Two-hundred and sixty-nine shoulders in 223 patients with a diagnosis of primary frozen shoulder were studied. The main outcome measure was the Oxford shoulder score. The mean follow-up from symptom onset was 4.4 years (range, 2-20 years). The mean age at symptom onset was 53.4 years; with women affected more commonly than men (1.6:1.0).Twenty percent of patients reported bilateral symptoms, but there were no recurrent cases. In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. The majority of these persistent symptoms were mild (94%), with pain being the most common complaint. Only 6% had severe symptoms with pain and functional loss.Those with the most severe symptoms at condition onset had the worst long-term prognosis, P

Long term outcome of frozen shoulder

Background In professional baseball pitchers, pitching biomechanics have not been examined for the slider, and the only known study for the curveball and changeup examined limited kinetics. Moreover, no known studies have investigated pitching biomechanics between strikes and balls. Purpose/Hypothesis: The purpose was to compare pitching biomechanics in professional baseball pitchers among the fastball, slider, curveball, and changeup and between balls and strikes. It was hypothesized that pitching kinematics and kinetics would be similar among the slider, fastball, and curveball; shoulder and elbow forces and torques would be significantly lower in the changeup; and pitching biomechanics would be similar between balls and strikes. Study design Controlled laboratory study. Methods Among 18 professional baseball pitchers, 38 reflective markers were positioned on the body and each player threw 32 to 40 maximum effort pitches-consisting of the fastball, curveball, slider, and changeup pitch types-from a regulation mound to a catcher. The markers were tracked by 18 high-speed 180-Hz cameras, and data were processed and run through a computer program to calculate 25 kinematic parameters, 7 kinetic parameters, and 4 temporal parameters for each pitch type and for both strikes and balls. A 2-way repeated-measures analysis of variance ( P Results During arm cocking, elbow varus torque was 8% to 9% greater in the fastball and slider compared with the changeup, shoulder horizontal adduction torque was 17% to 20% greater in the slider and curveball compared with the changeup, and shoulder anterior force was 13% greater in the curveball compared with the changeup. During arm deceleration, elbow flexor torque was 9% to 14% greater in the fastball compared with the curveball and changeup, and elbow and shoulder proximal forces were 10% to 14% greater in the fastball, slider, and curveball compared with the changeup. At ball release, forward trunk tilt was 16% to 19% greater in the fastball and curveball compared with the changeup, contralateral trunk tilt was 26% to 41% greater in the curveball compared with the slider and changeup, knee flexion was 18% greater in the changeup compared with the fastball, and the knee extended 7° more from lead foot contact to ball release in the fastball compared with the changeup. During arm cocking, pelvis angular velocity was 7% to 8% greater in the fastball compared with the curveball and changeup, and upper trunk angular velocity was 5% greater in the fastball compared with the changeup. During arm acceleration, shoulder internal rotation angular velocity was 6% to 7% greater in the fastball, slider, and curveball compared with the changeup, and ball velocity at ball release was 11% to 18% greater in the fastball compared with the slider, changeup, and curveball and 6% greater in the slider compared with the curveball. For all the kinematic, kinetic, and temporal parameters, analysis showed no significant differences between balls and strikes and no significant interactions between pitch type and pitch result. Conclusion Nearly all kinetic differences among pitch types occurred between the changeup and the remaining 3 pitch types. Shoulder and elbow forces and torques and injury risk were greater among the fastball, slider, and curveball compared with the changeup but were similar among the fastball, slider, and curveball. Body segment and joint positions were similar among all pitch types at lead foot contact and at maximum shoulder external rotation; however, at ball release, throwing a fastball and curveball resulted in greater knee extension and more forward and contralateral trunk tilt compared with throwing a changeup and slider. Movement speeds for the pelvis, upper trunk, and shoulder were greatest in the fastball and least in the changeup and were generally similar among the fastball, slider, and curveball. The timing of when pelvis, upper trunk, elbow, and shoulder velocities occurred among the fastball, slider, curveball, and changeup was similar, and no kinematic or kinetic differences were noted between throwing balls and strikes. Clinical relevance The results from the current study will help clinicians understand differences in pitching biomechanics in professional baseball pitchers among the fastball, slider, curveball, and changeup; the study provides limited insight into shoulder and elbow injury risk associated with different types of pitches.

Biomechanical Comparisons Among Fastball, Slider, Curveball, and Changeup Pitch Types and Between Balls and Strikes in Professional Baseball Pitchers.

The purpose of this study was to assess biomechanical differences among overhand, three-quarter, and sidearm arm-slot professional baseball pitchers. It was hypothesized that kinematic-and-kinetic differences would be found among the three groups, with sidearm pitchers demonstrating greater movement along the transverse plane, and overhead pitchers demonstrating greater movement along the sagittal plane. Based upon arm-slot-angle at ball-release, 30-overhand, 156-three-quarter, and 21-sidearm pitchers were tested using a 240-Hz-motion-analysis-system, and 37 kinematic-and-kinetic parameters were calculated. One-way-analyses-of-variance (α = 0.01) was employed to assess differences among groups. The comparisons showed the sidearm-group had less shoulder anterior force, whereas the overhand-group had the least elbow flexion torque. At ball release, trunk contralateral tilt and shoulder abduction were greatest for the overhand-group and least for sidearm-group. Additionally, the sidearm-group demonstrated th...

Differences Among Overhand, 3-Quarter, and Sidearm Pitching Biomechanics in Professional Baseball Players

Background:As the incidence of ulnar collateral ligament (UCL) surgery continues to rise rapidly, an update on the current prevalence and demographics in professional baseball players is warranted....

https://journals.sagepub.com/doi/pdf/10.1177/2325967119871442

Prevalence of Medial Ulnar Collateral Ligament Surgery in 6135 Current Professional Baseball Players: A 2018 Update.

textPurpose Displaced femoral neck fractures in healthy elderly patients have traditionally been managed with hemiarthroplasty (HA). Recent data suggest that total hip arthroplasty (THA) may be a better alternative. Methods A systematic review of the English literature was conducted. Randomized controlled trials comparing all forms of THA with HA were included. Three authors independently extracted articles and predefined data. Results were pooled using a random effects model. Results Eight trials totalling 986 patients were retrieved. After THA 4 % underwent revision surgery versus 7 % after HA. The one-year mortality was equal in both groups: 13 % (THA) versus 15 % (HA). Dislocation rates were 9 % after THA versus 3 % after HA. Equal rates were found for major (25 % in THA versus 24 % in HA) and minor complications (13 % THA versus 14 % HA). The weighted mean of the Harris hip score was 81 points after THA versus 77 after HA. The subdomain pain of the HHS (weighted mean score after THA was 42 versus 39 points for HA), the rate of patients reporting mild to no pain (75 % after THA versus 56 % after HA) and the score of WOMAC (94 points for THA versus 78 for HA) all favored THA. Quality of life measured with the EQ-5D favored THA (0.69 versus 0.57). Conclusions Total hip arthroplasty for displaced femoral neck fractures in the fit elderly may lead to higher patientbased outcomes but has higher dislocation rates compared with hemiarthroplasty. Further high-quality randomized clinical trails are needed to provide robust evidence and to definitively answer this clinical question.

https://repub.eur.nl/pub/39484/21_Burgers et al_Int Orthop 2012_36(8)_1549-1560.pdf

Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-Analysis and systematic review of randomized trials

Background Total hip (THA) and knee arthroplasty (TKA) are two of the most successful procedures in orthopedics. Current evaluation trends focus on patient-reported outcomes. We sought to compare the changing WOMAC scores from various time points from pre-operative to 1-year follow-up between separate THA and TKA cohorts. In addition, we compared THA and TKA patients’ joint perception, satisfaction, and function via a questionnaire. Methods One hundred elective THA (n = 50) and TKA (n = 50) patients at one institution were randomly selected and contacted between 2 and 4 years after the index surgery. A questionnaire assessed joint perception, satisfaction and function of their total joint. Clinical function scores utilizing the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from the pre-operative, 3-month and 1-year post-arthroplasty visits were compared between groups. Results 78% of the THA group perceived their replaced joint as “native” vs 32% of TKA patients. 54% of THA patients (vs 16% of TKA patients) reported uninhibited function of their total joint. 24% of TKA patients noted to be least satisfied with their total joint compared to 2% in the THA group. Both groups demonstrated significant improvement in WOMAC scores after surgery, but the mean 3-month (12.4 (THA) vs 19.3 (TKA)) and 1-year (6.5 (THA) vs 14.1 (TKA)) follow-up WOMAC scores were significantly better in the THA group. Conclusion Evaluation of a patient’s joint perception is a valuable tool that should be used to assess function in conjunction with validated clinical functional scores. Our data suggest further improvements in total knee implant design and implantation strategies are necessary.

Joint perception and patient perceived satisfaction after total hip and knee arthroplasty in the American population.

Background:Ulnar collateral ligament reconstruction (UCLR) is commonly performed in Major League Baseball (MLB) pitchers, but little is known about the preoperative pitch type and velocity characte...

https://journals.sagepub.com/doi/pdf/10.1177/2325967116653946

Pitch Characteristics Before Ulnar Collateral Ligament Reconstruction in Major League Pitchers Compared With Age-Matched Controls

OBJECTIVES To determine the independent risk factors associated with increasing costs and unplanned hospital readmissions in the 90-day episode of care (EOC) for isolated operative ankle fractures at our institution. DESIGN Retrospective cohort study. SETTING Level I Trauma Center. PATIENTS Two hundred ninety-nine patients undergoing open reduction internal fixation for the treatment of an acute, isolated ankle fracture between 2010 and 2015. INTERVENTION None. MAIN OUTCOME MEASURES Independent risk factors for increasing 90-day EOC costs and unplanned hospital readmission rates. RESULTS Orthopaedic (64.9%) and podiatry (35.1%) patients were included. The mean index admission cost was $14,048.65 ± $5,797.48. Outpatient cases were significantly cheaper compared to inpatient cases ($10,164.22 ± $3,899.61 vs. $15,942.55 ± $5,630.85, respectively, P < 0.001). Unplanned readmission rates were 5.4% (16/299) and 6.7% (20/299) at 30 and 90 days, respectively, and were often (13/20, 65.0%) due to surgical site infections. Independent risk factors for unplanned hospital readmissions included treatment by the podiatry service (P = 0.024) and an American Society of Anesthesiologists score of ≥3 (P = 0.017). Risk factors for increasing total postdischarge costs included treatment by the podiatry service (P = 0.011) and male gender (P = 0.046). CONCLUSIONS Isolated operative ankle fractures are a prime target for EOC cost containment strategy protocols. Our institutional cost analysis study suggests that independent financial clinical risk factors in this treatment cohort includes podiatry as the treating surgical service and patients with an American Society of Anesthesiologists score ≥3, with the former also independently increasing total postdischarge costs in the 90-day EOC. Outpatient procedures were associated with about a one-third reduction in total costs compared to the inpatient subgroup.

Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital.

National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database

/pdf/national-trends-in-total-hip-arthroplasty-for-traumatic-hip-rbgtn31hlm.pdf

and feel that it is more accurately described as a “tendinosis” or “tendinopathy” [5]. Tendinopathy is defined as an overuse condition manifested by pain in or around tendons secondary to failure of tendon regeneration [6,7]. Tendinosis is defined as degeneration and disorganization of collagen with increased vascularity and cellularity without obvious inflammatory cells [7,8]. Neer described rotator cuff disorders as occurring on a spectrum, progressing from tendinitis to tendinosis with degeneration, partial thickness, or full thickness rotator cuff tears [9]. Throughout this section, rotator cuff tendinitis will be defined as a general term, referring to chronic tendon pain associated with overuse, irritation, strain, degeneration, and poor mechanics [7].

/pdf/nonoperative-management-of-common-shoulder-conditions-5afqo2vvg4.pdf

Kevin Denehy

Papers

Joint perception and patient perceived satisfaction after total hip and knee arthroplasty in the American population.

Pitch Characteristics Before Ulnar Collateral Ligament Reconstruction in Major League Pitchers Compared With Age-Matched Controls

Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital.

National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database

Nonoperative Management of Common Shoulder Conditions