Atrophy patterns in isolated subscapularis lesions

Background!#!While supraspinatus atrophy can be described according to the system of Zanetti or Thomazeau there is still a lack of characterization of isolated subscapularis muscle atrophy. The aim of this study was to describe patterns of muscle atrophy following repair of isolated subscapularis (SSC) tendon.!##!Methods!#!Forty-nine control shoulder MRI scans, without rotator cuff pathology, atrophy or fatty infiltration, were prospectively evaluated and subscapularis diameters as well as cross sectional areas (complete and upper half) were assessed in a standardized oblique sagittal plane. Calculation of the ratio between the upper half of the cross sectional area (CSA) and the total CSA was performed. Eleven MRI scans of patients with subscapularis atrophy following isolated subscapularis tendon tears were analysed and cross sectional area ratio (upper half /total) determined. To guarantee reliable measurement of the CSA and its ratio, bony landmarks were also defined. All parameters were statistically compared for inter-rater reliability, reproducibility and capacity to quantify subscapularis atrophy.!##!Results!#!The mean age in the control group was 49.7 years (± 15.0). The mean cross sectional area (CSA) was 2367.0 mm!##!Conclusion!#!Analysis of typical atrophy patterns of the subscapularis muscle demonstrates that the CSA ratio represents a reliable and reproducible assessment tool in quantifying subscapularis atrophy. We propose the classification of subscapularis atrophy as Stage I (mild atrophy) in case of reduction of the cross sectional area ratio < 0.4, Stage II (moderate atrophy) in case of < 0.35 and Stage III (severe atrophy) if < 0.3

An ECG-based algorithm for the automatic identification of autonomic activations associated with cortical arousals

OBJECTIVES: EEG arousals are associated with autonomic activations. Visual EEG arousal scoring is time consuming and suffers from low interobserver agreement. We hypothesized that information on changes in heart rate alone suffice to predict the occurrence of cortical arousal. METHODS: Two visual AASM EEG arousal scorings of 56 healthy subject nights (mean age 37.0 ± 12.8 years, 26 male) were obtained. For each of 5 heartbeats following the onset of 3581 consensus EEG arousals and of an equal number of control conditions, differences to a moving median were calculated and used to estimate likelihood ratios (LRs) for 10 categories of heartbeat differences. Comparable to 5 consecutive diagnostic tests, these LRs were used to calculate the probability of heart rate responses being associated with cortical arousals. RESULTS: EEG and ECG arousal indexes agreed well across a wide range of decision thresholds, resulting in a receiver operating characteristic (ROC) with an area under the curve of 0.91. For the decision threshold chosen for the final analyses, a sensitivity of 68.1% and a specificity of 95.2% were obtained. ECG and EEG arousal indexes were poorly correlated (r = 0.19, P <0.001, ICC = 0.186), which could in part be attributed to 3 outliers. The Bland-Altman plot showed an unbiased estimation of EEG arousal indexes by ECG arousal indexes with a standard deviation of ± 7.9 arousals per hour sleep. In about two-thirds of all cases, ECG arousal scoring was matched by at least one (22.2%) or by both (42.5%) of the visual scorings. Sensitivity of the algorithm increased with increasing duration of EEG arousals. The ECG algorithm was also successfully validated with 30 different nights of 10 subjects (mean age 35.3 ▯ 13.6 years, 5 male). CONCLUSIONS: In its current version, the ECG algorithm cannot replace visual EEG arousal scoring. Sensitivity for detecting <10-s EEG arousals needs to be improved. However, in a nonclinical population, it may be valuable to supplement visual EEG arousal scoring by this automatic, objective, reproducible, cheap, and time-saving method. CITATION: Basner M; Griefahn B; Müller U; Plath G; Samel A. An ECG-based Algorithm for the automatic identification of autonomic activations associated with cortical arousal. SLEEP 2007;30(10):1349-1361

Prevalence of and risk factors for dislocation arthropathy: radiological long-term outcome of arthroscopic bankart repair in 100 shoulders at an average 13-year follow-up

Background:Glenohumeral osteoarthritis is a well-documented, long-term complication of open stabilization procedures. However, there is a lack of knowledge about long-term radiographic outcome after arthroscopic Bankart procedures.Hypothesis:Glenohumeral osteoarthritis will develop less frequently in arthroscopic Bankart repair compared with open repairs reported in the literature.Study Design:Case series; Level of evidence, 4.Methods:The inclusion criteria for this study were (1) all-arthroscopic Bankart repair for a (2) symptomatic anteroinferior shoulder instability and (3) a minimum follow-up of 10 years. True anteroposterior and lateral radiographs were obtained to evaluate the prevalence and grade of osteoarthritis according to the Samilson classification. Patients were assessed by the Constant score and examined for passive external rotation deficits.Results:Of 165 shoulders that fulfilled the inclusion criteria, 100 were available for evaluation. The median Constant score at an average ± SD 156.2 ± 18.5 months after Bankart repair was 94 (range, 46-100). Twenty-one shoulders (21%) sustained a recurrent dislocation. Overall, 31% of shoulders showed no evidence of glenohumeral osteoarthritis; 41% showed mild, 16% moderate, and 12% severe degenerative changes. Osteoarthritis did not correlate with Constant score results ( P = .427). The grade of osteoarthritis was significantly associated with the number of preoperative dislocations ( P = .016), age at initial dislocation ( P = .005) and at surgery ( P = .002), and the number of anchors used ( P = .001), whereas time from initial dislocation to surgery ( P = .854) and external rotation deficit at 0° and 90° of abduction ( P = .104 and .348, respectively) showed no significant correlation. Recurrent dislocation did not affect the presence or grade of osteoarthritis ( P = .796 and .665, respectively).Conclusion:At an average 13 years after arthroscopic Bankart repair, osteoarthritic changes are a common finding and, overall, are comparable with reports in the literature regarding open procedures as well as nonoperative treatment. The extent of trauma sustained during preoperative dislocations and the age of the patient seem to be more relevant for long-term dislocation arthropathy than the kind of treatment. Accordingly, the study hypothesis must be rejected. Avoiding preoperative dislocations is more important for the prevention of osteoarthritis than short-term treatment. The number of anchors used was found to be a predictor for long-term development of osteoarthritis.</jats:sec