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Supplemental material, sj-docx-1-sph-10.1177_19417381231155190 for Utilizing Scapula Retraction Exercises With or Without Glenohumeral Rotational Exercises With a Gradual Progression for Subacromial Pain Syndrome by Leyla Eraslan, Ozan Yar, Fatma Bilge Ergen, Gazi Huri and Irem Duzgun in Sports Health: A Multidisciplinary Approach

Background: Numerous radiographic measurement methods related to rotator cuff tears (RCTs) have been described. The most widely used of these parameters is the critical shoulder angle (CSA) as measured via radiography. However, magnetic resonance imaging (MRI) measurements provide more accurate results than direct radiography. Purpose: To determine the relationship between anatomic shoulder parameters and RCT type via MRI scans. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The data and physical examination notes of 389 patients were retrospectively analyzed, and 242 patients were included in the study. Patients were divided into 2 groups: those with RCT (n = 127) and those without RCT (control group; n = 115). Using suitable MRI sections, the CSA, lateral acromial angle, acromial index, superior glenoid inclination, acromion–greater tuberosity impingement index, and acromiohumeral distance were compared between the RCT and control groups. The correlation of these shoulder parameters with the presence of RCT was investigated, and the predictive value of each parameter was examined using receiver operating characteristic (ROC) analysis. Results: There were significant positive relationships between the presence of RCT and CSA, acromial index, acromion–greater tuberosity impingement index, and superior glenoid inclination, with the strongest correlation belonging to CSA ( r = 0.716). There were also significant negative relationships between presence of RCT and lateral acromial angle ( r = –0.510) and acromiohumeral distance ( r = –0.222). The ROC analysis revealed CSA to be the best predictor for the presence of RCT (area under the ROC curve = 0.899). Conclusion: The study outcomes showed that CSA as measured on MRI is the best predictor for determining the presence of RCTs. In patients with shoulder pain attributed to RCT, it may be helpful to examine the CSA on MRI.

Background: Peripheral nerve injuries are one of the most common and costly injuries especially in the young population. In this study, it is aimed to determine the histological role of epidermal growth factor (EGF) in nerve regeneration with an acute damage made on sciatic nerve in the rabbit model. Methods: We used 18 New Zealand rabbits (nine in control group and nine in experimental group). Each group was divided into two groups consisting of five rabbits planned for diameter measurement and four rabbits planned for spatial measurement. The sciatic nerve exploration in the right flank of each animal, full-thickness nerve damage, and then epineural repair was made by a single researcher. 10 µg/kg EGF was given to the repair area of the experimental group and five more EGF injections were given to the experimental group every other day postoperatively. In the control group, we used saline solution. Rabbits were observed for 8 weeks. During follow-up, two rabbits died. At the end of 8 weeks, the nerve tissue of each animal was evaluated histologically and morphologically. Results: In the experimental group consisting of five rabbits, the mean thickness of connective tissue (epineurium+ mesoneurium) was 156,867 µm; while, in the control group, the thickness was 25,170 µm. In the other groups, the numerical increase in epineurium and mesoneurium areas was detected in the EGF (+) group as a result of the comparative spatial measurements. Epineurium and mesoneurium enlargement was observed in the EGF-given group. Adipocyte and capillary increase was observed in connective tissue. Conclusion: EGF increases epineurium and mesoneurium diameters in peripheral connective tissue in acute peripheral nerve injury regeneration. However, further studies are needed to understand this effect clinically and physiologically.

Introduction: Histiocytoses are rare disorders and most orthopedic surgeons are unfamiliar with this diagnosis. We report a case of synovial non-Langerhans cell histiocytosis (LCH) located in the shoulder, which has not been reported in the literature previously. Case Report: A 24-year-old female patient presented to our clinic with shoulder pain and decreased range of motion. MRI results suggested pigmented villonodular synovitis. Arthroscopic synovial debridement and biopsy were performed. Histologic examination came back as non-LCH of the shoulder. Hematology/oncology evaluation indicated localized disease and no further treatment was necessary. At the 6th month follow-up, the patient gained full shoulder motion and is symptom free. Conclusion: This case represents a rare diagnosis of synovial non-LCH which should be considered in the differential diagnosis of synovial diseases. A misdiagnosis could result in inadequate treatment, and coordination with the hematology/oncology department is of utmost importance in the treatment of this neoplastic disease.

Amaç: Kliniğimizde minimal invaziv perkütan plak osteosentezi (MIPPO) ile tedavi edilen humerus cisim kırıklarının radyolojik ve fonksiyonel sonuçlarının değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: MIPPO ile tedavi edilen 20 hastanın 21 humerus cisim kırığına ait verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, yaralanma şekilleri, AO sınıflaması ve bölgesine göre kırık sınıflaması, sigara kullanımı, radial sinir yaralanması kaydedildi. Radyografik olarak 6. ayda kaynama durumu ve dizilim değerlendirildi. Hastaların son kontrollerinde omuz ve dirsek hareket açıklığı ile objektif, Amerikan Omuz ve Dirsek Derneği (ASES) skoru, California Üniversitesi Los Angeles (UCLA) skoru, Mayo dirsek performans indeksi (MEPI), Kol Omuz El Engellilik (DASH) skoru ve Constant omuz skoru ile subjektif değerlendirme yapıldı.Bulgular: Hastaların ortalama omuz fleksiyonu 169,5°±26,4°, abdüksiyonu 169,5°±26,4° idi. Ortalama dirsek hareket arkı 131,4°±19,8° bulundu. Ortalama ASES ve UCLA skorları sırasıyla 88,5±16,4 ve 32,1±5,2, MEPI ve DASH skoru sırasıyla 93,1±11,3 ve 11,8±20,0, ortalama Constant skoru 9,1±15,3 bulundu. İki hastada 6. ayda kaynamama gözlendi.Sonuç: MIPPO yöntemi humerus cisim kırıklarının tedavisinde; minimal yumuşak doku hasarı, korunmuş omuz ve dirsek fonksiyonları ile başarılı bir tekniktir., Purpose: We aimed to evaluate the radiological and functional results of humeral shaft fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) in our clinic.Materials and Methods: Data of 21 humeral shaft fractures of 20 patients treated with MIPPO were evaluated retrospectively. Demographic data, type of injury, fracture classification according to AO classification and fracture location, smoking, radial nerve injury were recorded. Radiographically, the union at 6th month and alignment were evaluated. Objective results were evaluated in terms of shoulder and elbow range of motion. Subjective results were assessed by the American Shoulder and Elbow Society Score (ASES), University of California, Los Angles (UCLA) score, Mayo Elbow Performance Index (MEPI), the Disability of The Arm, Shoulder and Hand (DASH) Score and Constant Shoulder Score. Results: The average elbow motion was 131.4° ± 19.8°. The mean ASES and UCLA scores were 88.5 ± 16.4 and 32.1 ± 5.2, respectively. The mean MEPI and DASH scores were 93.1 ± 11.3 and 11.8 ± 20.0, respectively, and the Constant score was mean 9.1 ± 15.3. Nonunion was observed in two patient at 6th month.Conclusion: We believe that MIPPO is a successful technique for the treatment of humeral shaft fractures with minimal soft tissue damage, intact shoulder and elbow motion function.

Supplemental material, sj-pdf-2-taj-10.1177_2040622321990262 for Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score? by Jan Zabrzyński, Maciej Gagat, Łukasz Łapaj, Łukasz Paczesny, Alper Yataganbaba, Dawid Szwedowski and Gazi Huri in Therapeutic Advances in Chronic Disease

Supplemental material, sj-pdf-1-taj-10.1177_2040622321990262 for Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score? by Jan Zabrzyński, Maciej Gagat, Łukasz Łapaj, Łukasz Paczesny, Alper Yataganbaba, Dawid Szwedowski and Gazi Huri in Therapeutic Advances in Chronic Disease

Proper posture and sufficient scapular stabilization is necessary to provide normal shoulder functions after anterior shoulder instability surgery. A six-months rehabilitation program was performed to gain full shoulder functions and return to the sport after arthroscopic anterior shoulder instability surgery, a recreational athlete with bilateral idiopathic proximal muscular atrophy with marked prominence in the contralateral side of the surgery and scapular winging with significant deterioration in posture. Range of motion, pain, scapular kinematics, shoulder isokinetic rotator muscle strength and shoulder functions were measured bilaterally after surgery. Rehabilitation program was performed to achieve gradual external rotation in the surgical shoulder during the first three months. Scapular exercises combined with electrical stimulation were performed after contralateral trapezius and infraspinatus muscle atrophy and followed up since six months. Shoulder motions and muscle strength improved with rehabilitation end of the six-months in both shoulders and pain decreased on the surgical shoulder. The scapular movements were more symmetrical after treatment and scapular upward rotation and posterior tilt movements increased. At six months after surgery, the patient achieved full shoulder function and returned to the sport., Omuz anterior instabilite cerrahisi sonrası normal omuz fonksiyonlarının sağlanması için düzgün bir postür ve yeterli bir skapular stabilizasyona ihtiyaç vardır. Artroskopik anterior omuz instabilitesi cerrahisi sonrası, cerrahi tarafın kontralateralinde belirgin olmak üzere bilateral idiopatik proksimal kas atrofisi gelişen ve postüründe belirgin bozulma ile skapular kanatlaşma görülen rekreasyonel bir sporcuya; tam omuz fonksiyonlarını kazandırmak ve spora dönüşü sağlamak amacıyla, cerrahi sonrası altı aylık süreçte rehabilitasyon programı uygulandı. Cerrahi sonrası eklem hareketi, ağrı, skapular kinematik ve omuz izokinetikrotator kas kuvveti ile omuz fonksiyonel değerlendirmesi bilateral olarak yapıldı. İlk üç ay hastanın cerrahi uygulanan omzunda, dereceli eksternal rotasyon kazanımını hedefleyen rehabilitasyon programı uygulandı. Zamanla oluşan kontralateral taraf trapezius ve infraspinatus kas atrofisi sonrasında üçüncü aydan itibaren elektrik stimülasyonuyla kombine uygulanan skapula temelli egzersiz tedavisi ile cerrahi sonrası altıncı aya kadar takip edildi. Uygulanan rehabilitasyon protokolüyle, altıncı ayın sonunda, her iki omuzda da eklem hareketi ve kas kuvvetinde artış ve cerrahi uygulanan omzundaki ağrıda azalma sağlandı. Skapular hareketlerin tedavi sonrasında daha simetrik olduğu ve yukarı rotasyon ve posterior tilt hareketlerinde artış olduğu gözlendi. Cerrahi sonrası altıncı ayda olgu tam omuz fonksiyonlarını kazandı ve spora dönüşü sağlandı.

Purpose The aim of this study was to compare differences in current orthopaedic and trauma training programs across Europe. Methods A questionnaire was sent to the FORTE (Federation of Orthopaedic Trainees in Europe) representatives of 25 different European countries, of which 18 responded. The questionnaire included demographic information and information concerning the structure of the training programs, including duration, selection, and mandatory training requirements. Results The number of trainees per specialist varied between countries from a ratio of 1:2 to 1:7. Residency was generally five to six years in all the countries. In more than half of the countries selection was interview-based. Nearly all countries utilized a logbook. About 80% of the participating countries had a final examination. When assessing the components of training it was found that only one country (the United Kingdom) had mandatory minimum requirements for (1) courses, (2) surgical procedures, (3) research and (4) leadership. Nearly 40% of the participating countries had only one or none of these four components as a mandatory training requirement. Conclusions There are many similarities in training programs, but some important differences remain in overall requirements and final qualification. The main limitation of this study was that we were unable to get data from all the European countries. FORTE will continue to serve as a forum for sharing best practices with the ultimate goal of improving and harmonizing the level of orthopaedic training across Europe. Future studies should aim to include further details about training programs as well as to include data from more countries.

Objective: The purpose of this study was to describe the morphology of the proximal and diaphysis of femur, distribution of neck version, neck-shaft angles, and radius of anterior curvature in a Turkish population to compare with that of femoral intramedullary implants.Methods: Using 84 cadaveric femora, three-dimensional (3D) modeling was performed with a light scanner, data were transferred to Solidworks 2013 software (Solidworks, Waltham, MA, USA) to determine the variability in the femoral length (FL), neck version, neck-shaft angle (NSA), and anterior bow. Three independent observers’ measurements were tested with a reliability analysis and then evaluated using Cronbach’s alpha value, after which they were compared with the neck-shaft angles, and the radii of curvature (RAC) of intramedullary femoral nails, as stated on the official manufacturer websites.Results: Mean FL, femoral neck anteversion (FNA), and NSA had ranges of 346.1–454.1 mm, -11.3–40.4°, and 105.9–149.0°, respectively, and RAC was between 1.0 and 1.2 m. The correlation coefficient and 95% confidence intervals (CI) were 0.89 (CI 0.849–0.928), 0.86 (CI 0.799–0.904), and 0.85 (95% CI 0.785–0.898) for FL, FNA, and NSA, respectively. FNA was 14° 38 (44.7%). NSA was between 130° and 135° in 40 femora (47.1%), and RAC ranged from 0.5 to 1.5 m in 76 femora (91.6%), 1.5 m in 7 (8.4%).Conclusion: FNA and NSA show a wide distribution, mostly out of the range of intramedullary implants. There is a need for implants that are compatible with a range of NSAs and versions, so that they are suitable for use with a variety of morphologies.