ABSTRACT
INTRODUCTION: In late 2019 and early 2020 a novel coronavirus (Covid-19) spread across the world creating a global pandemic. In the state of Pennsylvania, non-emergent, elective operations were temporarily delayed from proceeding with normal standard of care. The primary purpose of this study was to determine the proportion of patients who required prescription pain medication during the surgical delay. Secondarily, we sought to determine the proportion of patients who perceived their surgery as non-elective and evaluate how symptoms were managed during the delay. MATERIALS AND METHODS: A single institutional database was used to retrospectively identify all shoulder and elbow surgeries scheduled between March 13, 2020 and May 6, 2020. Charts were manually reviewed. Patients who underwent non-shoulder and elbow related procedures and patients of surgeons outside of Pennsylvania were excluded. Patients whose surgeries were "postponed" or "canceled" were administered a survey evaluating how symptoms were managed and perceptions regarding the delay. Preoperative functional scores were collected. Statistical analysis was performed to determine associations between procedure status, preoperative functional scores, perception of surgery, and requirement for prescription pain medication. RESULTS: 338 patients were scheduled for shoulder/elbow surgery at our practice in Pennsylvania. 89 patients (26.3%) underwent surgery as initially scheduled. 179 patients (71.9%) had their surgeries postponed. 70 patients (28.1%) canceled surgery. The average delay in surgery was 86.7 days (range, 13-299 days). 176 (70.7%) patients who were postponed or canceled responded to the survey. 39 patients (22.2%) required prescription pain medication during the delay. 73 patients (41%) considered their procedure to be elective in nature. 137 patients (78%) would have moved forward with surgery if done safely under appropriate medical guidelines. Lower preoperative ASES and SANE scores (r= -0.36, p<0.001; r=-0.26, p=0.016, respectively), and higher preoperative VAS scores were correlated with requiring prescription pain medication (r=0.28, p=0.009). Higher preoperative ASES score was positively correlated with perception of surgery as elective (r=0.4; p<0.001). CONCLUSION: Patients undergoing elective shoulder and elbow surgery during the Covid-19 pandemic experienced a delay of nearly 3 months on average. Fewer than half of patients perceived their surgeries as elective procedures. Nearly a quarter of patients surveyed required extra prescription pain medicine during their delay. This study elucidates the fact that while orthopedic shoulder and elbow surgery is generally considered "elective" it is more important to a majority of patients. These findings may also be applicable to future potential mandated surgical care delays by other third- party organizations.
ABSTRACT
Shoulder injury related to vaccine administration (SIRVA) is a rare but potentially debilitating injury characterized by persistent shoulder pain, typically occurring within 48 hours of intramuscular deltoid vaccine administration. With over 150 million flu vaccines being administered in the United States each year, and the US Centers for Disease Control's goal of immunizing greater than 70% of the population for the coronavirus disease 2019 virus, cases of SIRVA can be expected to rise. A search of current literature was done to identify published material corresponding to incidence, diagnosis, and treatment of SIRVA. Most events have been associated with poor needle placement and/or a local reaction to the delivered serum during vaccine administration. Shoulder injury related to vaccine administration events can lead to persistent and possibly permanent injury. Clinical evaluation involves a thorough history, physical examination, and often diagnostic studies including radiographs, magnetic resonance imaging, and nerve studies. Treatment is individually directed and should initially consist of observation and local symptom management. Recalcitrant cases or infections may warrant surgical intervention. Published outcomes vary widely, and our understanding of SIRVA remains limited. Large-scale studies are necessary to better understand the pathophysiology of SIRVA, its treatment, and its outcomes. Overall, the initial priority in managing SIRVA should be awareness and prevention.