Satisfied patients after shoulder arthrodesis for brachial plexus lesions even after 20 years of follow-up.

PURPOSE: Patients with an upper brachial plexus lesion can suffer from dysfunction, joint deformities and instability of the shoulder. The goal of this study was to determine pain, shoulder function, patient satisfaction and muscle strength in shoulder arthrodesis in patients with an upper brachial plexus lesion more than 15 years after surgery. METHODS: We retrospectively studied 12 patients with a brachial plexus lesion of mean age 46 years (27-61). At a mean of 19.8 years (15.4-30.3) after shoulder arthrodesis, patient-reported outcome measures (PROMs), range of motion (e.g., active and passive), patient satisfaction, strength of the affected and non-affected side (e.g., maximum isometric strength in Newton in forward and retroflexion, ab- and adduction, internal and external rotation) and position of fusion were obtained. PROMS consisted of the Visual Analogue Scale (VAS; 0-100, 0 being painless) for pain and the Disabilities of the Arm, Shoulder and Hand Score (DASH; 0-100, 0 being the best score) for function. RESULTS: At latest follow-up, the median VAS pain score was 49 (0-96) and 0 for, respectively, the affected and unaffected side. The DASH was 15 (8-46), meaning a reasonable to good function of the upper extremity. Active and passive retroflexion was significantly different (p = 0.028). All subjects stated that in the same situation they would undergo a shoulder arthrodesis again. The unaffected side was significantly stronger in every direction. Arthrodesis showed position of fusion of 31° (12-70) abduction, 20° (10-50) forward flexion and 22° (- 14 to 58) internal rotation. The unaffected side was significantly (p ≤ 0.05) stronger in every movement direction. CONCLUSION: At a mean of 20 years after shoulder arthrodesis, patients with an upper brachial plexus lesion are still satisfied with a good to moderate functional improvement. LEVEL OF EVIDENCE III: A retrospective cohort study.

Clinical and radiological results 7 years after Copeland shoulder resurfacing arthroplasty in patients with primary glenohumeral osteoarthritis: an independent multicentre retrospective study.

PURPOSE: The aim of this multicentre cohort study was to evaluate the midterm outcomes and survival after cementless stemless resurfacing arthroplasty (CSRA) in a series of 33 shoulders in 27 patients with primary osteoarthritis. METHODS: Clinical outcome assessment included: Constant-Murley score (CMS); Simple Shoulder Test (SST); Disability of Arm, Shoulder, Hand (DASH); EuroQol-5D (EQ-5D) utility scores; Numerous Rating Scale (NRS) for pain. Radiographs were assessed by two independent observers for oversizing, radiolucency, glenohumeral subluxation, glenoid erosion and subsidence. Correlations between the clinical and radiological outcomes were calculated. Complications were registered, and revision and survival rates were calculated. RESULTS: Mean age at time of surgery and mean follow-up time were, respectively, 67.7 (range 50.2-85.1) and 7.2 years (range 5.7-9.3 years). Means (SD) for CMS, age- and gender-adjusted CMS, SST, DASH and EQ-5D utility scores were: 56.4 (20.2), 76.5 (25.0), 54.0 (29.8), 37.6 (23.3) and 0.8 (0.1), respectively. NRS for pain was 2.0 and 3.8, respectively, in rest and during activities. Radiographic assessment of the CSRAs showed oversizing in 54.5%; radiolucency in 18.2%; superior glenohumeral subluxation in 33.3%; glenoid erosion in 45.5%; and subsidence in 3.0%. Perioperative complications did not occur. Revision surgery was performed in one patient (3.0%). CONCLUSION: For primary osteoarthritis, the CSRA showed good clinical but poor radiological outcomes at midterm follow-up.

Inertia based functional scoring of the shoulder in clinical practice.

Shoulder-related dysfunction is the second most common musculoskeletal disorder and is responsible for an increasing burden on health-care systems. Commonly used clinical outcome scores suffer from subjectivity, pain dominance and a ceiling effect. Objective functional measurement has been identified as a relevant issue in clinical rehabilitation. In recognition of this goal simple techniques for routine clinical application have been investigated with some success. Inertia based motion analysis (IMA) is a new generation of objective outcome assessment tool; it can produce objective movement parameters while being fast, cheap and easy to operate. This study investigates if a simple IMA shoulder test is suitable as a functional outcome measure for routine clinical follow-up. We measured 100 healthy subjects and 50 patients with confirmed unilateral shoulder pathology. Two motion tasks were performed on both shoulders and two simple motion parameters based on angular rate and acceleration were calculated. Patients were also assessed by the disability of arm, shoulder and hand (DASH) and the simple shoulder test. IMA produced high intra- (ICC = 0.94) and inter-assessor reliability (ICC = 0.90). Asymmetry was >3 times higher in patients than in healthy controls (p < 0.01). Healthy and pathological subjects could be distinguished with high diagnostic sensitivity (>84.0%) and specificity (>81.0%). There was a weak correlation between the IMA shoulder score and the clinical questionnaires (Pearson R < 0.25), as it may add an objective functional dimension to outcome assessment. The fast assessment (t < 5 min) of a simple motion task makes it workable for routine clinical follow-up. The IMA shoulder test adds objective information on functional capacity to the clinical scores and may help the physician in his decision-making, follow-up of treatment, effect of training and possibly lead to the development of new therapeutic interventions.

Wall shear stress assessment in the common carotid artery of end-stage renal failure patients.

Under physiological circumstances in the common carotid artery (CCA), mean wall shear stress (WSS), defined as mean wall shear rate (WSR) times local whole blood viscosity (WBV), is maintained at approximately 1.5 Pa. In patients with end-stage renal failure (ESRF) whole blood viscosity is low and it is not unlikely that mean WSS is lower in these patients than in control subjects. Moreover, hemodialysis causes an acute increase in blood viscosity with possible effects on WSS. In this study WSS in the CCA was determined with the Shear Rate Estimating System, an apparatus based on ultrasound, in ESRF patients (n = 13) and in presumed healthy age- and sex-matched control subjects (n = 13). Prior to hemodialysis, mean WSS (0.67 +/- 0.23 Pa) was significantly lower (p < 0.05) in patients with ESRF, due to both a lower WBV (2.80 +/- 0.52 mPa.s) and mean WSR (271 +/- 109 s(-1)), than in the control subjects (mean WSS: 1.24 +/- 0.20 Pa; WBV: 3.20 +/- 0.29 mPa.s; WSR: 387 +/- 51 s(-1)). Hemodialysis induced an increase in WBV (up to 3.71 +/- 1.54 mPa.s, p < 0.01), but mean WSS did not change significantly due to a reciprocal decrease in mean wall shear rate. These findings demonstrate that WSS is lower in hemodialysis patients than in control subjects, and that mean WSS is maintained at this low level despite an acute change in blood viscosity.

Wall shear stress in the human common carotid artery as function of age and gender.

OBJECTIVES: It has been postulated that in the arterial system mean wall shear stress is maintained at a constant value. The present study was performed to investigate the level of wall shear stress in the common carotid artery (CCA) as function of age and possible interactions between diameter and storage capacity, defined as the absolute area change per heart beat, with mean wall shear stress. METHODS: Wall shear stress (wall shear rate multiplied by whole blood viscosity) was assessed in the right CCA of 111 presumed healthy male (n = 56) and female (n = 55) volunteers, varying in age between 10 and 60 years. Wall shear rate was measured with a high resolution ultrasound system. Simultaneously, arterial diameter and storage capacity were determined. Whole blood viscosity was calculated from haematocrit, plasma viscosity and shear rate. RESULTS: From the second to the sixth age decade peak wall shear stress was significantly higher in males than in females and decreased from 4.3 Pa to 2.6 Pa (r = -0.56, p < 0.001) in males and from 3.3 Pa to 2.5 Pa (r = -0.54, p < 0.001) in females. Mean wall shear stress tended to decrease from 1.5 Pa to 1.2 Pa (r = -0.26, p = 0.057) in males and decreased significantly from 1.3 Pa to 1.1 Pa (r = -0.30, p = 0.021) in females. No significant difference in mean wall shear stress was found between males and females in any age decade. The diameter of the CCA increased significantly in both males (r = 0.26, p < 0.05) and females (r = 0.40, p < 0.003). Storage capacity decreased significantly in both sexes (males: r = -0.63, p < 0.001; females: r = -0.68, p < 0.001). CONCLUSIONS: These observations suggest that the reduction in mean wall shear stress with age results from the concomitant increase in diameter in an attempt of the arterial system to limit the reduction in storage capacity of the arterial system with increasing age.

Reproducibility of shear rate and shear stress assessment by means of ultrasound in the common carotid artery of young human males and females.

In the present study, the reliability of an ultrasonic shear rate estimating system, in terms of intrasubject intrasession, intersubject intrasession and intersubject intersession variability coefficients for the assessment of wall shear rate (WSR) in the common carotid artery (CCA) was determined in eight presumed healthy volunteers. Measurements were performed on consecutive days (day 1, day 2 and day 7). To investigate whether there were differences in WSR due to gender, dynamic WSR in the CCA was assessed in 11 presumed healthy males (mean age 24 y) and 11 presumed healthy females (mean age 25 y). Wall shear stress (WSS) was estimated from WSR and calculated whole blood viscosity. The average intrasubject intrasession variability was about 15% for peak WSR and about 12% for mean WSR. The intersubject intrasession variability for peak WSR decreased from 19% on day 1 to 16% on day 7 and for mean WSR from 17% on day 1 to 11% on day 7. The intersubject intersession variability is on the order of 5% for peak WSR and about 4% for mean WSR. No significant differences could be detected between peak and mean WSR values on day 1, day 2 and day 7, indicating good short- and medium-term intersubject intersession reproducibilities. No differences in peak and mean WSR were found between the left and the right CCA in the male group as well as in the female group. Mean WSS was similar in males (1.3 +/- 0.3 Pa) and in females (1.2 +/- 0.2 Pa), but peak WSS was slightly, but significantly, higher in males (4.3 +/- 1.3 Pa) than in females (3.3 +/- 0.7 Pa). It can be concluded that peak and mean WSR can be reliably determined noninvasively using ultrasound.

Noninvasive determination of shear-rate distribution across the arterial lumen.

In vitro experiments have shown that the shear stress exerted by flowing blood on the endothelial surface affects the morphology of the vascular wall and the release of vasoactive substances and growth factors by that wall. It is believed that the caliber of a vessel adjusts to the local shear stress to maintain a specific value of the shear stress. The local shear stress follows from local shear rate by multiplying shear rate by the local blood viscosity. The present article describes a method in which ultrasound techniques are used to assess transcutaneously the time-dependent wall shear rate in vivo in arteries. This method is applied to the assessment of wall shear rate in the common carotid artery of volunteers, presumed to be healthy, in two age categories (young age group, 20 to 30 years old, n = 8; old age group, 60 to 70 years old, n = 6). Although the peak shear rate in the young age group is markedly higher than in the old age group, the mean shear rate averaged over a cardiac cycle has the same value of 210 s-1 for both groups, corroborating earlier observations that mean shear rate and, hence, mean shear stress are maintained at a particular value. Conversion of the observed shear rates to shear stresses, assuming a blood viscosity of 3.5 mPa.s for both age groups, gives shear stresses of approximately 0.7 Pa. This is a factor of two lower than the shear stresses estimated from the relation between volume flow and artery caliber (1.5 Pa).