Short-Term Clinical Outcomes and Comparison of Ultrasound Versus Magnetic Resonance Imaging of Superior Capsular Reconstruction

Purpose To evaluate the short-term outcomes of 10 patients with irreparable massive rotator cuff tears treated with arthroscopic superior capsular reconstruction (SCR) using dermal allograft. Methods Between 2016 and 2018, patients with symptomatic irreparable rotator cuff tears were prospectively enrolled for treatment with arthroscopic SCR. Investigational review board approval was achieved. All patients were treated by a single fellowship-trained shoulder surgeon. Minimum follow-up was 1 year. Range of motion and functional outcome according to visual analog scale pain, American Shoulder and Elbow Surgeons, and Simple Shoulder Test scores were assessed preoperatively and at routine follow-up intervals. Magnetic resonance imaging (MRI) and ultrasound were obtained at a minimum of 1 year to assess graft integrity and to correlate clinical outcomes. Results Ten patients with a mean age of 58.6 years had a minimum follow-up of 1 year. In all patients, preoperatively to postoperatively, mean forward flexion improved from 141° to 173° (P = .018), mean visual analog scale pain score decreased from 6.5 to 1 (P = .004), and mean American Shoulder and Elbow Surgeons score improved from 43 to 87 (P = .005). At 1 year, ultrasound evaluation identified graft failure in 1 patient (10%), whereas MRI diagnosed graft failure in 7 patients (70%). Of the 7 failures diagnosed by MRI, 4 failed at the level of the glenoid, 2 failed mid-graft, and 1 failed at the humerus. Conclusions Although clinical outcomes are statistically improved following arthroscopic SCR using a dermal allograft, the early high failure rates of the graft raise concerns about the long-term outcomes of the procedure. Furthermore, the use of ultrasound alone to validate an intact graft should be used with caution, as failures can occur at the glenoid and can be missed without MRI correlation. Level of Evidence Level IV, Therapeutic case serie

Patients with Obstructive Sleep Apnea Display Increased Carotid Intima Media: A Meta-Analysis

Background. Obstructive sleep apnea (OSA) is associated with coronary artery disease. Intermittent hypoxia associated with OSA increases sympathetic activity and may cause systemic inflammation, which may contribute to atherosclerosis leading to an increase in the size of carotid intima media thickness (CIMT). Methods. PubMed and Cochrane library were reviewed by utilizing different combinations of key words: sleep apnea, carotid disease, intima media thickness, and carotid atherosclerosis. Inclusion criteria were English articles; studies with adult population with OSA and without OSA; CIMT recorded by ultrasound in mean and standard deviation or median with 95% confidence interval; and OSA defined as apnea hypopnea index of ≥5/h. A total of 95 studies were reviewed for inclusion, with 16 studies being pooled for analysis. Results. Ninety-five studies were reviewed, while 16 studies were pooled for analysis; since some studies have more than one data set, there were 25 data sets with 1415 patients being pooled for meta-analysis. All studies used ultrasound to measure CIMT. CIMT standardized difference in means ranged from −0.883 to 8.01. The pooled standardized difference in means was 1.40 (lower limit 0.996 to upper limit 1.803, ( < 0.0001). Conclusion. Patients with OSA appear to have increased CIMT suggestive of an atherosclerotic process

Ultrasound diagnosis of medial clavicular epiphysis avulsion fracture in a neonate.

Clavicle fractures are the most common bony injury that occurs during the delivery process. We present a case of medial clavicular physeal fracture mimicking sternoclavicular dislocation diagnosed by ultrasound (US) in a neonate. The infant presented to our clinic at 12 days old with improving left upper extremity pseudoparalysis and outside radiographs interpreted as left sternoclavicular dislocation. US demonstrated a displaced physeal fracture rather than a dislocation. The radiologist should be aware of this potential distinction. Our case shows the usefulness of US in obtaining the definitive diagnosis without the need for radiation or sedation, demonstrates a unique use of this modality, and illustrates that US should be considered for clarification in future cases of suspected sternoclavicular injury in the neonate

Substance use disorders among forcibly displaced people:a narrative review

Purpose of review Forced displacement, from wars, terrorism, internal disputes and environmental disasters, has been witnessed throughout human history. Forcibly displaced people face unimaginable difficulties and atrocities in their attempts to survive. Provision of support often focuses on basic needs, such as food, shelter and essential health demands. We present here a narrative review informed by syndemic theory to understand the existing literature on the associations between substance use disorders and experiences of forced displacement.Recent findings The risk factors associated with SUDs are similar to or overlap with those experienced by forcibly displaced people, yet there is substantial heterogeneity in patterns and prevalence of substance use across the different forcibly displaced people. Despite recognition that SUDs among forcibly displaced people are concerning, there are large gaps in knowledge. These include questions around whether forced displacement is directly and consistently linked with SUDs prevalence, what the patterns of risk and resilience look like across different cultures experiencing different causes of displacement over varying durations, and what constitutes effective interventions for these groups. These gaps are at least partly due to research having been disproportionately conducted in developed countries rather than in low- and middle-income countries.Summary Specifically, we categorise syndemic risks of both forced displacement and substance use disorders into four areas: trauma and violence, loss and instability, transit and resettlement and acculturation. We use causal loop diagramming to illustrate important synergistic interactions. We propose a research and intervention policy agenda informed by a broad and varied stakeholder base, accounting for generational and life-course effects and context specific cultural, structural and economic priorities and values