[The shoulder prosthesis in the past 7 years: increasingly used, with good results]. / De schouderprothese in de afgelopen 7 jaar.

The shoulder prosthesis is increasingly used as a solution for various shoulder problems. On the basis of a few cases, an overview is given of the various situations in which a shoulder prosthesis can be used, with a small risk of complications, a high risk of pain reduction and a long survival. In addition, a shoulder prosthesis improves the quality of life and is cost-effective. It is important, however, to set the correct indication with an eye for various psychosocial factors. The individual end result depends on patient-related factors such as pathology, general condition, activity and expectations. But the type of prosthesis and surgical expertise and experience also play a role.

Needle aspiration of calcific deposits versus shock wave therapy for conservative therapy resistant calcifying tendinitis of the shoulder: protocol of a randomized, controlled trial.

BACKGROUND: Calcific tendinitis of the shoulder (CT) is a common disorder with a large disease burden. The initial treatment is with conservative measures. However, when this fails the next step treatment remains unclear. Minimal invasive treatment modalities have emerged. Needle aspiration of the calcific deposits (NACD) and extracorporeal shock wave therapy (ESWT) have both shown good clinical results. Nonetheless, in the current orthopedic literature there are not any studies available that compare both the effectiveness and cost-effectiveness of those two treatment modalities. Therefore, our primary objective is to compare the effectiveness of NACD to ESWT. A secondary objective is to compare the cost-effectiveness of both treatment modalities and workability. METHODS: Following a power calculation using the minimal clinical important difference of our primary outcome (Constant-Murley score, CMS) 140 patients will be included in the study. Enrolment is based upon strict inclusion/ exclusion criteria outlined in the Methods section. Participants will be randomized by computer in two groups (e.g. 70 patients will receive NACD and 70 patients will receive ESWT). The NACD treatment will consist of a sonographically guided removal of the calcific deposits and the ESWT treatment will be a focused ESWT. Both treatments will be conducted according to a standardized protocol, as part of care as usual in our hospital. The primary outcome will be the between group differences in functional outcome (measured with the CMS) between baseline and after 12 months follow-up. Secondary outcomes will be questionnaires regarding the clinical outcome (SST) and quality of life (EQ-5D-5L). Furthermore, NRS pain and cost related questionnaires (iPCQ and ProDisQ) will be collected during follow-up after two months, six months and at final follow-up after 12 months. DISCUSSION: This study will provide more insight regarding treatment for conservative therapy resistant calcific tendinitis of the shoulder by comparing NACD to focused ESWT, which will aid the physician and patient in determining the appropriate treatment plan. TRIAL REGISTRATION: Dutch trial register: NTR7093 registered on 11 March 2018.

Translation and evaluation of psychometric properties of the Dutch version of the Single Assessment and Numeric Evaluation Method (SANEM) in shoulder patients.

BACKGROUND: The Single Assessment Numeric Evaluation Method (SANEM) is a holistic patient-reported outcome measure (PROM) that includes all aspects involving the shoulder. It is simple and easy to administer. It consists of only one question, namely how would you rate your shoulder today as a percentage of normal (0 to 100% with 100% being normal)? The purpose of this study was to translate the SANEM in Dutch and to assess its construct validity, reliability, and responsiveness. METHODS: The SANEM was translated into Dutch using forward and backward translation. Hypothesis testing was used to determine construct validity and responsiveness, 75% needed to be confirmed. Previous validated PROMs were used as comparator instrument for testing construct validity. Test-retest reliability (2-week interval), Standard Error of Measurement, and Smallest Detectable Change were calculated as reliability analyses. One year after baseline, we evaluated the responsiveness. RESULTS: One hundred seven patients (55% women) with a mean age of 54 years were included. Of the hypotheses formed in advance to assess construct validity, 67% was confirmed, meaning there was no adequate construct validity and the SANEM cannot replace all other PROMs. With an intraclass correlation coefficient of 0.95, excellent test-retest reliability was found. Of the hypotheses formed in advance to evaluate the responsiveness, 75% was confirmed, indicating the SANEM has good responsiveness. CONCLUSION: Although the SANEM cannot replace all other PROMs, it is a reliable instrument to assess if a patients' shoulder, regarding the whole shoulder, changes over time or stays unchanged. LEVEL OF EVIDENCE: Level II.

Compartment pressure curves predict surgical outcome in chronic deep posterior compartment syndrome.

BACKGROUND: Results of surgery for chronic exertional compartment syndrome (CECS) of the lower leg deep posterior compartment are inferior compared with other types of CECS. Factors predicting success after surgery are unknown. PURPOSE: To study the prognostic value of preoperative compartmental pressure curves in patients receiving surgery for deep posterior compartment CECS. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Intracompartmental pressures (ICPs) of patients with deep posterior lower leg CECS were obtained at 4 time points (ie, before, immediately after, and 1 and 5 minutes after a standard exercise challenge test). Area under the 4-point pressure curve was calculated. Patients received a questionnaire investigating residual symptoms after surgery. RESULTS: A complete data set was available for 52 patients (men, n = 23; age, 33 ± 14 years). They rated their 3-month postoperative clinical outcome as excellent (14%), good (38%), fair (35%), or poor (13%). Outcome at 3 months was related to the area under the preoperative 4-point pressure curve (excellent, 127 ± 28; good, 113 ± 25; fair, 100 ± 22; and poor, 88 ± 15; P = .005; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.08). At the long-term follow-up (39 ± 24 months), all 5 cardinal symptoms (pain, tight feeling, cramps, weakness, and diminished sensibility) were greatly attenuated (P < .001) in the successfully operated group. Long-term success was 48%. Delay in diagnosis was related to poor outcome (P = .04). Correlations between pressures/area under the 4-point pressure curve and long-term outcome were not significant, however. CONCLUSION: Preoperative measured intracompartmental pressures obtained in rest and after a standard exercise test may predict success of surgery for deep posterior compartment CECS of the lower limb. Further standardizing of preoperative pressure protocols may confirm that compartmental pressure analysis has diagnostic as well as predictive properties.

Spontaneous scapular spine fracture related to rotator cuff pathology: a report of two cases.

Spontaneous fractures of the scapula are rare, especially those involving the scapular spine. There are only a few case reports addressing this topic. Two cases are presented of spontaneous scapular spine fractures in patients with cuff-tear arthropathy. Treatment was conservative, resulting in a stiff shoulder in both patients. The combination of oral steroids and cuff-tear arthropathy seems to have caused a spontaneous scapular spine fracture in these patients. Considering the risk of operative intervention in the elderly patient conservative treatment seems a reasonable alternative.