Dr. Gartsman

What’s New in Shoulder and Elbow Surgery

noemail@drgartsman.com — Mon, 01 May 2006 14:00:00 GMT

The sources for this annual update on shoulder and elbow surgery were presentations and symposia at meetings of The American Orthopaedic Society for Sports Medicine (Specialty Day, February 26, 2005, Washington, DC), the Arthroscopy Association of North America (Specialty Day, February 26, 2005, Washington, DC; Twenty-fourth Annual Meeting, May 12-15, 2005, Vancouver, British Columbia, Canada; and Twenty-third Fall Course, December 2-4, 2004, Palm Desert, California), the American Academy of Orthopaedic Surgeons (Seventy-second Annual Meeting, February 23-27, 2005, Washington, DC), the Orthopaedic Research Society (Fifty-first Annual Meeting, February 20-23, 2005, Washington, DC), the American Shoulder and Elbow Surgeons (Twenty-first Open Meeting, Specialty Day, February 26, 2005, Washington, DC; and Twenty-first Annual Meeting, September 29-October 2, 2004, New York, NY) and the American Orthopaedic Association (118th Annual Meeting, June 22-25, 2005, Huntington Beach, California).

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1-May-06 9:00 AM

Adhesive Capsulitis

noemail@drgartsman.com — Fri, 17 Jun 2005 21:00:00 GMT

I feel that the cause of your pain is a condition called Adhesive Capsulitis or Frozen Shoulder. This is a common shoulder problem that affects thousands of people every year. We do not know the cause of frozen shoulder. It does not seem to result from an injury. While some people relate the onset of their pain to an injury or illness, many more say the problem began out of the blue, without any cause. Pain may start suddenly or begin slowly. Pain and stiffness in the shoulder increase. Often patients report difficulty with sleep as the shoulder is particularly painful at night. Reaching up to get items off shelves, reaching behind the back to tuck in a shirt or blouse become difficult or impossible. Adhesive capsulitis is not a disease or aging. Most patients are between the ages of 40 and 60. The condition does not increase as you get older. Let me emphasize that this is a condition, not an injury. Like any condition it has a beginning, a middle and an end. You know the...

17-Jun-05 4:00 PM

Radiographic comparison of pegged and keeled glenoid

Wed, 18 May 2005 22:00:00 GMT

Glenoid loosening is one reason for failure of tota shoulder arthroplasty. Several factors, including radiographic lucency, have been shown to be associated with glenoid loosening. The purpose of this study was to assess the correlation between glenoid design and immediate radiographic lucency in a prospective randomized clinical trial. Total shoulder arthroplasty was performed in 43 patients over a 2-year period. Twenty-three patients were randomized into the keel group and twenty patients into the pegged group. Postoperative radiographs obtained within 6 weeks of surgery were evaluated by 3 raters to determine glenoid lucency. On a scale from 0 (no lucency) to 5 (gross lucency and component loosening), the rate of lucency was 39% (9/23) in the keeled components, which was significantly higher than the rate of 5% (1/20) observed in the pegged components (P = .026). Patient age, gender,and glenoid size did not significantly affect glenoid component lucency (P > .05). The consistency reliability among raters was 0.87,and the intertester reliability was 0.87. Pegged glenoid components have less radiographic lucency when compared with keeled glenoid components in the immediate postoperative period. (J Shoulder Elbow Surg 2005;14:252-257.)

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18-May-05 5:00 PM

The relationship among strength and mobility measures and self-report outcome scores in persons after rotator cuff repair surgery:Impairment measures are not enough

Thu, 31 Mar 2005 13:00:00 GMT

Until recently, few investigators challenged the pre-vailing medical view of health. Medicine perceived health as an observable, biologic fact, and the goal of medical assessment was to objectively evaluate the body’s status. Because patient reports of health status are subjective, they were considered unreliable and unscientific. The use of self-reports to evaluate health and health outcomes, however, has burgeoned in the last 10 to 20 years, as has the authority assigned to patients’ evaluations. Sullivan 14 described this move toward a “new subjective medicine” as a change in medicine’s focus from patients’ bodies to patients’ lives. In the current milieu, self-reported perceptions of health, function, and health-related quality of life (of-ten called patient-centered outcomes) are prominent. These outcomes have authority not in spite of their subjectivity but because of their subjectivity. The inter-est of health policy agents and third-party insurers in health care value and cost-effectiveness may have been at the root of the shift toward patient-centered outcomes.14

31-Mar-05 8:00 AM

Specialty Update: What’s New in Shoulder and Elbow Surgery (2005)

Tue, 01 Feb 2005 17:00:00 GMT

Sources The sources for this annual update on shoulder and elbow surgery were presentations and symposia at meetings of the American Shoulder and Elbow Surgeons (October 8 through 11, 2003, and March 13, 2004), the Arthroscopy Association of North America (November 13 through 16, 2003; March 13, 2004; and April 23 through 25, 2004), the Orthopaedic Re-search Society (March 6 through 9, 2004), the American Academy of Orthopaedic Surgeons (March 9 through 13, 2004), the American Orthopaedic Society for Sports Medi-cine (March 13, 2004), and the American Orthopaedic Asso-ciation (June 23 through 26, 2004). Shoulder Rotator Cuff Basic Science Zuckerman discussed the early work on cartilage-derived morphogenetic protein-2 (CDMP-2). Rat tendon repairs that had been treated with CDMP-2 were stronger than untreated repairs at four weeks. Dines discussed his initial investigations involving platelet-derived growth factor (PDGF) and insulin-like growth factor-1...

1-Feb-05 11:00 AM

Development of a Flexilevel Scale for use with computer adaptive testing for assessing shoulder function

Tue, 01 Feb 2005 14:45:00 GMT

In a 5-year study, a self-report measure of shoulder function—the Flexilevel Scale of Shoulder Function (FLEX-SF)—was developed by use of item response the-ory. A large pool of candidate items (N 68) was developed. A questionnaire that included the 68 items, another scale of shoulder function, and clinical and demographic questions were administered to 400 per-sons with shoulder complaints. Patients’ responses to the 68 items were calibrated by use of Andrich’s rat-ing scale model. Thirty-three items were selected from the pool and subdivided into three overlapping testlets targeting low, medium, and high shoulder function. A table translates raw scores on testlets to a common mathematical metric. The validity and reliability of the FLEX-SF was evaluated in a longitudinal study of 199 patients. The FLEX-SF scores were highly reliable and exhibited excellent validity (including responsiveness). We report on a simulation of a computer-adaptive test of shoulder function. This simulation is based on the developmental items we tested for use in the FLEX-SF. The results indicate that greater measurement effi-ciency can be achieved with a computer-adaptive test format. (J Shoulder Elbow Surg 2005;14:90S-94S.)

1-Feb-05 8:45 AM

Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: A prospective, randomized study of one-year outcomes

Tue, 31 Aug 2004 14:00:00 GMT

All other aspects of the surgical and postsurgical treatment were identical. We included patients with full-thickness tears limited to the supraspinatus tendon and a type 2 acromion. We excluded patients with prior surgery, those with larger tears involving two or more tendons, those with a type 1 or 3 acromion, those with workers’ compensation claims, and those who had concomitant procedures (labral repair, acromioclavicular joint resection) There were 47 patients in group 1 and 46 in group 2. Minimum follow-up was 1 year (mean, 15.6 3.3 months). We recorded the American Shoulder and Elbow Surgeons (ASES) shoulder scores preoperatively and postoperatively. There was no statistical difference in postoperative ASES scores between group 1 (91.5 10.3) and group 2 (89.2 15.1) (P .392). The change in ASES score over time did not differ between the two groups (61.1 vs 60.2, P .363). In conclusion, within the parameters described above, arthroscopic subacromial decompression does not appear to change the functional outcome after arthroscopic repair of the rotator cuff. (J Shoulder Elbow Surg 2004;13:424–6.)... (download full pdf article)

31-Aug-04 9:00 AM

Outcome Expectancies, Functional Outcomes, and Expectancy Fulfillment for Patients With Shoulder Problems

Wed, 04 Feb 2004 14:00:00 GMT

Methods: Patients (n 199) treated for shoulder problems at one orthopedic surgeon’s office completed a baseline survey comprised of measures of outcome expectancies, shoulder function, health status, and demographics. At 1 month, 2 months, and 3 months, patients completed a mailed follow-up survey comprised of all baseline measures except demographic variables. At 3 months, a measure of expectancy fulfillment was added. A general linear modeling approach was used to assess the significance and effect size of 1) outcome expectancies on changes in shoulder function; and (2) outcome expectancies, shoulder function changes, and their interaction on perceptions of expectancy fulfillment. Results: Outcome expectancies significantly predicted changes in shoulder function and accounted for 10% of the variance in functional improvement. The improvement difference between patients with high expectancies compared with those with low expectancies was clinically relevant (4.57 points), as it was greater than the minimal clinically important difference (3.02 points). Outcome... (download full pdf article)

4-Feb-04 8:00 AM

Specialty Update: What’s New in Shoulder and Elbow Surgery (2004)

Sun, 04 Jan 2004 15:00:00 GMT

Shoulder Rotator Cuff Basic Science Kelly compared the muscle-firing patterns in both symptomatic and asymptomatic patients who had two-tendon rotator cuff tears. Asymptomatic patients demonstrated increased firing of the intact subscapularis, whereas symptomatic patients continued to rely on torn rotator cuff tendons and scapular muscle substitution, resulting in compromised function. Kalandiak compared the in vivo kinematics of painless shoulders that had massive rotator cuff tears with those of normal shoulders with use of cinefluoroscopy. Only one patient demonstrated normal ball and socket kinematics; most demonstrated increased scapulothoracic motion during initial forward elevation. The mean active forward elevation was 129° when performed against no resistance but only 86° when performed against resistance. Rubino studied the progression of fatty infiltration by harvesting the supraspinatus muscle bilaterally at various timeintervals following unilateral surgical detachment of...

4-Jan-04 9:00 AM

Specialty Update: What’s New in Shoulder and Elbow Surgery (2003)

Fri, 03 Jan 2003 15:00:00 GMT

Shoulder Rotator Cuff Basic Science Several studies have employed sophisticated animal models to investigate rotator cuff repair and healing. Coleman reported on a chronic rotator cuff injury and repair model involving sheep. Infraspinatus contractile forces and histological findings were evaluated at various times following either immediate or delayed tendon repair. Longer delays to repair led to greater decreases in force and more modest recovery following repair. Muscle biopsies confirmed progressive fatty infiltration that was partially reversed after tendon repair in the group with a six-week delay before repair but not in the group with an eighteen-week delay before repair. This model has important implications regarding the recovery of strength following the repair of chronic rotator cuff tears. Rodeo presented a study on growth factor-enhanced rotator cuff tendon-bone healing in a sheep model. Histological analysis demonstrated greater new-bone and fibrovascular tissue...

3-Jan-03 9:00 AM