including tendon weakening, dermal atrophy and infection. NSAIDs may offer similar anti-inflammatory properties but without the side effects of corticosteroids. Tenoxicam is a long-acting water soluble NSAID and is available without irritant preservatives. Studies have shown that peri-articular Tenocixam injection was useful in treating painful shoulders and local tolerability was good. The aim of this study is to carry out a blinded ran-domised controlled study comparing subacromial Tenoxicam injection (NSAID) against methylprednisolone (steroid) injection in patients with clinical
To assess the value of physiotherapy in the treatment of patients with
The purpose of this study was to assess the value of physiotherapy in the treatment of patients with
Aim: To assess the value of physiotherapy in the treatment of patients with
Background: The aim of this study is to evaluate the efficacy of extracorpereal shock wave therapy (ESWT) in some of most frequent muscularskeletal pathologies. Material and methods: From July to October 2004 310 patients were treated with ESWT, suffering from the following pathologies: 96 symptomatic calcific tendonitis of the shoulder, 53 symptomatic
Purpose: To evaluate the use of a steroid and local anaesthetic subacromial injection as a prognostic tool for patient recovery following arthroscopic subacromial decompression (ASD). Methods: A prospective study of all patients seen in our unit with a clinical diagnosis of
Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or posterior approach to the subacromial space. It is not currently known which approach is superior in terms of improving clinical symptoms and function. This is the protocol for a randomized controlled trial (RCT) to compare the clinical effectiveness of a steroid injection given via the anterolateral or the posterior approach to the subacromial space. The Subacromial Approach Injection Trial (SAInT) study is a single-centre, parallel, two-arm RCT. Participants will be allocated on a 1:1 basis to a subacromial steroid injection via either the anterolateral or the posterior approach to the subacromial space. Participants in both trial arms will then receive physiotherapy as standard of care for subacromial pain syndrome. The primary analysis will compare the change in Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include the change in OSS at six and 12 months, as well as the Pain Numeric Rating Scale (0 = no pain, 10 = worst pain), Disabilities of Arm, Shoulder and Hand questionnaire (DASH), and 36-Item Short-Form Health Survey (SF-36) (RAND) at three months, six months, and one year after injection. Assessment of pain experienced during the injection will also be determined. A minimum of 86 patients will be recruited to obtain an 80% power to detect a minimally important difference of six points on the OSS change between the groups at three months after injection.Aims
Methods
Background. Shoulder impingement syndrome (SIS) is a common debilitating condition, treated across multiple health disciplines including Orthopaedics, Physiotherapy, and Rheumatology. There is little consistency in diagnostic criteria with ‘Shoulder impingement syndrome’ being used for a broad spectrum of complex pathologies. We assessed patterns in diagnostic procedures for SIS across multiple disciplines. Methods. This is a systematic review of electronic databases MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL five years of publications, January 2009 - January 2014. Search terms for SIS included
68 patients underwent arthroscopic subacromial decompression for shoulder impingement syndrome. Patients were evaluated preoperatively, at 3 weeks and 3 months post operatively using the Constant score. Mean preoperative Constant score was 46. 5 (34–67), at 3 weeks 65. 8 (40–86), and at 3 months 82. 4 (50–99). There was no correlation between the impingement grade, presence of a cuff tear or acromioclavicular joint involvement, and a significant poorer outcome. Arthroscopic subacromial decompression is a reliable method of improving the functional ability of patients with
Intra-articular shoulder pathology has been recognised in more detail following widespread use of shoulder arthroscopy. The purpose of this epidemiological study is to present the incidence and exact type of SLAP lesions in our operated population and to correlate them with the presence of other shoulder lesions. Between 2004 and 2010 425 patients underwent shoulder arthroscopy in our department (311 for rotator cuff tears or subacromial impingement, 102 for shoulder instability, 12 for SLAP lesions). Eighty-two SLAP lesions (19.2% overall) were recognized during these procedures. In 44 cases the lesion was SLAP type I (53.6%), in 10 type II (12.2%), in 1 type III (1.2%), in 1 type IV (1.2%), in 24 type V (29.26%) and finally in 2 type VI (2.43%). In more detail SLAP I lesions were associated in 8 patients with
Introduction. There are over 110 special tests described in the literature for clinical examination of the shoulder, but there is no general consensus as to which of these are the most appropriate to use. Individual opinion appears to dictate clinical practice. Rationalising which tests and clinical signs are the most useful would not only be helpful for trainees, but would also improve day to day practice and promote better communication and understanding between clinicians. Methodology. We sent a questionnaire survey to all shoulder surgeons in the UK (BESS members), asking which clinical tests each surgeon found most helpful in diagnosing specific shoulder pathologies; namely
Aims: The purpose of this study was to verify a partial bursal-side rupture of the rotator cuff (RC) using different imaging techniques with special emphasis on the validity of a specific method of subacromial arthrography (SAA). Methods: Patients (n=92, age 53.8 years) with a
Purpose:
Purpose: Appropriate treatment of full-thickness tears of the rotator cuff with subacromial impingement remains a subject of debate. Considering that in most patients, spontaneous tears of the long biceps tendon reduces the pain and that subacromial osteoarthritis is well tolerated by many patients, we proposed arthroscopic tenotomy of the long biceps in this indication with the aim of relieving pain. We report here the long-term outcome. Material and methods: Between 1988 and 1999, 307 arthroscopic tenotomies of the long biceps tendon were performed in patients with unrepairable tears of the rotator cuff tendons (massive full thickness tears, old patients, non-motivated patients). The procedure was isolated in 64% and associated with acromioplasty in 36%. All patients were given prior medical treatment. Mean age at surgery was 64.3 years. The preoperative subacromial height was 6.6 mm. The tendon lesion was an isolated tear of the supraspinatus in 31%, tears of two tendons in 44.6% and tears of three tendons in 21.8%, and isolated tears of the subscapularis in 2.6%. Mean follow-up was 57 months (24–168). Results: The Constant score improved from 48.4 to 67.6 points (p<
0.001). Glenohumeral osteoarthritis (Samilson) increased from 38% to 67% of the shoulders postoperatively. Association with acromioplasty improved the objective and subjective result solely in the group of isolated tears of the supraspinatus. The size of the tear and the degree of fatty degeneration of the rotator cuff muscles had a statistically significant influence on functional and radiographic outcome (p<
0.001) while time since surgery had no effect on radiographic outcome (p<
0.001). Discussion: This simple easy-to-perform procedure yielded pain relief at rest and also nighttime pain. It can be recommended for massive rotator cuff tears with
Purpose: To present our experience in the treatment of
Purpose: Operative wounds are commonly washed with a more or less diluted antiseptic solution to prevent infection or to treated overt infection. Chlorhexidine is widely used. We report the cases of nine patients who developed joint destruction attributed to peroperative irrigation with a chlorhexidine solution. Material and methods: Nine patients (three men and six women) who had undergone surgery in another facility were referred to our unit for unexplained postoperative chondrolysis. The joint localisations were: wrists (n=7) after surgery for a dorsal arthrosynovial cyst (mean age 37 years); elbow (n=1) after surgery for epicondylalgia (age 49 years); shoulder (n=1) after arthroscopy for