Randomized controlled trial of suprascapular nerve blocks for subacute adhesive capsulitis.

BACKGROUND: Shoulder pain and loss of function remain a therapeutic challenge in adhesive capsulitis. Suprascapular nerve blocks, a common treatment in adhesive capsulitis, are considered a safe and effective method for the resolution of pain and restoration of shoulder range of motion (ROM). To our knowledge, no data are available on the use of suprascapular nerve blocks in adhesive capsulitis in the subacute phase. AIM: The aim of this study was to compare the efficacy of ultrasound-guided suprascapular nerve blocks versus saline injections for treating adhesive capsulitis in the subacute phase. DESIGN: Randomized double-blinded controlled trial; level of evidence 2. SETTING: Out-patient consultation of Physical and Rehabilitation Medicine in a general hospital. POPULATION: Thirty-five patients with subacute adhesive capsulitis. METHODS: Patients were randomly allocated to receive either 3 successive (1-week interval) ultrasound-guided suprascapular nerve blocks with ropivacaine 5 mL 2 mg/mL (intervention group) or ultrasound-guided injections of 5 mL sterile saline solution (NaCl 0.9%) (control group), at the floor of the suprascapular fossa. Primary outcome was shoulder function assessed by the Constant-Murley Score. Secondary outcomes were shoulder ROM and shoulder pain intensity. Assessments were performed before each injection and 4 weeks after the last injection. RESULTS: A significant increase of Constant-Murley Score (P<0.001), increase of shoulder ROM (all directions: P<0.011) and decrease of pain (P<0.001), were observed over time in both study groups. However, no significant differences were observed between the intervention and the control group. CONCLUSIONS: Three successive suprascapular nerve blocks did not provide a better outcome than saline injections on shoulder function, ROM, and pain in subacute adhesive capsulitis. These negative findings warrant some considerations on the natural history of adhesive capsulitis, as well as timing, type, and placebo effects of injections. CLINICAL REHABILITATION IMPACT: The current place of suprascapular nerve blocks in the treatment strategy of adhesive capsulitis needs to be rediscussed.

Outpatient total hip arthroplasty : the future?

With advancements in minimally invasive surgical technique, pain management and rehabilitation proto- cols, and prevention of post-operative complications, outpatient total hip arthroplasty became a realistic goal. This study reports our experience of performing outpatient total hip arthroplasty assessing its feasi- bility and safety. Between December 2015 and January 2018, 52 outpatient total hip arthroplasties were performed. We implemented a peri-operative management proto- col that included education, improved analgesia and rapid rehabilitation. Patients were asked about any complications they had experienced after surgery and about the perception of their experience as outpatient. Any early post-operative emergency department visits, acute office appointments or hospital re-ad- missions were registered. Fifty-one of 52 patients (98,1%) enrolled in the study met the discharge criteria and achieved their goal of going home on the day of surgery, and only one patient (1,9%) required an overnight stay. There were two visits to the emergency room, with one hospital re-admission (1,9%) on the night of the surgery. There were no major post-discharge complications in the short-term follow-up (minimum of three months). Only one patient (1,9%) reported a significantly negative experience. With this first Belgian experience reporting on out- patient primary total hip arthroplasty, our data demonstrate that early discharge does not result in excessive re-admissions or other post-discharge complications due to an early discharge. This study suggests that total hip arthroplasty can be performed safely and successfully in appropriately selected patients and that patients who experienced that ambulatory protocol declared themselves highly satisfied.

Os acromiale : literature review and treatment options.

Os acromiale is due to a defect of fusion of the different ossification centers of the acromion. It is a common cause of shoulder pain that should be evoked in the differential diagnosis of the sub-acromial conflict. CT scan or magnetic resonance are therefore often helpful to confirm the diagnosis. Conservative treatment is the first-line management but various surgical techniques are described in case of initial treatment failure. In this context, new arthroscopic techniques offer encouraging results. This article overviews the key points of pathophysiology, clinical manifestations, para-clinical studies and treatment of os acromiale.

Breakage of a volar locking plate after delayed union of a distal radius fracture.

This is a case report of a 58-year-old obese, diabetic female who sustained a dorsally angulated distal radius fracture, treated with a volar locking plate. Union was delayed and the plate broke. The fracture healed after repeated surgery involving replacement of the plate and grafting with demineralised bone matrix. Delayed unions of distal radius fractures are rare. This case shows that fracture treatment with locking compression plates has some specific biomechanical consequences which have to be taken into account, and special attention will be given to technical peculiarities and possible drawbacks.

First-time traumatic anterior dislocation of the shoulder in young adults: the position of the arm during immobilisation revisited.

In contrast to the surgical treatment of chronic shoulder instability, there are only scarce publications about the management after a first episode of anterior shoulder dislocation and how to prevent the evolution towards chronic instability. We present here a review of the literature on this subject. Particular attention is paid to recent studies about the position of the arm during immobilisation. According to recent views, it may be preferable to immobilise the arm in external rather than internal rotation, but this has to be confirmed by further clinical studies. The issue of early arthroscopic stabilisation after a first dislocation event in young athletic patients is also discussed.

Results of arthroscopic acromioplasty for chronic rotator cuff lesion.

The influence of acromioplasty in long standing rotator cuff deficiency with intractable pain was retrospectively evaluated in a consecutive series of 13 patients who were followed for a mean period of 19 months (range, 12 to 42 months) after arthroscopic acromioplasty. The Constant score improved from 59.3 (range, 39.9 to 90.3) preoperatively to 98.7 (69.1 to 122.7) postoperatively. Pain and motion improved significantly whereas strength did not improve. Arthroscopic acromioplasty in painful chronic rotator cuff avulsion was found to be an effective means to control pain and improve motion; it can be recommended when conservative treatment has failed.