Acromioclavicular joint cyst in ASA 3-4 patients. Whether and how quickly it recurs after aspiration and steroid injection

We observed the clinical course, in the short-medium term, of patients with voluminous type II acromio-clavicular (AC) joint cyst who underwent aspiration and steroid injection regarded as the only possible treatment to avoid possible skin complications. Four patients (7.4% of cases described in literature) (3F-1M ; mean age 83 years, range : 78-87 years) with a voluminous ( > 7 cm) oval, no mobile, no fluctuant cyst overlying the AC joint, were retrospectively observed. The patients, judged by the anesthesiologist as ASA 3-4 patients, were merely submitted to cyst aspiration and steroid injection. The content of the cyst was microscopically analysed. All patients were clinically evaluated on the day of aspiration and after 14-30 days and after 1 year. Shoulder function and pain intensity were analysed with Constant score and VAS. We were able to aspirate 80-150 ml of amorphous joint fluid. At the first follow-up, all patients had a recurrence of the cyst, a lower grade of tension of the skin overlying the cyst and also a very little decreasing of pain intensity. After a month from aspiration, the cysts of the 4 patients had the same size as that present before aspiration. The range of motion, the average value of VAS and Constant were similar to those recorded before aspiration. In no case signs of infection or draining sinus occurred. Aspiration is a useless practice. However it is still a motive for discussion if the reduced suffering of the skin overlying the cyst after the aspiration has avoided, or simply postponed, an imminent complication

Association between alcohol consumption and rotator cuff tear

Background and purpose - Long-term alcohol intake is associated with various negative effects on capillary microcirculation and tissue perfusion. We hypothesized that alcohol consumption might be a risk factor for both the occurrence and the severity of rotator cuff tears (RCTs). Patients and methods - A case-control study was performed. We studied 249 consecutive patients (139 men and 110 women; mean age 64 (54-78) years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group had 356 subjects (186 men and 170 women; mean age 66 (58-82) years) with no RCT. All participants were questioned about their alcohol intake. Participants were divided into: (1) non-drinkers if they consumed less than 0.01 g of ethanol per day, and (2) moderate drinkers and (3) excessive drinkers if women (men) consumed > 24 g (36 g) per day for at least 2 years. Results - Total alcohol consumption, wine consumption, and duration of alcohol intake were higher in both men and women with RCT than in both men and women in the control group. Excessive alcohol consumption was found to be a risk factor for the occurrence of RCT in both sexes (men: OR = 1.7, 95% CI: 1.2-3.9; women: OR = 1.9, 95% CI: 0.94-4.1). Massive tears were associated with a higher intake of alcohol (especially wine) than smaller lesions. Interpretation - Long-term alcohol intake is a significant risk factor for the occurrence and severity of rotator cuff tear in both sexes

Adhesive capsulitis of the shoulder: pain intensity and distribution

Purpose Papers regarding adhesive capsulitis (AC) of the shoulder focused on etiology, epidemiology, diagnosis, and treatment; until now, information on shoulder pain characteristics is still scarce. Our aim was to analyze pain intensity and distribution in patients with AC. Methods The study group was composed of 278 (133M–145F) consecutive patients with AC. After diagnosis, shoulder pain distribution was assessed through an upper limb pain map and pain intensity through a visual analog scale. Patients were distinguished on the basis of gender, age, time elapsed from onset of symptoms, and severity of functional limitation. Data were submitted to statistical analysis. Results Intensity of shoulder pain caused by AC was higher in females (p 0.05). Conclusion Shoulder pain due to AC may be influenced by gender and severity of functional limitation. AC pain distribution principally involves anterior aspect of the shoulder with downward extension of the arm until its distal third

The effects of rotator cuff tear on shoulder proprioception

Purpose: To evaluate the effects of rotator cuff tear (RCT) and its severity on shoulder proprioception. Methods: We studied 132 consecutive patients (67 M-65 F; mean age ± SD, 66.03 ± 9.04; range, 43–78) who underwent arthroscopic rotator cuff repair. Tear size was determined intra-operatively. The control group included 82 subjects (38 M-44 F; mean age ± SD, 65.87 ± 8.06; range, 41–75) with no RCT. All participants, wearing an eye mask, were submitted to the evaluation of the joint position sense (JPS) at 30°, 60°, 90°, 120°, and 150° of shoulder forward flexion during the sitting position, using a digital inclinometer securely attached to the subject’s arm using hook-and-loop straps. The passive placement and active replacement method was used; the order of the tested angles was randomly selected. The entire test was repeated three times. The error score, by averaging the three trials, was measured as the absolute difference between the target angle and the observed angle. Statistics were performed. Results: The intraclass correlation coefficient for all degrees of flexion movement measured was > 0.90, exhibiting a very high correlation. We found significant differences between cases and controls regarding the results of joint position sense error at all measurements (p < 0.05). According to RCT size, we found significant differences between groups at 30° (F = 27.27, p < 0.001), 90° (F = 5.37, p = 0.006), 120° (F = 10.76, p < 0.001), and 150° (F = 30.93, p < 0.001) of shoulder flexion; in details, patients with massive RCT showed greater absolute error value than those with both small and large RCT at 30°, 90°, 120°, and 150° of shoulder flexion (p < 0.05). Conclusions: RCT provokes an alteration of shoulder proprioception, evaluated as the loss of joint position sense, and the impairment is related to tear severity

The 2-scope technique for rotator cuff surgery: are 2 scopes better than 1?

The arthroscopic treatment of rotator cuff tear involves 2 distinct phases: intra-articular and subacromial. We present the 2-scope technique with the aim to simultaneously perform these phases, entrusting them to 2 experienced surgeons, and to obtain possible benefits compared with the classic 1-scope technique. Better nosology of the lesion and a more accurate evaluation of suture passer action (equidistance of the sutures and avoidance of degenerated articular-side tendon areas) represent benefits of this technique. In contrast, the 2-scope technique needs an additional lateral portal and could give rise to an erroneous distribution of costs and surgeons

Scapular dyskinesis in young, asymptomatic elite swimmers

Background: Overhead athletes are at a greater risk of developing scapular dyskinesis (SD). Although swimming is considered an overhead sport, information regarding SD in these athletes is scarce. Purpose: To determine the prevalence of SD in young, asymptomatic elite swimmers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 661 asymptomatic elite swimmers were enrolled in this study (344 male, 317 female; mean age, 15.83 ± 2.20 years). Anthropometric characteristics, training routine, and stroke specialty were recorded. SD was assessed using a dynamic test consisting of an examination of the shoulder blades throughout synchronous forward flexion motion in the sagittal plane and was deemed to be either present or absent. Each movement was repeated 5 times. These evaluations were performed with athletes at rest, before any training or competition. Statistical analysis was performed. Results: SD was detected in 56 (8.5%) participants. Type I SD was the most common (46.5%); male participants were 2 times as likely to have SD as female participants (39 male, 17 female; P < .01). No correlation was found between the dominant limb and side affected (P = .258); rather, a correlation was found between the breathing side and side affected, in that swimmers with a preferred breathing side were more prone to develop SD in the opposite shoulder (P < .05). Swimmers involved in long-distance races were found to have a greater risk of developing SD (P = .01). Conclusion: SD may be an asymptomatic condition in elite young swimmers and is present in 8.5% of these athletes. Early diagnosis may be useful for asymptomatic athletes with SD and to avoid its possible evolution to a symptomatic condition