Objective: Adhesive capsulitis has been suggested as an adverse effect of vaccine administration into the shoulder area. The purpose of this case series is to report 3 cases of acute onset of adhesive capsulitis following pneumococcal and influenza vaccines. Clinical Features: Patients reported painful shoulder and limited motion following routine vaccination. After clinical examination, a diagnosis of adhesive capsulitis was noted. Intervention and Outcome: All 3 patients were treated conservatively with physical therapy (active ranges of motion and active-assisted motion), nonsteroidal anti-inflammatory drugs, and activity modification with eventual resolution of symptoms. Conclusion: Reports implicating vaccination with adhesive capsulitis are rare. This case series raises the awareness of pneumococcal and influenza vaccinations as possible causes of adhesive capsulitis that appear to respond to standard treatment. Although vaccines are of tremendous importance in the prevention of serious illness, we emphasize the importance of administering them at the appropriate depth and location for each patient.
The purpose of this study was to examine the accuracy of physical examination in the detection of subscapularis tendon tears and compare it with the gold standard of arthroscopy to determine whether clinical examination can reliably predict the presence of subscapularis tendon tears. This was a retrospective analysis of 52 patients (52 shoulders) who underwent arthroscopic subscapularis tendon repairs between September 2008 and April 2012. Positive findings on any combination of the belly press, lift-off, and bear hug tests constituted a positive physical examination result. There was a positive finding on physical examination in 42 of 52 patients. The sensitivity of the physical examination as a whole was 81%. The literature has shown that the belly press, bear hug, and lift-off tests are specific to the subscapularis tendon. To the authors’ knowledge, this is the first study to evaluate the sensitivity of these 3 separate clinical tests as a composite. Knowledge regarding the sensitivity of the subscapularis-specific physical examination as a composite can lead practitioners to implement all 3 components, even when 1 test has a negative finding, thus promoting a more thorough physical examination. Because unrepaired subscapularis tendon tears can result in poor outcomes in the repair of other rotator cuff tendons, a complete physical examination would be beneficial to patients with shoulder pathology. The authors conclude that physical examination, when performed consistently by an experienced practitioner, can reliably predict the presence of subscapularis tendon tears.
This technical note describes a method of biceps tenodesis called the Modified Norwegian Method that is an allarthroscopic, intra-articular, bony biceps tenodesis that uses a suture shuttle passer through an anterosuperolateral portal. It allows for easy passage of suture through the long head of the biceps tendon while one is viewing through the posterior portal. We believe this method to be a very reasonable and simple method of biceps tenodesis that has complication rates similar to those described for subpectoral and other methods of fixation.
Objectives:The main purpose of this study was to obtain the accuracy of the physical exam in the detection of subscapularis tendon tears and compare it to the gold standard of arthroscopy to determine whether clinical examination can reliably predict the presence of subscapularis tendon tears.Methods:This was a retrospective analysis of 52 patients (52 shoulders) who underwent arthroscopic subscapularis tendon repairs between September 2008 and April 2012. The inclusion criteria for this study were that all patients must have had at least 1 of the 3 screening tests performed prior to arthroscopy, arthroscopic evidence of a subscapularis tear, and subsequent repair of this tear. Exclusion criteria in this study included lack of documentation of screening tests. Positive findings on any combination of the belly press, lift-off, and bear hug tests constituted a positive physical exam resultResults:There was a positive finding on physical exam in 42/52 patients. The sensitivity of the physical exam in the detection of subscapularis tendon injury was found to be 81%. Ten of the 52 patients with subscapularis tendon tears had negative physical exam results (false negatives). The median number of days between the physical exam and arthroscopic confirmation of a subscapularis tendon tear was 16 days.Conclusion:The belly press, lift-off, and bear hug tests can reliably predict subscapularis tendon tears. Consistent implementation of these three components of the physical exam can potentially lead to fewer undetected subscapularis tears, resulting in fewer failed rotator cuff repairs and improved overall post-operative outcomes.
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