Hyaluronic acid injections for treatment of pediatric sickle cell avascular necrosis of the humeral head

BackgroundAvascular necrosis (AVN) can impact up to 50% of patients with sickle cell disease (SCD) and can result in significant pain, decline in physical function and decreased quality of life. While hyaluronic acid (HA) has been used in the adult population for shoulder osteoarthritic pain, we present the first published pediatric case of HA injections in the glenohumeral joint, used to improve function and pain control.Case presentationThe patient is a 12-year-old woman with SCD, who suffered from chronic pain due to AVN of the humeral and femoral head. Despite engaging in a multidisciplinary pain management plan, she continued to have severe decline in physical functioning and became a wheelchair user. As a result, she was scheduled for a right total hip arthroplasty, which necessitated aggressive postoperative therapies using the glenohumeral joint. To improve this pain and to facilitate postoperative recovery, the patient underwent 4 weekly HA injections into the glenohumeral joint. Over a 2-month period, the patient was able to improve physical functioning, decrease opiate use and participate in all postoperative therapies.ConclusionConservative options to improve functioning and pain are especially important in pediatric patients where it may be desirable to delay surgical interventions until skeletal maturity. Our case report demonstrates the benefits of intra-articular HA as part of a multidisciplinary pain management plan to improve function and decrease pain related to AVN of the humeral head. Future studies should assess the long-term benefits of HA injections for AVN in the setting of SCD.

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Shoulder arthroplasty in sickle cell patients with humeral head avascular necrosis

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2006.05.012 ◽

2007 ◽

Vol 16 (2) ◽

pp. 129-134 ◽

Cited By ~ 14

Author(s):

Michelle W. Lau ◽

Morey A. Blinder ◽

Kimberly Williams ◽

Leesa M. Galatz

Keyword(s):

Avascular Necrosis ◽

Sickle Cell ◽

Shoulder Arthroplasty ◽

Humeral Head

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Surgical Treatment of Humeral Head Avascular Necrosis in Sickle Cell Disease Patients: A Systematic Review

JSES International ◽

10.1016/j.jseint.2021.01.011 ◽

2021 ◽

Author(s):

Jawaher M. Alkhateeb ◽

Mohammad A. Arafah ◽

Mariam Tashkandi ◽

Saad M. Al Qahtani

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Sickle Cell Disease ◽

Avascular Necrosis ◽

Sickle Cell ◽

Humeral Head ◽

Cell Disease

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Results of Arthroplasty for Avascular Necrosis of the Humeral Head in Sickle Cell Patients.

Blood ◽

10.1182/blood.v106.11.3809.3809 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3809-3809

Author(s):

Michelle W. Lau ◽

Leesa M. Galatz ◽

Kimberly Williams ◽

Morey A. Blinder

Keyword(s):

Sickle Cell Disease ◽

Avascular Necrosis ◽

Sickle Cell ◽

Shoulder Arthroplasty ◽

Humeral Head ◽

Cell Disease ◽

Assessment Scores ◽

The Mean ◽

Operative Assessment

Abstract Avascular necrosis (AVN) of the humeral head is a debilitating complication of sickle cell disease (SCD) estimated to occur in ~5% of patients for which the optimal therapy is not well defined. Although shoulder replacement is often used for AVN in other settings, little information is available about the outcome of shoulder arthroplasty in this population. In this study, medical records, radiographs, and pre-operative assessment scores of eight adult patients with sickle cell disease were reviewed. Post-operative assessment scores and radiographs were prospectively collected by an independent observer at follow-up appointments. All eight patients had >2 years of follow up. The mean age of the patients at the time of surgery was 37 years old and there were 4 males and 4 females. Six of the patients had Hgb SS, one had Hgb SC and one had Hgb Sβ+ thalassemia. The average duration of symptoms prior to surgery was 26 months. Based on pre-operative shoulder radiographs, 5 of 7 evaluable patients had grade 3 or greater disease. Seven of eight patients had a hemiarthroplasty and one patient had a total arthroplasty. The mean follow up was 51 months. Complications included two episodes of sickle cell crises in the immediate post-operative period, and one intraoperative rotator cuff tear. One patient developed stiffness that required arthroscopic capsular release 22 months after his initial surgery. No infections were seen in the operated shoulder and no shoulder revisions were performed. At the most recent follow-up, the average American Shoulder and Elbow Society (ASES) score improved 31 points, indicating substantial functional improvement (J Shoulder Elbow Surg. 3(6):347–352, 1994). However, only 25% of the patients reported improvement in pain as assessed by a visual analog scale. While two patients had dramatic improvements in all aspects of our outcome measures, two other patients had decreased functional capacity with no improvement in pain. Radiographs at the most recent follow up revealed slight loosening of the prosthetic stem in one patient but no other radiographic complications. In conclusion, shoulder arthroplasty provides improvements in range of motion and joint function in the majority of patients. However, pain relief is less predictable, suggesting that other causes of sickle cell related pain are occuring. Nevertheless, given the limited options available for the treatment of AVN in sickle cell patients who have failed conservative approaches, shoulder arthroplasty is a reasonable treatment option.

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The impact of a multidisciplinary pain management model on sickle cell disease pain hospitalizations

Pediatric Blood & Cancer ◽

10.1002/pbc.22874 ◽

2010 ◽

Vol 56 (5) ◽

pp. 789-793 ◽

Cited By ~ 18

Author(s):

Amanda M. Brandow ◽

Steven J. Weisman ◽

Julie A. Panepinto

Keyword(s):

Pain Management ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Management Model ◽

Cell Disease ◽

Multidisciplinary Pain Management ◽

The Impact

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NECROSIS OF THE FEMORAL HEAD AND HEALTH-RELATED QUALITY OF LIFE OF CHILDREN AND ADOLESCENTS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182604174253 ◽

2018 ◽

Vol 26 (4) ◽

pp. 227-230 ◽

Cited By ~ 4

Author(s):

Marcos Almeida Matos ◽

Luanne Lisle dos Santos Silva ◽

Giordano Bruno Alves ◽

Walter Silva de Alcântara Júnior ◽

Davi Veiga

Keyword(s):

Quality Of Life ◽

Femoral Head ◽

Sickle Cell Disease ◽

Avascular Necrosis ◽

Sickle Cell ◽

Physical Functioning ◽

School Functioning ◽

Cell Disease ◽

Disease Group

ABSTRACT Objective: To verify the impact of avascular necrosis of the femoral head on the quality of life of children and adolescents with Perthes disease and sickle cell disease. Methods: A comparative study including 24 children between eight and 18 years old with avascular necrosis of the femoral head secondary to Perthes disease and sickle cell disease (Group with Necrosis) and 24 children considered asymptomatic (Group without Necrosis). Clinical and sociodemographic data were collected and the PedsQL 4.0 and the Charnley score for hip dysfunction were applied. Results: There was no difference in the overall score and in any domain when comparing the Perthes group (global = 73.1) and the sickle cell disease group (global = 65.9). When comparing the groups with necrosis and without necrosis, the Perthes group had a lower overall score only for the Physical Functioning domain (87.5 versus 68.5); sickle cell disease group had a lower overall score (64.9 versus 79.4) and in the Physical Functioning (68.5 versus 87.5) and School Functioning (62.9 versus 73.7) domains. Conclusion: Avascular necrosis of the femoral head produces lower quality of life scores both in the global evaluation and in the domains Physical Functioning and School Functioning. Necrosis, bilateral lesion, and hip function were found to be associated with the loss of quality of life. Level of Evidence III, Sectional comparative study.

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A Healthcare Improvement Initiative to Increase Multidisciplinary Pain Management Referrals for Youth with Sickle Cell Disease

Pain Management Nursing ◽

10.1016/j.pmn.2020.03.005 ◽

2020 ◽

Vol 21 (5) ◽

pp. 403-409

Author(s):

Rae Ann Kingsley

Keyword(s):

Pain Management ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Cell Disease ◽

Healthcare Improvement ◽

Multidisciplinary Pain Management

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Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02395-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Noboru Matsumura ◽

Kazuya Kaneda ◽

Satoshi Oki ◽

Hiroo Kimura ◽

Taku Suzuki ◽

...

Keyword(s):

Humeral Head ◽

Glenohumeral Joint ◽

Three Dimensional ◽

Clinical Results ◽

Bone Defects ◽

Symptom Duration ◽

Glenohumeral Instability ◽

Explanatory Variables ◽

Large Bone ◽

Large Bone Defects

Abstract Background Significant bone defects are associated with poor clinical results after surgical stabilization in cases of glenohumeral instability. Although multiple factors are thought to adversely affect enlargement of bipolar bone loss and increased shoulder instability, these factors have not been sufficiently evaluated. The purpose of this study was to identify the factors related to greater bone defects and a higher number of instability episodes in patients with glenohumeral instability. Methods A total of 120 consecutive patients with symptomatic unilateral instability of the glenohumeral joint were retrospectively reviewed. Three-dimensional surface-rendered/registered models of bilateral glenoids and proximal humeri from computed tomography data were matched by software, and the volumes of bone defects identified in the glenoid and humeral head were assessed. After relationships between objective variables and explanatory variables were evaluated using bivariate analyses, factors related to large bone defects in the glenoid and humeral head and a high number of total instability episodes and self-irreducible dislocations greater than the respective 75th percentiles were evaluated using logistic regression analyses with significant variables on bivariate analyses. Results Larger humeral head defects (P < .001) and a higher number of total instability episodes (P = .032) were found to be factors related to large glenoid defects. On the other hand, male sex (P = .014), larger glenoid defects (P = .015), and larger number of self-irreducible dislocations (P = .027) were related to large humeral head bone defects. An increased number of total instability episodes was related to longer symptom duration (P = .001) and larger glenoid defects (P = .002), and an increased number of self-irreducible dislocations was related to larger humeral head defects (P = .007). Conclusions Whereas this study showed that bipolar lesions affect the amount of bone defects reciprocally, factors related to greater bone defects differed between the glenoid and the humeral head. Glenoid defects were related to the number of total instability episodes, whereas humeral head defects were related to the number of self-irreducible dislocations.

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What is the content of virtually delivered pain management programmes for people with persistent musculoskeletal pain? A systematic review

British Journal of Pain ◽

10.1177/20494637211023074 ◽

2021 ◽

pp. 204946372110230

Author(s):

Gregory Booth ◽

Deborah Williams ◽

Hasina Patel ◽

Anthony W Gilbert

Keyword(s):

Systematic Review ◽

Pain Management ◽

Musculoskeletal Pain ◽

Clinical Guidelines ◽

Reporting Quality ◽

Skills Training ◽

Evidence Based ◽

Core Element ◽

Multidisciplinary Pain Management ◽

Pain Services

Introduction: Virtual consultations (VC) have been embraced by healthcare organisations during the COVID-19 pandemic. VC allows continuation of patient care while adhering to government advised restrictions and social distancing measures. Multidisciplinary pain management programmes (PMPs) are a core element of many pain services and utilising virtual methods to deliver PMPs has allowed them to continue to provide care. This systematic review aimed to explore the content of existing virtually delivered PMPs and discuss if and how these findings can be used to guide clinical delivery. Methods: Eligible studies included adults (aged ⩾18 years) with persistent musculoskeletal pain and any virtually delivered intervention that was described as a PMP or that had components of PMPs. Databases were searched from inception until July 2020. We performed a content analysis comparing existing interventions with established evidence-based clinical guidelines published by the British Pain Society (BPS). Intervention reporting quality was assessed using the Template for Intervention Description and Replication (TIDieR) checklist: an established checklist developed to improve the completeness of the reporting of interventions. Results: Eight studies were included. One intervention included six of the seven components recommended by the BPS; none included all seven. ‘Skills training and activity management’ was present in all eight interventions; ‘education’ and ‘cognitive therapy methods’ were present in six interventions; ‘graded activation’ and ‘methods to enhance acceptance, mindfulness and psychological flexibility’ were present in four interventions; ‘physical exercise’ was present in two interventions and ‘graded exposure’ was present in one intervention. None of the studies described all 12 items of the TIDieR checklist adequately enough for replication. Conclusion: Published virtual PMPs partially meet established clinical guidelines. Future virtual PMPs should be based on evidence-based clinical guidelines, and more research is needed to explore the effectiveness of virtually delivered PMPs and each recommended component.

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