Costs of physician and diagnostic imaging services for shoulder, knee, and low back pain conditions: A population-based study in Alberta, Canada.

Objectives: To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services.

Methods: All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients' sex and age.

A scoping review and best evidence synthesis for treatment of partial-thickness rotator cuff tears.

Background: Rotator cuff disorders include a broad spectrum of pathological conditions including partial-thickness and full-thickness tears. Studies have shown partial-thickness rotator cuff tear (PTRCT) prevalence to be twice that of full-thickness tears. In the working population, PTRCTs are one of the most common causes of shoulder pain and often result in occupational disability due to pain, stiffness, and loss of shoulder function.

Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada.

Background: Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes.

Is Immobilization Necessary for Early Return to Work Following Distal Biceps Repair Using a Cortical Button Technique?: A Randomized Controlled Trial.

Background: Improvements in surgical fixation to repair distal biceps tendon ruptures have not fully translated to earlier postoperative mobilization; it is unknown whether earlier mobilization affords earlier functional return to work. This parallel-arm randomized controlled trial compared the impact of early mobilization versus 6 weeks of postoperative immobilization following distal biceps tendon repair.

Methods: One hundred and one male participants with a distal biceps tendon rupture that was amenable to a primary repair with use of a cortical button were randomized to early mobilization (self-weaning from sling and performance of active range of motion as tolerated during first 6 weeks) (n = 49) or 6 weeks of immobilization (splinting for 6 weeks with no active range of motion) (n = 52).

Move It or Lose It? The Effect of Early Active Movement on Clinical Outcomes Following Rotator Cuff Repair: A Systematic Review With Meta-analysis.

Objective: To assess the effect of early active shoulder movement after rotator cuff repair, compared to delayed active shoulder movement, on clinical outcomes, rotator cuff integrity, and return to work.

Study Design: Intervention systematic review.

Literature Search: We searched 14 databases in November 2017 and updated the search in December 2018 and February 2020.

Factors associated with maintaining reduction following locking plate fixation of proximal humerus fractures: a population-based retrospective cohort study.

Background: Loss of reduction (LoR) can occur after locking plate fixation of proximal humerus fractures (PHFs). This study determined biomechanical features of fracture fixation associated with preventing LoR postoperatively. One-year reoperation rates were also compared between those with/without LoR.

Exploring the Business Case for Improving Quality of Care for Patients With Chronic Rotator Cuff Tears.

Background And Objectives: Currently, management of patients presenting with chronic rotator cuff tears in Alberta is in need of quality improvements. This article explores the potential impact of a proposed care pathway whereby all patients presenting with chronic rotator cuff tears in Alberta would adopt an early, conservative management plan as the first stage of care; ultrasound investigation would be the preferred tool for diagnosing a rotator cuff tear; and only patients are referred for surgery once conservative measures have been exhausted.

Methods: We evaluate evidence in support of surgery and conservative management, compare care in the current state with the proposed care pathway, and identify potential solutions in moving toward optimal care.

Validation of a tool to assess patient satisfaction, waiting times, healthcare utilization, and cost.

Aim: Patients' experience of the quality of care received throughout their continuum of care can be used to direct quality improvement efforts in areas where they are most needed. This study aims to establish validity and reliability of the Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ) - a tool that collects patients' experience that quantifies aspect of care used to make judgments about quality from the perspective of the Alberta Quality Matrix for Health (AQMH).

Background: The AQMH is a framework that can be used to assess and compare the quality of care in different healthcare settings.

Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

Purpose: To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24 months following arthroscopic rotator cuff (RC) repair.

Methods: A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n = 103; self-weaned from sling and performed pain-free active ROM during the first 6 weeks) or SR (n = 103; wore a sling for 6 weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6 weeks and 3, 6, 12, and 24 months postoperatively by a blinded assessor.

Can clinical assessment differentiate partial thickness rotator cuff tears from full thickness rotator cuff tears? A secondary analysis.

Shoulder pain causes significant disability, with rotator cuff disease as a common diagnosis. Differentially diagnosing partial tears of the rotator cuff tendons is difficult despite use of imaging and clinical examination. Our objective was to determine if a clinical assessment framework could discriminate between patients with partial and full thickness tears.

Evaluating quality of care for patients with rotator cuff disorders.

Background: Measuring quality in healthcare is vital in evaluating patient outcomes and system performance. The availability of reliable and valid information about the quality of care for patients presenting with rotator cuff disorders (RCD) in Alberta, Canada is scarce. The objective of this study is to measure quality of care for patients with RCD in order to identify areas of improvement.

Indication for Computed Tomography Scan in Shoulder Instability: Sensitivity and Specificity of Standard Radiographs to Predict Bone Defects After Traumatic Anterior Glenohumeral Instability.

Background: Quantifying glenohumeral bone loss is key in preoperative surgical planning for a successful Bankart repair.

Hypothesis: Simple radiographs can accurately measure bone defects in cases of recurrent shoulder instability.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Using the modified Delphi method to establish clinical consensus for the diagnosis and treatment of patients with rotator cuff pathology.

Background: Patients presenting to the healthcare system with rotator cuff pathology do not always receive high quality care. High quality care occurs when a patient receives care that is accessible, appropriate, acceptable, effective, efficient, and safe. The aim of this study was twofold: 1) to develop a clinical pathway algorithm that sets forth a stepwise process for making decisions about the diagnosis and treatment of rotator cuff pathology presenting to primary, secondary, and tertiary healthcare settings; and 2) to establish clinical practice guidelines for the diagnosis and treatment of rotator cuff pathology to inform decision-making processes within the algorithm.

Imaging methods for quantifying glenoid and Hill-Sachs bone loss in traumatic instability of the shoulder: a scoping review.

Background: Glenohumeral instability is a common problem following traumatic anterior shoulder dislocation. Two major risk factors of recurrent instability are glenoid and Hill-Sachs bone loss. Higher failure rates of arthroscopic Bankart repairs are associated with larger degrees of bone loss; therefore it is important to accurately and reliably quantify glenohumeral bone loss pre-operatively.

A retrospective cohort study of displaced segmental radial head fractures: is 2 mm of articular displacement an indication for surgery?

Hypothesis: Many investigators agree that 2 mm of articular displacement is a reasonable indication for open reduction and internal fixation of Mason type II fractures of the radial head. However, there is no evidence to support that this degree of articular displacement is predictive of poor outcomes in conservatively treated fractures. We hypothesized there would be no difference between conservatively treated radial head fractures with greater 2 mm of displacement and those with less than 2 mm of displacement in terms of patient-reported or clinical outcomes.

Suprascapular nerve injury during arthroscopic superior labral repair: a prospective evaluation.

Purpose: This prospective study evaluated suprascapular nerve injury risk during arthroscopic superior labral repair in patients of average height or shorter.

Methods: From 2009 to 2011, 12 patients <179 cm tall undergoing arthroscopic superior labral repair were prospectively enrolled. Portal location, tear and anchor characteristics, and surgeon impression of medial glenoid wall perforation were collected.

An evaluation of the responsiveness and discriminant validity of shoulder questionnaires among patients receiving surgical correction of shoulder instability.

Health-related quality-of-life (HRQL) measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age = 26.00 ± 8.

Systematic review: nonoperative and operative treatments for rotator cuff tears.

Background: Many approaches exist for managing rotator cuff tears.

Purpose: To compare the benefits and harms of nonoperative and operative interventions on clinically important outcomes in adults with rotator cuff tears.

Data Sources: 12 electronic databases (1990 to September 2009), gray literature, trial registries, and reference lists were searched.

The interobserver reliability of classification systems for radial head fractures: the Hotchkiss modification of the Mason classification and the AO classification systems.

BACKGROUND: Radial head fractures are common injuries, and there is little information on the reliability of classification systems for such injuries. The purpose of our study was to report the interobserver reliability of 2 commonly used classification systems: the Hotchkiss modification of the Mason classification and the AO classification systems. METHODS: We compiled the radiographs from a cohort series of 43 patients with radial head fractures, and 5 observers classified the radiographs according to both classification systems.

The anatomic characteristics of the tibial insertion of the posterior cruciate ligament.

Purpose: The purpose of the study was to better define the tibial insertion of the posterior cruciate ligament (PCL) and to identify landmarks that could be used to aid in placement of independent tibial tunnels for a 2-bundle PCL reconstruction.

Type Of Study: Descriptive anatomic study.

Methods: Ten knees from 8 cadavers were dissected and the PCL was identified.

Simple dislocations of the elbow: evaluation and treatment.

Simple dislocations of the elbow or dislocations occurring without an associated fracture are common injuries. Evaluation of these injuries must include an assessment of the entire involved upper extremity and a complete neurovascular examination. Principles of management include a prompt, controlled reduction, a determination of postreduction stability, and an immediate rehabilitation protocol that considers the stability of the joint following reduction.