scholarly journals ADOLESCENT POSTERIOR-SUPERIOR GLENOID LABRAL PATHOLOGY: DOES INVOLVEMENT OF THE BICEPS ANCHOR MAKE A DIFFERENCE?

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Cody H. Hansen ◽  
Alicia M. Asturias ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Limited Information ◽  
Self Assessment ◽  
Superior Labrum ◽  
Labral Tears ◽  
Posterior Group ◽  
Outcome Scores ◽  
Age Cohort ◽  
Biceps Anchor ◽  
Labral Pathology ◽  
Overhead Sport

Background: Adolescent athletes are at risk to sustain an injury to the posterior and superior labrum of the glenoid. Limited information is available regarding the outcomes of surgical intervention in this specific age cohort. Purpose: To compare those patients with pure posterior pathology and those with involvement of the biceps anchor (superior labrum anterior-posterior tears - SLAP) to determine risks for failure in the surgical management. Methods: A retrospective review was performed on all patients under the age of 19 years over an eight year period to identify those treated for superior and posterior labral pathology, followed by chart review, radiographic review and arthroscopic findings. Demographics and other variables were recorded, including: etiology (traumatic versus atraumatic), activity/sports (overhead versus non-overhead), involvement of the biceps anchor – crossing the 12 o’clock position (Posterior vs SLAP), associated pathologies, outcome scores (SANE – Self Assessment Numerical Evaluation versus PASS – Pediatric Adolescent Shoulder Score), and complications. Results: 48 patients (30 males, 18 females) with a mean age at surgery of 16.5 years (range 13.5 to 19) were identified that met criteria with a mean follow-up of 4.1 years (range 1.3 to 6.9). Nineteen subjects had SLAP tears, and 29 subjects had posterior tears. All but 2 regularly participated in sports at the time of their injury; of the athletes, 26 (56.5%) played an overhead sport and 20 (43.5%) played a non-overhead sport. The etiology of the injury was traumatic in 25 cases (52.1%), and atraumatic in 23 cases (47.9%). Outcome scores were not significantly different between etiology or type of sports played; but, the mean PASS score in the SLAP group was 88.7, compared to 76.2 in the posterior group (p=0.005) at final assessment. Only 1 SLAP patient failed management (5.3%) compared to 5 patients in the posterior only cohort (17.2%). Conclusion: SLAP tears have better outcomes and lower failure rates than posterior only tears in the adolescent population. Posterior-superior labral tears can occur in all sport types with multiple etiologies, but the only factor that appears to play a role in ultimate outcome is whether or not the tear crosses under the biceps anchor to the anterior side.

Adolescent Posterior-Superior Glenoid Labral Pathology: Does Involvement of the Biceps Anchor Make a Difference?

2020 ◽  
Vol 48 (4) ◽  
pp. 959-965
Author(s):  
Cody H. Hansen ◽  
Alicia M. Asturias ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Patient Characteristics ◽  
Limited Information ◽  
Level Of Evidence ◽  
Superior Labrum ◽  
Labral Tears ◽  
Posterior Group ◽  
Outcome Scores ◽  
Age Cohort ◽  
Biceps Anchor ◽  
Labral Pathology

Background: Adolescent athletes are at risk of sustaining an injury to the posterior and superior labrum of the glenoid. Limited information is available regarding the outcomes of surgical intervention in this specific age cohort. Purpose: To compare those patients with pure posterior pathology and those with posterior labral tears that involve the biceps anchor (superior labrum anterior-posterior [SLAP] tears) to determine risks for failure in the surgical management. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed on all patients under the age of 19 years over an 8-year period to identify those treated for superior and posterior labral pathology, followed by chart review, radiographic review, and arthroscopic findings. Patient characteristics and other variables were recorded, including cause (traumatic vs atraumatic), activity/sports (overhead vs nonoverhead), involvement of the biceps anchor—crossing the 12-o’clock position (posterior vs SLAP), associated pathologies, outcome scores (Single Assessment Numerical Evaluation [SANE] and Pediatric/Adolescent Shoulder Survey [PASS] scores), and complications. Results: Forty-eight patients (30 boys, 18 girls) with a mean age at surgery of 16.5 years (range, 13.5-19 years) were identified who met criteria, with a mean follow-up of 4.1 years (range, 1.3-6.9 years). Nineteen patients had SLAP tears and 29 patients had posterior tears. All but 2 regularly participated in sports at the time of their injury; of the athletes, 26 (56.5%) played an overhead sport and 20 (43.5%) played a nonoverhead sport. The cause of the injury was traumatic in 25 cases (52.1%) and atraumatic in 23 cases (47.9%). Outcome scores were not significantly different between cause or type of sports played; SANE scores were not significantly different by tear type (mean SLAP score, 88.4 compared with mean posterior score, 80.9; P = .124); but the mean PASS score in the SLAP group was 88.7, compared with 76.2 in the posterior group ( P = .005) at final assessment. Only 1 SLAP patient had failed management (5.3%) compared with 5 patients in the posterior-only cohort (17.2%). Conclusion: Posterior SLAP tears have better outcomes and lower failure rates than posterior-only tears in the adolescent population. Posterior-superior labral tears can occur in all sports types with multiple causes, but the only factor that appears to play a role in ultimate outcome is whether the tear crosses under the biceps anchor to the anterior side.

Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging

2012 ◽  
Vol 2 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Ankur M Manvar ◽  
Sheetal M Bhalani ◽  
Grant E Garrigues ◽  
Nancy M Major
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
High Signal Intensity ◽  
Labral Tear ◽  
High Signal ◽  
Resonance Imaging ◽  
Superior Labrum ◽  
Labral Tears ◽  
Biceps Anchor ◽  
Labral Pathology

ABSTRACT Objective To improve the magnetic resonance imaging (MRI) and magnetic resonance arthrogram (MRA) interpretation of a ‘meniscoid-type’ superior labrum vs a superior labral tear by evaluation of a simple sign. Materials and methods Retrospective analysis of our institution's shoulder MRIs and MRAs yielded 144 patients thought to have a superior labral tear. Fifty-five patients had arthroscopy. Analysis of the orthopaedic database for superior labral repair surgeries performed in the same time frame yielded seven additional patients without prospective MRI/MRA diagnosis of superior labral tear. Results Two of 17 (11.8%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy. Both cases failed to have extension of high signal intensity behind the biceps anchor to the most posterior oblique coronal image. Nine of 38 (23.7%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy, but a meniscoid-type superior labrum. Four of seven patients known to have superior labral tears by arthroscopy but incorrectly diagnosed as meniscoid-type superior labrum on MRI or MRA, were retrospectively found to have extension of high signal intensity in the superior labrum to the most posterior image. Conclusion Signal abnormality that continues through the remainder of the superior labrum posterior to the biceps anchor indicates a superior labral tear. Absence of this sign in the setting of more anterior high signal under the labrum may indicate a meniscoid variant. Manvar AM, Bhalani SM, Garrigues GE, Major NM. Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging. The Duke Orthop J 2012;2(1):44-49.

scholarly journals Determination of Factors Effecting Medication Adherence in Depressed Patients Receiving Antidepressants in Pakistan

2020 ◽  
Vol 8 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Muhammad Amir ◽  
Nathanial Rickles ◽  
Zeeshan Feroz ◽  
Anwer Ejaz Beg
Keyword(s):  
Medication Adherence ◽  
Significant Influence ◽  
Assessment Tool ◽  
Outpatient Setting ◽  
Vital Role ◽  
Limited Information ◽  
Self Assessment ◽  
Duration Of Therapy ◽  
Depressed Patients ◽  
Relationship Of

Background: The prevalence of depression in Pakistan is considered to be higher than other developing countries. Medication adherence is a major factor in the success and cost effectiveness of the treatment of depression. Limited information relating medication adherence and its factor are available for patients in Pakistan. Objective: The study aim to determine the factors associated with adherence of antidepressants in depressed patients. Methods: The study was conducted in outpatient setting of hospital. 200 participants were enrolled in the study. Self-assessment tool was used to determine the medication adherence. Results: The results showed that factors such as gender, education, employment and total number of medications have significant influence on adherence of antidepressants. The study also shows that the relationship of factors and adherence changes with the duration of therapy. Conclusion: Factors play a vital role in understanding the barriers in medication non-adherence. Factors effecting medication adherence change with respect to the duration of therapy. Gender, employment, morbidity and number of medications taken earlier have significant influence on medication adherence of antidepressants in depressed patients.

scholarly journals Sensitivity of Magnetic Resonance Imaging for Acetabular Labral Pathology in Adolescent and Young Adult Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0043
Author(s):  
Christine M. Kelly ◽  
Nicole M. Chevalier ◽  
Laura A. Vogel ◽  
Jonathan D. Gelber ◽  
Carl W. Nissen ◽  
...  
Keyword(s):  
Young Adult ◽  
Sports Medicine ◽  
False Negative ◽  
False Negative Rate ◽  
Adolescent And Young Adult ◽  
Radiology Report ◽  
Negative Rate ◽  
Labral Tears ◽  
Mri Scans ◽  
Labral Pathology

Objectives: Hip impingement and associated labral tears are a common source of pain in adolescent and young adult athletes. The majority of current literature focuses on adult populations while there is a relative paucity of literature on younger athletes. It has been our experience that the proper diagnosis and management of patients with labral pathology in the adolescent athletes is often delayed. One of the reasons for this delay may be the sensitivity of MRIs in diagnosing hip pathology. The sensitivity of MRI to detect labral tears in adults has been reported to be 71-91%. However, the sensitivity of MRI to detect labral pathology in adolescent athletes is unknown. The purpose of this study was to evaluate the sensitivity of MRI in diagnosing labral tears in an adolescent and young adult population. Methods: Patients undergoing hip arthroscopy by 3 sports medicine trained orthopedic surgeons between 2006-2018 were retrospectively reviewed. Patients were included in this study if they had a MRI and subsequently confirmed labral pathology during hip arthroscopy. Patients were excluded if they had a history of prior surgeries of the ipsilateral hip, did not have a diagnosis of femoral-acetabular impingement (FAI) or acetabular labral pathologies, were over the age of 25 or if the MRI did not have a radiologist report available for review. The MRI reports of the patients who met study criteria were reviewed to determine if the radiologist suspected labral pathology. The MRIs were also reviewed by a sports medicine fellowship trained orthopaedic surgeon who was not involved in the patients’ care and was blinded to the radiologist reports. The radiology report and the orthopaedist’s read were then compared against the surgical findings to determine the sensitivity and false negative rates for MR imaging in this patient population. Results: A total of 140 hips in 132 patients (26 males, 106 females) were included in this study with a mean age of 16.7 ± 2.4 years. Of this study cohort, 112 patients had a labral repair and 20 had a labral debridement. Results showed that of the 140 hip MRIs, the official radiology report described the presence of labral pathology in only 76 MRI scans; indicating that the MRI has a sensitivity of 55% and a false negative rate of 44% for the presence of labral pathology. Results of the blinded orthopaedic surgeon’s review showed that of the 140 hip MRIs available, the presence of labral pathology was seen in only 92 MRI scans with a sensitivity of 65% and a false negative rate of 34%. Conclusion: Routine MRI scans had a low sensitivity and high false negative rate for labral pathology in adolescent and young adults regardless of reviewer, even in the presence of retrospective bias. The sensitivity of MRI for labral pathology in this population is lower than that reported in the literature for adult patients. These findings have implications for clinicians who rely heavily on MRI results and radiologist reports in their clinical decision making which may result in delays in appropriate surgical management.

Suprascapular intraneural ganglia and glenohumeral joint connections

2006 ◽  
Vol 104 (4) ◽  
pp. 551-557 ◽  
Author(s):  
Robert J. Spinner ◽  
Kimberly K. Amrami ◽  
Michel Kliot ◽  
Shawn P. Johnston ◽  
Joaquim Casañas
Keyword(s):  
Glenohumeral Joint ◽  
Suprascapular Nerve ◽  
Symptomatic Improvement ◽  
Labral Tear ◽  
Suprascapular Neuropathy ◽  
Operative Outcomes ◽  
Labral Tears ◽  
Supraclavicular Fossa ◽  
Biceps Anchor ◽  
The Many

Object Unlike the more commonly noted paralabral cysts (extraneural ganglia), which are well known to result in suprascapular nerve compression, only four cases of suprascapular intraneural ganglia have been reported. Because of their rarity, the pathogenesis of suprascapular intraneural ganglia has been poorly understood and a pathoanatomical explanation has not been provided. In view of the growing literature demonstrating strong associations between paralabral cysts and labral (capsular) pathology, joint connections, and joint communications, the authors retrospectively reviewed the magnetic resonance (MR) imaging studies and postoperative results in the two featured patients to test a hypothesis that suprascapular intraneural ganglia would have analogous findings. Methods Two patients who presented with suprascapular neuropathy were found to have intraneural ganglia. Connections to the glenohumeral joint could be established in both patients through posterior labrocapsular complex tears. In neither patient was the joint connection identified preoperatively or intraoperatively, and cyst decompression was performed by itself without attention to the labral tear. The suprascapular intraneural ganglia extended from the glenohumeral joint as far proximally as the level of the nerves’ origin from the upper trunk in the supraclavicular fossa. Although both patients experienced symptomatic improvement after surgery, neurological recovery was incomplete. In both cases, postoperative MR images revealed cyst persistence. In addition, previously unrecognized superior labral anteroposterior (SLAP) Type II lesions (tears of the superior labrum extending anteroposterior and involving the biceps anchor at the labrum without actual extension into the tendon) were visualized. In one patient with a persistent cyst, an MR arthrogram was obtained and demonstrated a communication between the joint and the cyst. Conclusions The findings in these two patients support the synovial theory for intraneural ganglia. Based on their experience with intraneural ganglia at other sites, the authors believe that suprascapular intraneural ganglia arise from the glenohumeral joint, egress through a superior (posterior) labral tear, and dissect within the epineurium along an articular branch into the main nerve, following the path of least resistance. Furthermore, these two cases of intraneural ganglia with SLAP lesions are directly analogous to the many cases of paralabral cysts associated with these types of labral tears. By better understanding the origin of this unusual type of ganglia and drawing analogies to the more common extraneural cysts, surgical strategies can be formulated to address the underlying pathoanatomy, improve operative outcomes, and prevent recurrences.

scholarly journals Magnetic resonance imaging evaluation of meniscoid superior labrum: normal variant or superior labral tear

2016 ◽  
Vol 49 (4) ◽  
pp. 220-224 ◽  
Author(s):  
Marcelo Novelino Simão ◽  
Emily N. Vinson ◽  
Charles E. Spritzer
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Final Analysis ◽  
Labral Tear ◽  
Resonance Imaging ◽  
Imaging Evaluation ◽  
Magnetic Resonance Imaging Evaluation ◽  
Superior Labrum ◽  
Labral Tears ◽  
Operative Report

Abstract Objective: The objective of this study was to determine the incidence of a "meniscoid" superior labrum. Materials and Methods: This was a retrospective analysis of 582 magnetic resonance imaging examinations of shoulders. Of those 582 examinations, 110 were excluded, for a variety of reasons, and the final analysis therefore included 472 cases. Consensus readings were performed by three musculoskeletal radiologists using specific criteria to diagnose meniscoid labra. Results: A meniscoid superior labrum was identified in 48 (10.2%) of the 472 cases evaluated. Arthroscopic proof was available in 21 cases (43.8%). In 10 (47.6%) of those 21 cases, the operative report did not include the mention a superior labral tear, thus suggesting the presence of a meniscoid labrum. In only one of those cases were there specific comments about a mobile superior labrum (i.e., meniscoid labrum). In the remaining 11 (52.4%), surgical correlation demonstrated superior labral tears. Conclusion: A meniscoid superior labrum is not an infrequent finding. Depending upon assumptions and the requirement of surgical proof, the prevalence of a meniscoid superior labrum in this study was between 2.1% (surgically proven) and 4.8% (projected). However, superior labral tears are just as common and are often confused with meniscoid labra.

scholarly journals Predictors of Large Labral Tears: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0041
Author(s):  
Kevin Cronin ◽  
Brian Wolf ◽  
Justin Magnuson ◽  
Gregory Hawk ◽  
Azimeh Sedaghat ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Demographic Data ◽  
Demographic Variables ◽  
Labral Tear ◽  
Time Of Surgery ◽  
Racquet Sports ◽  
Cell Counts ◽  
Labral Tears ◽  
Patient Reported ◽  
Labral Pathology

Objectives: Labral tears are often described by either their location (superior, anterior, or posterior) or their size, commonly defined as degrees of labral involvement from 0° to 360°. Large tears are thought to include 270° or more of the labrum, which has been reported to include 3.3% to 6.5% of those undergoing shoulder instability surgery for labral pathology. Demographic or injury characteristics of those with large labral tears (>270°) has not been defined in the literature. The purpose of this study was to identify factors predictive of a large labral tear at the time of shoulder instability surgery. Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients undergoing open or arthroscopic shoulder instability surgery for a labral tear were evaluated. Those with an isolated SLAP (superior labrum anterior to posterior) tear or a concomitant rotator cuff tear requiring repair were excluded. Demographic data, injury history, preoperative patient-reported outcome scores (PROs), imaging and intraoperative findings, and surgical procedures performed were recorded. The treating surgeon reported the size and location of labral pathology visualized at the time of surgery. Patients with greater than a 270° tear were defined as having a large labral tear. For categorical demographic variables, a chi-square test or Fisher’s Exact test was used, as appropriate based on cell counts. For continuous demographic variables, a two-sample t-test was performed. In order to build a predictive logistic regression model for large tears, the Feasible Solutions Algorithm (Lambert et al. 2018) was used to add significant interaction effects iteratively until no more significant two-way interactions could be added to the model. Results: After applying exclusion criteria, 1235 patients were available for analysis. There were 222 females (18.0%) and 1013 males (82.0%) in the cohort with an average age of 24.7 years old (12 – 66 years old). The incidence of large tears was 4.6% with the average tear size being 141.9°, or 39.4%. Males accounted for significantly more of the large tears seen in the cohort (94.7%, p = 0.01). Racquet sports (p = 0.002), swimming (p = 0.02), softball (p = 0.05), skiing (p = 0.04), and golf (p = 0.04) were all found to be predictive of large labral tears as was a higher Western Ontario Shoulder Instability (WOSI) score (p = 0.01) (Table 1). Patients with a larger body mass index (BMI) who played contact sports were also more likely to have large tears (p = 0.007). Age, race, history of dislocation, injury during sport, or previous shoulder surgery were not associated with having a larger tear. Conclusion: Patients with large labral tears are a small, but not insignificant, subset of patients undergoing shoulder instability surgery. Multiple factors were identified as being associated with large labral tears at the time of surgery including male sex, pre-operative WOSI score, and participation in certain sports including racquet sports, softball, skiing, swimming, and golf. Surgeons treating patients with these risk factors should be prepared to encounter a large labral tear at the time of surgery. Further studies will evaluate the outcomes of this patient population. [Table: see text]

Magnetic Resonance Arthrographic Demonstration of Association of Superior Labrum Anterior and Posterior Lesions With Extended Anterior Labral Tears

2019 ◽  
Vol 43 (1) ◽  
pp. 51-60 ◽  
Author(s):  
Hayri Ogul ◽  
Veysel Ayyildiz ◽  
Berhan Pirimoglu ◽  
Gokhan Polat ◽  
Kutsi Tuncer ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Superior Labrum ◽  
Labral Tears

scholarly journals Characteristics and Symptoms of App Users Seeking COVID-19–Related Digital Health Information and Remote Services: Retrospective Cohort Study

10.2196/23197 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e23197
Author(s):  
Amichai Perlman ◽  
Alina Vodonos Zilberg ◽  
Peter Bak ◽  
Michael Dreyfuss ◽  
Maya Leventer-Roberts ◽  
...  
Keyword(s):  
Health Information ◽  
Clinical Characteristics ◽  
Digital Health ◽  
Relative Rate ◽  
Limited Information ◽  
Self Assessment ◽  
Ocular Symptoms ◽  
Medical Evaluation ◽  
Predominantly Female ◽  
Remote Care

Background Patient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice. Objective The aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19–related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools. Methods This study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)–driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19–related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician. Results During the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department. Conclusions Our results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19.

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