Publications by authors named "Kenneth J Faber"

108 Publications

Regional apparent density correlations within the proximal humerus.

JSES Int 2021 May 9;5(3):525-531. Epub 2021 Feb 9.

University of Western Ontario, London, ON, Canada.

Background: Bone quality influences humeral implant selection for shoulder arthroplasty. However, little is known about how well bone near the humeral resection represents more distal cancellous bone. This investigation aimed to quantify the correlations between the apparent density of sites near the humeral head resection plane and cancellous sites throughout the metaphysis.

Methods: Using computed tomography data from 98 subjects, apparent bone density was quantified in 65 regions throughout the proximal humerus. Pearson's correlation coefficient was determined comparing the density between samples from the humeral resection and all supporting regions beneath the resection. Mean correlation coefficients were compared for (i) each sample region with all support regions, (ii) pooling all sample regions within a slice, and (iii) considering sample regions correlated with only the support regions in the same anatomic section.

Results: Stronger correlations existed for bone sampled beneath the resection (0.33 ± 0.10≤ r ≤ 0.88 ± 0.10), instead of from the resected humeral head (0.22 ± 0.10≤ r ≤ 0.66 ± 0.14). None of sample region correlated strongly with all support regions; however, strong correlations existed when sample and support regions both came from the same anatomic section.

Discussion: Assessments of cancellous bone quality in the proximal humerus should be made beneath the humeral resection not in the resected humeral head; and each anatomic quadrant should be assessed independently.
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http://dx.doi.org/10.1016/j.jseint.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178593PMC
May 2021

Reproducibility: Reliability and Agreement Parameters of the Revised Short McGill Pain Questionnaire Version-2 for use in Patients with Musculoskeletal Shoulder Pain.

Can J Pain 2020 Dec 30;4(4):45-46. Epub 2020 Dec 30.

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada.

: The Revised Short-Form McGill Pain Questionnaire Version-2 (SF-MPQ-2) is a multidimensional outcome measure designed to evaluate neuropathic and nonneuropathic pain. A recent systematic review found insufficient psychometric data with respect to musculoskeletal health conditions. : The aim of this study was to describe the reproducibility (reliability and agreement) and internal consistency of the SF-MPQ-2 for use among patients with musculoskeletal shoulder pain. : Eligible patients with shoulder pain from musculoskeletal (MSK) sources completed the SF-MPQ-2 at baseline ( = 195), and a subset did so again after 3 to 7 days ( = 48) if their response to the global rating of change scale remained unchanged. Cronbach's alpha (α) and intraclass correlation coefficient (ICC[2,1]) were calculated. Standard error of measurement (SEM), group and individual minimal detectable change (MDC90), and Bland-Altman plots were used to assess agreement. : Cronbach's α ranged from 0.83 to 0.95, suggesting very satisfactory internal consistency across the SF-MPQ-2 domains. Excellent ICC(2,1) scores were found in support of the total (0.95) and continuous (0.92) subscales; the remaining subscales displayed good ICC(2,1) scores (0.78-0.88). Bland-Altman analysis revealed no systematic bias between the test and retest scores (mean difference = 0.13 to 0.19). Though the best agreement coefficients were seen on the total scale (SEM = 0.5; MDC90 = 1.2, MDC90 = 0.3), they were acceptable for the SF-MPQ-2 subscales (SEM: range, 0.7-1; MDC90: range, 1.7-2.3; MDC90: range, 0.4-0.5). : The SF-MPQ-2 provides good to excellent test-retest reliability for multidimensional pain assessment among patients with musculoskeletal shoulder pain conditions.
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http://dx.doi.org/10.1080/24740527.2020.1712653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7942798PMC
December 2020

Automated Nerve Monitoring in Shoulder Arthroplasty: A Prospective Randomized Controlled Study.

Anesthesiology 2021 Apr 30. Epub 2021 Apr 30.

Background: Evoked potential monitoring is believed to prevent neurologic injury in various surgical settings; however, its clinical effect has not been scrutinized. It was hypothesized that an automated nerve monitor can minimize intraoperative nerve injury and thereby improve clinical outcomes in patients undergoing shoulder arthroplasty.

Methods: A prospective, blinded, parallel group, superiority design, single-center, randomized controlled study was conducted. Study participants were equally randomized into either the automated nerve-monitored or the blinded monitored groups. The primary outcome was intraoperative nerve injury burden as assessed by the cumulative duration of nerve alerts. Secondary outcomes were neurologic deficits and functional scores of the operative arm, and the quality of life index (Euro Quality of life-5 domain-5 level score) at postoperative weeks 2, 6, and 12.

Results: From September 2018 to July 2019, 213 patients were screened, of whom 200 were randomized. There was no statistically significant difference in the duration of nerve alerts between the automated nerve-monitored and control groups (median [25th, 75th interquartile range]: 1 [0, 18] and 5 [0, 26.5]; Hodges-Lehman difference [95% CI]: 0 [0 to 1] min; P = 0.526). There were no statistically significant differences in secondary outcomes between groups. However, in the ancillary analysis, there were reductions in neurologic deficits and improvements in quality of life index occurring in both groups over the course of the study period.

Conclusions: Protection from nerve injury is a shared responsibility between surgeons and anesthesiologists. Although a progressive improvement of clinical outcomes were observed over the course of the study in both groups as a consequence of the real-time feedback provided by the automated nerve monitor, this trial did not demonstrate that automated nerve monitoring by itself changes important clinical outcomes compared with no monitoring.

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http://dx.doi.org/10.1097/ALN.0000000000003797DOI Listing
April 2021

Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis.

J Shoulder Elbow Surg 2021 Jul 20;30(7S):S8-S13. Epub 2021 Apr 20.

The Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada. Electronic address:

Background: Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies.

Methods: A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score.

Results: The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies.

Conclusion: CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis.
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http://dx.doi.org/10.1016/j.jse.2021.04.001DOI Listing
July 2021

Measurement Properties of the Brief Pain Inventory-Short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) in Pain-related Musculoskeletal Conditions: A Systematic Review.

Clin J Pain 2021 Jun;37(6):454-474

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London.

Objective: The objective of this study was to systematically locate, critically appraise, and summarize clinical measurement research addressing the use of Brief Pain Inventory-Short Form (BPI-SF) and Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) in pain-related musculoskeletal (MSK) conditions.

Materials And Methods: We systematically searched 4 databases (Medline, CINAHL, EMBASE, and SCOPUS) and screened articles to identify those reporting the psychometric properties (eg, validity, reliability) and interpretability (eg, minimal clinically important difference) of BPI-SF and SF-MPQ-2 as evaluated in pain-related MSK conditions. Independently, 2 reviewers extracted data and assessed the quality of evidence with a structured quality appraisal tool and the updated COSMIN guidelines.

Results: In all, 26 articles were included (BPI-SF, n=17; SF-MPQ-2, n=9). Both tools lack reporting on their cross-cultural validities and measurement error indices (eg, standard error of measurement). High-quality studies suggest the tools are internally consistent (α=0.83 to 0.96), and they associate modestly with similar outcomes (r=0.3 to 0.69). Strong evidence suggests the BPI-SF conforms to its 2-dimensional structure in MSK studies; the SF-MPQ-2 4-factor structure was not clearly established. Seven reports of high-to-moderate quality evidence were supportive of the BPI-SF known-group validity (n=2) and responsiveness (n=5). One report of high quality established the SF-MPQ-2 responsiveness.

Discussion: Evidence of high-to-moderate quality supports the internal consistency, criterion-convergent validity, structural validity, and responsiveness of the BPI-SF and SF-MPQ-2 and establishes their use as generic multidimensional pain outcomes in MSK populations. However, more studies of high quality are still needed on their retest reliability, known-group validity, cross-cultural validity, interpretability properties, and measurement error indices in different MSK populations.
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http://dx.doi.org/10.1097/AJP.0000000000000933DOI Listing
June 2021

Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients.

JSES Int 2021 Mar 10;5(2):291-295. Epub 2021 Jan 10.

Roth McFarlane Hand and Upper Limb Center, University of Western Ontario, London, ON, Canada.

Background: Surgical treatment of displaced olecranon fractures in the elderly has a high rate of complications, including wound breakdown and fixation failure. The purpose of this study was to assess the clinical, radiographic, and functional outcomes of nonsurgical management of displaced olecranon fractures in low-demand elderly and medically unwell patients.

Methods: A retrospective review of 28 patients with displaced closed olecranon fractures was performed with an average follow-up of 11 months. The mean age at the time of injury was 79 ± 10 years. The average Charlson Comorbidity Index was 6.4 ± 2.6. Treatment modalities were at the discretion of the treating surgeon. A sling alone was used in 3 cases, an extension circumferential cast in 9, or a plaster or thermoplastic splint in 16. The mean period of immobilization was 5 ± 1 weeks. Outcomes included range of motion, ability to perform active overhead extension, as well as radiographic and functional outcomes.

Results: At final follow-up, the mean elbow range of motion for the cohort was from 28° ± 21° extension to 127° ± 15° flexion. Active overhead elbow extension against gravity was noted or documented in 24 (86%) patients. Two patients (7%) were unable to perform active extension. No pain was noted in 18 elbows, severe pain was present in 1 elbow, and the remainder reported mild occasional pain. All olecranon fractures in this cohort were displaced on the initial lateral radiograph. The mean displacement was 11 ± 7 mm. Nonunion at final radiographic outcome was observed in 23 (82%) elbows. Two (7%) patients developed skin complications related to posteriorly placed splints; one of which was severe.

Discussion: This study adds to the growing literature that supports nonoperative management of displaced olecranon fractures in elderly and medically unwell patients with low upper extremity demand. Patients can be counseled that they have a good chance of obtaining overhead extension, with minimal pain. Posteriorly based splints should not be used to minimize skin complications.
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http://dx.doi.org/10.1016/j.jseint.2020.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910720PMC
March 2021

Results of Linked Convertible Total Elbow Arthroplasty for the Management of Distal Humeral Fractures in the Elderly.

J Hand Surg Am 2021 May 8;46(5):396-402. Epub 2021 Jan 8.

Department of Surgery, St Joseph's Hospital, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Hospital London, Ontario, Canada. Electronic address:

Purpose: Total elbow arthroplasty (TEA) is increasingly used for the management of comminuted distal humeral fractures in elderly patients. There are limited data on the outcome of modern elbow arthroplasty designs in larger patient cohorts. The aim of the current study was to review the outcomes and complications using a cemented convertible TEA system in a linked configuration in patients with distal humeral fractures.

Methods: Patients with distal humeral fractures treated with TEA and a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome, functional and radiographic outcome assessments, and complications were reported.

Results: Forty patients met inclusion criteria; 35 were female. Median follow-up was 4 years (range, 2-13 years). Average age of patients at the index procedure was 79 ± 9 years. All implants were linked. Range of motion was: extension 16° ± 13°, flexion 127° ± 14°, supination 79° ± 11°, and pronation 73° ± 20°. Patient-reported outcome scores were: Patient-Rated Elbow Evaluation 37 ± 35, Quick-Disabilities of the Arm, Shoulder, and Hand 31 ± 31, and Mayo Elbow Performance Index 90 ± 18. Seven patients had heterotopic ossification. Lucent lines were noted predominantly in humeral implant zone V. No lucent lines were noted around the ulnar component in any radiographic zone. Complications occurred in 9 patients (22%) and 2 revisions were performed: one for infection and one for a late periprosthetic fracture.

Conclusions: Total elbow arthroplasty for fracture in elderly patients provides pain relief, functional range of motion, and good patient-reported outcome scores. No implant-related complications of this convertible implant system were encountered, but longer-term follow-up is needed.

Type Of Study/level Of Evidence: Therapeutic IV.
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http://dx.doi.org/10.1016/j.jhsa.2020.10.034DOI Listing
May 2021

Reproducibility: reliability and agreement parameters of the Revised Short McGill Pain Questionnaire Version-2 for use in patients with musculoskeletal shoulder pain.

Health Qual Life Outcomes 2020 Nov 11;18(1):365. Epub 2020 Nov 11.

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, N6A 4L6, Canada.

Background: The Revised Short McGill Pain Questionnaire Version-2 (SF-MPQ-2) is a multidimensional outcome measure designed to capture, evaluate and discriminate pain from neuropathic and non-neuropathic sources. A recent systematic review found insufficient psychometric data with respect to musculoskeletal (MSK) health conditions. This study aimed to describe the reproducibility (test-retest reliability and agreement) and internal consistency of the SF-MPQ-2 for use among patients with musculoskeletal shoulder pain.

Methods: Eligible patients with shoulder pain from MSK sources completed the SF-MPQ-2: at baseline (n = 195), and a subset did so again after 3-7 days (n = 48), if their response to the Global Rating of Change (GROC) scale remained unchanged. Cronbach alpha (α) and intraclass correlation coefficient (ICC), and their related 95% CI were calculated. Standard error of measurement (SEM), group and individual minimal detectable change (MDC90), and Bland-Altman (BA) plots were used to assess agreement.

Results: Cronbach α ranged from 0.83 to 0.95 suggesting very satisfactory internal consistency across the SF-MPQ-2 domains. Excellent ICC scores were found in support of the total scale (0.95) and continuous subscale (0.92) scores; the remaining subscales displayed good ICC scores (0.78-0.88). Bland-Altman analysis revealed no systematic bias between the test and retest scores (mean difference = 0.13-0.19). While the best agreement coefficients were seen on the total scale (SEM = 0.5; MDC = 1.2 and MDC = 0.3), they were acceptable for the SF-MPQ-2 subscales (SEM: range 0.7-1; MDC: range 1.7-2.3; MDC: range 0.4-0.5).

Conclusion: Good reproducibility supports the SF-MPQ-2 domains for augmented or independent use in MSK-related shoulder pain assessment, with the total scale displaying the best reproducibility coefficients. Additional research on the validity and responsiveness of the SF-MPQ-2 is still required in this population.
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http://dx.doi.org/10.1186/s12955-020-01617-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661222PMC
November 2020

Effectiveness of surgical and non-surgical interventions for managing diabetic shoulder pain: a systematic review.

Disabil Rehabil 2020 Sep 15:1-14. Epub 2020 Sep 15.

Roth|McFarlane Hand and Upper Limb Center, St. Joseph's Health Care London, London, Canada.

Purpose: This systematic review evaluated and compared the effectiveness of non-surgical and surgical interventions for managing shoulder pain in patients with diabetes.

Methods: PubMed, Scopus, CINAHL, EMBASE, Sport Discus, and Cochrane library were searched for studies published in the last 20 years. Randomized clinical trials (RCTs) and cohort studies that assessed shoulder pain in patients with diabetes and implemented one or a combination of non-surgical and surgical interventions were eligible for inclusion. The quality of the included studies was assessed using the Structured Effectiveness Quality Evaluation Scale (SEQES) tool. Data extracted from the eligible studies included study design, patient characteristics, duration of symptoms, type of interventions, outcome measures used to assess pain, follow-up intervals, and research findings.

Results: A narrative synthesis with effect sizes (ES) or between-group differences was conducted. A total of 25 (14 non-surgical and 11 surgical) studies met the inclusion criteria. Six studies addressed physiotherapeutic interventions (three RCTs and three cohorts - ES = 0.07-1.3), three studies assessed the effect of steroid injections (two RCTs and one cohort - ES = 0.2-0.4), two cohorts addressed arthrographic capsular distension (between-group difference of 1.1 on Visual Analogue Scale), two cohorts addressed MUA, and one RCT addressed suprascapular nerve block (ES = 1-6). For the surgical studies, six cohorts addressed arthroscopic capsular release (ES = 0.2), three cohorts addressed arthroscopic rotator cuff repair (ES = 0.05-0.5), and one cohort addressed arthroplasty (ES = 0.3).

Conclusion: Moderate- to very-low-quality evidence suggests large effects of physiotherapy modalities plus exercise and suprascapular nerve block, and trivial to small effects for surgical interventions for improving shoulder pain in patients with diabetes. Future well-designed studies are needed to provide accurate estimates of the true effects of these interventions on improving shoulder pain in patients with diabetes.Implications For RehabilitationShoulder pain may lead to disability in patients with diabetes.We recommend the use of physiotherapy interventions to reduce shoulder pain.Corticosteroid injections are recommended for short-term shoulder pain relief.
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http://dx.doi.org/10.1080/09638288.2020.1811783DOI Listing
September 2020

The role of biceps loading and muscle activation on radial head stability in anterior Monteggia injuries: An in vitro biomechanical study.

J Hand Ther 2020 Jun 26. Epub 2020 Jun 26.

Roth-McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.

Introduction: Little evidence-based information is available to direct the optimal rehabilitation of patients with anterior Monteggia injuries.

Purpose Of The Study: The aims of this biomechanical investigation were to (1) quantify the effect of biceps loading and (2) to compare the effect of simulated active and passive elbow flexion on radial head stability in anterior Monteggia injuries.

Study Design: In vitro biomechanical study.

Methods: Six cadaveric arms were mounted in an elbow motion simulator. The effect of biceps loading, simulated active and passive elbow flexion motions was examined with application of 0N, 20N, 40N, 60N, 80N, and 100N of load. Simulated active and passive elbow flexion motions were then performed with the forearm supinated. Radial head translation relative to the capitellum was measured using an optical tracking system. After testing the intact elbows, the proximal ulna was osteotomized and realigned using a custom jig to simulate an anatomical reduction. We then sequentially sectioned the anterior radiocapitellar joint capsule, annular ligament, quadrate ligament, and the proximal and middle interosseous membrane to simulate soft tissue injuries commonly associated with anterior Monteggia fractures.

Results: Greater magnitudes of biceps loading significantly increased anterior radial head translation. However, there was no significant difference in radial head translation between simulated active and passive elbow flexion except in the final stage of soft tissue sectioning. There was a significant increase in anterior radial head translation with progressive injury states with both isometric biceps loading and simulated active and passive motion.

Conclusions: Our results demonstrate that anatomic reduction of the ulna may not be sufficient to restore radial head alignment in anterior Monteggia injuries with a greater magnitude of soft tissue injury. In cases with significant soft tissue injury, the elbow should be immobilized in a flexed and supinated position to allow relaxation of the biceps and avoid movement of the elbow in the early postoperative period.
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http://dx.doi.org/10.1016/j.jht.2020.03.012DOI Listing
June 2020

Static and Dynamic External Fixation are Equally Effective for Unstable Elbow Fracture-Dislocations.

J Orthop Trauma 2021 03;35(3):e82-e88

Department of Surgery, St. Joseph's Health Care, Hand and Upper Limb Centre, Western University, London, ON, Canada; and.

Objective: To compare the clinical outcomes of static versus dynamic external fixation for elbow fracture-dislocations with persistent instability after surgical management.

Design: Comparative, retrospective review.

Setting: Two tertiary referral upper-extremity centers.

Patients: Twenty-four elbows requiring external fixation for persistent elbow instability within 90 days of surgical management of an elbow fracture-dislocation.

Intervention: Static and dynamic external fixation was used in 16 and 8 patients, respectively, for a median of 39 days (interquartile range, 33-48 days).

Main Outcome Measurements: Elbow range of motion, complications, and revision surgeries.

Results: Immediately after static and dynamic external fixation removal, there was no difference in elbow extension [33 degrees ± 16 degrees vs. 41 degrees ± 13 degrees, mean difference (MD) 7 degrees, 95% confidence interval (CI) -6 degrees-22 degrees] or flexion (114 degrees ± 35 degrees vs. 118 degrees ± 11 degrees, MD 4 degrees, 95% CI -23 degrees-132 degrees), respectively. At last follow-up, static and dynamic external fixation groups had no difference in elbow extension (27 degrees ± 13 degrees vs. 24 degrees ± 10 degrees, MD -3 degrees, 95% CI -15 degrees-7 degrees) or flexion (129 degrees ± 12 degrees vs. 128 degrees ± 14 degrees, MD -1 degree, 95% CI -13 degrees-10 degrees), respectively. Static and dynamic external fixation groups had no difference in complications [7 (44%) vs. 5 (63%), difference 19%, 95% CI -23%-54%] or revision surgeries [6 (38%) vs. 4 (50%), difference 13%, 95% CI -27%-49%].

Conclusions: No difference in range of motion, complications, and revision surgeries was detected after static versus dynamic external fixation of persistently unstable elbow fracture-dislocations. Due to ease of application, static external fixation is our preferred treatment for these injuries.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000001876DOI Listing
March 2021

Evaluating the reproducibility of the short version of the Western Ontario Rotator Cuff Index (Short-WORC) prospectively.

JSES Int 2020 Mar 20;4(1):197-201. Epub 2019 Dec 20.

Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.

Background: Recently, a shorter version of the Western Ontario Rotator Cuff Index (Short-WORC) was created to reduce patient response burden. However, it has yet to be evaluated prospectively for reproducibility (reliability and agreement) and floor and ceiling effects.

Methods: Patients (N = 162) with rotator cuff disorders completed the Short-WORC at baseline. From this cohort, 47 patients underwent measurement of test-retest reliability within 2 to 7 days. We used the Cronbach α to determine internal consistency and the intraclass correlation coefficient (ICC) to assess test-retest reliability. To evaluate parameters of agreement, the standard error of measurement, minimal detectable change (based on a 90% confidence interval), and Bland-Altman plots were used.

Results: The Cronbach α was 0.82 at baseline, and the intraclass correlation coefficient (ICC) was 0.87. The agreement parameter was 8.4 for the standard error of measurement of agreement, and the limits of agreement fell within the range of -22.9 to 23.8. The Short-WORC is reliable over time and reflective of a patient's true score after an intervention.

Conclusions: The Short-WORC demonstrated strong reproducibility parameters and can be used for patients with rotator cuff disorders. The Short-WORC indicated no systematic bias and was reflective of the true score of both individual patients and groups of patients at 2 time points.
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http://dx.doi.org/10.1016/j.jses.2019.10.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7075774PMC
March 2020

Measurement Properties of the Brief Pain Inventory-Short Form (BPI-SF) and the Revised Short McGill Pain Questionnaire-Version-2 (SF-MPQ-2) in Pain-related Musculoskeletal Conditions: A Systematic Review Protocol.

Arch Bone Jt Surg 2020 Mar;8(2):131-141

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada.

Background: The Brief Pain Inventory-Short Form (BPI-SF) and Revised Short-Form McGill Pain Questionnaire Version-2 (SF-MPQ-2) are generic pain assessment tools used in research and practice for pain assessment in musculoskeletal (MSK) conditions. A comprehensive review that systematically analyses their measurement properties in MSK conditions has not been performed. This review protocol describes the steps that will be taken to locate, critically appraise, compare and summarize clinical measurement research on the BPI-SF and SF-MPQ-2 in pain-related MSK conditions.

Methods: Medline, EMBASE, CINAHL and Scopus will be searched for publications that examine the measurement properties of the Brief Pain Inventory and Revised Short-Form McGill Pain Questionnaire Version-2. Two reviewers will independently screen citations (title, abstract and full text) and extract relevant data. The extensiveness, rigor, and quality of measurement property reports will be examined with a structured measurement studies appraisal tool, and with the updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Findings will be descriptively summarized, and when possible, a meta-analysis will be performed.

Discussion: This review will summarize and compare the current level of evidence on the measurement properties of the BPI-SF and SF-MPQ-2 in a spectrum of musculoskeletal conditions. We expect clinicians/researchers dealing with MSK conditions to have synthesized evidence that informs their decision making and preferences. In addition, the review hopes to identify gaps and determine priorities for future research with or on the BPI-SF and SF-MPQ-2 in MSK conditions.
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http://dx.doi.org/10.22038/abjs.2020.36779.1973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191979PMC
March 2020

Posterior Shoulder Instability Classification, Assessment, and Management: An International Delphi Study.

J Orthop Sports Phys Ther 2020 Jul 29;50(7):373-380. Epub 2020 Apr 29.

Objective: To reach consensus among international shoulder experts on the most appropriate assessment and management strategies for posterior shoulder instability (PSI).

Design: Delphi.

Methods: In phase 1 of the study, we reviewed the literature, generated the Delphi items, created the survey, and identified clinical experts. In phase 2 of the study, clinical shoulder experts (physical therapists, orthopaedic surgeons, sports medicine physicians, and researchers) participated in a 3-round e-Delphi survey. For consensus, we required a minimum of 70% agreement per round. Descriptive statistics were used to present the characteristics of the respondents, the response rate of the experts in each round, and the consensus for PSI classification, assessment, and management.

Results: Round 3 was completed by 47 individuals from 5 different countries. The response rate ranged from 57/70 (81%) to 47/50 (94%) per round. Respondents agreed on 3 subgroups to define PSI: traumatic (100% agreement), microtraumatic (98% agreement), and atraumatic (98% agreement).

Conclusion: International shoulder experts agreed that the clinical presentation, management strategy, and outcome expectations differ for traumatic, microtraumatic, and atraumatic PSI. Their recommendations provide a framework for managing these subgroups, with additional consideration of sport and work participation and subsequent risks. .
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http://dx.doi.org/10.2519/jospt.2020.9225DOI Listing
July 2020

Interpretation and content validity of the items of the numeric rating version short-WORC to evaluate outcomes in management of rotator cuff pathology: a cognitive interview approach.

Health Qual Life Outcomes 2020 Mar 30;18(1):88. Epub 2020 Mar 30.

Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.

Background: The shortened version of the Western Ontario Rotator Cuff Index (Short-WORC) is a patient reported outcome measure that evaluates quality of life (QoL) of patients with rotator cuff pathology. However, formal content validation of the full or Short-WORC has not been reported. This study aims to understand how 1) people interpret and calibrate responses to items on the Short-WORC and 2) compensatory strategies that might enhance function and thereby affect responses.

Methods: This study uses cognitive interviewing, a qualitative methodology that focuses on the interpretation of questionnaire items. Patients with rotator cuff disorders (n = 10), clinicians (n = 6) and measurement researchers (n = 10) were interviewed using a talk aloud structured interview that evaluated each of the 7 items of the Short-WORC. All interviews were recorded and transcribed verbatim by one researcher (R.F). Analysis was done through an open coding scheme using a previously established framework.

Results: Overall, the items on the Short-WORC were well received by participants. Through the interviews, the 6 themes of: Comprehension, Inadequate response definition, Reference Point, Relevance, Perspective Modifiers and Calibration Across Items emerged. The items of working above the shoulder (90%), compensating with the unaffected arm (88%) and lifting heavy objects (92%) were the most relevant to participants. Participants calibrated their scores on the items of sleeping and styling (19%) the most. Perspective modifiers of gender, influenced the calibrations of items of styling your hair (30%) and dressing or undressing (19%). Compensatory strategies of task-re allocation and using assistive devices/resources were frequently mentioned by participants. Overall, participants had minor comprehension issues, but found the 7- items of the Short-WORC to be relevant to QoL.

Conclusions: Therefore, the findings demonstrate that the Short-WORC is not cognitively complex, but varies with patient perspectives. Overall, the Short-WORC provides evidence of demonstrating strong content validity when used for rotator cuff disorder patients.
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http://dx.doi.org/10.1186/s12955-020-01339-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106799PMC
March 2020

In vivo volumetric and linear wear measurement of reverse shoulder arthroplasty at minimum 5-year follow-up.

J Shoulder Elbow Surg 2020 Aug 16;29(8):1695-1702. Epub 2020 Mar 16.

Imaging Research Laboratories, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. Electronic address:

Background: Reverse shoulder arthroplasty is quickly becoming the most frequently performed glenohumeral joint replacement. The purpose of this study was to evaluate the volumetric and linear wear rates of ultrahigh-molecular-weight polyethylene humeral liners in vivo at a minimum 5-year follow-up.

Methods: Radiostereometric analysis was used to image 15 patients at terminal range of motion in forward flexion, abduction, external rotation, and internal rotation and with the arm at the side. The relative position and orientation of the glenosphere and polyethylene were identified for each arm position. The apparent intersection of the glenosphere into the polyethylene was recorded as wear. Mean volumetric and linear wear rates were recorded, and Pearson correlation coefficients were applied to the 36-mm liners to assess the relationship between the wear rate and term of service.

Results: The mean reverse shoulder arthroplasty term of service at the time of imaging was 8 ± 1 years (range, 6-11 years). The mean volumetric and linear wear rates for the 36-mm liners (n = 13) were 42 ± 22 mm/yr (r = 0.688, P = .009) and 0.11 ± 0.03 mm/yr (r = 0.767, P = .002), respectively. The mean volumetric and linear wear rates for the 42-mm liners (n = 2) were 114 ± 44 mm/yr and 0.17 ± 0.01 mm/yr, respectively. No single arm position was able to capture all recorded wear individually.

Conclusion: This study showed volumetric and linear wear rates of approximately 40 mm/yr and 0.1 mm/yr, respectively, for the 36-mm polyethylene liners. The 42-mm liners showed higher wear rates, although a greater number of subjects is required for conclusive results. In vivo wear of reverse total shoulder arthroplasty is multidirectional and perceptible.
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http://dx.doi.org/10.1016/j.jse.2019.11.031DOI Listing
August 2020

Effect of ulnar angulation and soft tissue sectioning on radial head stability in anterior Monteggia injuries: an in vitro biomechanical study.

J Shoulder Elbow Surg 2020 Jun 8;29(6):1249-1258. Epub 2020 Feb 8.

Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, London, ON, Canada.

Background: Radial head instability continues to be a challenge in the management of anterior Monteggia injuries; however, there is a paucity of literature on the factors that contribute to this instability. The aim of this biomechanical investigation was to examine the effects of ulnar angulation and soft tissue insufficiency on radial head stability in anterior Monteggia injuries.

Methods: Six cadaveric arms were mounted in an elbow motion simulator. Radial head translation was measured during simulated active elbow flexion with the forearm supinated. After testing the elbows in the intact state, the ulna was osteotomized and tested at 0°, 10°, 20°, and 30° of extension angulation. To examine the effect of soft tissue insufficiency, the anterior radiocapitellar joint capsule, annular ligament, quadrate ligament, and the proximal and middle interosseous membrane (IOM) were sequentially sectioned.

Results: There was a significant increase in anterior radial head translation with greater ulnar extension angulation. Sequential soft tissue sectioning also significantly increased anterior radial head translation. There was no increase in radial head translation with isolated sectioning of the anterior radiocapitellar joint capsule. Additional sectioning of the annular ligament and quadrate ligament slightly increased anterior radial head translation but did not reach statistical significance. Subsequent sectioning of the proximal and middle IOM resulted in significant increases in anterior radial head translation.

Conclusion: Our study demonstrates that progressive ulnar extension angulation results in an incremental increase in anterior radial head translation in anterior Monteggia injuries. Moreover, increasing magnitudes of soft tissue disruption result in greater anterior radial head instability.
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http://dx.doi.org/10.1016/j.jse.2019.10.025DOI Listing
June 2020

Cross-cultural adaptions and measurement properties of the WORC (Western Ontario rotator cuff index): a systematic review.

Health Qual Life Outcomes 2020 Jan 29;18(1):17. Epub 2020 Jan 29.

Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.

Background: To evaluate the translations, cross-cultural adaptation procedures and measurement properties of the Western Ontario Rotator Cuff Index (WORC), when it is adapted for different cultures.

Methods: A systematic review was performed, considering different cultural adaptions of the WORC accessible through MEDLINE, CINAHL, EMBASE and/or Google Scholar. Included were prospective cohort studies that used an adapted version of the WORC to measure QoL in patients with rotator cuff disorders. All studies were evaluated according to the current guidelines for cross-cultural adaptations and measurement properties.

Results: The search retrieved 14 studies that met the inclusion criteria. According to the recommended guidelines for cross-cultural adaptations, 8 studies performed 100% of the steps, 2 studies performed 80% of the steps and 4 studies used previously translated measures. When evaluating the studies' psychometric properties based on the quality criteria, none of the studies reported all recommended measurement properties. All of the studies reported the measurement property of reliability, but none of the studies reported agreement. Internal consistency was fully reported by 15% of studies. Construct validity was reported by 43% of studies. Only one study reported 100% of the cross-cultural adaption guidelines and 83% of the quality criteria.

Conclusions: Although the majority of studies demonstrated proper adaptation procedures, testing of the measurement properties were inadequate. It is recommended that the current adapted versions of the WORC undergo further testing before use in clinical practise, and researchers continue to adapt the WORC for different cultures as it proves to be an appropriate instrument for assessing rotator cuff pathology.
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http://dx.doi.org/10.1186/s12955-020-1276-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988228PMC
January 2020

RETRACTED: Clinical and functional impairment after nonoperative treatment of distal biceps ruptures.

J Shoulder Elbow Surg 2020 Feb;29(2):420

Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.

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http://dx.doi.org/10.1016/j.jse.2019.12.001DOI Listing
February 2020

The effect of short-stem humeral component sizing on humeral bone stress.

J Shoulder Elbow Surg 2020 Apr 9;29(4):761-767. Epub 2019 Nov 9.

Roth|McFarlane Hand and Upper Limb Center, London, ON, Canada. Electronic address:

Background: Several humeral stem design modifications for shoulder arthroplasty, including reduced stem length, changes to metaphyseal geometry, and alterations to implant surface texture, have been introduced to reduce stress shielding. However, the effect of changes in the diametral size of short-stem humeral components remains poorly understood. The purpose of this finite element study was to quantify the effect of varying the size of short-stem humeral components on the changes in bone stress from the intact state to the reconstructed state.

Methods: Three-dimensional models of 8 male cadaveric humeri (mean age, 68 ± 6 years; all left-sided humeri) were constructed from computed tomography data using Mimics software. Each humerus was then reconstructed with 2 short-stem components (Exactech Preserve), one having a larger diametral size (SH+) and one having a smaller diametral size (SH-). Modeling was conducted for loading states consistent with 45° and 75° of abduction, and the resulting changes in bone stress compared with the intact state and the expected bone response were determined.

Results: The smaller (SH-) short-stem implant produced humeral cortical and trabecular bone stresses that were closer to the intact state than the larger (SH+) short-stem implant at several locations beneath the humeral head resection (P ≤ .032). A similar trend was observed for expected bone response, where the smaller (SH-) short-stem implant had a smaller proportion of bone that was expected to resorb following reconstruction compared with the larger (SH+) short-stem implant for several slice depths in the medial quadrant (P ≤ .02).

Discussion: These findings may indicate that smaller short-stem components are favorable in terms of stress shielding.
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http://dx.doi.org/10.1016/j.jse.2019.08.018DOI Listing
April 2020

Management of rheumatoid arthritis of the elbow with a convertible total elbow arthroplasty.

J Shoulder Elbow Surg 2019 Nov;28(11):2205-2214

St Joseph's Hospital, Roth | McFarlane Hand & Upper Limb Center, London, ON, Canada. Electronic address:

Background: Total elbow arthroplasty (TEA) is commonly performed in patients with rheumatoid arthritis (RA). The purpose of this study was to compare outcomes and complications of unlinked and linked TEA using a convertible system in patients with RA.

Methods: All patients with RA who underwent TEA at a single center with a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome scores, functional outcome assessments, and radiographic parameters were evaluated at most recent follow-up.

Results: We evaluated 82 patients (27 with unlinked TEA and 55 with linked TEA) with RA. The mean age at surgery was 61 ± 10 years, with a mean follow-up period of 6 ± 4 years. Demographic characteristics were similar between groups, with the exception of longer follow-up in the unlinked group (8 years vs. 5 years, P = .001). No differences in range of motion were noted. Elbow strength was similar other than pronation strength (74% ± 8% for unlinked vs. 100% ± 8% for linked, P = .03). The mean Mayo Elbow Performance Index was 83 ± 16; Patient Rated Elbow Evaluation score, 15 ± 18; and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score, 34 ± 20. No differences in the rates of reoperation (17% vs. 24%, P = .4), complications (32% vs. 31%, P = .4), or revisions (13% vs. 17%, P = .3) were found between unlinked and linked devices. Four patients with instability, all with unlinked designs, underwent revision to a linked design. Four patients, all with linked designs, underwent revision for aseptic loosening of smooth short-stem ulnar components.

Conclusion: TEA using a convertible implant design provides good patient-reported outcomes at mid-term follow-up in patients with RA. Our study was unable to detect a difference in the use of either unlinked or linked implant designs; further large comparison trials are needed.
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http://dx.doi.org/10.1016/j.jse.2019.07.029DOI Listing
November 2019

Predictors of Clinical Benefits and One-Year Functional Outcomes Following Shoulder Arthroplasty.

Iowa Orthop J 2019 ;39(1):69-75

Hand and Upper Limb Center, St. Joseph's Health Care London, London, Ontario, Canada.

Background: Shoulder arthroplasty has been shown to improve function in patients with advanced shoulder disease. However, the response to surgery and final outcomes are not easily predictable. This study assessed the effect of residual pain, age, sex, diabetes, hypertension, and depression on changes and status at one-year following arthroplasty with respect to shoulder function and overall physical and mental health status.

Methods: A retrospective analysis of a prospective cohort of 140 patients tested preoperatively and one-year following shoulder arthroplasty was conducted at our tertiary hospital. Pearson's correlations and multiple regression analysis were performed to test the impact of predictors on shoulder pain and function assessed using the American Shoulder and Elbow Surgery (ASES) questionnaire, and on physical and mental health assessed using the Short Form-12.

Results: Pain and female sex were significant predictors of poorer function at one-year (R = .56, = .001); and with other predictors, they explained 32% of the variability in function. The explained variability of changes in function scores was 15% with pain being the only significant predictor. Physical health was lower in older patients ( = -.31, < .05) and was less predictable for physical health change scores (12%) and the physical status at one-year (14%).

Conclusions: Residual pain is associated with poorer function status and less clinical benefits. Female sex is not associated with less change in function which suggests that men and women get equal benefit from the surgery. Advanced age relates to poorer physical health and to a lesser extent physical change over the year. III.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604540PMC
February 2020

Response to Long et al regarding: "Cutibacterium acnes and the shoulder microbiome".

J Shoulder Elbow Surg 2019 08;28(8):e277-e278

Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

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http://dx.doi.org/10.1016/j.jse.2019.04.047DOI Listing
August 2019

Does diabetes affect functional outcomes after shoulder arthroplasty?

J Clin Orthop Trauma 2019 May-Jun;10(3):544-549. Epub 2019 Mar 10.

Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada.

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http://dx.doi.org/10.1016/j.jcot.2019.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6491921PMC
March 2019

The Capitate-to-Axis-of-Radius Distance (CARD): A New Radiographic Measurement for Wrist and Carpal Alignment in the Sagittal Plane.

J Hand Surg Am 2019 Sep 23;44(9):797.e1-797.e8. Epub 2019 Jan 23.

Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada.

Purpose: To determine the reliability of a new radiographic index evaluating sagittal radiocarpal alignment, the capitate-to-axis-of-radius distance (CARD). A secondary purpose was to validate this index by comparing values between normal wrists and those with distal radial fractures (DRFs) and rheumatoid arthritis (RA).

Methods: The CARD is defined as the perpendicular distance from the center of the capitate head to the axis of the radius. Inter- and intraobserver reliability was tested. Cronbach alpha was calculated, and 2 methods of measurement were compared. The superior one (volar border of radial shaft) was used in the second part of the study. The normal CARD was then compared with unilateral DRFs with dorsal displacement DRF (n = 25) and RA (n = 25). Correlations between the CARD and other radiographic parameters (dorsal angulation, radial inclination, and ulnar variance) were calculated as well as between the CARD and the severity of disease or fracture displacement (mild/moderate/severe).

Results: The CARD showed excellent intra- and interobserver reliability. The volar radius measurement method was superior to the midaxis method and was, therefore, used for the second portion of the study. The mean CARD for normal, fractured, and RA wrists was significantly different (2.2 ± 2.5 mm, 15.7 ± 6.5 mm and 0.2 ± 4.4 mm, respectively). There was a strong side-to-side correlation in normal wrists (r = 0.77) and a significant correlation between the CARD (mm) and the severity of deformity (RA, r = -0.7; DRF, r = 0.8).

Conclusion: The CARD is a reproducible, easy-to-use measurement of sagittal carpal alignment with a strong side-to-side correlation. The CARD increases with dorsal angulation of the distal radius and decreases as severity of deformity with RA increases.

Clinical Relevance: The correlation of the CARD with severity of deformity in DRFs and RA makes it a useful method of assessing deformities in the sagittal plane. The normal wrist can be used as a comparison when evaluating the CARD in the setting of unilateral wrist disease.
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http://dx.doi.org/10.1016/j.jhsa.2018.10.024DOI Listing
September 2019

Clinical and functional impairment after nonoperative treatment of distal biceps ruptures.

J Shoulder Elbow Surg 2019 Apr 28;28(4):757-764. Epub 2018 Dec 28.

Roth McFarlane Hand and Upper Limb Center, St. Joseph's Health Care, University of Western Ontario, London, ON, Canada.

Background: Clinical and functional impairment after nonoperative treatment of distal biceps ruptures is not well understood. The goal of this study was to measure patients' perceived disability, kinematic adjustment, and forearm supination power after nonoperative treatment of distal biceps ruptures.

Methods: Fourteen individuals after nonoperative treatment of distal biceps ruptures were matched to a control group of 18 uninjured volunteers. Both groups prospectively completed the Disabilities of the Arm, Shoulder and Hand (DASH), Single Assessment Numerical Evaluation (SANE), and Biceps Disability Questionnaire. Both performed a new timed isotonic supination test that was designed to simulate activities of daily life. The isotonic torque dynamometer measures the supination arc, center of supination arc, torque, angular velocity, and power. Motion analysis quantifies forearm and shoulder contributions to the arc of supination.

Results: The nonoperative treated group's DASH (23.2 ± 10.3) and SANE (59.6 ± 16.2) scores demonstrated a clinical meaningful impairment. The control group showed no significant differences in kinematic values between dominant and nondominant arms (P = .854). The nonoperative biceps ruptured arms, compared with their uninjured arms, changed supination motion by decreasing the supination arc (P ≤ .036), shifting the center of supination arc to a more pronated position (P ≤ .030), and increasing the shoulder contribution to rotation (P ≤ .001); despite this adaptation, their average corrected power of supination decreased by 47% (P = .001).

Conclusion: Patients should understand that nonoperative treatment for distal biceps ruptures will result in varying degrees of functional loss as measured by the DASH, SANE, and Biceps Disability Questionnaire, change their supination kinematics during repetitive tasks, and that they will lose 47% of their supination power.
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http://dx.doi.org/10.1016/j.jse.2018.09.017DOI Listing
April 2019

Cutibacterium acnes and the shoulder microbiome.

J Shoulder Elbow Surg 2018 Oct 13;27(10):1734-1739. Epub 2018 Jun 13.

Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada. Electronic address:

Background: Advances in DNA sequencing technologies have made it possible to detect microbial genome sequences (microbiomes) within tissues once thought to be sterile. We used this approach to gain insights into the likely sources of Cutibacterium acnes (formerly Propionibacterium acnes) infections within the shoulder.

Methods: Tissue samples were collected from the skin, subcutaneous fat, anterior supraspinatus tendon, middle glenohumeral ligament, and humeral head cartilage of 23 patients (14 male and 9 female patients) during primary arthroplasty surgery. Total DNA was extracted and microbial 16S ribosomal RNA sequencing was performed using an Illumina MiSeq system. Data analysis software was used to generate operational taxonomic units for quantitative and statistical analyses.

Results: After stringent removal of contamination, genomic DNA from various Acinetobacter species and from the Oxalobacteraceae family was identified in 74% of rotator cuff tendon tissue samples. C acnes DNA was detected in the skin of 1 male patient but not in any other shoulder tissues.

Conclusion: Our findings indicate the presence of a low-abundance microbiome in the rotator cuff and, potentially, in other shoulder tissues. The absence of C acnes DNA in all shoulder tissues assessed other than the skin is consistent with the hypothesis that C acnes infections are derived from skin contamination during surgery and not from opportunistic expansion of a resident C acnes population in the shoulder joint.
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http://dx.doi.org/10.1016/j.jse.2018.04.019DOI Listing
October 2018

Arthroscopic debridement for primary elbow osteoarthritis with and without capsulectomy: a comparative cohort study.

Shoulder Elbow 2018 Jul 30;10(3):223-231. Epub 2017 Aug 30.

Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada.

Background: Arthroscopic elbow debridement for primary osteoarthritis may be performed with or without a joint capsulectomy. The purpose of this comparative cohort study was to compare range of motion (ROM) and early complications between patients with and without anterior capsulectomy.

Methods: In total, 110 patients with primary osteoarthritis of the elbow who underwent an arthroscopic debridement for primary osteoarthritis were reviewed with a minimum of 3 months postoperative follow-up. The first group consisted of 51 patients who had a concomitant capsulectomy and the second group consisted of 59 patients who either had a capsulotomy or did not have the capsule addressed.

Results: There was significantly greater pre-operative stiffness in the group who had an anterior capsulectomy versus those who did not. A greater improvement in arc of ROM occurred in patients who had a concomitant capsulectomy compared to patients without (24° versus 12°) (p < 0.003); however, there were no significant differences in final ROM between groups. There were no statistically significant differences in the incidence of complications between the groups (16% capsulectomy versus 18% no capsulectomy).

Conclusions: Elbow arthroscopy and debridement for primary elbow osteoarthritis yields satisfactory motion at short-term follow-up with or without a capsulectomy. The incidence of early complications was low at this tertiary referral centre, with no significant differences between groups.
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http://dx.doi.org/10.1177/1758573217726429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960874PMC
July 2018

Rotator cuff tendon surgery and postoperative therapy.

J Hand Ther 2017 Apr - Jun;30(2):147-157

Hand and Upper Limb Clinic, St. Joseph's Health Care, Western University, London, Ontario, Canada.

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http://dx.doi.org/10.1016/j.jht.2017.05.008DOI Listing
May 2019

Effect of Concomitant Elbow Injuries on the Outcomes of Radial Head Arthroplasty: A Cohort Comparison.

J Orthop Trauma 2017 Oct;31(10):e327-e333

*Orthopaedics, London, Roth McFarlane Hand & Upper Limb Center, ON, Canada; and †Department of Surgery, The University of Western Ontario, London, ON, Canada.

Objectives: To compare physical impairments and patient-reported outcomes in patients after simple and complex elbow injuries who were treated with radial head arthroplasty.

Design: Prospective.

Setting: Quaternary upper extremity referral hospital.

Patients/participants: 148 patients with isolated elbow trauma and no previous injury to the elbow were prospectively enrolled after radial head arthroplasty for an acute unreconstructable fracture. Injury patterns were classified as simple or complex based on the presence or absence of associated elbow fractures and/or dislocation.

Intervention: Radial head arthroplasty.

Main Outcome Measurements: Patient-Rated Elbow Evaluation (PREE), Disability of the Arm, Shoulder, and Hand, range of motion (ROM), and Biodex measurements.

Results: At a minimum 1-year follow-up PREE and Disability of the Arm, Shoulder, and Hand, and ROM and strength values were similar. Forty-four patients evaluated at a mean of 7 years demonstrated no effect of injury pattern on clinical outcomes at any time point. Continued statistical improvements in PREE, supination ROM, and flexion ROM at medium term compared with earlier follow-up were observed. Eight patients required secondary surgery, 2 in the simple injury group and 6 complex injury patients.

Conclusions: Concomitant elbow injuries do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty. Patient outcomes continued to improve beyond 2 years of follow-up.

Level Of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000000921DOI Listing
October 2017