Tears of the rotator cuff : Diagnosis, treatment and symptomatic status

Skulderplager er et økende problem i dagens samfunn. Arbeidsstillinger med langvarig, ensidig skulderbelastning, og et ønske om høy aktivitet hos mange eldre, kan ha bidratt til dette. Plagene er ofte relatert til en skade i rotatorcuffen, skulderens senemansjett. Rupturer i rotatorcuffen forekommer hovedsakelig i aldersgruppen over 40 år. Den naturlige senealdringen, enten alene eller i kombinasjon med traume, ansees som den viktigste utløsende faktoren. I sitt doktorgradsarbeid har ortoped og forsker Stefan Moosmayer vist at rupturer i rotatorcuffen kan påvises med høy grad av nøyaktighet med ultralyd utført av ortoped, senesutur gir bedre resultater enn fysioterapi, og asymptomatiske rupturer forekommer i aldersgruppen fra 50 til 79 år. I to studier ble resultatene fra preoperativ ultralydundersøkelse av skulderen sammenlignet med funnene fra operasjon. Når ultralyd ble utført av en ortoped med lite erfaring med metoden, var sensitivitet og spesifisitet for påvisning av full tykkelses rotatorcuffruptur på 77 % og 98 %. For mer erfaren undersøker, som var blindet for pasientens sykehistorie og kliniske funn, var sensitivitet og spesifisitet på 100 % og 97 %. Dette er like bra som tilsvarende studier har vist for magnettomografisk (MR) rotatorcuff utredning. I en randomisert studie av 103 pasienter sammenlignet Moosmayer og medarbeidere effekten av senesutur og fysioterapi ved rotatorcuffruptur. Ved kontroll etter ett år fant de bedret skulderfunksjon i begge grupper, men på en skala fra 0 til 100 var resultatene etter kirurgi 13 poeng bedre. Hvorfor noen rotatorcuffrupturer er asymptomatiske er uklart. I en sonografisk screeningsstudie av 420 skulderfriske personer i alderen 50 til 79 år, fant Moosmayer og medarbeidere asymptomatiske full tykkelsesrupturer hos 7,6 %. Prevalensen økte med alderen. Sammenligning av MR funn fra 50 asymptomatiske rupturer med funn fra 50 symptomatiske rupturer, viste at de symptomatiske rupturene var signifikant større, og at de hadde en alvorligere grad av muskelatrofi og fettdegenerasjon

Constellations of Transdisciplinary Practices:A Map and Research Agenda for the Responsible Management Learning Field

The emerging field of responsible management learning is characterized by an urgent need for transdisciplinary practices. We conceptualize constellations of transdisciplinary practices by building up on a social practice perspective. From this perspective, knowledge and learning are ‘done’ in interrelated practices that may span multiple fields like the professional, educational, and research field. Such practices integrate knowledge across disciplines (interdisciplinarity) and sectors (intersectorality) in order to learn to enact, educate, and research complex responsible management. Accordingly, constellations of collaborative transdisciplinary practices span the three layers of the responsible management field: Professional responsible management, responsible management education, and responsible management research. We apply this framework to map both recent responsible management learning publications and contributions to this special issue. We notice that although the responsible management field’s aspiration for transdisciplinarity is high the degree to which it has been realized is low. This results in our proposal for a research agenda, which points out impediments to transdisciplinary, and research directions for the responsible management learning field. We also highlight theoretical implications of our conceptual framework for the larger transdisciplinarity discussion

Interrater reliability of physical examination tests in the acute phase of shoulder injuries

Background The physical examination is one of the cornerstones of the diagnostic process in patients with acute shoulder injuries. The discriminative properties of a given examination test depend both on its validity and reliability. The aim of the present study was to assess the interrater reliability of 13 physical examination manoeuvres for acute rotator cuff tears in patients with acute soft tissue shoulder injuries. Methods In a large walk-in orthopaedic emergency department, 120 consecutive patients ≥40 years of age were included in a diagnostic study. Patients who had follow-up within three weeks of an acute shoulder injury without fracture on radiographs were eligible. Four emergency department physicians participated as examiners. In a subset of 48 patients, the physical examination tests were performed by two physicians, randomly chosen by their work rotation. The physicians were blinded to the findings of each other and the results of the ultrasound screening. The interrater reliability was assessed by Cohen’s kappa, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland-Altman plots depending on whether the examination test result was registered as a binary, ordered categorical or continuous numerical variable. Results The median age was 55.5 years, 46% were female. Twenty-seven percent had a rotator cuff full-thickness tear on ultrasound screening; all but one involved the supraspinatus tendon. Cohen’s kappa for binary tests ranged from excellent to fair. Excellent agreement (kappa > 0.8) was found for the inability to abduct above 90° and abduction strength. External rotation strength expressed substantial agreement (kappa 0.7). The lowest scores were registered for Hawkins` test and the external rotation lag sign (kappa 0.25 and 0.40, respectively). The ICCs for active range of abduction and external rotation were 0.93 (0.88–0.96) and 0.84 (0.72–0.91), whereas the SEM was 15 and 9, respectively. Conclusions The results indicate that examination manoeuvres assessing abduction and external rotation range of motion and strength are more reliable than manoeuvres assessing pain in patients in the acute phase of traumatic shoulder injury. The poor agreement observed is likely to limit the validity in the present setting of two commonly used tests. Trial registration The Norwegian Regional Ethics Committee South East (2015/195)

Additional file 2: of KALK study: ultrasound guided needling and lavage (barbotage) with steroid injection versus sham barbotage with and without steroid injection - protocol for a randomized, double-blinded, controlled, multicenter study

Folder physiotherapy procedure. (DOCX 490 kb