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Reply to: “The association between hypertension and rotator cuff disease: a spurious result?”
No full textThank you for giving us the opportunity to answer the Letter to the Editor. As mentioned by the author of this letter, it is well known that the incidence of rotator cuff tears increases with age and that a large proportion of tears are completely asymptomatic.4, 5 and 6 The population prevalence of full-thickness rotator cuff tears is 22.2% in women aged 60 to 83 years, and 47% of these tears are asymptomatic.4
The author affirms that the failure to consider the presence of asymptomatic cuff tears in the control group could fully account for the author's observation of an association between hypertension and rotator cuff tears. If we hypothetically assume that we had a plausible 22.2% prevalence of asymptomatic cuff tears in the control group,3 it would not affect the result that the prevalence of hypertension is significantly higher in the cuff tear patient group, but, on the contrary, it makes it more evident.
In our article, we selected 201 patients negative for shoulder pathologies because the shoulder was painless2 and because of negative results to clinical tests for cuff tears. Of course, as the author states, there is no radiologic assessment of their rotator cuff.2 However, a patient affected by a cuff tear (symptomatic or asymptomatic) usually does not have normal shoulder external or internal rotation strength or does have a negative external rotation lag sign.1 In addition, the main result of our study is that there is an association between size of cuff tear and hypertension, and thus, this result is not affected by eventual bias of selection of the control group, being this result was calculated only in the study group of patients who underwent arthroscopic cuff repair
Response to: The association between hypertension and rotator cuff disease: a spurious result?
No full textResponse to: The association between hypertension and rotator cuff disease: a spurious result?
Dear editor,
Thank you for giving me the opportunity to answer to letter to the Editor JSES-D-12-00464. As mentioned by the author of this letter, it is well known that the incidence of rotator cuff tears increases with age and that a large proportion of tears is completely asymptomatic4,5,6. The population prevalence of full thickness rotator cuff tears is 22.2% in females of age 60-83 years and 47% of these tears are completely asymptomatic3. The author affirms that the failure to consider the presence of asymptomatic cuff tears in the control group could fully account for the authors observation of an association between hypertension and rotator cuff tears. If we hypothetically assume that we had a plausible prevalence in the control group of asymptomatic cuff tears of 22.2%,3 it will not not affect the result that in the cuff tear patient group the prevalence of hypertension is significantly higher, but, on the contrary, it makes it more evident.
In our article, we selected 201 patients negative for shoulder pathologies because shoulder painless2 and because negative to clinical tests for cuff tears. Of course, as the author state, there is no radiological assessment of their rotator cuff.2 On the other side, a patient affected by a cuff tear (symptomatic or asymptomatic) usually does not have normal shoulder external or internal rotation strength or does have a negative external rotation lag sign.1 In addition, the main result of our study is that there is an association between size of cuff tear and hypertension and, thus, this result is not affected by eventual bias of selection of the control group, being this result calculated only in the study group (patients who underwent arthroscopic cuff repair).
Best personal regards,
Prof. Stefano Gumina (MD, PhD)
References
1)Castoldi F, Blonna D, Hertel R. External rotation lag sign revisited: Accuracy for
diagnosis of full thickness supraspinatus tear. J Shoulder Elbow Surg 2009; 18: 529-534.
2)Gumina S, Arceri V, Carbone S, Albino P, Passaretti D, Campagna V, Fagnani C, Postacchini F. The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2012 Jun 27. doi: 10.1016/j.jse.2012.05.023
3) Oag HCL, Daines MD, Nichols AS, Arden NK, Carr AJ. The association between rotator cuff tears, shoulder pain and activities of daily living: Normal population data. Presented at BESS (British Shoulder and Elbow Society) 2012 and awaiting publication in Proceedings of BESS.
4) Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006; 88: 1699-1704. doi:10.2106/JBJS.E.00835
5) Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Osawa T. Factors involved in the presence of symptoms associated with rotator cuff tears: a comparison of asymptomatic and symptomatic rotator cuff tears in the general population. J Shoulder Elbow Surg 2011; 20:1133-1137. doi:10.1016/j.jse.2011.01.011
6) Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010; 19: 116-20. doi:10.1016/j.jse.2009.04.00
Scapular dyskinesis and SICK syndrome in patients with chronic type III acromioclavicular dislocation. Results of rehabilitation
No full textPurpose: Recently, scapular dyskinesis and SICK scapula syndrome have been related to type III acromioclavicular dislocation conservatively treated.
Aim: To evaluate the efficacy of the rehabilitation program proposed for scapular dyskinesis secondary to acromioclavicular dislocation after 2 years of at least one hour per week of rehabilitation.
Methods: 24 patients with a diagnosis of chronic type III acromioclavicular dislocation and scapular dyskinesis were enrolled in this study.4 Of these, 14 had a SICK Syndrome. Adopted rehabilitation protocol consists of 10 exercises of strengthening and stretching of the scapulae. Follow-up was performed at 24 months with clinical measurements of scapular position and clinical evaluation of scapular motion. For evaluating SICK scapula syndrome, we applied the SICK Scapula Rating Scale. Shoulder function was evaluated with Constant Score and Subjective Shoulder Value.
Results: At 24 months of follow-up, 18/23 patients (78,26%) did not present scapular dyskinesis. SICK scapula syndrome was observed in 4 (50%) of patients with scapular dyskinesis. The Scapula Rating Scale score in 4 patients with SICK scapula was 7,5 points. After 24 months of rehabilitation, mean Constant score was 80 points for injured side and 92 points for healthy side. At final follow-up, the mean SSV was 75% on the injured side.
Conclusions: Patients who developed scapular dyskinesis due to a type III acromioclavicular dislocation conservatively treated can resolve the condition with a rehabilitation program in the majority of cases (about 70%). Also those with SICK syndrome can effectively treat it with this program. Nevertheless, shoulder function and patient’s satisfaction still remain compromised
Scapular Dyskinesis and SICK Scapula Syndrome in Patients With Chronic Type III Acromioclavicular Dislocation
No full textPurpose: This study was aimed at evaluating whether scapular dyskinesis and, eventually, SICK (Scapular malposition, Interior medial border prominence, Coracoid pain and malposition, and dysKinesis of scapular movement) scapula syndrome develop in patients with chronic type III acromioclavicular (AC) dislocation. Methods: Scapulothoracic motion was studied in 34 patients with chronic AC dislocation by use of the protocol described by Kibler et al. and Burkhart et al. An anteroposterior radiograph of the scapulae with the arms abducted was also obtained. The SICK Scapula Rating Scale was applied to patients with SICK scapula syndrome. Shoulder function was assessed with the Constant score and Simple Shoulder Test (SST). Results: Of the 34 patients, 24 (70.6%) had scapular dyskinesis with the arms at rest, and 14 of these (58.3%) had SICK scapula syndrome. The mean SICK Scapula Rating Scale score was 6.9 points (out of a possible 20 points). Clinical and radiographic evaluations with the arms abducted at 90 degrees confirmed scapular dyskinesis in 61.7% and 64.7% of patients, respectively (P >.05). The Constant score was 83 points for the pathologic side and 91 points for the contralateral side. The Constant score value was 75 and 88, respectively, in patients with dyskinesis and those without dyskinesis (P<.05); the mean value for the SST was 8 of 12 and 10 of 12, respectively. Conclusions: Chronic type III AC dislocation causes scapular dyskinesis in 70.6% of patients. Of the latter, 58.3% have SICK scapula syndrome develop. Dyskinesis might be due to loss of the stable fulcrum of the shoulder girdle represented by the AC joint and due to the superior shoulder pain caused by the dislocation. The values for the Constant score and SST were lower in patients with dyskinesis. Level of Evidence: Level IV, prognostic case series
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
The amount of humeral head impaction of proximal humeral fractures fixed with the Humerusblock device
No full textThe Humerusblock is a minimally invasive device allowing fixation of proximal humeral fractures. A drawback of the device is possible K-wire perforation of the head with the need for early removal of the implant. We assessed the amount of humeral head impaction and its role in the postoperative varus/valgus deviation of the humeral head in fractures of the upper humerus treated with Humerusblock. Fractures were classified according to the Codman-Lego system. The length of the posteromedial metaphyseal extension and integrity of medial hinge were measured; metaphyseal comminution was assessed. Accuracy of fracture reduction was classified as excellent to poor. An original method of measurement of amount of postoperative impaction of the humeral head was developed. The impaction and varus/valgus inclination of the heads were measured comparing postoperative and three-month follow-up radiographs. Constant score and its relation to sintering was calculated at 12-month follow-up. Forty-three fractures were available for follow-up. The amount of humeral head impaction was 3.9 mm on average and was directly correlated with patient's age, sex, Codman-Lego classification, varus inclination and mataphyseal comminution. The postoperative cervico-diaphyseal angle was restored in 35 cases, with 81 % good results. The Humerusblock was removed in 41 % of cases because of K-wire perforation of the humeral head. A negative correlation was found between impaction and Constant score. The amount of humeral head impaction is related to patients' age, sex, and fracture patterns, being the most prone to compaction those with metaphyseal comminution. Humeral head impaction negatively affects final Constant score.The Humerusblock is a minimally invasive device allowing fixation of proximal humeral fractures. A drawback of the device is possible K-wire perforation of the head with the need for early removal of the implant. We assessed the amount of humeral head impaction and its role in the postoperative varus/valgus deviation of the humeral head in fractures of the upper humerus treated with Humerusblock.
METHODS:
Fractures were classified according to the Codman-Lego system. The length of the posteromedial metaphyseal extension and integrity of medial hinge were measured; metaphyseal comminution was assessed. Accuracy of fracture reduction was classified as excellent to poor. An original method of measurement of amount of postoperative impaction of the humeral head was developed. The impaction and varus/valgus inclination of the heads were measured comparing postoperative and three-month follow-up radiographs. Constant score and its relation to sintering was calculated at 12-month follow-up.
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Pigmented villonodular synovitis of the shoulder associated with massive rotator cuff tear treated with arthroscopic synovectomy and debridement.
No full textIntroduction
Pigmented villonodular synovitis(PVNS) is a rare condition affecting approximately 1.8 cases per 1 million persons. The shoulder is involved in about 2% of cases.
Aim
To present the largest series of patients with shoulder PVNS, massive irreparable rotator cuff tear and gleno-humeral(G-O)osteoarthritis treated with arthroscopic debridement and synovectomy.
Methods
We treated 9 patients with PVNS of the shoulder,irreparable rotator cuff tear and slight G-O arthropathy(group I) with arthroscopic synovectomy and debridement. Results were compared to those obtained from 33 patients(group II) undergoing arthroscopic debridement for irreparable cuff tear and having no(23 patients)or slight(10 patients)G-O arthropathy. Shoulder function was evaluated with Constant Score(CS).
Results
Preoperative shoulder function in group I was lower than group II(CS: 12 vs. 35). Upon follow-up, CS was lower in group I than in group II(CS: 40 vs. 54);the mean CS increase in the 9 PVNS patients(+28 points) was higher than other group(+14 points). Pre-operatively, differences were always statistically significant; instead, upon follow-up, significant differences emerged in CS,ADL and ROM. Differences relative to pre-operative CS in group I and II were statistically significant; while,at the follow-up, significant differences emerged only between CS of patients with PVNS and of group II without G-O arthropathy.
Conclusion
PVNS patients have a worse postoperative outcome respect to irreparable cuff tear patients with/without G-O arhtropathy. No differences emerged between final outcome of PVNS patients and that of patients with irreparable tear with G-O arthropathy. This suggest that arthroscopic synovectomy is an effective treatment for PVNS and that the poor outcome can be attributed to G-O arthropathy
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