Concomitant glenohumeral injuries in patients with distal clavicle fractures undergoing arthroscopic-assisted surgery: a systematic review

Background To determine the incidence of concomitant intra-articular glenohumeral injuries in patients undergoing surgical management from distal clavicle fractures (DCF) with shoulder arthroscopy and their impact on outcome. Methods This systematic review was conducted following the PRISMA guidelines. PubMed, EMBASE, and Virtual Health Library databases were accessed in October 2021. All the clinical studies evaluating the surgical management of DCF and using concomitant intra-operatory shoulder arthroscopy were included. Studies that did not specify the concomitant injury type were not eligible. Data from the incidence of intra-articular glenohumeral injuries, injury type, length of the follow-up, and clinical outcomes were retrieved. The quantitative content assessment was performed using the STROBE statement checklist. Evaluation of the publication bias of the included studies was performed using the risk of bias assessment tool for systematic reviews. Results Data from five retrospective and five prospective cohort studies were analyzed. Eight of the included studies were conducted on patient cohorts with Neer type II injuries. Data pooling revealed a mean of 17.70% of concomitant glenohumeral injuries, whereas 84.21% of them required additional surgical management (Table 1). Rotator cuff injuries, labral tears, and biceps pulley lesions were the most common concomitant injuries. Conclusion Preoperative MRI or diagnostic arthroscopy to evaluate glenohumeral associated injuries to DCF should be recommended.

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

BackgroundThe occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database.MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.ResultsA total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson’s disease, prior shoulder arthroscopy, and blood transfusion.ConclusionsIt is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

Arthroscopic Resection of Humeral Enchondroma

Enchondromas are common benign bone tumors. They are often found incidentally and usually do not require any treatment other than clinical surveillance. Signs of lesion progression or nontolerable pain are criteria for surgical resection. We present a case of a 44-year-old woman with long-lasting shoulder pain, diagnosed with enchondroma. Imaging studies showed an enchondroma near the great tuberosity. Shoulder arthroscopy made it possible to diagnose and treat an SLAP lesion as well as to resect by curettage and shaving through the subacromial lateral portal. One year after surgery, the patient had significant pain relief and improved shoulder function. Shoulder arthroscopy seems to be a safe and suitable technique for resection of small-sized humeral enchondromas, with the advantage of allowing to treat other possible concomitant shoulder pathologies.

Application of Dexmedetomidine Sedation Combined With Suprascapular Nerve Block and Axillary Nerve Block in Shoulder Arthroscopy, A Randomized Single-Blind Study

Objective: The aim of the present study was to evaluate the anesthetic and analgesic effects of dexmedetomidine combined with suprascapular nerve block and axillary nerve block in shoulder arthroscopy.Methods: A total of 60 patients were randomly divided into the experimental group (DEX group) and the control group (GA group) via a random number table method. Dexmedetomidine sedation combined with suprascapular nerve block and axillary nerve block was used in the DEX group, while general anesthesia with tracheal intubation combined with interscalene brachial plexus block was used in the GA group. The perioperative indexes, intraoperative hemodynamics, cerebral oxygen saturation, and postoperative pain score, as well as any complications, were compared between the two groups.Results: The anesthesia duration (p &lt; 0.05) and postoperative monitoring time (p &lt; 0.05) in the DEX group were significantly shorter than those in the GA group. At most time points during the anesthesia, the cerebral oxygen saturation (p &lt; 0.05) and mean arterial pressure (p &lt; 0.05) in the DEX group were significantly higher than those in the GA group. Additionally, the decrease in the cerebral oxygen saturation and mean arterial pressure in the GA group was significantly higher than that in the DEX group (p &lt; 0.05). The pain score of DEX group 12 h after operation significantly lower than that in the GA group (p &lt; 0.05), and the incidence of postoperative hypoxemia along with nausea and vomiting in the GA group was significantly higher than that in the DEX group (p &lt; 0.05).Conclusion: Dexmedetomidine combined with suprascapular nerve block and axillary nerve block could reduce the incidence of hypoxemia, while the approach demonstrated better hemodynamic stability, fully ensured the cerebral blood perfusion, and exhibited better anesthetic and analgesic effects, meaning it could be safely and effectively applied in shoulder arthroscopy procedures.

An assessment of SLAP type 5 lesions using proton density oblique sagittal imaging in magnetic resonance arthrography

Background Bankart lesions accompany superior labrum anteroposterior (SLAP) lesions; these are called SLAP type 5. Purpose To compare SLAP type 5 lesions using routine magnetic resonance arthrography (MRA) and thin-slice oblique sagittal proton density (PDW) sequences and correlation operation results. Material and Methods In total, 181 patients were admitted with shoulder instability. The study was completed with 44 patients. The presence or absence of isolated Bankart and SLAP type 5 lesions in routine MRA and PDW oblique sagittal images were evaluated separately. Absence of rupture scored 0 points, suspected ruptures scored 1 point, and apparent ruptures scored 2 points. The two scores were compared with the shoulder arthroscopy findings. Results According to the findings in the shoulder arthroscopy, 40 patients had Bankart lesions and 17 patients had accompanying SLAP type 5 lesions. To detect a Bankart lesion, there was no significant difference between routine MRA sequences and PDW oblique sagittal images ( P = 0.061). Routine MRA sensitivity was 95%, specificity 25%, positive predictive value (PPV) 92%, negative predictive value (NPV) 33%, while for PDW oblique sagittal images, sensitivity was 75%, specificity 100%, PPV 100%, and NPV 28.5%. In 8/17 type 5 SLAP lesions, routine MRA detected sensitivity 47%, specificity 92.6%, PPV 80%, and NPV 73.5%; in 14/17 SLAP type 5 lesions, PDW oblique sagittal images detected sensitivity 82%, specificity 100%, PPV 100%, and NPV 90% ( P = 0.015). Conclusion The PDW oblique sagittal images may play a significant role in assessing the anterior and superior extent of the tears.

An unusual case of anteroinferior paralabral cyst with axillary nerve compression: A case report

Paralabral cysts are an uncommon cause of shoulder pain in young adults. Their association with neurological symptoms is seldom reported in the literature. The cysts are believed to develop when there is a labral tear allowing synovial fluid entry into tissues causing one-way valve effect. This case report describes a case of anteroinferior paralabral cyst in a painful shoulder associated with axillary nerve palsy. MRI revealed an anteroinferior labral cyst. Electromyography revealed denervation of deltoid and teres minor muscles. Shoulder arthroscopy was performed with cyst decompression and labral repair. Shoulder function improved gradually and by the end of 1 year, power was back to pre-injury status. Paralabral cysts are a rare entity. When associated with nerve injury, prompt decompression is necessary to prevent irreversible nerve and muscle damage.

Efficacy of intra-articular ketorolac for pain control in arthroscopic surgeries: a systematic review and meta-analysis

Background The current systematic review and meta-analysis aimed to synthesize evidence on the efficacy of intra-articular ketorolac for patients undergoing arthroscopic surgeries. Methods PubMed, Embase, ScienceDirect, and Google Scholar databases were searched for randomized controlled trials assessing the analgesic effect of intra-articular ketorolac for arthroscopic surgery of hip/knee or shoulder joint. Results Six studies were included. Two studies were on shoulder arthroscopy, while others were on knee joint. Meta-analysis revealed that patients receiving intra-articular ketorolac had significantly lower pain scores at 2–4 h (MD: − 0.58 95% CI: − 0.88, − 0.19 I2 = 49% p = 0.002), 6–8 h (MD: − 0.77 95% CI: − 1.11, − 0.44 I2 = 31% p < 0.00001), 12 h (MD: − 0.94 95% CI: − 1.21, − 0.67 I2 = 0% p < 0.00001), and 24 h (MD: − 1.28 95% CI: − 1.85, − 0.71 I2 = 84% p < 0.00001) as compared to the control group (Certainty of evidence: low-moderate). Analysis of three studies revealed a tendency of reduced analgesic consumption in patients receiving intra-articular ketorolac, but the difference did not reach statistical significance (MD: − 0.53 95% CI: − 1.07, 0.02 I2 = 55% p = 0.06). Conclusions Preliminary evidence from a limited number of studies indicates that additional intra-articular ketorolac to multimodal analgesia results in reduced pain scores up to 24 h after arthroscopic surgery. The clinical relevance of small changes in pain scores is debatable. Also, scarce data suggest that consumption of analgesics may not be reduced with intra-articular ketorolac. Since pain scores can be influenced by the primary diagnosis and dose of ketorolac, the results should be interpreted with caution. The certainty of the evidence is low-moderate. There is a need for future RCTs to further strengthen current evidence.