RCT #Rotator-cuff tear | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

You can view up to 4 cases without signing up

RCT #Rotator-cuff tear

Why you should join Figure 1

Article Review

"The Timing of Injections Prior to Arthroscopic Rotator Cuff Repair Impacts the Risk
of Surgical Site Infection” Forsythe et al. JBJS 2019;101:682-7.

The purpose of this study was to determine if an association exists between preoperative corticosteroid injections and the rate of postoperative shoulder infection in patients undergoing arthroscopic rotator cuff repair.

The authors hypothesized that the prevalence of developing an infection is higher in patients who received an injection prior to the surgical procedure and that this relationship exists in a temporal manner as those patients receiving an injection closer to the operative date have a higher risk of infection.

Level III Retrospective comparative study

The authors reviewed the Humana database within PearlDiver from 2007 to 2016 for patients who underwent a shoulder injection and for patients that had an arthroscopic rotator cuff repair. Additional procedures at the time of rotator cuff repair, such as acromioplasty, distal clavicle excision, arthroscopic or open biceps tenodesis, or glenohumeral debridement, were included in the investigation. Patient demographics, timing of injection, and contents of the injection were also noted. Patients were grouped according to timing of injection in relation to surgery <1 month, 1-2 months, 2-3 months,..to 1 year. They also had a control cohort of patients without a preoperative injection that had an arthroscopic rotator cuff repair.

They identified 60,823 patients who underwent an arthroscopic rotator cuff repair . 48,763 patients (80.2%) underwent a rotator cuff repair without a prior shoulder injection, and 12,060 patients (19.8%) received a shoulder injection within 1 year prior to the surgical procedure. Descriptive statistical analysis was then performed.

They found that 98% of patients that had an injection of corticosteroids. They found no significant increase of infection in patients that had a biceps tenodesis in addition to a rotator cuff repair in either the injection or the control group.

Patients receiving a shoulder injection within 1 month prior to the surgical procedure demonstrated a significant increase in infection risk at 1.3% compared with 0.8% for those patients not receiving a preoperative injection. An injection at any other time frame further from surgery was not significant.

Additional statistical evaluation determined that male sex, obesity (body mass index >30 kg/m2), diabetes mellitus, smoking status, and preoperative corticosteroid injections within 1 month prior to the surgical procedure were independent risk factors for the development of an infection. The age of the patient was not an independent risk factor for shoulder infection.

In regards to infection, this research does make me feel more comfortable performing rotator cuff repairs on patients that have had injections. I would normally wait 3 months after the last injection to operate on shoulders. Of course, this study was looking at infection. The other issue associated with preop corticosteroid injections is increased rate of revision repair.

This study was a database study so it is limited by the quality of coding. Additionally, the technique/location of injection and the size/chronicity of the RTC tears could not be characterized. Nevertheless, I think its findings are valuable.

Male 78 yo. Bilateral #Rotator-cuff artropathy. Waiting for a reverse #Arthroplasty

open #Rotator-cuff repair

this is an update on my previous case. Arrows on the supraspinatus aponeurosis which in this case extends along the biceps tendon

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?