daniel davis

The goal of this study was to determine if there is an association between glenohumeral synovitis andearly post-operative pain after arthroscopic rotator cuff repair. Fifty patients with symptomatic rotator cuff tears were prospectively enrolled prior to RCR. Baseline ASESscore, VAS Pain score, forward elevation, and external rotation were recorded. Intra-operatively, synovitis was gradedon a scale of zero to six as based on a previously validated scoring system. VAS Pain scores were obtained frompatients post-operatively on days one through 14, week 6, and 3 months. Average intra-operative synovitis score was 2.4 ± 1.6. No significant correlation was found between synovitisscore and pre-operative forward elevation (P=0.171), external rotation (P=0.126), VAS Pain (P=0.623), or ASES(P=0.187) scores. No significant correlation was found between synovitis score and post-operative VAS Pain level atany time point. There was a moderate correlation between both pre-operative VAS Pain and ASES scores and postoperativeVAS Pain in the first post-operative week. Workers’ compensation patients had worse pain at 3 months postoperativelycompared to non-workers compensation patients (P=0.038). This study reveals that macroscopically assessed glenohumeral synovitis does not have any significantcorrelation with pre-operative or post-operative pain in patients undergoing arthroscopic rotator cuff repair; althoughhigher pre-operative pain levels, worse pre-operative ASES scores, and workers compensation status do influencepost-operative pain levels in arthroscopic rotator cuff repair.Level of evidence: III

As preferred treatment options for superior labral tears continue to evolve, this study aims to describethe recent longitudinal trends in the treatment of SLAP tears in a sub-specialized practice at a single institution. Wehypothesized that there was a trend toward biceps tenodesis over repair for Type II SLAP lesions. A retrospective review was performed using an institutional billing database to identify all patients with aSLAP tear who underwent surgical intervention between January 2002 and January 2016. Procedural codes associatedwith the surgery were analyzed to determine type of treatment each patient received. Of the 6,055 patients who underwent surgery for a SLAP tear during the study period, 39.1% (2,370)underwent labral repair, 15.4% (930) underwent tenodesis without repair, and 45.5% (2,755) underwent arthroscopywithout tenodesis or repair. Labral repair made up a significantly higher proportion of surgical interventions in 2002(82.2%) compared to in 2015 (21.8%; P<0.001). Surgeon experience did not impact trends. Over the study period,the mean age of patients receiving labral repair decreased from 40.4 years (range: 16.2 – 63.9) to 32.6 years (range:14.0 – 64.7; P<0.001). This study demonstrates that over the 14-year study period the rate of labral repairs for SLAP tears hasdecreased significantly and that these repairs have been directed towards a younger patient population.Level of evidence: III

The primary goals of total shoulder arthroplasty (TSA) are to relieve pain, improve range of motion,and restore function. Physical therapy is commonly used to help achieve these goals. Recent evidence has pointedto the success and safety of a purely physician-guided, home-based or internet-based, program versus the traditionaltherapist guided program.The purpose of this study was to evaluate outcomes of TSA in patients using a web-based, home therapy program.

A retrospective review was performed of TSA patients who were given the option of using a web-based,home therapy program. Functional outcomes were collected preoperatively, 6-month, and 12-month post-operativeexaminations. Physical examination parameters were recorded at preoperative, 3-month, 6-month, and 12-month timepoints.

Forty-seven patients used the web-based, home therapy program and had complete follow-up data at alltime intervals. All mean range of motion parameters and functional scores improved significantly from preoperatively topostoperatively. There was one reported complication in a patient who sustained a subscapularis rupture and underwentsubsequent open repair at 10 months postoperatively.

This study demonstrates successful improvements in range of motion and functional outcomes in asubset of patients who utilized an online therapy program after TSA. Future study will be necessary to directly compareresults in patients enrolled in formal, outpatient therapy programs and to determine barriers to utilization of web-basedtherapy programs.Level of evidence: IV