Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration

This study aims to evaluate the severity of postoperative pain and the time to the onset of pain after arthroscopic surgical treatment of rotator cuff tear or instability under interscalene block. Patients and methods: Between October 2015 and June 2016, a total of 172 patients (82 males, 90 females; mean age: 47.9±16.9 years; range, 15 to 83 years) who underwent shoulder arthroscopy under interscalene block by a single surgeon were retrospectively analyzed. The relationship between the postoperative 24-h Visual Analog Scale (VAS), the time to the onset of pain with the type of surgical procedure (rotator cuff repair, n=101 or instability surgery, n=71), and the duration of surgery (<30 min n=92; ≥30 min n=80) was examined. Results: No significant relationship was found between the type of surgical procedure, VAS scores, and the onset of pain after the block (p=0.577 and p=0.780, respectively). No significant relationship was found between the operation duration, and VAS, and the onset of pain after the block (p=0.570 and p=0.408, respectively). The mean duration until the start of postoperative pain was 734±313 (range, 60 to 1,440) min. There was no statistically significant difference in the need for rescue analgesics at the postoperative 24th h and the duration of surgery between the two groups (p=0.393 and p=0.675, respectively). Conclusion: Our study results show no significant difference in the time for the onset of postoperative pain and the VAS scores according to the characteristics of the surgical procedure, operation duration, or age and sex of the patient. Shoulder arthroscopy performed by experienced surgeons under interscalene block eliminates the need for analgesics within the first 12 h postoperatively

Does the presence of arthroscopically detected stage 1-2 glenohumeral osteoarthritis have any clinical impact on the outcome of arthroscopic rotator cuff repairs?

MakaleWOS:000941667500026PubMed ID: 36945963Background/aim: Rotator cuff rupture (RCR) and glenohumeral osteoarthritis (GHO) are two common disorders of the shoulder joint. However, there are very few reports that examine the relationship between them. This study aimed to present at least two years' clinical results of arthroscopic rotator cuff repair of full-thickness and massive tears accompanied by arthroscopically detected early-stage osteoarthritis.Materials and methods: From August 2016 to December 2017, three hundred and twenty patients with total or massive rotator cuff tears were evaluated retrospectively. Thirty-five patients who were determined as stage 1 and 2 according to the Outerbridge scale for cartilage lesions were found appropriate for investigation. Patients were assessed using the University of California Los Angeles (UCLA) score, and a visual analog scale (VAS) score before surgery and at the final follow-up. The American Shoulder and Elbow Surgeons (ASES) shoulder score was used to evaluate the final outcomes and compare the UCLA shoulder scores.Results: The UCLA scores increased from the preoperative value of 19.1 +/- 3.2 to 29.8 +/- 4.8 at the last follow-up and increased by an average of 10.7 +/- 6.0 (p < 0.001). The median VAS score decreased from the preoperative value of 3.0 to 1.0 (p < 0.001). Besides, the mean ASES score was found as 80.2 +/- 10.6. An excellent positive correlation was found between postoperative UCLA scores and ASES scores (r = 0.887; p < 0.001).Conclusion: To the best of our knowledge, this is one of the first arthroscopic comparative studies about the effect of early glenohumeral osteoarthritis on clinical outcomes after rotator cuff tear treatment. Finding good and excellent results up to 71% after RCR repair in patients with early-stage osteoarthritis was an indication that arthroscopic repair could be planned as the first-line treatment option for RCR pathologies in patients with early-stage degenerative arthritis without considering the rerupture rate.Department of Public Health, Gazi University Medical Facult

Is lesser tuberosity morphology related to subscapularis tears and anterior shoulder instability?

Makale (Early Access)WOS:000924508300001PubMedID: 3672921Purpose: Although the morphological relationship of the scapula and the humeral head has been claimed to be related to shoulder pathologies, few studies examined the relationship between subscapularis (Ssc) tears and lesser tuberosity (LT)— humeral head (HH) and between Ssc tears and HH—glenoid. This study aims to evaluate the relationship of LT with HH and glenoid in patients with Ssc tears and anterior shoulder instability (ASI). We hypothesized that the glenoid, HH, and their combined relationship with LT may impact Ssc tears and ASI. Material and methods: The study included 34 patients with ASI, 28 patients with isolated Ssc tears, and 40 patients as the control group. The radius of HH (Hr), the distance between the center of HH and LT (LTr), and the glenoid radius (Gr) were measured in shoulder magnetic resonance (MR) images. The LTr to Hr (LTr/Hr) ratio was defned as the lesser tuberosity humeral head index (LTHHI), whereas the LTr to Gr (LTr/Gr) ratio was defned as the lesser tuberosity-glenoid index (LTGI). The three groups were compared regarding LTHHI, LTGI, LTr, Hr, and Gr. Results: There was a signifcant diference between each group concerning LTGI (p<0.001). LTGI values below 1.99 showed 93.1% sensitivity and 93.3% specifcity for Ssc tears, while values above 2.24 showed 86.7% sensitivity and 86.2% specifc ity for ASI. Also, there was a signifcant diference when the groups were compared for LTHHI (p<0.001). This rate was lowest for Ssc tears, and LTHHI values below 1.17 showed 82.8% sensitivity and 80.1% specifcity. Conclusion: LTGI may be a new predictive factor showing 93.1% sensitivity and 93.3% specifcity for Ssc tears and 86.7% sensitivity and 86.2% specifcity for ASI. In addition, LTHHI may be a new predictive factor showing 82.8% sensitivity and 80.1% specifcity for Ssc tears. Level of evidence: III retrospective comparative study

Humerus proksimal uç iki parçalı kırıklarının tek yönlü ve çok yönlü Kirschner teli ile tespitinin biyomekanik olarak karşılaştırılması

Objectives: The stability and effectiveness of uni-planar Kirschner wire (K-wires) was compared to multi-planar K-wires osteosynthesis combined with tension band wiring for fixation of two-part osteoporotic surgical neck fracture of the proximal humerus. Materials and methods: Two groups each with eight cadaveric elderly (mean age 72.6; range 70 to 80 year) frozen human humeri were used in the study. Transverse osteotomy of the proximal humerus was performed using a thin oscillating saw. The first group (group A) was fixed using two anterograde smooth K-wires, sent from lateral cortex, combined with tension band wiring. The second group (group B) was fixed using multi-planar (anterograde and retrograde) four smooth K-wires combined with tension band wiring on the lateral cortex. Biomechanical tensile properties for 3 mm displacement (gap load) and maximum load were assessed. Results: The mean value for the gap load was 1045.0&plusmn;45.4 N (Newton) for group A and 1238.1&plusmn;115.8 N for group B. Gap load values of groups were similar (p=0.01). The maximum load was 1261.8&plusmn;52.4 N in group A and 1471.1&plusmn;107.3 N in group B. The maximum load values were statistically higher in the multiplanar fixation technique (group B) when compared to that of the uniplanar fixation technique (group A), (p=0.004). Conclusion: Fixation in osteoporotic two-part surgical neck fractures of the proximal humerus using multiplanar K-wires combined with tension band wire provides substantially more effective stability compared to that of uniplanar fixation.Amaç: Humerus proksimal uç cerrahi boyun iki parçalı kırıklarında tek yönlü Kirschner teli (K-teli) ile tespit yönteminin stabilite ve etkinliği, çok yönlü K-teli ve gergi bandı yöntemi ile biyomekanik olarak karşılaştırıldı.Gereç ve yöntemler: Çalışma iki grup halinde düzenlendi. Her bir grupta sekizer adet dondurulmuş insan (ort. yaş 72.6; dağılım 70-80 yıl) kadavra humerus kemiği kullanıldı. Humerus proksimalinde ince el testeresi yardımı ile transvers osteotomi yapıldı. Birinci grupta (grup A) gergi bandı yöntemi ile güçlendirilen ve lateral korteksten antegrad olarak gönderilen iki adet düz K-teli ile tek yönlü tespit uygulandı. İkinci grupta ise lateral kortekste gergi bandı yöntemi ile güçlendirilmiş dört adet K-teli ile çok yönlü (antegrad ve retrograd) tespit uygulandı. Üç milimetre aralık oluşma sırasındaki yüklenme (ayrışma gücü) ve maksimum yüklenme miktarları biyomekanik olarak değerlendirildi. Bulgular: Ortalama ayrışma gücü, grup A’da 1045.0±45.4 N (Newton) ve grup B’de 1238.1±115.8 N olarak tespit edildi. Ayrışma gücü açısından, iki grup benzerdi (p=0.01). Maksimum yüklenme miktarı grup A’da 1261.8±52.4 N, grup B’de ise 1471.1±107.3 N olarak bulundu. Maksimum yükleme değerleri, çok yönlü tespit tekniğinde (grup B), tek yönlü tespit tekniğinden (grup A) istatiksel olarak yüksek bulundu (p=0.004). Sonuç: Humerus proksimal uç iki parçalı cerrahi boyun kırıklarının sabitlenmesinde, gergi bandı ve K-telleri ile güçlendirilmiş çok yönlü tespit yöntemi, tek yönlü tespit yöntemine göre daha etkilidir

Treatment of Osteochondral Lesions of the Talus With Cell-free Polymer-based Scaffold in Single-Step Arthroscopic Surgery.

Arthroscopic techniques have recently gained popularity for the treatment of osteochondral defects of the talus. The microfracture procedure is the most commonly applied arthroscopic technique. However, it is not effective for the treatment of larger lesions. Tissue-engineered scaffolds have been used for cartilage regeneration arthroscopically, and promising results have been reported. We treated larger osteochondral lesions of the talus with polyglycolic acid-hyaluronan scaffold biomaterial (Chondrotissue, BioTissue AG, Zurich, Switzerland) in a single-step arthroscopic surgery. Traction methods and fibrin glue were avoided

Researching the effect of longtime skate using on distribution of sole pressure in ice hockey players

Amaç: Bu araştırmanın amacı buz hokeycilerle ile sağlıklı kişilerin ayak tabanı 11 temas alanı bölgesine ait zirve basınç, ortalama maksimal basınç ve basınç–zaman entegrali pedobarografik parametreleri karşılaştırılarak, buz hokeyinin ayak tabanı üzerine etkisi araştırılmıştır. Çalışma Planı: Çalışmaya ayak şikâyeti olmayan 22 erkek buz hokeyi oyuncusu (18.37 ± 2.2 yaş ) ve kontrol gurubu olarak 25 erkek gönüllü (26.10 ± 2.40 yaş) dâhil edilmiştir. Araştırmada EMED-SF plantar basınç analiz sistemi kullanılmıştır. Denek ve kontrol grubu ortalamaları arasında istatistiksel olarak anlamlı farkın olup olmadığı non-parametrik Mann Whitney U testi, fiziksel yapı ve ayak tabanına ait değişkenler arasındaki doğrusal ilişkinin büyüklüğü Pearson’un (r) katsayısı hesaplanarak incelenmiştir (P<0.01–0.05). Bulgular: Ölçümler sonunda ayak tabanı 11 temas alanı zirve basınçta sol ayak 3. metatars başı ve toplamı (TOTAL) ile sağ ayak 2. metatars başı, ortalama maksimal basınçta sağ ayak tabanı 2. metatars başında, zaman basınç entegrali karşılaştırmasında ise sol ayak toplamı (TOTAL), sağ ayak 2. metatars ile sol ayak 1., 2., 3. metatars başlarında buz hokeyi oyuncularıyla kontrol gurubu arasında anlamlı farklılıkların olduğunu tespit edilmiştir. Çıkarımlar: Sonuç olarak, buz hokeyinin uzun süreli antrenman ve maçlarda zorlayıcı hareketlerde ayak tabanlarına aşırı yüklenmeleri sporcuların ayak tabanı bazı basınç bölgeleri metatars başlarında değişime neden olduğunu göstermektedir.Purpose: The purpose of this research is to research the effect of football on sole comparing the peak pressure, average maximal pressure and pressure–time integral pedobarographic parameters of 11 contact areas of soles of professional female football players and healthy individuals. Working Plan: 22 male ice hockey players (18.37 &plusmn; 2.2 age) and 25 male volunteers (26.10 &plusmn; 2.40 age) having no foot complaints were included in the study. In the research EMED-SF plantar pressure analysis system was used. It was examined whether there was any statistically significant difference between the experiment and control group means using non-parametric Mann Whitney U test, the size of the linear relation between physical structure and variables of sole was examined by calculating Pearson’s (r) coefficient (P&lt;0.01-0.05). Findings: At the end of the measurements, it was found that there were meaningful differences between the ice hockey players and control group in left foot 3rd metatarsal head and TOTAL and right foot sole 2nd metatarsal head peak pressure of 11 contact areas, in the 2nd metatars head at average maximal pressure and in right and left foot in 2nd metatarsal heads and time pressure integral in right foot sole 2nd and left foot TOTAL, 1st, 2nd, 3rd metatarsal heads and heel medial, heel lateral, 2nd, 3rd and 4th metatarsal heads. Arguments: As a result, ice hockey players players’ excessive pressing against their soles in forcing movements in long term exercises and matches are indicated to cause change in the sportsmen’s sole some pressure regions and values

Bayan futbolcularda ayak tabanı basınç dağılımlarının araştırılması

Amaç: Bu araştırmanın amacı profesyonel bayan futbolcular ile sağlıklı kişilerin ayak tabanı zirve basınç, ortalama maksimal basınç ve basınç–zaman integrali karşılaştırılarak futbolun ayak tabanı üzerine etkisinin araştırılmasıdır. Gereç ve Yöntem: Çalışmaya ayak şikâyeti olmayan 22 bayan futbolcu (18,80 ± 2,2yaş) ve kontrol gurubu olarak 28 bayan gönüllü (27,5 ±6,6yaş) dâhil edilmiştir. Araştırmada EMED-SF (NovelGmbH, Münih, Almanya) plantar basınç analiz sistemi kullanılmıştır. Denek ve kontrol grubu ortalamaları arasında istatistiksel olarak anlamlı farkın olup olmadığı non-parametrik Mann Whitney U testi, fiziksel yapı ve ayak tabanına ait değişkenler arasındaki doğrusal ilişkinin büyüklüğü Pearson’un (r) katsayısı hesaplanarak incelenmiştir. Ölçümlerde %95 güven aralığı ile P < 0.01 – 0.05 anlamlılık seviyesi kabul edilmiştir. Bulgular: Ölçümler sonunda ayak tabanı 11 temas alanı zirve basınç sağ ayak 2., sol ayak 1,2,3,4.metatars başlarında ve 3.4.5 ayak parmaklarında , ortalama maksimum basınçlarında sağ ve sol ayak 2. metatars başlarında ve basınç–zaman integrali ise sağ ayak 2 ve 3. metatars başları ile sol ayak topuk mediali,topuk laterali, 2,3 ve 4. metatars başlarında bayan futbolcularla kontrol gurubu arasında anlamlı farklılıkların olduğunu bulunmuştur. Sonuç: Bulgularımızda, futbolcuların ayak tabanı ön iç bölgelerindeki basınçların hem kontrol gurubuna göre hem de kendi ayaklarının diğer bölgelerine göre daha yüksek olduğu görülmektedir. Özellikle futbolcuların kullandıkları kramponların ayak tabanını korumada yetersiz kaldıkları ve ayak tabanı basınç parametrelerinde kalıcı değişiklikleri engelleyemedikleri belirlenmiştir. Sonuç olarak, futbolcuların uzun süreli antrenman ve maçlarda zorlayıcı hareketlerde ayak tabanlarına aşırı yüklenmeleri sporcularObjective: The purpose of this study is to investigate the effect of football on sole peak pressure, average maximal pressure and pressure–time integral soles of professional female football players and healthy individuals. Methods: 22 female football players (18,80 &plusmn; 2,2 age) and 28 female volunteers (27,5 &plusmn;6,6 age) (as the control group)having no foot complaints were included in the study. In the research EMED-SF (Novel GmbH, Munich, Germany) plantar pressure analysis system was used. It was examined whether there was any statistically significant difference between the experiment and control group means using non-parametric Mann Whitney U test, the size of the linear relation between physical structure and variables of sole was examined by calculating Pearson’s (r) coefficient. In the measurements 95% reliability range and P &lt; 0.01 – 0.05 were accepted as significance level. Results: At the end of the measurements, it was found that there were significant differences between the female football players and control group in right foot 2 left feet 1 st , 2 nd,3rd,4th metatarsal heads sole 11 contact areas peak pressure and in the 3 rd , 4 th and 5 th toes, at average maximal pressure in right and left foot in 2 nd metatarsalheads and time pressure integral in right foot 2 nd and 3 rd metatarsalheads and left foot heel medial, heel lateral, 2nd,3rd and 4 thmetatarsalheads. Conclusion: In our findings, it was found that the pressure in football players’ sole front interior regions was higher than both the control group and the other regions in their own feet. It was determined that the particularly the crampons used by the football players were insufficient to protect the sole and failed to prevent permanent sole pressure parameters. As a result, Football players’ excessive pressing against their soles in forcing movements in long term exercises and matches are indicated to cause change in the sportsmen’s sole pressure regions and values

Investigation of the effect of skate-use on the sole contact areas and maximal forces of ıce hockey players

Bu çalışmanın amacı profesyonel buz hokeyi sporcularıyla sağlıklı bireylerin ayak tabanı maksimal kuvvet ve temas alanları pedobarografik değerleri incelenerek buz hokeyi sporunun ayak tabanına etkisi araştırılmıştır. Çalışmaya 22 buz hokeyi sporcusu ve 25 sağlıklı gönüllü katılmıştır. Çalışma EMED-SF (Novel GmbH, Münih, Almanya) plantar basınç analiz sistemi kullanılarak yapılmıştır. Denek ve kontrol grubunun iki ölçümünün ortalamaları alınarak, ortalamalar arasında istatistiksel olarak anlamlı farkın olup olmadığı non-parametrik Mann Whitney U testi, fiziksel yapı ve ayak tabanına ait değişkenler arasındaki doğrusal ilişkinin büyüklüğü Pearson'un ( r ) katsayısı hesaplanarak incelenmiştir. Bulgulara göre buz hokeycilerin yaptıkları spor ile ayak tabanına ait değişkenler arasındaki ölçümler sonunda ayak tabanı 11 temas alanlarında sağ ayak topuk laterali ve sol ayak 4. metatars başında farklılıklar önemli bulunmuştur. Temas alanı maksimal kuvvetlerde ise sol ayak total, 2. metatars başı ve ayak başparmağında farklılığın anlamlı olduğu tespit edilmiştir (P<0.01-0.05). Sonuç olarak buz hokeyi sporunun ayak tabanın temas alanları ve temas alanlarındaki maksimal kuvvetlerinde bazı değişime neden olduğu ancak ayak tabanına genel anlamda büyük zararlara neden olmadığı görülmektedir. Özellikle kullandıkları ayakkabıların ayak tabanını destekleme ve koruma konusunda kısmı başarılı olduğu tespit edilmiştir. Bu çıkarımlar sonucunda buz hokeyi sporunun sporcuların ayak tabanlarında tıbbı müdahaleleri gerektirecek bir değişime neden olmadığı sonucuna varılmıştır.The aim of the present study was to compare the pedobarographic parameters of contact areas and maximal forces for 11 contact areas of foot-soles in professional male Ice hockey players and healthy people and to investigate the effect of Ice hockey on the foot-sole. The study consisted of 22 Ice hockey players without any foot-related complaints and as the control group, 25 male volunteers. EMED-SF plantar pressure analysis system was used in the study. Any statistically significant difference between the averages of the study and the control groups was examined using non-parametrical Mann Whitney U test and the extent of the linear relationship between the physical structure and the variables of the foot-sole was examined by calculating the Pearson (r) coefficient. According to these results and after the measurements on foot-sole variables and the sports done by the ice hockey players; a significant difference between right foot heel lateral and left foot 4th metatarsus head in terms of 11 contact areas. As for the maximal forces of the contact areas; it was found out that the difference between left foot total, 2th metatarsus head and pollex was found to be significant (P&lt;0.01-0.05). As a result; ice hockey caused some changes in contact areas of the foot-sole and maximal forces of the contact areas, but it did not cause big damages for the foot-sole. It was particularly seen that shoes worn were partly successful in supporting and protecting foot-sole. As the result of these conclusions; it was concluded that ice hockey did not cause such a serious damage to footsole of the players to require medical interventions

The effect of standard pain assessment on pain and analgesic consumption amount in patients undergoing arthroscopic shoulder surgery

Pain assessment has a key role in relief of the postoperative pain. In this study, we aimed to examine the effect of the Standard Pain Assessment Protocol (SPAP), which we developed based on acute pain guidelines, on pain level, and analgesic consumption. The study population consisted of a total of 101 patients who had arthroscopic shoulder surgery. The routine pain assessment was administered to the control group, while the SPAP was administered to the study group. The routine pain therapy of the clinic was administered to the subjects from both groups based on the pain assessment. Throughout the study, pain was assessed nearly two times more in the study group (p b 0.001) and the mean pain levels were lower at 8th–11th hours in the study group (p b 0.001). Pain assessment was not performed after 12th hour despite the severe pain in the control group, and, therefore, analgesia was administered at irregular intervals or was not administered at all. However, the hours of analgesic administration were found to be more regular according to the pain levels of the patients in the study group. In conclusion, the SPAP reduced the pain level by providing regular analgesiawhen used in combination with regular pain assessment. Perspective: This article highlights the appropriate assessment for patients with surgical pain. Inmajority of literature on the subject, the authors emphasize the importance of Standard Pain Assessment Protocol to provide adequate pain relie

Surgical treatment of bilateral femoral stress fractures related with long-term alendronate therapy.

A 67-year-old female patient admitted to our outpatient clinic suffering from pain in both thighs for one year without any history of trauma. Patient was receiving alendronate therapy for five years. Physical examination revealed pain increasing with weight-bearing in both thighs with full range of hip and knee movements. Radiographs showed an area of thickened cortex of middle femoral diaphysis in both femurs, but no fracture. Bone scan showed a single area of increased uptake of radioisotope. These images were compatible with stress fractures of both femurs. Dual-energy X-ray absorptiometry revealed a T-score of -3.2 for the lumbar spine and -3.5 for the hip. Alendronate treatment was ceased. Calcium and vitamin D treatment were started. Patient was performed prophylactic surgical stabilization by titanium elastic nails in May 2009. On first day after the surgery, unsupported mobilization and weight-bearing activities were started. Upon persistence of pain on left thigh, plate fixation was performed for the nonunion in June 2012. Patient is now pain-free and able to walk with full weight-bearing without any complications