Effect of Standardized Pain Management Combined with Clinical Teaching on the Adverse Reactions and Nursing Efficacy in Patients with Rotator Cuff Injury after Surgery

To study the effect of standardized pain management combined with clinical teaching on the adverse reactions and nursing efficacy in patients with rotator cuff injury after surgery. 104 patients with rotator cuff injury treated in our hospital (April 2019-April 2020) were chosen as study subjects and randomly split into experimental group (n=52) and control group (n=52). After all the patients received arthroscopic revision surgery, the experimental and control group received standardized pain management combined with clinical teaching and routine pain management postoperatively, respectively. After that, the effect of different pain management modes on the adverse reactions and nursing efficacy in patients with rotator cuff injury after surgery was analyzed by comparing various indexes between two groups. No obvious differences in sex ratio, average age, mean BMI, injury severity, injury cause, education level and residence were found between two groups (P > 0.05); no obvious differences in numeric rating scale (NRS) scores at T1 were found between the two groups (P > 0.05), and the NRS scores at T2 and T3 in experimental group were obviously lower compared with control group (P < 0.001); no obvious differences in the angle of shoulder abduction, anterior flexion and extension were found between the two groups before intervention (P > 0.05), and angle of shoulder abduction, anterior flexion and extension in experimental group at 3 and 6 months after surgery was obviously greater compared with control group (P < 0.001); no obvious differences in the constant shoulder scores were found between the two groups before the intervention (P > 0.05), and the constant shoulder scores in experimental group at 3 and 6 months after surgery were obviously higher compared with control group (P < 0.001); the nursing satisfaction in experimental group was obviously higher compared with control group (P < 0.05); the clinical effective rate in experimental group was obviously higher compared with control group (P < 0.05); the incidence of adverse reactions in experimental group after surgery was obviously lower compared with control group (P < 0.05). Standardized pain management combined with clinical teaching in treating rotator cuff injury of patients can significantly reduce shoulder pain severity and improve shoulder mobility, with significant efficacy and high safety, which is worthy of application and promotion.

1419 Targeted Use of Physiotherapy Resources in The COVID Era: How Does Face to Face Physiotherapy Compare with Simple Advice Sheets After Manipulation Under Anaesthetic for Frozen Shoulder?

Introduction This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2). Method A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate. Results The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The effect of physiotherapy was significant (p &lt; 0.001). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8). Conclusions We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist during and after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.

18 Manipulation Under Anaesthetic for Frozen Shoulder: Does Post-Operative Supervised Physiotherapy Affect the Outcome?

Introduction This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2). Method A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate. Results The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8). Conclusions We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

Background: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). Purpose: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. Results: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 ( P = .016). No significant differences were found between groups regarding clinical shoulder scores ( P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. Conclusion: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.

Comparison of Treatment Outcomes After Arthroscopic Repair and Biceps Tenotomy in Patients with Isolated Slap Lesions

Objective: We compared the clinical outcomes after arthroscopic repair to those after biceps tenotomy in patients with isolated superior labrum anterior posterior (SLAP) Type 2-3 lesions. Methods: A total of 48 patients with isolated SLAP Type 2-3 lesions, who underwent either arthroscopic repair (n=024) or tenotomy (n=24) were included in the study. CONSTANT shoulder scores in the postoperative 40th month were compared between both groups. Tenotomy was performed for the second time in 6 patients who did not benefit from arthroscopic repair, and their CONSTANT scores estimated before and 12 months after tenotomy were compared. Results: The clinical outcomes were evaluated in the arthroscopic repair group. Preoperative and postoperative CONSTANT scores were 43.87 (8.32), and 71.41 (9.75) (p<0. 001), respectively. In the tenotomy group pre-, and postoperative CONSTANT scores were 40.25(8.63), and 90.04 (4.04) (p<0.001), respectively. There was not a significant difference between the two groups in terms of the preoperative scores (p=0.146), however, the comparison of the postoperative scores revealed a significant difference (p<0.001). The mean CONSTANT score was 50.3 (±5.64) at the end of 27th month, and the mean postoperative CONSTANT score was 86.8 (±7.16) at the 12th month in six patients whose complaints did not resolve and underwent repeat arthroscopic tenotomy (p<0.001). Conclusion: In our opinion, there is no criterion for repair or tenotomy in isolated SLAP lesions. In these patients, tenotomy may be preferred in the first place because it results in more favourable outcomes compared to repair. The cause of the pain that persists after repair of the SLAP lesion should not be considered as an incorrect, inadequate repair or a complication. In the first place, intolerable biceps tendinitis should be considered.

Modified Arthroscopic Latarjet Procedure: Suture-button Fixation will not Cause Obvious Increasement of Superior Instability at 5-Year Follow-up

Background: Whether coracoacromial ligament (CAL) release during Latarjet procedure will increase superior instability of shoulder joint postoperatively remains controversial. This study aims to observe changes in the acromiaohumeral distance (AHD) of patients who underwent modified double-button Latarjet procedure and provide evidence to address the issue.Methods: A retrospective analysis was conducted among 155 patients who underwent modified double-button Latarjet procedure in our department from 2013 to 2015. Preoperative CT scan of bilateral shoulders were used for glenoid defect evaluation. CT scans were performed immediately after operation (PO 0) and during the follow-up at 6, 36, and 60 months postoperatively (POM) to observe the healing and remodeling of the graft, and AHD was measured. The intact sides were set as control group. VAS and objective shoulder scores, including ASES, ROWE, and Walch-Duplay scores, were recorded at each time point.Results: A total of 104 cases who met the criteria completed follow up. The average follow-up time was 62.6 ± 2.4 months. Compared with preoperative conditions, the function scores of the shoulders were significantly improved at the last follow-up. There were no statistical differences of the AHD values between bilateral shoulders preoperatively. The AHD values at PO 0 and POM 6 were significantly higher than those of intact side (p < 0.05). The AHD values at POM 36 and 60 were slightly higher than those of intact side and the differences were statistically significant (p < 0.05).Conclusions: The modified double-button Latarjet procedure not only offers satisfactory therapeutic effect but also will not cause obvious superior instability at the 5-year follow-up.

Pectoralis minor syndrome: diagnosis with Botulinum injection and treatment with tenotomy – a prospective case series

Background Pectoralis minor syndrome involves pain, paraesthesia and weakness in the arm due to compression of the brachial plexus passing beneath pectoralis minor; this paper reports the results of a single centre’s treatment pathway in affected patients. Methods During a four-year period, patients exhibiting symptoms of pectoralis minor syndrome without significant improvement following physiotherapy proceeded to Botulinum injection. Those with good response to injection but subsequent recurrence of symptoms were offered pectoralis minor tenotomy. Oxford shoulder Scores were collected at baseline and after interventions. Results Twenty-one patients received Botulinum injection; at six weeks following injection, mean change in Oxford Shoulder Score was +12.4, with only one patient reporting a worsening of symptoms. Of the 17 patients with clinically significant response to injection, 12 have subsequently undergone tenotomy; three months following tenotomy, mean change in Oxford Shoulder Score from baseline was +22.3. Improvement was maintained in all patients at prolonged follow-up (average 20 months post-tenotomy). Discussion This pathway has shown to be extremely effective in patients not responding to first-line treatment for pectoralis minor syndrome, with 85% of patients post-injection and 100% of patients post-tenotomy showing significant (greater than published minimal clinically important difference value of six points) improvements in Oxford Shoulder Score, maintained at follow-up.

Reconstruction of irreparable rotator cuff tears with an acellular dermal matrix in elderly patients without joint arthritis

Background Reverse shoulder arthroplasty is the mainstay of treatment for symptomatic irreparable rotator cuff tears in elderly patients without arthritis. However, this treatment incurs significant costs and is a major surgical undertaking. This study explores an alternative that involves the reconstruction of irreparable rotator cuff tears using an acellular dermal matrix in elderly patients without established joint arthritis. Methods We prospectively evaluated the reconstruction of massive irreparable rotator cuff tears in 21 patients aged 68 years and over without radiographic glenohumeral joint osteoarthritis in whom conservative management had failed. A human dermal acellular matrix graft was used as a bridging graft for reconstruction. Pain scores, Oxford Shoulder Scores and ranges of movement were all assessed preoperatively and postoperatively. The mean follow-up period was 5.8 years (range 2.6 to 8.9 years). Results Statistically significant ( p < 0.05) improvements were observed in Oxford Shoulder Scores (mean preoperative score, 21; mean postoperative score, 46), pain scores (mean preoperative score, 6; mean postoperative score, 0) and ranges of movement. Patients also reported a high satisfaction rate with the procedure. Discussion Human tissue matrix allografts could serve as a suitable option for the treatment of elderly patients with massive irreparable rotator cuff tears without arthritis.