Mid- to long-term success rate and functional outcomes of acromioclavicular injections in patients with acromioclavicular osteoarthritis

Background Acromioclavicular (AC) osteoarthritis (OA) is a frequent pathology of the shoulder in elderly patients. Drug injection plays an important role in treatment of AC OA. Literature has demonstrated excellent short-term results regarding shoulder function and pain. However, mid- to long-term results are lacking. The aim of this study was to assess the efficacy of a single intra-articular AC injection in patients with AC OA and to identify predictive factors for success. Methods A retrospective study was performed to analyze success rate, shoulder function, and pain perception after a single intra-articular injection in patients with AC OA. Success was defined as the absence of reinterventions such as additional injection or surgery. Outcome measures were 1-year success rate and clinical outcome scores of Numeric Rating Scale (NRS) for pain, Oxford Shoulder Score, and Subjective Shoulder Value. Results Ninety-eight patients participated in this study. At a median final follow-up of 0.8 years (interquartile range, 0–6), 57 of these patients (58%) had undergone a reintervention. The 1-year success rate was 47% (95% confidence interval, 37%–57%), with NRS at rest as the sole factor significantly associated with success. Thirty patients not requiring reintervention reported significant improvement from baseline for all reported outcome measures at final follow-up. Conclusions AC injections offer a 1-year success rate of 47%. The AC injection produces good mid- to long-term clinical outcomes regarding shoulder function, quality of life, and pain perception in one-third of patients. Further research is essential to analyze mid- to long-term outcomes of AC injections. Level of evidenceLevel IV

Ninety-day complication rate based on 532 Latarjet procedures in Dutch hospitals with different operation volumes

Background: In this study, we aimed to provide insight into the 90-day complication rates following the Latarjet procedure. Data from 2015 were collected from multiple hospitals in the Netherlands, with different volumes of Latarjet procedures. Our second aim was to examine which patient and surgical factors were associated with complications.Methods: We conducted a retrospective chart review of 13 hospitals between 2015 and 2022. Data regarding complications within 90 days of Latarjet procedures were extracted. The effect of sex, age, body mass index (BMI), smoking, previous shoulder operations, fixation material, hospital volume, screw size, and operation time on the complication rate was assessed by multivariable logistic regression analysis.Results: Of the 532 included patients, 58 (10.9%) had complications. The most common complications were material failure (n = 19, 3.6%) and nerve injury (n = 13, 2.4%). The risk of complications was lower for male patients than for female patients (odds ratio, 0.40; 95% confidence interval, 0.21-0.77; P = .006). Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time were not associated with complications.Conclusion: The 90-day complication rate after the Latarjet procedure was 10.9% and was higher in female patients than in male patients. Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time did not affect complication rates. We advise setting up a national registry to prevent under-reporting of complications.</p

Malunion after midshaft clavicle fractures in adults: The current view on clavicular malunion in the literature

This is an overview of the current literature on malunion after midshaft clavicle fracture. Anatomy, trauma mechanism, classification, incidence, symptoms, prevention, and treatment options are all discussed. The conclusion is that clavicle malunion is a distinct clinical entity that can be treated successfully

Human matrix metalloproteinases: An ubiquitarian class of enzymes involved in several pathological processes

Human matrix metalloproteinases (MMPs) belong to the M10 family of the MA clan of endopeptidases. They are ubiquitarian enzymes, structurally characterized by an active site where a Zn(2+) atom, coordinated by three histidines, plays the catalytic role, assisted by a glutamic acid as a general base. Various MMPs display different domain composition, which is very important for macromolecular substrates recognition. Substrate specificity is very different among MMPs, being often associated to their cellular compartmentalization and/or cellular type where they are expressed. An extensive review of the different MMPs structural and functional features is integrated with their pathological role in several types of diseases, spanning from cancer to cardiovascular diseases and to neurodegeneration. It emerges a very complex and crucial role played by these enzymes in many physiological and pathological processes

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

The scapular neck fracture : biomechanical, clinical and surgical aspects

After a short introduction to the topics of this thesis, in chapter 2 we described the functional and radiological results of a retrospective study in patients with an ipsilateral scapular neck and clavicular shaft fracture (floating shoulder). Forty-six patients were treated between 1991 and 1996. Thirty-five patients remained available for analysis (follow-up: 35 months). Thirty-one patients had been initially treated non-operatively and four operatively. Three patients underwent secondary surgery. Both operatively as non-operatively treated patients had a fair to good functional outcome (Constant score 71 versus 76). A correlation was found between radiological result (angular malunion of the neck) and functional result. Our study results suggest that conservative treatment is preferred in patients with an ipsilateral clavicular and scapular neck fracture, in absence of angular malunion. Fair to poor functional results are reported in literature on patients with a displaced scapular neck fracture. In chapter 3 occurrence of malunion was analysed in conservatively treated patients with a scapular neck fracture in relation with the clinical outcome. In the period 1991 and 2001, 24 patients with a locally isolated scapular neck fracture were treated. Thirteen patients were available (follow-up: 5.5 years). In four patients a translational displacement > 1 cm was found, but no significant angular displacement. The mean Constant score of all 13 patients was 90. This study suggests that there is no correlation between occurrence of translational displacement of the scapular neck and a poor functional result. In chapter 4 a biomechanical study was described .The aim was to identify a mechanical cause for loss of shoulder function in case of a malunited scapular neck. A 3D computer model was used to analyse shoulder biomechanics. Abduction of the humerus and loading of a 90º abducted humerus were simulated with presence and absence of caudal displacement of the glenoid. The patterns of muscle activation were studied, with attention to the rotator cuff muscles. A difference in muscle activation was found between the control and malunion cases. The rotator cuff muscles were significantly shortened in the fracture cases and their generated forces were strongly reduced when the humerus was loaded at 90º abduction. From the current study it appears that loss of the rotator cuff function can be compensated by other muscles with larger moment arms. In chapter 5, the current status of the anatomical, biomechanical and clinical aspects of a floating shoulder is reviewed. It is suggested in literature that in patients with a floating shoulder, O.R.I.F. of the clavicular shaft fracture will reduce the displaced scapular neck fracture and prevent malunion. In chapter 6 is explained-by presentation of three case reports- that this generally accepted theory is not correct. In chapter 7 an anatomical study is presented in which the best position of the arm for achieving an adequate exposure to the scapular neck and the safest distance of both axillary and suprascapular nerve to the glenoid is determined. Thirteen fresh-frozen shoulders were dissected through a posterior surgical approach.. The distance of neurovascular structures to the glenoid was measured with the arm in different positions. A significant increase in axillary nerve-glenoid distance by abducting the arm was observed in all cases. It was concluded that abduction of the arm facilitates the exposure to the scapular neck. Abduction up to 90º particularly in combination with external rotation of the arm increases the "safe zone" between the branch of the axillary nerve innervating the teres minor muscle and the glenoid. The posterior surgical approach according to Brodsky is elucidated in chapter 8 by presentation of a patient who was treated by O.R.I.F. of a displaced glenoid fracture

Humeral retroversion (Complexity of assigning reference axes in 3d and its influence on measurement): A technical note

Background: Humeral retroversion (RV) is important to the study of shoulder function and reconstruction. This study tests the hypothesis that clinically obtained computer tomography (CT) measurements for humeral RV (off-axis measurements) differ from those obtained after reformatting the image slice orientation so that the humeral shaft is perpendicular to the gantry (coaxial measurements) and explores deviations from true RV. Materials and methods: A custom-built application created in Mathematica was used to explore the effect of altering the humeral orientation on slice angle acquisition by 3D imaging technologies, on the perceived angle of RV from the 2D-projection of the reference axes. The application allows for control of humeral axis orientation relative to image slice (3D) or plain of projection (2D) and humeral rotation. The effect of rotating a virtual model of one humerus around its own axis and in discrete anatomical directions on the measured RV angle was assessed. Results: The coaxial measurement of humeral RV (31.2°) differed from off-axis measurement, with a maximum difference in measured RV of 50° in 45° of extension. The typical position of the humerus in a CT scan resulted in a difference in RV measurement up to 22°. Explorations of deviation led to the following outcomes, as divided by anatomic direction. Extension and abduction led to an underestimation, and flexion and adduction led to an overestimation of the RV-angle. Conclusion: Measurements must be done consistently about the position and orientation of the humerus. Deviation in the humeral alignment of as little as 10° can distort the measurement of version up to 15°

Recognition of psychopathology with religious content by clergy members: a case vignette study

Clergy members (CMs) frequently offer support and counselling for people with mental health problems. The current study aims to obtain insight into the ability among CMs to recognise psychopathology and need for psychiatric treatment. A random sample of CMs (N ¼ 143) and a control sample of mental health professionals (MHPs, N ¼ 73), were compared as to their evaluations of four vignettes. CMs considered the psychiatric states to be related to religious or spiritual problems to a similar degree as they did for the non-psychiatric states. Sensitivity of CMs with regard to the need of psychiatric care for the psychiatric states was modest (66%) and differed significantly from MHPs (96%). Specificity of the CMs was 89%, which was significantly lower than the MHPs (97%). The CMs did recognise psychopathology with religious content but clearly to a lower extent than MHPs. Requests by CMs for education about recognising psychopathology may be considered as justified

Irreparable rotator cuff tears: long-term follow-up, five to ten years, of arthroscopic debridement and tenotomy of the long head of the biceps

Purpose: Rotator cuff tears (RCT) are a common source of pain and disability of the shoulder and are frequently combined with pathology of the long head of the biceps tendon (LHBT). The aim of this study was to evaluate the long-term results (5–10 years) of arthroscopic debridement of the rotator cuff with or without tenotomy of the LHBT in patients with irreparable rotator cuff tears. Methods: Patient files between January 2005 and December 2010 were retrospectively reviewed. Suitable patients were contacted and invited to the outpatient clinic for assessment of their shoulder function by the constant score and were asked to fill out questionnaires, comprising the Oxford Shoulder Score (OSS), the SF-12, change in pain and function and satisfaction rate. Results: The outcome measures of 39 patients with a mean age of 75.6 (SD 6.6) years were evaluated at a mean follow-up time of 6.5 (SD 1.5) years. All patients had filled out the questionnaires and 23 patients (59%) visited the outpatient clinic. The median corrected constant score for age and gender was 90 (P25-P75: 73–94). Twenty-six patients (67%) were satisfied with the result. No significant differences in outcome measures were found between patients treated solely with debridement and patients treated with debridement combined with tenotomy of the LHBT. Conclusions: Both arthroscopic debridement and debridement combined with a bicepstenotomy yields high satisfactory shoulder function in elderly patients at long term

De herkenning van psychische problemen met religieuze inhoud door pastores: een vignetstudie

Clergy members (CMs) often attend to the religious needs of those with psychological or psychiatric disorders. There are indications in the literature that CMs feel they have not been adequately trained to recognize these disorders. AIM To gain insight into the extent to which CMs recognize psychiatric symptoms. METHOD CMs regionally recruited in the Southwest Netherlands (Roman Catholics, strictly Protestants, moderate Protestants and Evangelicals, n = 143) and a control group of mental health professionals (MHPs) (n = 73) assess four vignettes on psychological problems with religious content, two describing psychiatric cases (a psychotic state and a psychotic depression / melancholy state) and two describing non-psychiatric cases (a mystical experience and a mourning situation with a religious dilemma). For each vignette, the respondents score the usefulness of psychiatric medication, the desirability of assistance from the mental health care, the seriousness of the case and the assumed religious or mystical etiology. RESULTS Compared to MHPs, CMs recognize psychiatric problems to varying extents. Evangelical CMs recognize them the least accurately and strict Protestant CMs the best. Evangelical and strict Protestant CMs are more apt to interpret non-psychiatric states as pathological. CONCLUSION The findings in this study emphasize the importance of collaboration between MHPs and CMs and the importance of consultation