Strength testing, especially of the abducted shoulder, aids in diagnosis of rotator cuff tears: a study of senior athletes participating in upper extremity dominant sports

JSES International · 2025-06-10

Background: Small supraspinatus tears can be difficult to diagnose on history and physical examination alone. Normalized strength assessment may aid in diagnosis. We examined shoulder strength normalized to body weight and the nondominant shoulder as well as abduction (AB)/external rotation (ER) and ER/internal rotation strength ratios in senior athletes to determine if they aid in the diagnosis of supraspinatus tears. Methods: Ultrasound imaging of the dominant shoulder's rotator cuff was performed in 79 athletes over the age of 60 who were participating in an upper extremity dominant sport. The supraspinatus tendon condition was categorized into 3 groups: 1) intact (normal/tendinosis), 2) partial-thickness tear, and 3) full-thickness tear. Shoulder strength was assessed with a handheld dynamometer and normalized to body weight, the nondominant shoulder or as AB/ER and ER/internal rotation strength ratios. Receiver-operating characteristic (ROC) curves assessed the accuracy of cut points in the strength data for discriminating full tears from partial or no tears. We hypothesized there would be diminished shoulder strength for glenohumeral AB and ER, when normalized to body weight, in athletes with full-thickness supraspinatus tendon tears compared to those with partial-thickness supraspinatus tears or an intact tendon. Results: No differences among the 3 supraspinatus classifications were found for shoulder strength normalized to the nondominant shoulder or for shoulder strength ratios. However, senior athletes with full-thickness supraspinatus tendon tears had significantly less strength as a percentage of body weight for shoulder AB at 90° and shoulder ER at 90° of AB compared to athletes with intact tendons. ROC curve analysis revealed the best strength test for discriminating a full-thickness supraspinatus tendon tear from an intact tendon was strength of ER at 90° of AB. The ROC curve analyses found a full-thickness supraspinatus tear could be correctly detected 76% of the time when a strength cut point of 12% of bodyweight for ER strength at 90° of AB was used to categorize subjects as having an intact or torn tendon. Conclusion: No differences among the 3 supraspinatus classifications were found for shoulder strength normalized to the nondominant shoulder or for shoulder strength ratios. However, senior athletes with full-thickness supraspinatus tendon tears had significantly less strength as a percentage of body weight for shoulder AB at 90° and shoulder ER at 90° of AB compared to athletes with intact tendons. ROC curve analysis revealed the best strength test for discriminating a full-thickness supraspinatus tendon tear from an intact tendon was strength of ER at 90° of AB. The ROC curve analyses found a full-thickness supraspinatus tear could be correctly detected 76% of the time when a strength cut point of 12% of bodyweight for ER strength at 90° of AB was used to categorize subjects as having an intact or torn tendon.

How Do I Evaluate Tan Birthmarks?

2024-05-30

The vast majority of tan birthmarks are inconsequential; however, there are certain physical examination features that can alert a physician to the possibility of an underlying genetic syndrome or systemic disease. For the purpose of this review, the term birthmark will include those lesions noted at or soon after birth, as some pigmented birthmarks can be present, but are less noticeable, at the time of birth. In this review, I will outline a quick approach to tan birthmarks that can be utilized during the newborn physical examination. Specifically, your evaluation should focus on the size, number, and distribution of these birthmarks. As always, such an evaluation should include a full skin and mucous membrane examination and a thorough evaluation of the child’s global development. 1

Preoperative planning with three-dimensional CT vs. three-dimensional magnetic resonance imaging does not change surgical management for shoulder instability

JSES International · 2023-09-05 · 3 citations

Background: This study aims to determine the effect of time and imaging modality (three-dimensional (3D) CT vs. 3D magnetic resonance imaging (MRI)) on the surgical procedure indicated for shoulder instability. The hypothesis is there will be no clinical difference in procedure selection between time and imaging modality. Methods: Eleven shoulder surgeons were surveyed with the same ten shoulder instability clinical scenarios at three time points. All time points included history of present illness, musculoskeletal exam, radiographs, and standard two-dimensional MRI. To assess the effect of imaging modality, survey 1 included 3D MRI while survey 2 included a two-dimensional and 3D CT scan. To assess the effect of time, a retest was performed with survey 3 which was identical to survey 2. The outcome measured was whether surgeons made a "major" or "minor" surgical change between surveys. Results: = .8). Discussion: The findings suggest that the major factor related to procedural changes was time between reviewing patient information. Furthermore, this study demonstrates that there remains significant intrasurgeon variability in selecting surgical procedures for shoulder instability. Lastly, the findings in this study suggest that 3D MRI is clinically equivalent to 3D CT in guiding shoulder instability surgical management. Conclusion: This study demonstrates that there is significant variability in surgical procedure selection driven by time alone in shoulder instability. Surgical decision making with 3D MRI was similar to 3D CT scans and may be used by surgeons for preoperative planning.

Glenoid Version Assessment When the CT Field of View Does Not Permit the Friedman Method: The Robertson Method

Orthopaedic Journal of Sports Medicine · 2022-05-01 · 3 citations

Background: To improve spatial resolution, current clinical shoulder cross-sectional imaging studies reduce the field of view of the shoulder, excluding the medial scapula border and preventing glenoid version measurement according to the Friedman method. Purpose: To evaluate a method to accurately and reliably measure glenoid version on cross-sectional shoulder images when the medial scapula border is not included in the field of view, and to establish measurements equivalent to the Friedman method. Study Design: Controlled laboratory study. Methods: Sixty-five scapulae underwent computed tomography (CT) scanning with an optimal shoulder CT-positioning protocol. Glenoid version was measured on CT images of the full scapula using the Friedman method. We developed a measurement method (named the Robertson method) based on the glenoid vault version from partial scapula images, with a correction angle subtracted from the articular-surface-glenoid vault measurement. Comparison with the Friedman method defined the accuracy of the Robertson method. Three observers tested inter- and intraobserver reliability of the Robertson method. Accuracy was statistically evaluated with t tests and reliability with the intraclass correlation coefficient (ICC). Results: The statistical distribution of glenoid version was similar to published data,–0.5° ± 3° [mean ± SD]. The initial measurement using the Robertson method resulted in a more retroverted angle compared with the Friedman method, and a correction angle of 7° was then applied. After this adjustment, the difference between the 2 methods was nonsignificant (0.1° ± 4°; P > .65). Reliability of the Robertson method was excellent, as the interrater ICC was 0.77, the standard error of measurement (SEM) was 1.1° with P < .001. The intrarater ICC ranged between 0.84 and 0.92, the SEM ranged between 0.9° and 1.2° with P < .01. Conclusion: A validated glenoid version measurement method is now available for current clinical shoulder CT protocols that reliably create Friedman-equivalent values. Clinical Relevance: Friedman-equivalent values may be made from common clinical CTs of the shoulder and compared with prior and future Friedman measurements of the scapula.

Safety of dupilumab in a 5‐month‐old infant with severe atopic dermatitis

Pediatric Dermatology · 2022-03-01 · 4 citations

Dupilumab is a fully humanized monoclonal antibody that suppresses Th2-mediated inflammation by inhibiting signaling of interleukin-4 and interleukin-13 through the interleukin-4 alpha receptor subunit, and is approved by the FDA for the treatment of moderate to severe atopic dermatitis (AD) in children 6 years of age and older. While initial data from phase 2 trials in children less than 6 years are promising, dupilumab use in children less than 6 months of age is not well studied. Here we present a case of a 5-month-old boy with severe primary AD, eosinophilia, hypogammaglobulinemia, and poor weight gain, who was successfully treated with dupilumab and experienced no serious adverse effects. To our knowledge, this is the youngest patient to receive dupilumab to date.

Total Hip Replacement Interrupted by Intraoperative Arrest with a Final Component in Place: A Case Report.

PubMed · 2022-08-01 · 1 citations

No consensus recommendations exist as to the management of implants exposed during an interrupted total hip arthroplasty (THA). Given the infrequency of such events, documentation of successful outcomes in single case reports aids in decision-making. A 71-year-old male with a history of coronary artery disease and a BMI of 39.5 went into ventricular fibrillation half-way through a THA, after placement of a cementless acetabular component but before femoral preparation could begin. Continuation of the planned arthroplasty was aborted, the patient's wound was packed with sterile sponges and covered with an iodoform dressing, and he was flipped supine for CPR. He returned to the OR 6-hours following his arrest and his arthroplasty was completed with the original acetabular implant left in place. The patient was placed empirically on 2 weeks of IV vancomycin and 3 months of oral doxycycline based on infectious disease recommendations, and healed uneventfully. While validation of our strategy is challenging due to the infrequent nature of this event, it is hoped that this description and discussion may provide a template to those who encounter a similar challenging situation.

New‐onset head and neck dermatitis in adolescent patients after dupilumab therapy for atopic dermatitis

Pediatric Dermatology · 2021-01-10 · 20 citations

BACKGROUND/OBJECTIVES: Head and neck dermatitis after dupilumab therapy for atopic dermatitis has been frequently reported in adults and only rarely in adolescents. No cases detailing disease course and treatment response have previously been described in adolescents. METHODS/RESULTS: This case series presents five adolescent patients who developed new-onset or worsening head and neck dermatitis after dupilumab therapy for atopic dermatitis. All five patients improved after oral antifungal therapy. CONCLUSIONS: The clinical features, treatment response, and potential disease pathogenesis in pediatric patients are described. Adolescents with new-onset head and neck dermatitis after dupilumab therapy may clinically improve with antifungal therapy, suggesting that Malassezia species may be a contributing factor or antifungal therapy may be an effective antiinflammatory agent.

Pediatric teledermatology: A retrospective review of 1199 encounters during the COVID-19 pandemic

Journal of the American Academy of Dermatology · 2021-11-25 · 11 citations

Assessing the accuracy of arthroscopic and open measurements of the size of rotator cuff tears: A simulation-based study

World Journal of Orthopedics · 2021-12-14 · 2 citations

BACKGROUND: Arthroscopic procedures are commonly performed for rotator cuff pathology. Repair of rotator cuff tears is a commonly performed procedure. The intraoperative evaluation of the tear size and pattern contributes to the choice and completion of the technique and the prognosis of the repair. AIM: To compare the arthroscopic and open measurements with the real dimensions of three different patterns of simulated rotator cuff tears of known size using a plastic shoulder model. METHODS: We created three sizes and patterns of simulated supraspinatus tears on a plastic shoulder model (small and large U-shaped, oval-shaped). Six orthopaedic surgeons with three levels of experience measured the dimensions of the tears arthroscopically, using a 5 mm probe, repeating the procedure three times, and then using a ruler (open technique). Arthroscopic, open and computerized measurements were compared. RESULTS: < 0.001). No differences were observed between the open and computerized measurements (mean difference -0.4 ± 1.6 mm). The accuracy of arthroscopic and open measurements was 90.5% and 98.5%, respectively. When comparing between levels of experience, senior residents reported smaller tear dimensions when compared both to staff surgeons and fellows. CONCLUSION: This study suggests that arthroscopic measurements of full-thickness rotator cuff tears constantly underestimate the dimensions of the tears. Development of more precise arthroscopic techniques or tools for the evaluation of the size and type of rotator cuff tears are necessary.

Implementation of a pediatric provider‐to‐provider store‐and‐forward teledermatology system: Effectiveness, feasibility, and acceptability in a pilot study

Pediatric Dermatology · 2020-08-31 · 22 citations

BACKGROUND/OBJECTIVES: Long wait times for in-person appointments in pediatric dermatology can lead to delays in specialty care, additional health system touchpoints, patient and family dissatisfaction, poorer outcomes, and increased overall health care costs. Store-and-forward teledermatology may address these challenges and improve access to care in pediatric dermatology. METHODS: We describe a prospective, non-blinded cohort study with follow-up surveys conducted from March 1, 2018, to September 20, 2018. The study was conducted at a single center, in primary care and specialist settings. Patients included were <18 years old and received care at one of our affiliated primary care sites. Primary care providers submitted teledermatology consultations through a shared electronic medical record. A board-certified pediatric dermatologist evaluated each consultation; primary care providers conveyed recommendations to families. RESULTS: Forty-three consultations for patients (23 male, 20 female; median age: 7 years [IQR: 2.4-12]) were entered by primary care providers. Median time from consult request to dermatologist initiating consult was 12.1 hours [IQR: 1.9-18.8]; median time to complete consult note was 7 minutes [IQR: 5-10.5]. Median time from primary care provider initially consulting to conveying teledermatology recommendations to families was 3 days [IQR: 1-5]. All but one consult (42/43, 98%) were completed in the intended workflow. Follow-up in-person visits with pediatric dermatologists occurred with 10/43 (23%) patients. In follow-up surveys, parents were 83% likely to recommend the service to family and friends. All primary care providers and dermatologists felt the service improved quality of care. CONCLUSIONS: Provider-to-provider teledermatology consultation appears to be a feasible and acceptable method of providing care quickly and effectively to pediatric patients.