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The purpose of this study was to assess whether there is a universal pattern of movement of the finger joints while performing a cylinder grip. A sensor glove was used to record the finger joint motion of 48 participants. Our observations showed that when examining the fingers, flexion motion began either at the metacarpophalangeal (MP) or proximal interphalangeal (PIP) joints, with the distal interphalangeal (DIP) joints always last to move (p = 0.0052). The sequence of the joints at the end of the gripping motion was different than at the beginning. Here, the only statistically significant observation was that the DIP joints fully flexed only once the MP joints had flexed fully. Apart from that, it was completely variable which joint reached its final position first or last. The analysis also revealed that synchronization of four identical joints (i.e. the four PIP joints) was significantly higher than synchronization of the 12 finger joints. Although synchronization was already high at the beginning of the flexion motion, it increased significantly by the time the joints completed their movement. [ABSTRACT FROM PUBLISHER]

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Zusammenfassung  Eine Vielzahl unterschiedlicher Medikamente greift als „Nebenwirkung“ in den Knochenstoffwechsel und -umbau ein und verursacht Knochenschwund und Mineralisationsstörungen bis hin zu Osteonekrosen. Diese Formen der Knochenschädigung werden bisher als Arzneimittelnebenwirkung in Klinik und Praxis noch zu wenig beachtet und v. a. auch nicht mit den Patienten besprochen. Präventive Maßnahmen werden vor Einsatz des Medikamentes nicht bedacht, und selbst bei Auftreten der Knochenschäden werden therapeutische Strategien nur mangelhaft umgesetzt. Auch die Frakturheilung mit ihrem komplexen, phasenhaften Ablauf kann durch zahlreiche Medikamente sowohl negativ als auch positiv beeinflusst werden und bedarf einer Kontrolle. Vorschläge einer praxisnahen Vorsorge und Therapie der medikamenteninduzierten Osteopathien werden abschließend vorgestellt. [ABSTRACT FROM AUTHOR]

Objective: Previous research showed that individuals with eating disorders (EDs) can be subtyped by their levels of psychopathology and self-regulation abilities. However, nothing is known about whether self-regulation abilities are solely suited to depict the heterogeneity in ED and comorbid psychopathology in nonclinical samples. Therefore, this study sought to explore self-regulation profiles and their ability to discriminate ED, depression and anxiety disorders, and personality dysfunction in the adult population., Methods: Within a German representative sample, N = 2391 adults (18-92 years) were examined using latent profile analysis to identify profiles based on established cognitive and emotional self-regulation scales including attention control, cognitive reappraisal, and difficulties in identifying feelings. Profiles were validated with ED, depression, anxiety, and personality dysfunction measures., Results: The final solution selected as best balancing goodness of fit and interpretability included four profiles-High-Functioning, Moderate-Functioning, Dysregulated, and Alexithymic-with high explanatory power of R 2  = .99. Profiles were characterized primarily by differences in difficulties in identifying feelings followed by differences in attention control and differed significantly regarding ED, depression and anxiety disorders, and personality dysfunction, with the Dysregulated profile showing the most unfavorable correlates., Conclusions: This study uniquely revealed that low cognitive and emotional self-regulation were indicators for ED, depression, anxiety, and personality dysfunction in the adult population. Future research should investigate whether the identified profiles predict the development of ED and comorbid psychopathology longitudinally., Public Significance: Individuals with eating disorders present with difficulties in cognitive and emotional self-regulation, likely maintaining their symptoms. This representative study in the German adult population sought to build profiles based on cognitive and emotional self-regulation that differed in eating disorder and comorbid psychopathology. We discuss the potential to detect individuals with elevated eating disorder and comorbid psychopathology based on the identified profiles in nonclinical settings., (© 2022 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Introduction: Equine asthma represents a naturally occurring animal model for human allergic neutrophilic asthma. Inhalative nanoparticle-bound cytosine-phosphate-guanosine (CpG-GNP) immunotherapy, independent of specific allergens, has already shown promising clinical and immunological results in previous studies and offers the possibility to treat the underlying cause of the disease. This study analyses the relationship between dose and response, and evaluates a possible long-term effect., Methods: In the prospective, randomised, double-blind clinical field study, 29 horses suffering from equine asthma received 10 inhalation treatments with either 187.5 µg CpG-GNP (CpG single dose [CpGsd]; n = 11), 375 µg CpG-GNP double dose (CpG double dose [CpGdd]; n = 9) (q48h for 20 days) or 1600 µg beclomethasone (n = 9) (q24h for 10 days). Each horse was examined three times: before the treatment (I), immediately after the 10 inhalations (II), and 8 weeks after the final inhalation (III). The three groups were compared according to clinical and laboratory parameters. The study examined the sustainability of the long-term effect of the treatment after 8 weeks, as well as the tolerability of the formula as a double dose., Results: The CpGsd resulted in a significant improvement in 82% of the parameters, the CpGdd in 72%. In the long-term evaluation, the CpGsd showed a significant improvement in 100% of the parameters in comparison to the initial values, the CpGdd in 67%. On the immunological level, the bronchoalveolar lavage revealed a significant reduction of IL-4, IL-8, and interferon-γ., Conclusion: Both CpG groups displayed significant improvements in clinical and laboratory parameters, especially regarding the long-term effect of CpGsd. Doubling the CpG dose did not result in any improvement in comparison to the original single dose. On the immunological level, an anti-inflammatory, as well as an immunomodulatory effect, apart from a Th2-dominated immune response, could be observed. This immunomodulatory inhalation treatment could indicate a new possibility for human allergic asthma therapy., (© 2019 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

Fractures of the distal radius in elderly patients increasingly contribute to the workload in emergency departments worldwide. There is still no consensus about the best treatment option, e. g. closed reduction and cast stabilization, percutaneous pinning, external fixation or open reduction and internal fixation with volar locking plates (ORIF). In addition, the influence of pharmacological antiosteoporotic treatment (e. g. bisphosphonates) is unclear. In this overview five comparative studies were analyzed, which had been identified in a previous systematic review. The evaluation included 3 cohort studies and 2 randomized trials enrolling a total of 515 patients. A clinical or statistical advantage of ORIF over conservative treatment with respect to DASH scores 12 months after the index fracture event could not be demonstrated with a mean difference of 0.25 (95 % confidence interval CI -0.57-1.07). According to current best scientific evidence from preclinical and clinical investigations, antiosteoporotic medication does not have an unfavorable influence on fracture healing and should be continued due to its proven effectiveness in reducing subsequent osteoporotic fractures. Following distal radius fractures in elderly patients with clinical risk factors, an osteoporosis screening should be routine practice and a specific therapy should be initiated if the fracture risk is increased.

Background: The purpose of the study was to evaluate the recovery of the subscapularis and shoulder function dependent on the type of lesion and type of surgical treatment, when compared to the non-affected contralateral shoulder. We hypothesized that regardless of type of lesion and performed surgical intervention, a significant muscle insufficiency as compared to the healthy contralateral side will remain., Patients and Methods: Sixty-eight patients (14 females and 54 males) with an anterior or anterosuperior cuff lesion at an average age of 55.7 ± 11.7 years (range 20-80 years) were prospectively evaluated up to 24 months. Intraoperatively, the lesions were classified according to current systems and treated by debridement or reconstruction. Pre- and postoperatively, the Constant Score (CS) as well as the belly-press angle (BPA) and back-to-hand distance (BHD) on the affected and on the contralateral shoulder was noted., Results: 29.4% had an isolated subscapularis lesion whereas 69.1% had concomitant supraspinatus pathology. In 17 patients an arthroscopic debridement and in 51 patients an arthroscopic repair were performed. Postoperatively, all patients revealed a significant improvement of the CS, BPA and BHD (p < 0.05) independent of the type of lesion or the surgical intervention. However, reconstruction of the subscapularis tendon resulted in significant differences of CS, BPA and BHD (p < 0.05) compared to the contralateral shoulder., Conclusion: Reconstruction of subscapularis lesions cannot provide full subscapularis function since a residual subscapularis insufficiency remains, other than in patients with small partial tears treated with debridement alone.

Osteoporosis is still an underdiagnosed and insufficiently therapied widespread disease in Germany. Of the estimated 7 million osteoporosis patients only 1.5 million receive a guideline conform diagnosis and even less receive appropriate treatment. Some 90 % of patients are provided with analgesics but only 10 % receive an effective therapy, although efficacious, well-tested and affordable medications are available. In addition, approximately one half of the patients terminate treatment after only 1 year although according to the results of recent studies the duration of therapy should be at least 3-5 years. In view of the increasing average life expectancy, a consistent management for prevention of fractures associated with osteoporosis is always most important for society, even if only for reasons of costs. Achievement of this target depends on four circumstances: clarification of the origin of osteoporosis and fractures (bone consciousness), prophylaxis of bone loss and fractures (primary prevention), consistent guideline conform diagnostics and therapy (secondary and tertiary prevention) and cooperation of all disciplines in medicine (bone is everybody's business). This article describes the current state of diagnostics (bone density measurement with dual X-ray absorptiometry, FRAX®), prophylaxis of fractures (screening program) and therapy (use of economic and effective medications with low side effects). Novel medications are already undergoing clinical testing and a "healing" of bone reduction with restoration of the normal bone structure is to be expected.

Background: From 2000 to 2012, the annual incidence of inpatient treatment for distal radius fracture in Germany rose from 65 to 86 per 100 000 persons. It is unclear whether open reduction and volar angle-stable plate osteosynthesis (ORIF), a currently advocated treatment, yields a better functional outcome or quality of life than closed reposition and casting., Methods: In the ORCHID multi-center trial, 185 patients aged 65 and older with an AO type C distal radial fracture were randomly assigned to ORIF or closed reposition and casting. Their health-related quality of life and hand/arm function were assessed 3 and 12 months afterward with the Short Form 36 (SF-36) questionnaire and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. The radiological findings, range of movement of the wrist, and EuroQol-5D (EQ-5D) scores were documented as well., Results: Among the 149 patients in the intention-to-treat-analysis, there was no significant difference in SF-36 scores between the two treatment groups at one year (mean difference, 3.3 points in favor of ORIF; 95% confidence interval, -0.2 +6.8 points; p = 0.058). The DASH scores showed moderately strong, but clinically unimportant effects in favor of ORIF, and there was no difference in EQ-5D scores. ORIF led to better radiological results and wrist mobility at 3 months, with comparable results at 12 months. 37 of the patients initially allotted to nonsurgical treatment underwent secondary surgery due to significant loss of reduction., Conclusion: The findings with respect to mobility, functionality, and quality of life at 12 months provide marginal and inconsistent evidence for the superiority of volar angle-stable plate osteosynthesis over closed reduction and casting in the treatment of intra-articular distal radius fractures. Primary nonsurgical management is also effective in suitable patients.

The purpose of this study was to assess whether there is a universal pattern of movement of the finger joints while performing a cylinder grip. A sensor glove was used to record the finger joint motion of 48 participants. Our observations showed that when examining the fingers, flexion motion began either at the metacarpophalangeal (MP) or proximal interphalangeal (PIP) joints, with the distal interphalangeal (DIP) joints always last to move (p = 0.0052). The sequence of the joints at the end of the gripping motion was different than at the beginning. Here, the only statistically significant observation was that the DIP joints fully flexed only once the MP joints had flexed fully. Apart from that, it was completely variable which joint reached its final position first or last. The analysis also revealed that synchronization of four identical joints (i.e. the four PIP joints) was significantly higher than synchronization of the 12 finger joints. Although synchronization was already high at the beginning of the flexion motion, it increased significantly by the time the joints completed their movement.

Background: In this pilot study, we investigated the therapeutic efficacy of intravenous Ibandronate compared to pain medication on the outcome of bone marrow edemas (BME) of the knee and talus., Patients and Methods: Fifteen patients with a painful BME of the knee and 15 patients with a BME of the ankle, confirmed on MRI, were enrolled and treated with three ambulatory infusions of each 6 mg Ibandronate (group 1). A control group (group 2) of 10 patients with a BME of the knee and 10 patients with a BME of the talus was treated with pain medication and partial weight bearing. Patients were evaluated clinically at baseline and at 1, 3, 6 and 12 months after therapy start with a visual analog pain-scale (VAS) and specific joint scores (Larson knee- and Mazur ankle-score). BMEs were assessed with MRI at baseline and after 6 months in both groups., Results: In the knee group, the mean VAS pain score decreased from 8.5 at baseline to 1.2 at 12 months (p < 0.0001) in patients treated with Ibandronate and, respectively, from 8.1 to 4.0 in the control group (p < 0.001). In the ankle group, the mean VAS pain score decreased from 8.2 at baseline to 0.9 at 12 months (p < 0.0001) in patients treated with Ibandronate and, respectively, from 7.9 to 3.9 in the control group (p < 0.001). The mean Mazur ankle score increased from 51 to 91 points (p < 0.001) in group 1, and from 52 to 72 points in group 2 (p < 0.01). The mean Larson knee score increased from 54 to 89 points (p < 0.001) at 12 months in group 1, and from 51 to 70 points in group 2 (p < 0.01). For both joints, we observed a significant clinical improvement in the Ibandronate treatment group and in the control group, but functional results were significantly more improved in the Ibandronate treatment group. Only the Ibandronate treatment group showed a significant BME regression at the 6 months MRI follow-up., Conclusions: Intravenous Ibandronate therapy showed significantly better clinical results and BME regression rates on MR-imaging compared to analgesic medication in combination with partial weight bearing in the treatment of BME of the knee and talus and shortens the natural course of the disease.

Objective: Arthroscopic or open reconstruction of isolated subscapularis tendon tears with the use of suture anchors to restore the glenohumeral function and joint biomechanics., Indications: Traumatic full-thickness tears, chronic tears with a functional deficit or decentration of the humerus head, anterosuperior rotator cuff insufficiency, symptomatic reruptures after prior arthroscopic or open surgical procedures., Contraindications: Frozen shoulder, atrophy > grade II (Thomazeau) or fatty infiltration > grade III (Goutallier/Fox) of the muscle, high-grade omarthrosis., Surgical Technique: Diagnostic arthroscopy and careful tendon release. If the inferior edge of the rupture is reliable visible and the tendon-mobilisation works proper, the repair is performed arthroscopically. The footprint is decorticated lightly and 1-4 suture anchors (depending on the lesion-size) are placed from inferior to superior. Knots are tied starting from caudal in a modified Mason-Allen technique (alternative: single or double mattress stitches) with a slipknot and three half hitches in opposite directions. In case of larger tears, a double-row technique for better reconstruction of the trapezoidal footprint is performed. For open reconstruction, a deltopectoral approach is used to reattache the tendon in an analogous fashion., Results: Arthroscopic or open repair of isolated subscapularis tendon tears (Fox type II-IV) was performed in 35 patients. The Constant score increased significantly after 36 m, with no difference between these two groups. The majority of subscapularis tests were postoperatively negative, 6% in both groups showed a rerupture. A symptomatic period of > 6 m prior to the operation and a high grade atrophy and fatty infiltration of the muscle was correlated with poorer results.

Introduction: Arthroscopic capsulolabral reconstruction via the anteroinferior 5:30 portal allows secure placement of the suture anchors in the lower half of the glenoid and adequate retensioning of the inferior glenohumeral ligament., Step 1 Examination Under Anesthesia: With the patient under anesthesia, and prior to surgical intervention, assess the direction of glenohumeral instability and the presence of joint hyperlaxity to confirm the repair strategy preoperatively and to determine if additional procedures such as rotator interval closure or inferior capsular plications are needed., Step 2 Arthroscopic Evaluation and Portal Placement: Underestimating the anteroinferior bone loss is one of the most common failures of arthroscopic capsulolabral revision repairs., Step 3 Mobilization of Capsulolabral Complex: Mobilize the capsulolabral complex down to the 6:00 position with a bent rasp to create a bleeding surface for biological healing., Step 4 Anchor Placement: Place anchors at 5:30, 4:30, and 3:00, with additional anchors in the inferior half of the glenoid if more capsular material has to be shifted., Step 5 Capsulolabral Shift and Knot Tying: A sufficient capsular shift of the anterior band of the inferior glenohumeral ligament at the lowest fixation point (5:30 anchor) is a key step of the procedure., Step 6 Additional Tissue Reconstruction: Consider performing a rotator interval closure in patients with joint hyperlaxity or if a residual "drive through" sign with inferior instability remains after retensioning of the capsulolabral structures., Step 7 Rehabilitation: Start with passive exercises and increase to active-assisted and active exercises., Results: In our study of fifty-six patients treated with arthroscopic capsulolabral revision repair for recurrent anterior shoulder instability, arthroscopic evaluation at the revision repair showed glenoid bone loss measuring up to 10% of the inferior glenoid width due to compression fracture of the glenoid rim in almost 50% of the cases and glenoid bone loss measuring 10% to 20% in about 20% of the cases., What to Watch for: IndicationsContraindicationsPitfalls & Challenges.

Background: Anterosuperior rotator cuff tears involving the subscapularis and supraspinatus tendons are less common than other tears of the rotator cuff. The purpose of this study was to report the clinical outcome, rotator cuff strength and structural integrity of open repair of combined anterosuperior rotator cuff tears., Patients and Methods: Forty-eight patients at an average age of 58 years underwent open repair of a combined supraspinatus and subscapularis tendon tear. The follow-up evaluation included clinical scores, rotator cuff strength testing with a custom-made force measurement plate (FMP) and postoperative MRI to evaluate repair integrity and muscle cross-sectional area., Results: After a mean follow-up of 49 months the average Constant score improved from 43 points preoperatively to 79 points postoperatively. The SST and the pain VAS were significantly improved by the procedure (each <0.05). The combined tear group with partial subscapularis tears (G1) did not achieve significantly better score results than the combined tear group with a full-thickness subscapularis tear (G2) (p > 0.05). Strength for all rotator cuff components was reduced significantly (p < 0.05) compared with the contralateral shoulder in both groups. MRI revealed a retear-rate of 4% for the subscapularis and a retear-rate of 19% for the supraspinatus. Postoperative muscle cross-sectional area of all rotator cuff muscles did not differ significantly between G1 and G2 (p > 0.05)., Conclusion: Open repair of combined anterosuperior rotator cuff tears achieved good postoperative results despite a residual rotator cuff strength deficit. Combined supraspinatus-/full-thickness subscapularis tears achieved equal clinical and radiographic results compared with supraspinatus-/partial-thickness subscapularis tears.

Background: Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit., Materials and Methods: During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol., Results: The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs., Conclusions: Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years., Level of Evidence: Level IV.

Background: Results of arthroscopic repair of isolated subscapularis tendon tears have not been widely studied. A detailed evaluation of subscapularis function with subscapularis strength quantification has not been performed to date., Purpose: To evaluate postoperative subscapularis muscle function and to assess the clinical outcome and structural tendon integrity with postoperative magnetic resonance imaging after arthroscopic repair of isolated subscapularis tears., Study Design: Case series; Level of evidence, 4., Methods: In a prospective study, isolated subscapularis tendon tears in 21 patients were treated with an all-arthroscopic repair. The average age of the study population was 43 years. The mean interval between trauma and surgery was 5.8 months. In 19 patients, a traumatic event caused the onset of symptoms. Subscapularis muscle function was assessed with specific clinical tests and the Constant scoring system. Postoperative subscapularis strength was evaluated with a custom-made electronic force measurement plate. All patients underwent postoperative magnetic resonance imaging to assess structural integrity of the repair., Results: The average duration of follow-up was 27 months. The Constant score increased from 50 points preoperatively to 82 points postoperatively (P < .01). Most positive preoperative lift-off and belly-press tests were reversed by surgery, with a rate of 5 (24%) persistent positive tests after surgery. In operated shoulders, subscapularis strength in the belly-press (65 vs 87 N; P < .05) and the lift-off position (44 vs 68 N; P < .05) was significantly reduced compared with the contralateral shoulder. Magnetic resonance imaging revealed an intact repair in 20 patients. Atrophy of the upper subscapularis muscle portion was present in about one-fourth of the patients and in all patients with a positive postoperative belly-press test., Conclusion: Arthroscopic repair of isolated subscapularis tendon tears achieves substantial improvement of shoulder function and a low rerupture rate. Despite excellent clinical results, a significant postoperative subscapularis strength deficit compared with the contralateral shoulder persists that can be quantified with use of the force measurement plate. Atrophy of the upper subscapularis muscle is present in 25% of the patients in the postoperative course.

Background: Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF) with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation.Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting., Methods/design: ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius) is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool.The primary objective is to determine differences in the Short Form 36 (SF-36) Physical Component Score (PCS) between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH) instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery), as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture involves a central statistical unit, an independent monitoring institute, and a data safety monitoring board. Following approval by the institutional review boards of all participating centers, conduct and reporting will strictly adhere to national and international rules, regulations, and recommendations (e.g., Good Clinical Practice, data safety laws, and EQUATOR/CONSORT proposals)., Discussion: To our knowledge, ORCHID is the first multicenter RCT designed to assess quality of life and functional outcomes following operative treatment compared to conservative treatment of complex, intra-articular fractures of the distal radius in elderly patients. The results are expected to influence future treatment recommendations and policies on an international level., Trial Registration: ISRCTN: ISRCTN76120052 Registration date: 31.07.2008; Randomization of first patient: 15.09.2008.

Background: Open capsulolabral repair is still considered the standard revision procedure for a failed anterior shoulder instability repair. To date, only a few studies have evaluated the outcome of arthroscopic revision instability repair., Purpose: This study was undertaken to assess the clinical outcome and postoperative sports activity level of arthroscopic revision stabilization using defined inclusion criteria and a standardized operative revision technique., Study Design: Case series; Level of evidence, 4., Methods: Fifty-six patients with recurrent anterior shoulder instability after an anatomic index procedure (open or arthroscopic) were included in the study. Arthroscopic revision repair was performed by a single surgeon using standardized suture anchor repair technique via an anteroinferior 5:30-o'clock approach. Patients were evaluated after a mean follow-up of 37 months (range, 25-72 months) with the Rowe, the Constant score, and the Simple Shoulder Test (SST). Return to sports, including sports level and discipline, were evaluated with a sports activity assessment tool., Results: For the revision repair, a minimum of 3 anchors were placed in the lower glenoid half. Recurrent instability after the revision procedure was found in 6 cases (11%). There were 4 recurrent instability cases caused by trauma and 2 atraumatic cases. Arthroscopic revision repair did not result in an additional loss of external rotation or additional subscapularis muscle insufficiency. The Rowe and Constant scores and the SST were significantly improved by the procedure. Eighty-six percent of the patients rated their result as good or excellent. Sports activity level was significantly improved by the procedure and the majority of patients returned to their previous sports level., Conclusion: Arthroscopic capsulolabral revision repair via the anteroinferior 5:30-o'clock approach achieves results comparable with open revision repairs with a low recurrent instability rate. Arthroscopic revision repair reached a high patient satisfaction, good clinical outcomes, and a high rate of return to sports. The results suggest that arthroscopic revision repair is a viable treatment option for selected patients with a failed index repair.

Background: Diagnosis, operative treatment, and outcome assessment of isolated traumatic subscapularis tendon tears have not been widely studied., Purpose: To report the clinical outcome, value of clinical tests, predictive outcome factors, and return to sports in the management of isolated traumatic subscapularis tendon tears., Study Design: Case series; level of evidence, 4., Methods: Thirty consecutive patients with a confirmed isolated subscapularis tear, except for associated biceps tendon injury or humeral avulsion of the glenohumeral ligaments (HAGL) lesions, found at arthroscopy were included in the study. The average age of the study population was 43.1 years. In all 30 patients, a traumatic event caused the onset of symptoms. The mean delay between trauma and surgery was 4 months. All patients underwent open tendon reconstruction with a suture anchor technique via a deltopectoral approach. Clinical assessment was done using the Constant score and specific subscapularis tests. Postoperative tendon integrity was assessed with ultrasound and magnetic resonance imaging. Sports activity, including competition level, sports discipline, and postoperative return to sports, was evaluated., Results: The average duration of follow-up was 46 months (range, 25-72 months). Seven patients had a full-thickness tear of the upper third of the tendon, 11 patients a full-thickness tear of the upper two-thirds of the tendon, and 12 patients had a complete subscapularis tendon tear. The Constant score increased from 51.3 preoperatively to 82.2 postoperatively (P < .01). Twenty-seven patients rated their postoperative result as excellent or good. Most positive preoperative lift-off and belly-press tests were reversed by surgery, with a rate of 6 (20%) persistent positive tests after surgery. Positive postoperative subscapularis tests were more likely related to a higher preoperative degree of fatty subscapularis muscle infiltration (P < .05). Ultrasound and magnetic resonance imaging revealed a structural intact repair at follow-up in 28 shoulders (93%). Seventy-five percent of athletes returned to their previous competition level., Conclusion: Early repair of isolated traumatic subscapularis tendon tears and associated biceps tendon lesions or HAGL lesions achieves good functional outcomes with a low re-rupture rate and allows return to sports activity. Delay of surgery and higher degrees of preoperative fatty infiltration of the subscapularis muscle impair postoperative subscapularis function.

A number of drugs can have "side effects" on bone metabolism and formation, causing bone atrophy, impaired mineralisation, as well as osteonecrosis. In both clinical and general practitioner settings, these forms of bone damage have been hitherto considered as adverse drug side effects and have received insufficient attention; moreover, they have not been the subject of patient information. Preventive measures are not instigated prior to initiation of medication and even after onset of bone damage, therapeutic strategies are poorly implemented. Even fracture healing with its complex, staged course can be both positively and negatively influenced by a number of drugs and these effects require monitoring. Recommendations regarding practical screening and therapy of drug-induced osteopathies are presented.

A number of drugs can have "side effects" on bone metabolism and formation, causing bone atrophy, impaired mineralisation, as well as osteonecrosis. In both clinical and general practitioner settings, these forms of bone damage have been hitherto considered as adverse drug side effects and have received insufficient attention; moreover, they have not been the subject of patient information. Preventive measures are not instigated prior to initiation of medication and even after onset of bone damage, therapeutic strategies are poorly implemented. Even fracture healing with its complex, staged course can be both positively and negatively influenced by a number of drugs and these effects require monitoring. Recommendations regarding practical screening and therapy of drug-induced osteopathies are presented.

Over the past three decades, the members of the substance group called bisphosphonates (BP) have been employed with growing success to manage osteopathies caused by increased osteoclastic activity. The following developments in BP are responsible: Modern BP are now already 20,000 times more potent than the first preparation approved for use. Their biochemical and cellular mechanisms of action have meanwhile been elucidated. They have no effect on hormones so that they are open for all patients. They are well tolerated and can be administered orally or intravenously. They have admirably been thoroughly studied in multinational trials. They are the "gold standard" in the treatment of osteoporosis, a widespread disease. Rare but serious side effects such as osteonecrosis of the jaw or acute renal insufficiency can be avoided to a large extent. BP also have tumoricidal properties and are used to suppress tumor growth in bones. Their anti-inflammatory activity is also successfully used in the treatment of bone marrow edema and bone pain.