Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process.

Purpose: The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined.

Materials And Methods: This was an observational study.

Diagnostic Value of Acromiohumeral Distance in Rotator Cuff Pathology: Implications for Advanced-Practice Physiotherapists.

The primary purpose of this study was to examine the inter-tester reliability and criterion validity of reduced acromiohumeral distance (AHD; <6 mm) visualized on plain radiographs in detecting rotator cuff (RC) pathology. The secondary objective was to examine the relationship between this radiographic feature and patient demographics and clinical examination. This was a diagnostic study of patients seen in a tertiary care centre.

Reduced acromiohumeral distance and increased critical shoulder angle: implications for primary care clinicians.

: The literature indicates that reduced acromiohumeral distance (AHD) and increased critical shoulder angle (CSA) are associated with large and massive rotator cuff (RC) tears which may not be amenable to a successful repair. The purpose of this study was to examine the overall accuracy of these two radiographic features in diagnosing significant RC pathology. : This was a diagnostic study of patients with shoulder pain.

Accuracy of infraspinatus isometric testing in predicting tear size and tendon reparability: comparison with imaging and arthroscopy.

Background: The purpose of this study was to examine the accuracy of external rotation in neutral (0° external position) and in shortened position (45° external position) in relation to rotator cuff tear size, tendon reparability, and other clinical, surgical, and imaging findings.

Methods: This was a prospective blinded diagnostic study of consecutive surgical candidates for rotator cuff repair using magnetic resonance imaging and arthroscopic surgery as the "gold standards." The area under a receiver operating characteristic (AUROC) curve was calculated for each position.

Efficacy of postoperative radiation treatment for bone metastases in the extremities.

Background And Purpose: Impending or pathological fractures due to bone metastases may require surgical fixation. Postoperative radiation is often recommended to reduce local progression and prevent prosthesis displacement, hence reducing the need for second surgery. The objectives of this study were to investigate the need for second surgery, and to report on rates of re-irradiation, tumor progression and prosthesis displacement following postoperative radiation.

Impact of Radiographic Imaging of the Shoulder Joint on Patient Management: An Advanced-Practice Physical Therapist's Approach.

Recent care innovations using advanced-practice physical therapists (APPs) as alternative health care providers are promising. However, information related to the clinical decision making of APPs is limited with respect to ordering shoulder-imaging investigations and the impact of these investigations on patient management. The purpose of this study was twofold: (1) to explore the clinical decision making of the APP providing care in a shoulder clinic by examining the relationship between clinical examination findings and reasons for ordering imaging investigations and (2) to examine the impact on patient management of ordered investigations such as plain radiographs, ultrasound (US), magnetic resonance imaging (MRI), and magnetic resonance arthrogram (MRA).

Impact of Platelet-Rich Plasma on Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears: A Randomized Controlled Trial.

Background: Increased interest in using platelet-rich plasma (PRP) as an augment to rotator cuff repair warrants further investigation, particularly in smaller rotator cuff tears.

Purpose: To examine the effectiveness of PRP application in improving perioperative pain and function and promoting healing at 6 months after arthroscopic repair of small- or medium-sized rotator cuff tears.

Study Design: Randomized controlled trial; Level of evidence, 1.

Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy.

Background: There is limited information on the validity of magnetic resonance imaging (MRI) in detection of biceps disease. The purpose of this study was to examine the measurement properties of noncontrasted MRI in diagnosis of biceps disease using arthroscopic surgery as the "gold standard."

Materials And Methods: Prospectively collected surgical data of patients with impingement syndrome or rotator cuff tear, with biceps disease (study group) or without biceps disease (control group), were reviewed.

Impact of prosthetic design on clinical and radiologic outcomes of total shoulder arthroplasty: a prospective study.

Background: This prospective longitudinal study compared clinical and radiologic outcomes of total shoulder arthroplasty (TSA) using 3 different prosthetic designs, the Neer II system, the Bigliani-Flatow (BF), and a stemless prosthesis, the Total Evolutive Shoulder System (TESS).

Materials And Methods: Patients with advanced osteoarthritis of the glenohumeral joint who underwent TSA were followed up for 2 years. Four patient-oriented disability outcomes were used.

Immediate pain relief and improved structural stability after percutaneous vertebroplasty for a severely destructive vertebral compression fracture.

Approximately 10% to 30% of patients with cancer have metastases to the spine that require treatment. Spinal metastases can cause acute and chronic pain, compression fractures, spinal instability, and neurologic deficits. Vertebral compression fractures can be a significant cause of pain and impaired function.

The role of plain radiographs in management of bone metastases.

Approximately 50% of patients with cancer will develop skeletal metastases, which often lead to significant pain. When a patient complains of pain, a bone scan and/or plain x-rays are ordered as investigations. X-rays necessitate a 1-cm diameter mass and 50% bone mineral loss at minimum for detection.

Sonographically guided ilioinguinal nerve block.

Objective: The aim of this study was to describe a sonographically guided ilioinguinal nerve block in adults.

Methods: We developed a useful step-by-step technique of sonographically guided ilioinguinal nerve block based on visualization of abdominal muscles, fascial planes, and the branch of the deep circumflex iliac artery.

Results: We performed 9 sonographic examinations with subsequent blockade of the ilioinguinal nerve.

MR pulse sequences: what every radiologist wants to know but is afraid to ask.

The use of magnetic resonance (MR) imaging is growing exponentially, in part because of the excellent anatomic and pathologic detail provided by the modality and because of recent technologic advances that have led to faster acquisition times. Radiology residents now are introduced in their 1st year of training to the MR pulse sequences routinely used in clinical imaging, including various spin-echo, gradient-echo, inversion-recovery, echo-planar imaging, and MR angiographic sequences. However, to make optimal use of these techniques, radiologists also need a basic knowledge of the physics of MR imaging, including T1 recovery, T2 and T2* decay, repetition time, echo time, and chemical shift effects.

Computed tomography (CT) evaluation of breast cancer patients with osteolytic bone metastases undergoing palliative radiotherapy--a feasibility study.

Twenty-five patients with osteolytic metastases had computed tomography (CT) scans before and 3 months after palliative radiotherapy. The median % density change following single 8Gy, 20Gy/5#, 30Gy/10# were: 128 (range 98-255), 141 (79-342), and 145 (65-235), respectively. It is feasible to evaluate remineralization of osteolytic lesions with palliative radiotherapy.