Functional results and return to sports on recurrent anterior glenohumeral instability. Influence of the COVID-19 pandemic; Comparative retrospective study and short-term results.

AIMS: Our objective is to compare the functional results in patients that underwent surgery for recurrent anterior shoulder instability (RAGHI) during the COVID-19 pandemic with remotely-based rehabilitation, to those who had surgery before the pandemic and had in-person rehabilitation therapy. METHODS: A retrospective case series of 68 patients were included and divided into two groups: In person-group and Home-based group. Western Ontario Shoulder Instability Index (WOSI) and Subjective Shoulder Value (SSV) scores were used to evaluate objective and subjective clinical parameters. Time and level of return to sports was studied by the Subjective Patient Outcome for Return to Sports (SPORTS) score. RESULTS: The mean SSV score was 82% (40-100) on the In-Person group compared with 87% (65-100) for the Home-Based group. Results for WOSI score were similar, with an average of 210.42 (90%) for In-Person and 261.45 (88%) for the Home-Based group (p 0.12). Return to sports was carried out in an average of 6.6 (4-16) months for In-Person group, compared to 6.5 (5-8) months for Home-Based. CONCLUSION: Follow-up and rehabilitation methods for patients who underwent surgery for RAGHI, during COVID-19 lockdown, were not significantly (p 0.12) affected on functional and athletic return in comparison to traditional methods according to WOSI scale. LEVEL OF EVIDENCE: IV Retrospective series of cases.

Shoulder injury related to vaccine administration following SARS-CoV-2 inoculation: Case series and review of literature.

Introduction: Shoulder Injuries Related to Vaccine Administration (SIRVA), describes those cases of shoulder severe post-inoculation complications, including pain and prolonged disability. Most of the reported cases have been secondary to influenza vaccination. This study retrospectively describes a series of 18 patients following SARS-CoV-2 inoculation and compares the findings with those previously reported for other vaccines. Materials and methods: Inclusion criteria was onset of symptoms within 48 hours after injection, symptoms duration of at least seven days, and restricted range of motion in absence of symptoms prior to vaccination. Average age was 59.4 years old (38-76), and 72.2% were women. Results: In many cases (58%) the initial diagnosis was not clear, which lead to incorrect treatment. The most common pathological finding was subacromial-subdeltoid bursitis (66.6%). All patients who received depot corticosteroids followed by a gentle rehabilitation program showed strong clinical improvement but did not completely resolve the symptoms at 7.2 months average final follow-up. Surgical intervention was necessary in one of the patients due to the persistence of symptoms despite conservative treatment. Conclusions: Shoulder injury related to vaccine administration is rare, but when present, its torpid evolution makes it difficult to treat. We have found in our case series a similar pattern to that already described for other vaccines. A high index of suspicion helps to pick up the condition promptly and early treatment can bring satisfactory outcome.

Shoulder Injury Related to Vaccine Administration Following Misplaced SARS-CoV-2 Vaccination: A Case Report and Review of Literature

Introduction: To confront the SARS-CoV-2 pandemic, a large share of the population must be immunized. Intramuscular vaccination of the shoulder is the preferred technique as it is easily exposed and guarantees a good immune reaction. Local side effects, such as pain and swelling, are common after deltoid inoculation. They usually resolve within 3 days. Shoulder injury related to vaccine administration (SIRVA) should be considered if the symptoms persist. The aim of this presentation is to describe a typical case of SIRVA after SARS-CoV-2 vaccination and provide information to the general orthopedic surgeon to properly diagnose, report, and treat these cases. Case Report: A 69-year-old female health-care professional without history of shoulder pain consulted the senior author for persistent severe left shoulder pain 3 months following the second dose of Sputnik V COVID-19 vaccination. She claimed an improper application technique that caused immediate pain and loss of active range of motion (ROM). She underwent medical treatment with several doctors during 3 months with poor results. A magnetic resonance imaging (MRI) of the left shoulder done 5 days after vaccination showed mild subacromial-subdeltoid bursitis. A follow-up MRI at 2 months after application revealed synovial hypertrophy and distention of the subacromial-subdeltoid bursa. We prescribed a dose of depot betamethasone and home-based program of gentle exercises. Although initial response was quick, the patient required shoulder arthroscopy the following months, due to persistence in pain and functional limitations. Conclusion: SIRVA cases may occur and should be suspected in all individuals without a history of shoulder symptoms or dysfunction who experience sudden pain and reduced ROM following deltoid muscle vaccination. Treatment must be initiated early with corticosteroids and rehabilitation. The low probability of this complication does not outweigh the advantages of vaccination.

COVID-19 Tracheostomy: Experience in a University Hospital With Intermediate Follow-up.

The benefits of percutaneous dilational tracheostomy (PDT) placement have been well documented in patients requiring prolonged mechanical ventilation. However, the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients are scarce. The objective of this study is to evaluate the outcomes of a cohort of 37 patients who underwent tracheostomy as part of their COVID-19 care. Retrospective data from a series for 37 patients undergoing tracheostomy was collected using chart review. Primary outcomes included 30 and 60 day mortality, weaning rate, and decannulation rate. Secondary outcomes collected included admission demographics, comorbidities, and procedural information. Thirty-seven (37) patients requiring prolonged mechanical ventilation due to COVID-19. Of these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned from mechanical ventilation and 18 have been decannulated. The low mortality and high decannulation rates in this cohort in is a promising development in the care of critically ill COVID-19 patients. Of note, all participating physicians underwent routine polymerase chain reaction (PCR) testing for infection with the severe acute respiratory syndrome coronavirus-2 virus and no physician contracted COVID-19 as a result of their involvement. Overall, this case series describes the modified PDT technique used by our team and discusses the feasibility and potential benefit to PDT placement in COVID-19 patients requiring long-term mechanical ventilation.