Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study

Background: We prospectively tested technical feasibility and clinical outcome of percutaneous ultrasound-guided tenotomy of long head of biceps tendon (LHBT). Methods: We included 11 patients (6 women; age: 73 \ub1 8.6 years) with symptomatic full-thickness rotator cuff tear and intact LHBT, in whom surgical repair was not possible/refused. After ultrasound-guided injection of local anesthetic, the LHBT was cut with a scalpel under continuous ultrasound monitoring until it became no longer visible. Pain was recorded before and at least six months after procedure. An eight-item questionnaire was administered to patients at follow-up. Results: A median of 4 tendon cuts were needed to ensure complete tenotomy. Mean procedure duration was 65 \ub1 5.7 s. Mean length of skin incision was 5.8 \ub1 0.6 mm. Pre-tenotomy VAS score was 8.2 \ub1 0.7, post-tenotomy VAS was 2.8 \ub1 0.6 (p < 0.001). At follow-up, 5/11 patients were very satisfied, 5/11 satisfied and 1/11 neutral. One patient experienced cramping and very minimal pain in the biceps. Six patients had still moderate shoulder pain, 1/11 minimal pain, 2/11 very minimal pain, while 2/11 had no pain. No patients had weakness in elbow flexion nor limits of daily activities due to LHBT. One patient showed Popeye deformity. All patients would undergo ultrasound-guided tenotomy again. Conclusion: ultrasound-guided percutaneous LHBT tenotomy is technically feasible and effective

I.S.Mu.L.T - Rotator cuff tears guidelines

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources

Local anaesthesia efficacy as postoperative analgesia for open shoulder instability surgery. a prospective randomised controlled study

Background and objectives: The aim of present study was to evaluate for the first time, the clinical effect of local anaesthetic infiltration as postoperative analgesia in open shoulder surgery for anterior-inferior instability. The comparison of the local infiltration and interscalenic brachial plexus block to a control group test the local anaesthetic efficacy in this surgery. Methods: 78 patients scheduled for open shoulder surgery were enrolled and randomly assigned to one of three groups: local infiltration anaesthesia (LIA), interscalenic brachial plexus block (IBPB) and control (C). All patients received standardized general anaesthesia and all injections were performed with the same dose and volume of anaesthetic. The number boluses delivered by a PCA pump applied at the end of surgery and the visual analogue score (VAS) at 0, 2, 4, 6, 12, 18 and 24 hours after intervention were recorded. A patient satisfaction score was also assessed. Results: Mean bolus consumption of the rescue analgesic, compared to C, was significantly less both in the LIA and IBPB groups (P<0.05). The IBPB group showed VAS scores that were significantly better than C group at all time points (P<0.05). The VAS scores for LIA group were clinically comparable to IBPB, and only at the 2 and 6 hours, postoperative time points there were no significant differences found in respect to the C group. IBPB and LIA showed comparable patient satisfaction scores. Conclusion: The local anaesthetic infiltration as postoperative analgesia appears to be a clinically valid alternative, statistically comparable to IBPB, with no clinical meaningful adverse effects

Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy

Background Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions. Methods Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively. Results Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05). Conclusions In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery

Chronic Pain Associated with Lateral Epicondylitis: Treatment with Radiofrequency

Lateral epicondylitis is a painful condition that impairs the quality of life and the working capacities of many middle-aged people. Conservative treatments offer an opportunity for improvement in the majority of cases. Surgical alternatives can be considered in those patients with persisting pain. Open, arthroscopic and percutaneous extensor tendon procedures offer similar results with 10–20% failure rates. Radiofrequency microtenotomies have been introduced with comparable results to traditional surgical procedures. Although both thermal and pulsed radiofrequency techniques have been applied, there is more experience with the thermal. In the past, thermal radiofrequency has been applied through a 3–5 cm skin incision, but now some researchers have reported its percutaneous application with radiofrequency cannulas. The results are similar to former techniques but with significantly reduced surgical aggressiveness that correlates with less postoperative discomfort and a faster recovery

The surgical treatment of the long head of biceps tendon and the autotenodesis phenomenon: an ultrasound and arthroscopic study

Background: Open or mini-invasive operative procedures are methods of choice in the treatment of the advanced degenerative process of tendinopathy of long head of biceps tendon (LHBT). Cosmetic arm deformity and fatigue are the main complaints after the surgery. Researchers have noticed that in some cases the typical cosmetic deformity is often barely noticeable and the pain is significantly reduced as it occurs after spontaneous LHBT rupture due to extremely advanced tendinopathy. Materials and methods: This study included 41 of 75 patients who underwent LHBT arthroscopy-assisted tenotomy, followed by examination conducted by means of dedicated clinical tests, the American Shoulder and Elbow Surgeons Score (ASES) and ultrasounds. Results: The average time interval from surgery to follow-up in the cohort was 31 months, the mean outcome measured with the ASES was 87 points and the “Popeye deformity” complication was present in 15 individuals. In the group of 26 patients where the Popeye deformity was absent and the arm contour was similar to that of the opposite arm, sonographic examination revealed the LHBT stump at the level of the intertubercular groove that was hyperechogenic and wider than the part under the groove. Conclusions: Recent reports about the absence of the cosmetic deformity in the anterior area of the arm after shoulder arthroscopy are based on the autotenodesis phenomenon. The intra-articular part of LHBT is painlessly trapped in the bicipital groove by the surrounding soft tissues, which results in unchanged biceps muscle length; however, it is more probable to happen in patients without massive rotator cuff tears

Bone marrow mesenchymal stem cells do not enhance intra-synovial tendon healing despite engraftment and homing to niches within the synovium

Intra-synovial tendon injuries display poor healing, which often results in reduced functionality and pain. A lack of effective therapeutic options has led to experimental approaches to augment natural tendon repair with autologous mesenchymal stem cells (MSCs) although the effects of the intra-synovial environment on the distribution, engraftment and functionality of implanted MSCs is not known. This study utilised a novel sheep model which, although in an anatomically different location, more accurately mimics the mechanical and synovial environment of the human rotator cuff, to determine the effects of intra-synovial implantation of MSCs

Evaluation and nonsurgical management of rotator cuff calcific tendinopathy.

Rotator cuff calcific tendinopathy is a common finding that accounts for about 7% of patients with shoulder pain. There are numerous theories on the pathogenesis of rotator cuff calcific tendinopathy. The diagnosis is confirmed with radiography, MRI or ultrasound. There are numerous conservative treatment options available and most patients can be managed successfully without surgical intervention. Nonsteroidal anti-inflammatory drugs and multiple modalities are often used to manage pain and inflammation; physical therapy can help improve scapular mechanics and decrease dynamic impingement; ultrasound-guided needle aspiration and lavage techniques can provide long-term improvement in pain and function in these patients

Ultrasonography-guided anterior approach for axillary nerve blockade: an anatomical study

Combined ultrasound-guided blockade of the suprascapular and axillary nerves has been proposed as an alternative to interscalene blockade for pain control in shoulder joint pathology or post-surgical care. This technique could help avoid respiratory complications and/or almost total upper limb palsy. Nowadays, the axillary nerve blockade is mostly performed using an in-plane caudal-to-cephalic approach from the posterior surface of the shoulder, reaching the nerve immediately after it exits the neurovascular quadrangular space (part of the spatium axillare). Despite precluding most respiratory complications, this approach has not made post-surgical pain relief any better than an interscalene blockade, probably because articular branches of the axillary nerve are not blocked. Cephalic to caudal Methylene Blue injections were placed in the first segment of the axillary nerve of six Thiel-embalmed cadavers using an ultrasound-guided anterior approach in order to compare the distribution with that produced by a posterior approach to the contralateral axillary nerve in the same cadaver. Another 21 formalin-fixed cadavers were bilaterally dissected to identify the articular branches of the axillary nerve. We found a good spread of the dye on the axillary nerve and a constant relationship of this nerve with the subscapularis muscle. The dye reached the musculocutaneous nerve, which also contributes to shoulder joint innervation. We describe the anatomical landmarks for an ultrasonography-guided anterior axillary nerve blockade and hypothesize that this anterior approach will provide better pain control than the posterior approach owing to complete blocking of the joint nerve. This article is protected by copyright. All rights reserved