Repair of massive and irreparable rotator cuff tear using arthroscopic method

Rotator cuff tear is one of the major causes of shoulder pain and disability, especially in elderly patients over 60 years. Improvement of performance and reduction of pain hardly occur in patients with contracted rotator cuff tear. Despite therapeutic advances, yet there are many discussions over choosing the best type of treatment for major rotator cuff tear. Complete treatment of massive rotator cuff tear continues to be a challenge in the shoulder surgery. Treatment options have changed in compassion with traditional treatment methods in open or arthroscopic debridement surgery with or without decompression. Recently, many treatments have been introduced, including a range of non-surgical treatments, acromioplasty by debridement, biceps tenotomy, tuberoplasty by biceps tenotomy, minor repair, mini-open rotator cuff repair, arthroscopic rotator cuff, muscle movement, reverse shoulder arthroscopy, soft tissue reinforcement and hemiarthroplasty. Non-surgical massive rotator cuff control is typically assigned for patients with insignificant pain. This therapy functions by changing activities, proper use of steroid injections and physical therapy with an emphasis on the anterior deltoid exercises. But the main problem is the selection of the best treatment and making the final decision. In general, in the arthroscopic morbidity, postoperative pain along with hospital stay is less and the operation has better cosmetic results. So this information and our results have prompted us to study a variety of rotator cuff treatment methods with a focus on the arthroscopic treatment

Clinical Results of Platelet-Rich Plasma in Frozen Shoulder

Background: Frozen shoulder is a common cause of shoulder pain and disability. Several treatments are utilized to reduce patients' pain and improve range of motion (ROM). Recent researches have been conducted on Platelet-rich plasma (PRP) injection. In this study, the clinical results of PRP injection for patients with frozen shoulder was assessed. Materials and Methods: Forty-four patients in phases I or II of frozen shoulder were treated with PRP. During the first session, two syringes of PRP were injected in the subacromial bursa and intra-articular space; this process was repeated after four weeks. In the second stage, PRP was injected only in the glenohumeral joint. Results: The average pre-treatment flexion was about 65°; abduction was 70°while external rotation was 22°. Also, baseline scores for VAS, DASH, and SF-12 Health Survey questionnaire were 8.4, 65.9 and 26, respectively. After 25 weeks follow-up, all patients showed significant improvement in shoulder ROM, pain, and function (p˂0.001). Patients reported 66.7% improvement in pain, 51.6% in DASH score, and 100% in SF-12 Health Survey questionnaire. They were also 65% satisfied with the treatment protocol. Conclusion: This case series study demonstrated clinically and statistically significant improvement in patients' pain and disability outcomes following PRP injection. These results provide support for PRP as a safe treatment protocol that decreases pain and increases upper limb function. In addition, it can also improve shoulder range of motion

Intra-articular Along with Subacromial Corticosteroid Injection in Diabetic Patients With Adhesive Capsulitis

Background: To compare intra-articular plus subacromial corticosteroid injection with a single intra-articular injection in diabetics with adhesive capsulitis. Materials and Methods: A total of fifty-four diabetic patients were randomized into corticosteroid injection in both intra-articular and subacromial sites (group A) and one intra-articular injection (group B). Pain by a visual analog scale (VAS), shoulder range of motion, and functional state by the American Shoulder and Elbow Score was assessed before injection, and at follow-up months. Results: The pain VAS scores of group A were considerably lower than group B at the first-month follow-up visit (P=0.01). The range of motion in forward-elevation and internal rotation at three-month follow-up visits was significantly higher in group A than in group B (P=0.035, P=0.04, respectively). No notable differences in the range of motion in forward-elevation, internal rotation, and external rotation between groups at the final follow-up visit were seen. Though a significant difference in the ASES between groups at the third-month follow-up visit (P=0.03), the ASES score at the final sixth-month follow-up was similar in both groups (P=0.7). Conclusion: In diabetic adhesive capsulitis of the shoulder, subacromial combined with intra-articular steroid injections has superior subjective outcomes compared to single intra-articular corticosteroid injection

The Prevalence and Mortality in COVID-19 Positive Patients with Hip Fracture: a Case-Series and Literature Review

Background: The novel coronavirus has spread rapidly worldwide, with exceptionally high mortality in the elderly. Patients with hip fracture have an average age of 80 years, with an estimated 2.8 comorbidities per patient. This study aims to assess the impact of the COVID-19 pandemic on hip fracture care services and the associated mortality rate. Methods: PubMed, Medline, and Google Scholar databases were searched for relevant studies linked to mortality in COVID-19 patients who have undergone hip surgeries using the keywords “COVID-19” OR “SARS-cov-2” OR “Coronavirus Infections”; AND “Surgery” OR “Hip” OR “Fracture” OR “Orthopedics.” We included all patients with hip fractures but excluded pathological fractures and other non-traumatic hip pathologies 30 studies for the final review were selected according to the inclusion and exclusion criteria. Results: 30 studies were included in the review. The overall mortality was 10.52%. There was a significant difference in the mortality rate between patients with positive and negative tests and between the operative patients who tested positive and the operative patients who tested negative. Conclusions: COVID-19-infected elderly patients with hip fractures have a higher mortality rate than non-COVID-19 infected cases. Further studies are warranted to examine the morbidity and mortality rates in COVID-19-positive patients with hip fractures and investigate how these outcomes can be improved