Park, Sung Bae
(Department of Orthopedic Surgery, Dankook University Medical College)
,
Seo, Joong Bae
(Department of Orthopedic Surgery, Dankook University Medical College)
,
Ryu, Jee Won
(Department of Orthopedic Surgery, Dankook University Medical College)
,
Shin, Yong Eun
(Department of Orthopedic Surgery, Dankook University Medical College)
Background: The aim of the present study was to determine the correlation between the amount of pain reduction after local anesthetic injection into the subacromial space preoperatively and clinical outcome after arthroscopic rotator cuff repair. Methods: A total of 127 patients who underwent arthro...
Background: The aim of the present study was to determine the correlation between the amount of pain reduction after local anesthetic injection into the subacromial space preoperatively and clinical outcome after arthroscopic rotator cuff repair. Methods: A total of 127 patients who underwent arthroscopic rotator cuff repair and followed up at least 1 year were analyzed retrospectively. Preoperatively, a visual analogue scale (VAS) for pain was measured in all patients before and after the ultrasound guided impingement test. The participants were divied into four groups according to pain reduntion ater impingement test (Group A: >75%, Group B: 50%-75%, Group C: 25%-50%, Group D: <25%). VAS for pain, shoulder range of motion, shoulder isometric strength, ASES score were evaluated preoperatively and at 3, 6, 9, and 12 months postoperatively. Results: After surgery, the amount of pain reduction shows significantly at 3, 6 months in Groups A, B as compared to Groups C, D (p<0.05). Among the range of motion of shoulder joint, forward flexion was significantly improved in Group A at 3 months (p<0.05). The ASES score significantly improved at 3, 6 months in Groups A, B as compared to Group C, D (p<0.05). Conclusions: Preoperative degree of pain reduction after impingement test correlates with the improvement of pain after arthroscopic rotator cuff repair, especially in the early phase. Therefore, the impingement test could be effectively used.
Background: The aim of the present study was to determine the correlation between the amount of pain reduction after local anesthetic injection into the subacromial space preoperatively and clinical outcome after arthroscopic rotator cuff repair. Methods: A total of 127 patients who underwent arthroscopic rotator cuff repair and followed up at least 1 year were analyzed retrospectively. Preoperatively, a visual analogue scale (VAS) for pain was measured in all patients before and after the ultrasound guided impingement test. The participants were divied into four groups according to pain reduntion ater impingement test (Group A: >75%, Group B: 50%-75%, Group C: 25%-50%, Group D: <25%). VAS for pain, shoulder range of motion, shoulder isometric strength, ASES score were evaluated preoperatively and at 3, 6, 9, and 12 months postoperatively. Results: After surgery, the amount of pain reduction shows significantly at 3, 6 months in Groups A, B as compared to Groups C, D (p<0.05). Among the range of motion of shoulder joint, forward flexion was significantly improved in Group A at 3 months (p<0.05). The ASES score significantly improved at 3, 6 months in Groups A, B as compared to Group C, D (p<0.05). Conclusions: Preoperative degree of pain reduction after impingement test correlates with the improvement of pain after arthroscopic rotator cuff repair, especially in the early phase. Therefore, the impingement test could be effectively used.
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가설 설정
The present study was conducted to identify the correlation between the amount of pain reduction after injection of lidocaine into the subacromial space preoperatively and the symptomatic and functional outcomes after arthroscopic rotator cuff repair and subacromial decompression. We hypothesized that the amount of pain reduction after preoperative injection of lidocaine into the subacromial space relates to the pain reduction and functional improvement after arthroscopic rotator cuff repair and subacromial decompression, and can be a predictor of the outcome following surgery.
제안 방법
According to the results of impingement test, the participants were divided into four groups: Group A, pain reduction of 75% or more after the impingement test; Group B, pain reduction of 50% or more, but less than 75%; Group C, pain reduction of 25% or more, but less than 50%; Group D, pain reduction of less than 25%. No significant differences among groups were observed with respect to gender (p=0.
The American Shoulder and Elbow Surgeons (ASES) standardized form16) was used as an outcome evaluation tool. All evaluations were assessed preoperatively and at 3, 6, 9, and 12 months postoperatively.
All repairs were performed by the senior author with the arthroscopic technique using suture anchors (double row suture bridge technique) for full coverage according to tear configuration. The number of medial anchors was decided upon tear size.
Routine radiographic evaluation including an anteroposterior view of the glenohumeral joint, a supraspinatus outlet view, an axillary view, a Rockwood view, and MRI were conducted to provide adequate diagnosis and preoperative plan. An impingement test was performed the day before surgery in all cases, and the visual analogue scale (VAS) for pain was measured before and after the preoperative impingement test. Following arthroscopic rotator cuff repair and subacromial decompression, patients who were available for functional outcome assessment at least 1 year postoperatively were included.
Fourth, although pain is closely related to healing of the rotator cuff, healing after rotator cuff repair was not evaluated in the present study. However, the significance of our results lies in the fact that the present study sought to analyze the correlation between the preoperative impingement test and postoperative clinical outcomes in rotator cuff tears.
A rotator cuff tear was suspected clinically when the patient complaint of pain localized to the anterolateral aspect of the shoulder and when physical examination elicited a positive Neer12) and Hawkins and Kennedy13) impingement sign. Routine radiographic evaluation including an anteroposterior view of the glenohumeral joint, a supraspinatus outlet view, an axillary view, a Rockwood view, and MRI were conducted to provide adequate diagnosis and preoperative plan. An impingement test was performed the day before surgery in all cases, and the visual analogue scale (VAS) for pain was measured before and after the preoperative impingement test.
10) analyzed 30 patients with rotator cuff tendinosis and argued that the impingement test was a poor tool for predicting the success of subacromial decompression. The authors found no correlation between the reduction of pain after the impingement test and the change in Western Ontario Rotator Cuff Index and the ASES score following subacromial decompression.
The authors performed the impingement test under the guidance of ultrasonography to increase the accuracy. The accuracy of the blind impingement test was 70% to 80%,23-25) and the accurate placement of the injection was confirmed through the positive impingement test.
After physical examination, the impingement test9) was performed in a standardized manner in all cases. The patients were positioned upright and sitting with the arm dropped at the side and the affected shoulder was prepared using a sterile technique. The ultrasound assessment was performed with the arm in the internal rotation position.
The patients were positioned upright and sitting with the arm dropped at the side and the affected shoulder was prepared using a sterile technique. The ultrasound assessment was performed with the arm in the internal rotation position. The arm was positioned in pronation on the patients’ backs.
Second, we investigated VAS for pain only at passive motion and did not evaluate it during patients’ active motion of shoulder joints. Third, the participants were divided into four groups according to the pain reduction amount after the impingement test. Therefore, other factors for grouping that could have affected functional outcomes were not considered.
This study included individuals with full thickness small- to medium-sized supraspinatus tears, who had failed at least 6 months of conservative treatment. The anteroposterior dimension (size) and retraction of the cuff tear was measured with a probe during the arthroscopic procedures.
The repeated measures ANOVA was used to compare the symptomatic and functional outcomes after arthroscopic rotator cuff repair with acromioplasty between the four groups under study. Univariate regression analysis was used to evaluate the correlation between the pre- and post-injection VAS for pain difference and improvement of VAS for pain after surgery. The analyses were performed using IBM SPSS ver.
대상 데이터
Furthermore, 96 patients with radiographic evidence of glenohumeral or acromioclavicular arthritis, previous fractures around the shoulder joint, clinical evidence of instability or infection, partial thickness, or large to massive tears were also excluded. As a result, a total of 127 patients were evaluated in this study. The study group comprised 73 men and 54 women with a mean age of 55.
The study group comprised 73 men and 54 women with a mean age of 55.1 ± 7.8 years (range, 38–74 years).
데이터처리
The repeated measures ANOVA was used to compare the symptomatic and functional outcomes after arthroscopic rotator cuff repair with acromioplasty between the four groups under study. Univariate regression analysis was used to evaluate the correlation between the pre- and post-injection VAS for pain difference and improvement of VAS for pain after surgery.
이론/모형
The range of motion of the shoulder joint, including forward flexion, external rotation, and internal rotation by the level of the vertebral body, were measured. Shoulder isometric strength of the forward flexion, external rotation, and internal rotation were checked using the Oxford scale15) and a digital dynamometer (NIDEC-SHIMPO Corp., Kyoto, Japan). The American Shoulder and Elbow Surgeons (ASES) standardized form16) was used as an outcome evaluation tool.
성능/효과
038). Our data revealed a significant correlation between the amount of pain reduction after the preoperative impingement test and the decrease in VAS for pain after surgery, especially 3 and 6 months postoperatively.
11) categorized 55 patients with impingement syndrome based on the degree of pain reduction following the impingement test. The authors defined a positive impingement test as a patient with more than 75% pain relief and demonstrated that patients with a positive impingement test had a successful outcome after surgery. They further purported that the impingement test could be an effective tool to predict outcome after arthroscopic subacromial decompression.
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