Clinical outcome in patients with hand lesions associated with complex regional pain syndrome after arthroscopic rotator cuff repair.

BACKGROUND: Complex regional pain syndrome (CRPS)-related hand lesions are one of the complications following arthroscopic rotator cuff repair (ARCR). This study aimed to investigate the clinical outcomes of patients with CRPS-related hand lesions following ARCR. METHODS: Altogether, 103 patients with ARCR were included in this study (mean age, 63.6±8.2 years; 66 males and 37 females; follow-up period, preoperative to 12 months postoperative). Clinical assessment included the Japanese Orthopaedic Association (JOA) score, University of California, Los Angeles (UCLA) score, Constant score, 36-item short form health survey (SF-36) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score from preoperative to 12 months postoperatively. The patients were either assigned to the CRPS group or non-CRPS group depending on CRPS diagnosis until the final follow-up, and clinical outcomes were then compared between the groups. RESULTS: Of 103 patients, 20 (19.4%) had CRPS-related hand lesions that developed entirely within 2 months postoperatively. Both groups showed significant improvement in JOA, UCLA, and Constant scores preoperatively to 12 months postoperatively (P<0.001). Comparisons between the two groups were not significantly different, except for SF-36 "general health perception" (P<0.05) at 12 months postoperatively. At final follow-up, three patients had residual CRPS-related hand lesions with limited range of motion and finger edema. CONCLUSIONS: CRPS-related hand lesions developed in 19.4% of patients following ARCR. Shoulder or upper-limb function improved in most cases at 12 months, with satisfactory SF-36 patient-based evaluation results. Patients with residual CRPS-related hand lesions at the last follow-up require long-term follow-up.

Factors Affecting Return to Work in Patients Undergoing Arthroscopic Rotator Cuff Repair.

OBJECTIVE: Although clinical outcomes after arthroscopic rotator cuff repair are generally favorable, postoperative return to work is also an important issue. This study aimed to assess clinical outcomes and clarify the factors affecting return to work in patients who had undergone arthroscopic rotator cuff repair. METHODS: In total, 63 patients who had undergone arthroscopic rotator cuff repair were included in this study. Clinical assessment was performed using Japanese Orthopaedic Association (JOA) scores, along with measurements of pain, range of motion, muscle strength, cuff integrity, and fatty infiltration. Depending on their return-to-work status at the final follow-up, subjects were assigned to either the complete return group (the patient returned to work) or the incomplete return group (the patient had quit or had changed their occupation at final follow-up). Various clinical parameters affecting the return to work outcome were examined through univariate and multivariate analyses. RESULTS: Of the 63 subjects, 42 belonged to the complete return group and 21 belonged to the incomplete return group. Therefore, the working capability recovery rate following arthroscopic rotator cuff repair was 66.7%. Both groups showed significant improvement from their preoperative status, but there were statistically significant differences in JOA scores between the groups at 9 and 12 months postoperatively (P <0.01). Multivariate stepwise logistic regression analysis showed that heavy work and female sex were significantly adversely associated with return to work (P <0.05). CONCLUSION: The working capability recovery rate following arthroscopic rotator cuff repair was 66.7%, and the preoperative factors affecting recovery of working capability were heavy work and female sex.

Cutoff value of Japanese Orthopaedic Association shoulder score in patients with rotator cuff repair: Based on the University of California at Los Angeles shoulder score.

BACKGROUND: The Japanese Orthopaedic Association shoulder score cutoff values were calculated in patients with rotator cuff repair using the University of California at Los Angeles shoulder score. METHODS: Overall, 175 patients with rotator cuff repair were subjects in this study. The University of California at Los Angeles and Japanese Orthopaedic Association shoulder scores were evaluated before surgery and at 3, 6, 9, and 12 months after surgery. The cutoff value of the Japanese Orthopaedic Association shoulder score was determined using the 4-stage criteria of the University of California at Los Angeles shoulder score and a University of California at Los Angeles shoulder score of 28 points, which is the boundary between an excellent/good group and a fair/poor group. RESULTS: Both the JOA shoulder and UCLA shoulder scores showed significant improvement at 6, 9, and 12 months from the preoperative scores (p < 0.0001). There was a strong correlation between the total values of the two scores (r = 0.85, p < 0.0001). The cutoff value of the Japanese Orthopaedic Association shoulder score based on the highest accuracy from receiver operating characteristic curve analysis was 83 points. CONCLUSION: A Japanese Orthopaedic Association shoulder score cutoff value of 83 was equivalent to a University of California at Los Angeles shoulder score cutoff value of 28 for distinguishing between excellent/good and fair/poor outcomes after rotator cuff repair.

MRI quantification of muscle activity after volitional exercise and neuromuscular electrical stimulation.

OBJECTIVE: The efficacy, and even the depth, of muscle stimulation during surface electrode neuromuscular electrical stimulation (NMES) is a matter of debate. This study addresses these issues by assessing the utility of a magnetic resonance imaging (MRI) technique in localizing and quantitating changes in the nature of MRI signals in the quadriceps muscle after volitional exercise and NMES. DESIGN: Volitional isometric and NMES-evoked quadriceps muscle activity was evaluated in two controlled trials. In the first, isometric quadriceps strength was determined during NMES and maximal volitional isometric exercise in six healthy men. In the second, changes in the ratio of MRI T2 signal intensities before and after volitional isometric exercise and NMES were used to quantitate MRI signal changes associated with muscle activation in 12 additional healthy men. RESULTS: MRI clearly detected quadriceps muscle tissue activation after both volitional and stimulated contractions, even though the NMES knee extension torque was only 23.5% that of maximal volitional isometric exercise. In particular, the T2 intensity ratios increased 26.5% +/- 17.3% (mean +/- standard deviation) after volitional exercise and 12.9% +/- 12.8% after NMES. This pattern of volitional isometric exercise, producing larger T2 intensity ratio values than NMES, was present in both deep and superficial layers and throughout the quadriceps muscle. CONCLUSIONS: Although volitional muscle contractions were several times stronger than those induced by NMES in this study, our findings support the idea that MRI can provide a noninvasive way to quantitate and localize volitional and electrically stimulated muscle activation.