Prognostic Factors in Arthroplasty in the Rheumatoid Shoulder

Total shoulder arthroplasty is commonly considered a good option for treatment of the rheumatoid shoulder. However, when the rotator cuff and glenoid bone stock are not preserved, the clinical outcome of arthroplasty in the rheumatoid patients remains unclear. Aim of the study is to explore the prognostic value of multiple preoperative and peroperative variables in total shoulder arthroplasty and shoulder hemiarthroplasty in rheumatoid patients. Clinical Hospital for Special Surgery Shoulder score was determined at different time points over a mean period of 6.5 years in 66 rheumatoid patients with total shoulder arthroplasty and 75 rheumatoid patients with shoulder hemiarthroplasty. Moreover, radiographic analysis was performed to assess the progression of humeral head migration and glenoid loosening. Advanced age and erosions or cysts at the AC joint at time of surgery were associated with a lower postoperative Clinical Hospital for Special Surgery Shoulder score. In total shoulder arthroplasty, status of the rotator cuff and its repair at surgery were predictive of postoperative improvement. Progression of proximal migration during the period after surgery was associated with a lower clinical score over time. However, in hemiarthroplasty, no relation was observed between the progression of proximal or medial migration during follow-up and the clinical score over time. Status of the AC joint and age at the time of surgery should be taken into account when considering shoulder arthroplasty in rheumatoid patients. Total shoulder arthroplasty in combination with good cuff repair yields comparable clinical results as total shoulder arthroplasty when the cuff is intact

Factors influencing the surgical process during shoulder joint replacement:Time-action analysis of five different prostheses and three different approaches

Background: To evaluate the per-operative process of shoulder joint replacement, time-action analysis can be used.Material/Methods: Forty procedures performed by 7 surgeons with different experience rising 5 different prostheses and 3 different Surgical approaches were analyzed.Results: The surgical procedures showed a large variation in, for example, duration, tasks of team members, and protocol used. The surgical procedure was influenced by several factors, such as the prosthesis used, the surgical approach, the patient's condition, and the experience of the surgeon. Exposure of the glenoid was difficult and several retractors were needed, which were held by an extra assistant or clamped to the table or the surgeon. Two main limitations were seen in all procedures: repeated actions and waiting. Also, five errors could be identified. None of the alignment instruments was completely reliable and they allowed the surgeon to make major errors.Conclusions: Better alignment instruments, pre-operative planning techniques, and operation protocols are needed for shoulder prostheses. The training of resident surgeons should be focused on the exposure phase, the alignment of the humeral head, the exposure of the glenoid, and the alignment of the glenoid. Evaluating the surgical process using time-action analysis can be used to determine the limitations during surgical procedures. Furthermore, it shows the large variation in factors affecting surgical performance, indicating that a system approach is needed to improve surgical outcome.</p

Comparison of High-Grade and Low-Grade Mobilization Techniques in the Management of Adhesive Capsulitis of the Shoulder: Randomized Controlled Trial

AbstractBackground and Purpose. In many physical therapy programs for subjects with adhesive capsulitis of the shoulder, mobilization techniques are an important part of the intervention. The purpose of this study was to compare the effectiveness of high-grade mobilization techniques (HGMT) with that of low-grade mobilization techniques (LGMT) in subjects with adhesive capsulitis of the shoulder. Subjects. One hundred subjects with unilateral adhesive capsulitis lasting 3 months or more and a ≥50% decrease in passive joint mobility relative to the nonaffected side were enrolled in this study. Methods. Subjects randomly assigned to the HGMT group were treated with intensive passive mobilization techniques in end-range positions of the glenohumeral joint, and subjects in the LGMT group were treated with passive mobilization techniques within the pain-free zone. The duration of treatment was a maximum of 12 weeks (24 sessions) in both groups. Subjects were assessed at baseline and at 3, 6, and 12 months by a masked assessor. Primary outcome measures included active and passive range of motion and shoulder disability (Shoulder Rating Questionnaire [SRQ] and Shoulder Disability Questionnaire [SDQ]). An analysis of covariance with adjustments for baseline values and a general linear mixed-effect model for repeated measurements were used to compare the change scores for the 2 treatment groups at the various time points and over the total period of 1 year, respectively. Results. Overall, subjects in both groups improved over 12 months. Statistically significant greater change scores were found in the HGMT group for passive abduction (at the time points 3 and 12 months), and for active and passive external rotation (at 12 months). A statistically significant difference in trend between both groups over the total follow-up period of 12 months was found for passive external rotation, SRQ, and SDQ with greater change scores in the HGMT group. Discussion and Conclusion. In subjects with adhesive capsulitis of the shoulder, HGMTs appear to be more effective in improving glenohumeral joint mobility and reducing disability than LGMTs, with the overall differences between the 2 interventions being small. [Vermeulen HM, Rozing PM, Obermann WR, et al. Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial.]</jats:p

Factors influencing the surgical process during shoulder joint replacement: Time-action analysis of five different prostheses and three different approaches

Background: To evaluate the per-operative process of shoulder joint replacement, time-action analysis can be used. Material/Methods: Forty procedures performed by 7 surgeons with different experience rising 5 different prostheses and 3 different Surgical approaches were analyzed. Results: The surgical procedures showed a large variation in, for example, duration, tasks of team members, and protocol used. The surgical procedure was influenced by several factors, such as the prosthesis used, the surgical approach, the patient's condition, and the experience of the surgeon. Exposure of the glenoid was difficult and several retractors were needed, which were held by an extra assistant or clamped to the table or the surgeon. Two main limitations were seen in all procedures: repeated actions and waiting. Also, five errors could be identified. None of the alignment instruments was completely reliable and they allowed the surgeon to make major errors. Conclusions: Better alignment instruments, pre-operative planning techniques, and operation protocols are needed for shoulder prostheses. The training of resident surgeons should be focused on the exposure phase, the alignment of the humeral head, the exposure of the glenoid, and the alignment of the glenoid. Evaluating the surgical process using time-action analysis can be used to determine the limitations during surgical procedures. Furthermore, it shows the large variation in factors affecting surgical performance, indicating that a system approach is needed to improve surgical outcome

A comparison of two portable dynamometers in the assessment of shoulder and elbow strength

Objectives To compare the practical applicability and measurement properties of a hand-held dynamometer (MicroFET2 (R)) and a fixed dynamometer (Isobex2.1 (R)) in determining isometric strength of the shoulder and elbow. Design Muscle strength in four directions (glenohumeral abduction, external rotation and elevation and elbow flexion) was measured using both instruments by two examiners. The assessments were repeated by one of the examiners 3 days later. Setting Leiden University Medical Center. Participants Twenty healthy volunteers. Main outcome measures Time to complete a set of measurements and discomfort were recorded. To determine intra- and inter-observer reliability, intra-class correlation coefficients (ICCs), limits of agreement and smallest detectable difference were computed. Results The time to complete a set of measurements was significantly shorter for the hand-held dynamometer than for the fixed dynamometer in both examiners. The number of subjects reporting discomfort was similar with the two dynamometers. Except for glenohumeral abduction, the forces measured using the hand-held dynamometer were significantly higher than those when using the fixed dynamometer in both examiners. The intra- and inter-observer ICCs for the four directions ranged from 0.82 to 0.98 for both dynamometers. However, the mean differences between replications and the wide limits of agreement suggest substantial bias and variability. For example, for the measurement of shoulder abduction with the fixed dynamometer by one tester (190 N), the results suggest that on 95% of occasions the second tester's measurement would be between 158 and 275 N. Conclusions Although time taken and discomfort should be considered in the selection of dynamometers, due consideration should be given to the significant differences in absolute results. Neither the dynamometers nor the testers can be considered interchangeable. Both the intra- and inter-observer reliability of the two dynamometers were similar, yet both demonstrated systematic bias and variability in the measurements obtained. I (c) 2004 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved