Background:There is an association between throwing activity and glenohumeral internal rotation deficit (GIRD). An 18° to 20° deficit has been adopted as the standard definition of pathological GIRD, but specific findings as to how GIRD relates to an injury are inconsistent.Purpose:To systematically review the literature to clarify the definition of GIRD diagnosis for adolescent and adult overhead athletes and to examine the association between GIRD and an increased risk of injuries in these athletes.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed. Observational studies comparing glenohumeral internal rotation range of motion (ROM) in injured and uninjured overhead athletes were included for the meta-analysis. Studies of adolescent and adult athletes were analyzed separately. ROM was compared for the injured and uninjured groups, and a weighted mean GIRD was estimated. To account for potential heterogeneity across studies, both fixed- and random-effects models were used to calculate a standardized mean difference (SMD).Results:Nine studies of level 3 or 4 evidence were included. From these, 12 study groups (4 adolescent, 8 adult) comprising 819 overhead athletes (226 injured, 593 uninjured) were included in the meta-analysis. The estimated SMD in GIRD between the injured and uninjured groups was 0.46 (95% CI, 0.15-0.77; P < .01) for the overall sample. The between-group effect was larger for adults (SMD, 0.60 [95% CI, 0.18 to 1.02]; P < .01) than adolescents (SMD, 0.20 [95% CI, –0.24 to 0.63]; P = .13). The weighted mean GIRD for the injured and uninjured groups was 13.8° ± 5.6° and 9.6° ± 3.0°, respectively, which also differed by age group. Moderate study heterogeneity was observed (I 2 = 69.0%).Conclusion:Based on this systematic review, the current definition of pathological GIRD may be too conservative, and a distinct definition may be required for adolescent and adult athletes. While the results indicate a link between internal rotation deficits and upper extremity injuries in the overhead athlete, higher quality prospective research is needed to clarify the role that GIRD plays in future injuries to overhead athletes of various ages.

Background:Pectoralis major muscle (PMM) tendon ruptures are becoming more common. Multiple techniques for fixation of the avulsed tendon to its humeral insertion have been described. None of these techniques has been reviewed to compare outcomes in efforts to establish a first-line surgical technique.Purpose:To systematically review and analyze the data available in the literature to establish a clinically superior surgical technique and time frame in which surgery should occur.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature review was conducted. Only studies reporting the surgical techniques and outcomes of PMM repair were included. Data including patient age, injury mechanism, type and extent of the rupture, time from injury to surgery, surgical technique, outcome including complications, steroid use, location and year of publication, and activity level were extracted from the included studies. Statistical and descriptive analyses were conducted on the available literature.Results:Of 259 cases from studies that provided the timing of repair, 72.6% (n = 188) were repaired acutely, while the remaining were repaired more than 8 weeks after the injury. There was no statistical difference found in the outcomes of these repairs. There were 265 cases included in the statistical analysis comparing the outcomes of surgical techniques. The odds of an excellent/good outcome were significantly better for the transosseous suture (TOS) compared with the unicortical button (UCB) technique (odds ratio [OR], 6.28 [95% CI, 1.37-28.75]; P = .018) and also for the suture anchor (SA) compared with the UCB technique (OR, 3.40 [95% CI, 1.06-10.85]; P = .039). The odds of an excellent/good outcome were not significantly different when comparing the TOS, SA, and TOS with trough techniques to one another. The probability of complications was highest with the TOS with trough technique (12.0%), although the odds of having a complication were not statistically significant for any single technique compared with the others.Conclusion:The low quality of evidence available limited this review. There were no significant differences observed in the outcomes of PMM repair based on the timing of repair. The TOS and SA techniques had statistically significantly greater odds of resulting in an excellent/good outcome compared with the UCB technique, but 1 study that contributed to this analysis may have statistically skewed the results for the UCB technique. Therefore, all 3 surgical techniques are accepted options, and the best technique is that with which the surgeon is most proficient and comfortable. Comparative research with a greater level of evidence is needed to determine a definitive first-line surgical technique.

Adult day service centers (ADSCs) provide community-based long-term care, including meals, to racially diverse older adults, 47% of whom have dementia and consequently experience elevated nutritional risk. We examine nutritional behaviors for Chinese and Vietnamese persons living with dementia (PLWD) in ADSCs and evaluate the extent to which ADSCs provide person-centered nutritional care. Multi-stakeholder interviews were conducted. Data were coded using Dedoose and analyzed using Braun and Clarke’s six-step method. The Model for the Provision of Good Nutritional Care in Dementia guided analysis. Barriers to food intake included distracting meal environment, rigid mealtimes, and excessively restrictive diets. Conversely, peer relationships, culturally tailored meals and celebrations, and consistent staff assisting with feeding benefited PLWD. ADSCs can support healthy nutritional behaviors and quality of life among PLWD through person-centered nutritional care. To optimize nutritional services, further exploration is needed with respect to the ADSC environment, users’ culture and ethnicity, and liberalized diets for PLWD.

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