Culture positivity in primary total shoulder arthroplasty.

Background: The clinical significance of positive cultures in shoulder surgery remains unclear. This study determined the rate and characteristics of positive intraoperative cultures in a cohort of patients undergoing primary shoulder arthroplasty.

Methods: From February 2015 to March 2016, 94 patients, without prior surgery, underwent primary shoulder arthroplasty.

Motor adaptations to trunk perturbation: effects of experimental back pain and spinal tissue creep.

In complex anatomical systems, such as the trunk, motor control theories suggest that many motor solutions can be implemented to achieve a similar goal. Although reflex mechanisms act as a stabilizer of the spine, how the central nervous system uses trunk redundancy to adapt neuromuscular responses under the influence of external perturbations, such as experimental pain or spinal tissue creep, is still unclear. The aim of this study was to identify and characterize trunk neuromuscular adaptations in response to unexpected trunk perturbations under the influence of spinal tissue creep and experimental back pain.

Staphylococcus Lugdunensis Endocarditis and Cerebrovascular Accident: A Systemic Review of Risk Factors and Clinical outcome.

Infective endocarditis (IE) secondary to Staphylococcus lugdunensis has been increasingly recognized since 1988. IE-related thromboembolism represents an associated complication of the disease and carries a dismal prognosis. However, the incidence of cerebrovascular accident secondary to S.

Surgeons' experience and perceived barriers with outpatient shoulder arthroplasty.

Background: Recently, outpatient total shoulder arthroplasty (TSA) has been proposed as a safe and cost-effective alternative to the inpatient setting. This study evaluated the expert shoulder surgeon's experience with and perceived barriers to outpatient TSA.

Methods: A secure web application was used to perform an online survey of 484 active American Shoulder and Elbow Surgeons members.

Revision of failed hemiarthroplasty for painful glenoid arthrosis to anatomic total shoulder arthroplasty.

Background: The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Painful glenoid arthrosis following hemiarthroplasty is a common cause of reoperation, and conversion to anatomic total shoulder arthroplasty is one option.

Methods: We identified patients who underwent revision of painful hemiarthroplasty to total shoulder arthroplasty over a 15-year period in a single tertiary-care health system.

Risk Assessment and Management of Venous Thromboembolism in Women during Pregnancy and Puerperium (SAVE): An International, Cross-sectional Study.

The clinical burden of obstetric venous thromboembolism (VTE) risk is inadequately established. This study assessed the prevalence and management of VTE risk during pregnancy and postpartum outside the Western world. This international, noninterventional study enrolled adult women with objectively confirmed pregnancy attending prenatal care/obstetric centers across 18 countries in Africa, Eurasia, Middle-East, and South Asia.

Neer Award 2018: the effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial.

Background: Opioids are commonly administered for the treatment of acute and chronic pain symptoms. The current health care system is struggling to deal with increasing medication abuse and rising mortality rates from overdose. Preoperative patient-targeted education on opioid use is an avenue yet to be explored.

A Myth Still Needs to be Clarified: A Case Report of the Frank's Sign.

Despite advancements in diagnostic tools, physical signs such as xanthelasmata, arcus corneae, facial wrinkles, and gray hair are useful indicators of underlying diseases. The presence of bilateral diagonal earlobe creases (DELCs), also known as Frank's sign, correlates with a myriad of cardiovascular diseases such as coronary artery disease, cerebrovascular disease, and peripheral vascular disease. The use of Frank's sign as a bedside predictor of underlying coronary artery disease is controversial among clinicians.

Management of Failed Rotator Cuff Repair in Young Patients.

Management of failed rotator cuff repair may be very difficult, especially in young patients. Various nonmodifiable and modifiable patient factors, including age, tendon quality, rotator cuff tear characteristics, acute or chronic rotator cuff tear, bone quality, tobacco use, and medications, affect rotator cuff repair healing. Surgical variables, such as the technique, timing, tension on the repair, the biomechanical construct, and fixation, as well as the postoperative rehabilitation strategy also affect rotator cuff repair healing.

Glenohumeral Arthritis in Young Patients: Scope, Arthroplasty, Interposition, Arthrodesis, and Resurfacing.

The management of glenohumeral arthritis in young patients is a challenge given the higher demand for use of the arms, need for longer implant survivorship, and higher postoperative expectations in this patient population. Shoulder arthroplasty is an excellent treatment option for elderly patients with glenohumeral arthritis because this patient population does not have demands as high as those of younger patients with glenohumeral arthritis. Common causes of glenohumeral arthritis in young patients include chondrolysis, inflammatory arthropathies, chronic instability, osteonecrosis, glenoid dysplasia, and early-onset osteoarthritis.

Stemless Prosthesis for Total Shoulder Arthroplasty.

The fourth generation of humeral components currently are being used in anatomic shoulder arthroplasty. Anatomic shoulder arthroplasty implants have evolved to better re-create anatomy, improve fixation, preserve bone, and facilitate revision surgery. Most of the design changes for shoulder arthroplasty implants have centered on the humeral stem, with a transition to shorter, metaphyseal humeral stems.

Preoperative Sterilization Preparation of the Shoulder: A Comparative Study Evaluating Gauze Sponge and Commercially Available Applicator Prep Stick.

Background: Surgical site infection (SSI) remains a concern in shoulder surgery, especially during arthroplasty. While many studies have explored the characteristics and efficacy of different sterilizing solutions, no study has evaluated the method of application. The purpose of this study was to compare two popular pre-surgical preparatory applications (two 4 x 4 cm gauze sponges and applicator stick) in their ability to cover the skin of the shoulder.

Effect of Facility Ownership on Utilization of Arthroscopic Shoulder Surgery.

Introduction: We examined practice patterns and surgical indications in the management of common shoulder procedures by surgeons practicing at physician-owned facilities.

Methods: This study was a retrospective analysis of 501 patients who underwent arthroscopic shoulder procedures performed by five surgeons in our practice at one of five facilities during an 18-month period. Two of the facilities were physician-owned, and three of the five surgeons were shareholders.

Outcomes of an anatomic total shoulder arthroplasty with a contralateral reverse total shoulder arthroplasty.

Background: It is common for patients to require staged bilateral shoulder arthroplasties. There is a unique cohort of patients who require an anatomic total shoulder arthroplasty (TSA) and a contralateral reverse shoulder arthroplasty (RSA). This study compared the outcomes of patients with a TSA in 1 shoulder and an RSA in the contralateral shoulder.

The effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position: a randomized blinded study.

Background: Beach chair positioning for shoulder surgery is associated with measurable cerebral desaturation events (CDEs) in up to 80% of patients. Near-infrared spectroscopy (NIRS) technology allows real-time measurement of cerebral oxygenation and may minimize the frequency of CDEs. The purpose of this study was to investigate the incidence of CDEs when anesthetists were aware of and blinded to NIRS monitoring and to determine the short-term cognitive effects of surgery in the beach chair position.

Trends and Variability in the Use of Total Shoulder Arthroplasty for Medicare Patients.

Introduction: As policies are implemented to encourage high-quality care, it is important to identify any persistent limitations to the uniform delivery of anatomic and reverse total shoulder arthroplasty (TSA). The study's goal was to assess current TSA use and identify predictors of geographic variability.

Methods: We used data from 2012 through 2014 that was obtained from public Medicare databases to identify the case volume, locations, and names of surgeons performing >10 TSAs annually.

Apremilast Use in a Case of Cicatricial Ectropion Secondary to Severe Lamellar Ichthyosis.

Ichthyosis is a cutaneous disorder characterized by excessive amounts of dry thickened skin surface scales. Ocular manifestations of ichthyosis include cicatricial ectropion, which may cause exposure keratoconjunctivitis and rarely corneal perforation. Topical emollients, anti-inflammatory ointments, and systemic retinoids have been used to control the disease process, while surgical correction with donor graft has been reserved for severe cases involving corneal exposure.

Humeral shaft fractures.

Fractures of the humeral shaft are common injuries with multiple management strategies. Many still regard nonoperative management as the standard of care; however, as the understanding of these injuries increases, treatment recommendations are also evolving. Fracture pattern, fracture location, and identifiable patient risk factors may predict poor outcome with nonoperative management, and earlier operative intervention may be recommended.

Expectations of Shoulder Surgery Are Not Altered by Surgeon Counseling of the Patient.

 The primary objective of this study was to evaluate if the current mechanisms of preoperative counseling influence patients' expectations of shoulder surgery.  Patients were asked to complete the Hospital for Special Surgery's (HSS) Shoulder Surgery Expectations Survey. The first survey was completed before the first appointment with one of four fellowship-trained shoulder surgeons.

Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder.

Background: Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology.

Incidence of peripheral nerve injury during shoulder arthroplasty when motor evoked potentials are monitored.

To report the incidence of clinically detectable nerve injuries when utilizing transcranial electrical motor evoked potentials (MEPs) during shoulder arthroplasty. A retrospective review of patients undergoing shoulder arthroplasty with continuous IONM was performed. The criteria for nerve alerts was an 80% amplitude reduction in MEPs.

Return to Play Criteria Following Surgical Stabilization for Traumatic Anterior Shoulder Instability: A Systematic Review.

Purpose: To identify and describe in the existing literature any criteria used for return to play following surgical stabilization for traumatic, anterior shoulder instability.

Methods: We performed a systematic review evaluating surgical stabilization for primary traumatic anterior shoulder instability in skeletally mature patients with a minimum of 1-year follow-up using Level I to IV studies in PubMed and EMBASE from January 1994 to January 2017.

Results: Fifty-eight studies with at least 1 explicitly stated criterion for return to play were identified from a review of more than 5,100 published articles.

Trunk proprioception adaptations to creep deformation.

Purpose: This study aimed at identifying the short-term effect of creep deformation on the trunk repositioning sense.

Methods: Twenty healthy participants performed two different trunk-repositioning tasks (20° and 30° trunk extension) before and after a prolonged static full trunk flexion of 20 min in order to induce spinal tissue creep. Trunk repositioning error variables, trunk movement time and erector spinae muscle activity were computed and compared between the pre- and post-creep conditions.