Mental health and tobacco use are correlated with PROMIS upper extremity and pain interference scores in patients with shoulder pathology.

PURPOSE: To determine whether patient demographics have predictive influence on patient-reported outcomes measurement information system (PROMIS) domains of pain interference (PROMIS-PI), depression (PROMIS-D), and upper extremity (PROMIS-UE) for patients with shoulder pathology treated nonoperatively. METHODS: Patients with partial rotator cuff tears, impingement, scapular dyskinesia, osteoarthritis, muscle strains, biceps tendonitis, instability, and acromioclavicular arthritis were retrospectively identified. Patients who underwent surgery were excluded. Demographic characteristics were documented, and PROMIS scores before and after nonoperative intervention were analyzed for correlations between each domain. RESULTS: A total of 638 questionnaires (PROMIS-UE, PROMIS-PI, and PROMIS-D) were analyzed. PROMIS-UE had a strong negative correlation with PROMIS-PI (R = - 0.73, P < .001). PROMIS-PI and PROMIS-D demonstrated a positive correlation of moderate strength (R = 0.54, P < .001). Patients who never used tobacco, compared to current or former users, had significantly higher PROMIS-UE scores (34.5 vs. 30.6 and 31.9; P < .001), lower PROMIS-PI (59.7 vs. 63.1 and 60.9; P < .001), and lower PROMIS-D scores (47.3 vs. 52.1 and 49.3; P < .001). Patients with body mass index < 24.8 had significantly higher PROMIS-UE scores than those with > 24.8 (P < .05). CONCLUSION: There is an inverse relationship between upper extremity physical function and pain and depression, as measured by PROMIS scores. Smoking and increased BMI are significant contributors to worse outcomes in patients with shoulder pathology, even in nonoperative populations. Counseling patients regarding prognosis and functional outcomes is important in managing their expectations in this patient population.

National Basketball Association combine performance after a partial meniscectomy.

BACKGROUND: An arthroscopic meniscectomy is one of the most common orthopedic procedures in athletes. Return to play rates and deficits in muscle function have been reviewed after meniscectomy, but no study has reviewed functional performance after an isolated partial meniscectomy. HYPOTHESIS/PURPOSE: To compare the performance of elite-level basketball players after a partial meniscectomy to a control group of players with no previous reported knee injury. We believe that there is no difference between the two groups in functional performance. STUDY DESIGN: Case Series. METHODS: Functional performance results from the National Basketball Association (NBA) combine were reviewed between 2000 and 2015. Twelve out of 1092 players were found to have undergone a partial meniscectomy prior to competing in the NBA combine. The partial meniscectomy group was compared to an age-, size-, and position-matched control group with respect to functional performance testing such as the shuttle run test, lane agility test, ¾ court sprint, vertical jump (no step), and vertical jump (max). RESULTS: The meniscectomy and the control groups that there was no significant difference between the two groups in agility, quickness, sprinting, and jumping ability. However, there was a - 0.596 spearman correlation between months after surgery and agility (p = 0.041), while there was a + 0.690 and + 0.650 spearman correlation between both months after surgery and standing vertical and max vertical (p = 0.013 and p = 0.022). CONCLUSIONS: Athletes competing in the NBA combine who have undergone a partial meniscectomy perform as well as uninjured athletes in all NBA combine performance testing. Furthermore, as athletes are further out from surgery, they have an improvement in both standing and max vertical jump.

The utility of botulinum toxin A in the repair of distal biceps tendon ruptures.

PURPOSE: The purpose of our study is to report the outcomes and complications in patients who underwent distal biceps tendon repair with the use of Botulinum toxin A (BoNT-A) as an adjunct to surgery. METHODS: A retrospective review of 14 patients who underwent 15 distal biceps tendon repairs was performed. All repaired tendons had their correlating muscle bellies injected intraoperatively with a mixture of 100U of BoNT-A and 10 ml of normal saline. Each patient was evaluated for surgical and post-operative complications and followed with Disabilities of the Arm, Shoulder and Hand (DASH) Disability Scores. RESULTS: The cohort was exclusively male, 14/14 (100%). The mean age at procedure was 52.1 years (range: 29-65 years). Types of injuries repaired included: 12 acute biceps tendon ruptures, one chronic partial (> 50% of tendon) biceps tear, and two chronic biceps ruptures. Average final follow-up was 32.9 months (SD: 19.6; range: 7.07-61.72). Average time to repair of chronic injury was 5.75 months (range: 2-12 months). There were no intraoperative complications, and all patients were discharged home on the day of surgery. Average DASH score at latest follow-up was 4.9 (range: 0.0-12.5). All patients had return of function of paralyzed muscle prior to final follow-up. One patient required an incision and drainage for a deep infection 1 week post-operatively, without any further complications. Another patient required operative removal of heterotopic ossification located around the tendon fixation site, which was the result of a superficial infection treated with antibiotics 2 weeks post-operatively. This patient later healed with improvement in supination/pronation range-of-motion and no further complications. CONCLUSIONS: Injection of BoNT-A is safe and effective to protect distal biceps tendon repair during the early phases of bone-tendon healing. CLINICAL RELEVANCE: BoNT-A may is safe and effective to protect distal biceps tendon repair. The utility of BoNT-A as an adjunct to surgical repair may be applicable to acute or chronic tears as well as repairs in the non-compliant patient without decreases in functional scores after return of function of the biceps muscle. LEVEL OF EVIDENCE: Level 4.