JAAOS

JAAOS, Volume 27, No. 11


A Comprehensive Review of Physical Examination Tests of the Cervical Spine, Scapula, and Rotator Cuff

A thorough physical examination of the shoulder and cervical spine is critical in establishing a focused differential diagnosis of the pathology in and around the shoulder joint. Numerous tests have been described in the literature to help improve the diagnostic accuracy of specific shoulder or cervical spine pathology. A comprehensive approach for the physical examination of the cervical spine, scapula, and rotator cuff is presented and descriptions on how the tests are performed and the evidence behind why specific tests are used in enabling improved diagnosis of shoulder pathology are discussed.

special-propertyvideoSDCT

      • Subspecialty:
      • Spine

      • Shoulder and Elbow

    Comprehensive Review of Provocative and Instability Physical Examination Tests of the Shoulder

    A detailed physical examination of the shoulder is crucial in creating a diagnosis in patients who present with shoulder pain. Tests of the cervical spine, scapula, and rotator cuff muscles have already been evaluated in a previous article. This article assesses provocative and instability examination tests of the shoulder. Descriptions on how the tests are performed and their diagnostic accuracy are presented.

    special-propertyvideoSDCT

        • Subspecialty:
        • Shoulder and Elbow

      Effect of Obesity on the Development, Management, and Outcomes of Spinal Disorders

      Obesity is a major public health issue in the United States, and rates of obesity continue to increase across the population. The association of obesity with degenerative spinal pathology underlies the observation that a substantial number of patients undergoing spine surgery are either overweight or obese. Obesity is a notable independent risk factor for both surgical and medical complications in the perioperative period and an important consideration in preoperative planning, intraoperative strategies, and postoperative management. Despite these increased risks, surgery in obese patients for a variety of degenerative conditions results in improvement in outcomes. Although obese patients may undergo gains that are absolutely lower than their nonobese counterparts, they still experience a positive treatment effect with surgery appropriate for their condition. An evidence-based approach to both preoperative and perioperative management of patients with obesity is not well established. The purpose of this article is to review the effect of obesity on the development, management, and outcomes of patients with spinal disorders and to provide data that may guide an evidence-based approach to care in this expanding patient population.

      STATUSONLINE-ONLY

          • Subspecialty:
          • Spine

        Biplane Double-supported Screw Fixation of Femoral Neck Fractures: Surgical Technique and Surgical Notes

        Osteosynthesis of femoral neck fractures is still associated with high complication rates. The novel method of biplane double-supported screw fixation offers better osteosynthesis stability by buttressing two of three medially diverging cannulated screws on the inferior neck cortex. Biomechanically, the most effective component of this fixation is the third, inferior obtuse screw, supported along considerable distance on both the inferior and posterior cortices of the femoral neck following its spiral anterior curve. Thus, biplane double-supported screw fixation achieves greater inferoposterior cortical support of the implants, allowing immediate full weight bearing for patients older than 55 years. Although the method has been recently communicated, some important surgical aspects still remain to be discussed. This report aims at describing a detailed and modified surgical technique and providing criteria and recommendations for its successful application according to the clinical experience over more than 9 years.

        Level of Evidence:

        Level V, expert evidence

        OPEN-ACCESSTRUESTATUSONLINE-ONLYSDCTspecial-propertyvideo

            • Subspecialty:
            • General Orthopaedics

          The Accuracy and Clinical Utility of Intraoperative Frozen Section Analysis in Open Biopsy of Bone

          Background: Open biopsy of bone is the diagnostic benchmark for the diagnosis of skeletal lesions. Intraoperative pathology consultation with frozen section analysis is commonly performed to confirm adequacy of lesional tissue and guide intraoperative decision making. The purpose of this study was to determine the accuracy and clinical utility of intraoperative frozen section during open bone biopsy.

              • Subspecialty:
              • General Orthopaedics

            Correlation of Short Knee Radiographs and Full-length Radiographs in Patients Undergoing Total Knee Arthroplasty

            Introduction: The clinical success and longevity of a primary total knee arthroplasty (TKA) in large part depend on our ability to control coronal alignment. However, controversy exists regarding which radiographs to use for the most accurate interpretation. The study assesses the accuracy of coronal alignment measurements using a single short knee radiograph (SKR) in comparison with full-length radiographs (FLRs).

                • Subspecialty:
                • Adult Reconstruction

              The Association of Financial Distress With Disability in Orthopaedic Surgery

              Introduction: Increased out-of-pocket costs have led to patients bearing more of the financial burden for their care. Previous work has shown that financial burden and distress can affect outcomes, symptoms, satisfaction, and adherence to treatment. We asked the following questions: (1) Does patients' financial distress correlate with disability in patients with nonacute orthopaedic conditions? (2) Do patient demographic factors affect this correlation?

                  • Subspecialty:
                  • General Orthopaedics

                Inhospital Complications of Patients With Neuromuscular Disorders Undergoing Total Joint Arthroplasty

                Introduction: Orthopaedic surgeons are wary of patients with neuromuscular (NM) diseases as a result of perceived poor outcomes and lack of data regarding complication risks. We determined the prevalence of patients with NM disease undergoing total joint arthroplasty (TJA) and characterized its relationship with in-hospital complications, prolonged length of stay, and total charges.

                    • Subspecialty:
                    • General Orthopaedics

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