Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequen...Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.展开更多
Objective: To explore the clinical efficacy of shoulder arthroscopic one-knot-two-wire suture bridge technique in the treatment of small and medium-sized rotator cuff tears. Methods: The clinical data of 22 patients w...Objective: To explore the clinical efficacy of shoulder arthroscopic one-knot-two-wire suture bridge technique in the treatment of small and medium-sized rotator cuff tears. Methods: The clinical data of 22 patients with small and medium-sized rotator cuff injuries treated with the one-knot-two-wire suture bridge technique from February 2022 to June 2023 in the Department of Orthopaedics of Jingzhou Hospital Affiliated to Yangtze University were retrospectively analysed, among which 14 cases were male and 8 cases were female;the age ranged from 35 to 68 years old, with an average of (50.86 ± 10.80) years old. All cases underwent an MRI examination of the shoulder joint to understand the type and degree of injury. The duration of the disease ranged from 120 to 166 d, with a mean of (141.23 ± 13.46) d. The evaluation of the operation time, intraoperative bleeding, visual analogue scale (VAS) of pain, Constant-Murley score and Sugaya grading of shoulder MRI were performed at the last follow-up. Results: All 22 patients were followed up for 12 - 18 months, with a mean of (14.68 ± 1.89 d). The operation time was 38 - 58 min, mean (48.18 ± 5.92) min;intraoperative bleeding was 5 - 15 mL, mean (10.00 ± 3.45) mL. All patients achieved normal healing without re-tear, vascular and nerve injury, incision infection, anchor nail loosening and dislodgement and other complications. At the last follow-up, both shoulders were normal in shape and symmetrical on both sides. The VAS score was 0 - 1.2 points, with an average of 0.61 ± 0.42 points, and the Constant-Murley score was 70 - 98 points, with an average of 86.09 ± 8.56 points. The Sugaya classification of MRI examination was 17 cases of grade I, 4 cases of grade II, and 1 case of grade III. Conclusion: One-knot-two-wire suture bridge technique is used for the treatment of small and medium-sized rotator cuff tears with short operative time, low bleeding, and good clinical outcome.展开更多
Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-ope...Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-open subpectoral tenodesis(ST).We hypothesized that the clinical and structural results after HAT and ST are similar.Methods:We included 40 patients with rotator cuff tear and LHB tendinopathy.Twenty patients(7 women and 13 men;mean age:57.9 years;range:56-63 years)were treated using HAT,and 20 patients(8 women and 12 men;mean age:58.5 years;range:55-64 years)were treated using ST.Functional evaluation was performed preoperatively and at 6 weeks,6 months,and 1 year after surgery,using the Constant Murley Score and Simple Shoulder Test scores;the LHB was evaluated using the LHB score.A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.Results:The postoperative total and pain subscale’s Constant scores were significantly higher in the ST group.Moreover,2 LHB score values were significantly different between the groups.The postoperative LHB total score in the ST and HAT groups averaged 86.9±4.1(mean±SD)points and 73.3±6.4 points,respectively.The Pain/Cramps subscale in the ST and HAT groups averaged 47.1±5.9 and 33.2±4.6 points,respectively.The 2 groups showed no difference in Visual Analogue Scale values(5.5 in the HAT group;5.8 in the ST group)postoperatively.One patient in the HAT group reported a secondary onset of Popeye deformity.Conclusion:Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results,but the ST group was associated with better postoperative clinical outcomes.展开更多
Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help ...Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help of the PubMed database. Of the articles searched through, three have been chosen to specifically address topics of interest concerning the factors affecting arthroscopic vs mini-open RCR surgical approaches. Discussion: As we continue to progress down the line of factors impacting a clinician’s decision making, we begin to see how postoperative management is unchanged. Tear severity lacks sufficient evidence to base a decision on, but financial, educational, and logistical factors are proven to play a significant role in this decision. Conclusion: As of right now it seems that mini-open RCR is the most cost and time efficient method, especially amongst non-fellowship trained surgeons or ones with lower volume of shoulder scopes. However, further studies should be done to examine cost and efficiency in Sport Medicine fellowship trained orthopedic surgeons to validate these findings.展开更多
Arthroscopic superior capsular reconstruction is an innovative technique for the irreparable rotator cuff tears,but spontaneous pneumothorax after surgery is very rare.The present case was a 66-year-old female with ir...Arthroscopic superior capsular reconstruction is an innovative technique for the irreparable rotator cuff tears,but spontaneous pneumothorax after surgery is very rare.The present case was a 66-year-old female with irreparable rotator cuff tears of the right shoulder,treated with the arthroscopic shoulder superior capsular reconstruction.The general anesthesia and operation went smoothly,but the patient experienced stuffiness in the chest and shortness of breath after recovery from anesthesia.Thoracic CT scans showed spontaneous pneumothorax in the right side,which was successfully treated by the conservative treatments(oxygen therapy)according to multidisciplinary team.Prompt and accurate early-stage diagnosis is necessary in controlling postoperative complications and standardized treatment is the key to relieve the suffering.Spontaneous pneumothorax after arthroscopic shoulder surgery has been rarely reported in previous literatures.展开更多
文摘Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
文摘Objective: To explore the clinical efficacy of shoulder arthroscopic one-knot-two-wire suture bridge technique in the treatment of small and medium-sized rotator cuff tears. Methods: The clinical data of 22 patients with small and medium-sized rotator cuff injuries treated with the one-knot-two-wire suture bridge technique from February 2022 to June 2023 in the Department of Orthopaedics of Jingzhou Hospital Affiliated to Yangtze University were retrospectively analysed, among which 14 cases were male and 8 cases were female;the age ranged from 35 to 68 years old, with an average of (50.86 ± 10.80) years old. All cases underwent an MRI examination of the shoulder joint to understand the type and degree of injury. The duration of the disease ranged from 120 to 166 d, with a mean of (141.23 ± 13.46) d. The evaluation of the operation time, intraoperative bleeding, visual analogue scale (VAS) of pain, Constant-Murley score and Sugaya grading of shoulder MRI were performed at the last follow-up. Results: All 22 patients were followed up for 12 - 18 months, with a mean of (14.68 ± 1.89 d). The operation time was 38 - 58 min, mean (48.18 ± 5.92) min;intraoperative bleeding was 5 - 15 mL, mean (10.00 ± 3.45) mL. All patients achieved normal healing without re-tear, vascular and nerve injury, incision infection, anchor nail loosening and dislodgement and other complications. At the last follow-up, both shoulders were normal in shape and symmetrical on both sides. The VAS score was 0 - 1.2 points, with an average of 0.61 ± 0.42 points, and the Constant-Murley score was 70 - 98 points, with an average of 86.09 ± 8.56 points. The Sugaya classification of MRI examination was 17 cases of grade I, 4 cases of grade II, and 1 case of grade III. Conclusion: One-knot-two-wire suture bridge technique is used for the treatment of small and medium-sized rotator cuff tears with short operative time, low bleeding, and good clinical outcome.
文摘Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-open subpectoral tenodesis(ST).We hypothesized that the clinical and structural results after HAT and ST are similar.Methods:We included 40 patients with rotator cuff tear and LHB tendinopathy.Twenty patients(7 women and 13 men;mean age:57.9 years;range:56-63 years)were treated using HAT,and 20 patients(8 women and 12 men;mean age:58.5 years;range:55-64 years)were treated using ST.Functional evaluation was performed preoperatively and at 6 weeks,6 months,and 1 year after surgery,using the Constant Murley Score and Simple Shoulder Test scores;the LHB was evaluated using the LHB score.A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.Results:The postoperative total and pain subscale’s Constant scores were significantly higher in the ST group.Moreover,2 LHB score values were significantly different between the groups.The postoperative LHB total score in the ST and HAT groups averaged 86.9±4.1(mean±SD)points and 73.3±6.4 points,respectively.The Pain/Cramps subscale in the ST and HAT groups averaged 47.1±5.9 and 33.2±4.6 points,respectively.The 2 groups showed no difference in Visual Analogue Scale values(5.5 in the HAT group;5.8 in the ST group)postoperatively.One patient in the HAT group reported a secondary onset of Popeye deformity.Conclusion:Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results,but the ST group was associated with better postoperative clinical outcomes.
文摘Objective: To further understand what factors should be considered when deciding to do mini-open versus arthroscopic rotator cuff repair. Methods: A systematic literature search on the computer was done with the help of the PubMed database. Of the articles searched through, three have been chosen to specifically address topics of interest concerning the factors affecting arthroscopic vs mini-open RCR surgical approaches. Discussion: As we continue to progress down the line of factors impacting a clinician’s decision making, we begin to see how postoperative management is unchanged. Tear severity lacks sufficient evidence to base a decision on, but financial, educational, and logistical factors are proven to play a significant role in this decision. Conclusion: As of right now it seems that mini-open RCR is the most cost and time efficient method, especially amongst non-fellowship trained surgeons or ones with lower volume of shoulder scopes. However, further studies should be done to examine cost and efficiency in Sport Medicine fellowship trained orthopedic surgeons to validate these findings.
文摘Arthroscopic superior capsular reconstruction is an innovative technique for the irreparable rotator cuff tears,but spontaneous pneumothorax after surgery is very rare.The present case was a 66-year-old female with irreparable rotator cuff tears of the right shoulder,treated with the arthroscopic shoulder superior capsular reconstruction.The general anesthesia and operation went smoothly,but the patient experienced stuffiness in the chest and shortness of breath after recovery from anesthesia.Thoracic CT scans showed spontaneous pneumothorax in the right side,which was successfully treated by the conservative treatments(oxygen therapy)according to multidisciplinary team.Prompt and accurate early-stage diagnosis is necessary in controlling postoperative complications and standardized treatment is the key to relieve the suffering.Spontaneous pneumothorax after arthroscopic shoulder surgery has been rarely reported in previous literatures.
