Assessment of functional outcome of mini-open rotator cuff repair: a hospital based prospective study

Background: The mini-open repair is considered to be the gold standard for rotator cuff repair. This study was aimed to assess functional outcome of mini-open rotator cuff repair of shoulder joint in adult patients.Methods: This was a one year hospital based prospective study conducted from January 2016 to December 2016. A total of 20 patients diagnosed to have rotator cuff tear of shoulder joint undergoing rotator cuff repair in the department of Orthopaedics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, and KLES Dr. Prabhakar Kore Charitable Hospital, Belagavi were studied.Results: Majority of the patients (85%) of the patients was male and male to female ratio was 5.6:1. Most of the patients were aged between 31 to 40 years (30%). The mean age was 41.90±13.98 years. Most of patients had degenerative rotator cuff tear (45%) and (70%) presented with features of swelling. At enrollment all the patients (100%) had poor constant score (>30) and fair/poor UCLA score (<27) suggestive of severe pain functional restriction. There were gradual but steady increase in scores from enrollment to each follow up till six month follow up with respect to mean flexion (6.25±5.35 to 163.50±7.63),abduction (5.50±5.10 to 112.0±5.94),external rotation (3.00±4.7 to 82.50±2.56 ),internal rotation (2.50±4.44 to 67.25±3.43 ) and UCLA score (5.35±1.63 to 29.60±0.82 ) (p<0.001) also there was gradual but steady decrease in mean VAS score from enrolment (7.70±0.47 ) to six months follow up (0.00±0.00) and constant score ( from 85.70±1.98 to 7.85±1.46 respectively) (p<0.001). The constant score and UCLA score at six month follow up revealed excellent functional outcome. Conclusions: The mini-open rotator cuff repair of shoulder joint results in excellent functional outcome among adult patients with rotator cuff tear of shoulder joint especially after six month with no complications and complete pain relief

An open-label, multicenter, randomized, parallel, single-dose, comparative bioavailability study of two triamcinolone hexacetonide injectable suspensions in patients with knee osteoarthritis

Background: Triamcinolone hexacetonide (THA), a synthetic glucocorticoid with low solubility, can provide sustained pain relief and less systemic side effects in patients with knee osteoarthritis. This study aimed to characterize pharmacokinetic profile of THA-test product containing 20 mg/ml injectable suspension and compare its bioavailability with the standard reference in Indian patients with knee osteoarthritis. Methods: In this open-label, randomized, multicenter study, 44 adult patients were randomized (1:1; test n=23, reference n=21) to receive a single dose of test or reference products. The primary objective was to characterize the pharmacokinetic profile and compare bioavailability of both products via serum triamcinolone acetonide (TCA) concentration. Secondary objectives included safety and tolerability evaluation, impact on hypothalamic-pituitary-adrenal axis, and efficacy of test and reference products in reducing index knee pain. Results: Both products were absorbed with a median Tmax of 23.9 hours. Comparative bioavailability analysis demonstrated no statistically significant formulation effect for ln-transformed Cmax (1098.052 pg/ml for test, 1333.850 pg/ml for reference) and AUC0-t (159112.561 pg×h/ml for test, 211531.035 pg×h/ml for reference) for TCA. T/R ratio for Cmax was 82.3% and T/R ratio for AUC0-t was 75.2%, with >100% inter-subject variability for both Cmax and AUC0-t. Additionally, recovery time of cortisol levels of test and reference arms was 96 hours and 456 hours, respectively. Both products significantly reduced knee pain (p<0.0001). Conclusions: The test product provided lower systemic exposure and faster recovery of serum cortisol levels than the reference, while still providing similar beneficial effect in sustained index knee pain reduction

Study of functional outcome of humerus shaft fracture in adults treated with dynamic compression plating

Background and Objectives: Fractures of humeral shaft account for approximately 3-5% of all fractures. Most will heal with appropriate conservative care, although a small but consistent number will require surgery for optimal outcome. The aim of this study is to assess the results of humeral shaft fractures with dynamic compression plate (DCP). Materials and Methods: This is a prospective study of 35 cases of fracture shaft of humerus admitted to Bapuji Hospital and C.G. Hospital attached to J.J.M. Medical College, Davangere, between October 2005 and September 2007. Cases were taken according to inclusion and exclusion criteria. Results: In our series of 35 cases, there were 31 men and 4 women, with average age of 42.5 years. Twenty-six (74%) cases were admitted due to road traffic accident and with slight predominance of left side. Of 35 cases, 4 (11%) were proximal third, 28 (80%) were middle third, and 3 (9%) were distal third. Transverse or short oblique fractures were most common, that is, 18 (51%) patients. Eleven (31%) cases were having associated injuries. The fractures united in 33 (94%) patients with 2 (6%) cases going for nonunion due to deep infection in one, in other case may be due to immediate weight-bearing activity done by the patient. There was one (3%) case of delayed union, which united after six months. Good or full range of mobility of shoulder and elbow joints was present in 32 (91%) patients with 3 (9%) patients having stiffness of shoulder and elbow joint. Conclusion: Internal fixation of the humerus with DCP achieves higher union rates and comparable better results as compared with other modes of treatment

The diagnostic value of the combination of clinical tests for the diagnosis of supraspinatus tendon tears

CONTEXT: A large number of special tests have been described to examine the shoulder. It is unknown which combination of clinical tests might be optimal for the diagnosis of rotator cuff tears. AIMS OF OUR STUDY: To estimate the diagnostic accuracy of history and clinical tests and to find out which combination of clinical tests is best in diagnosing supraspinatus tendon tears. SETTINGS AND DESIGN: Diagnostic test accuracy study. METHODOLOGY: One hundred and thirty-four patients with shoulder pain were evaluated with history-taking and clinical tests and magnetic resonance imaging of the shoulder. STATISTICAL ANALYSES: Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratios were calculated with a 2 × 2 table. RESULTS: The combination of Neer test, painful arc test, and full can test yielded 100% sensitivity and 100% specificity in diagnosing supraspinatus tears of any type. CONCLUSIONS: Our study shows that individual clinical tests have moderate diagnostic value for the diagnosis of supraspinatus tears. Diagnostic value improves significantly when clinical tests are combined together. Neer test, painful arc test, and full can test form the best combination in diagnosing supraspinatus tears of any type

Chondromyxoid fibroma at an unusual site

Chondromyxoid fibroma (CMF) is a rare tumor, accounting for <1% of all bone tumors. It generally affects the metaphysis of long bones of the lower limbs and involvement of the upper limb is rare. It can be confused with chondroblastoma and chondrosarcoma. Its recognition and differentiation from other tumors are of paramount importance. Here, we report a case of CMF involving the right ring finger

Assessment of functional outcome of mini-open rotator cuff repair: a hospital based prospective study

Background: The mini-open repair is considered to be the gold standard for rotator cuff repair. This study was aimed to assess functional outcome of mini-open rotator cuff repair of shoulder joint in adult patients.Methods: This was a one year hospital based prospective study conducted from January 2016 to December 2016. A total of 20 patients diagnosed to have rotator cuff tear of shoulder joint undergoing rotator cuff repair in the department of Orthopaedics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, and KLES Dr. Prabhakar Kore Charitable Hospital, Belagavi were studied.Results: Majority of the patients (85%) of the patients was male and male to female ratio was 5.6:1. Most of the patients were aged between 31 to 40 years (30%). The mean age was 41.90±13.98 years. Most of patients had degenerative rotator cuff tear (45%) and (70%) presented with features of swelling. At enrollment all the patients (100%) had poor constant score (&gt;30) and fair/poor UCLA score (&lt;27) suggestive of severe pain functional restriction. There were gradual but steady increase in scores from enrollment to each follow up till six month follow up with respect to mean flexion (6.25±5.35 to 163.50±7.63),abduction (5.50±5.10 to 112.0±5.94),external rotation (3.00±4.7 to 82.50±2.56 ),internal rotation (2.50±4.44 to 67.25±3.43 ) and UCLA score (5.35±1.63 to 29.60±0.82 ) (p&lt;0.001) also there was gradual but steady decrease in mean VAS score from enrolment (7.70±0.47 ) to six months follow up (0.00±0.00) and constant score ( from 85.70±1.98 to 7.85±1.46 respectively) (p&lt;0.001). The constant score and UCLA score at six month follow up revealed excellent functional outcome. Conclusions: The mini-open rotator cuff repair of shoulder joint results in excellent functional outcome among adult patients with rotator cuff tear of shoulder joint especially after six month with no complications and complete pain relief