Faculty Bibliography

Case/UNASSIGNED:We report a rare case of a spontaneous, atraumatic rupture of the anterior and middle heads of the deltoid with an underlying massive rotator cuff tear. Unique clinical findings included a palpable mass of torn deltoid distally with a proximal tissue defect. Magnetic resonance imaging of the deltoid demonstrated complete tear of the anterior head; involvement of the middle head was found intraoperatively. Given the acute nature of injury and potential impact on the feasibility of future reverse shoulder arthroplasty, surgical repair of the torn deltoid was discussed with the patient and performed via superior approach. Conclusion/UNASSIGNED:Direct surgical repair is a viable treatment option if diagnosed early.

We present a case of a surgically treated latissimus dorsi (LD) and teres major (TM) tear with a one-year outcome. The postoperative course was complicated by wound dehiscence requiring operative intervention and neuropraxia of the posterior cutaneous nerve of the arm. The report highlights previously unreported surgical risks associated with repair of LD/TM tendons.

BACKGROUND:The objective of this study is to assess patient satisfaction and preference for telemedicine- versus in-person visits for outpatient shoulder and elbow musculoskeletal consultation during the COVID-19 pandemic and in the future. METHODS:Patients who had telemedicine visits for shoulder and elbow musculoskeletal complaints at a single institution from March through June, 2020, were invited to respond to a post-visit survey. The survey included a standardized questionnaire that focused on the patient's satisfaction with the telemedicine visit(s) during the pandemic and preference for using the telemedicine platform in the future following the pandemic. Additional details regarding their virtual visits (severity of their medical condition, previous virtual- or ER visits) were also obtained. Data regarding patient demographics and visit details (primary diagnosis, type of visit, length of visit, treating physician) were extracted from electronic medical records. RESULTS:In total, 153 patients participated in the study. Overall, high satisfaction scores regarding the telemedicine visit were noted: 91% of patients reported that their concerns were adequately addressed, 89% would recommend telemedicine to a friend and 94% stated that they would use this platform again in the presence of a situation like the COVID-19 pandemic. However, the majority of patients (76%) reported a preference for in-person visits for the same musculoskeletal complaint if it were not for COVID-19. A telemedicine visit duration of more than 10 minutes and a first-time telemedicine visit correlated with higher satisfaction rates (P=0.037 and P=0.001, respectively). CONCLUSIONS:COVID-19 has provided a boost to the use of our telemedicine platform, with a high satisfaction rate among patients with shoulder and elbow musculoskeletal complaints, largely due to safety reasons and limited access to in-person doctor visits. However, a considerable number of patients would have preferred in-person visits for similar health complaints if there were no pandemic. Further research on optimizing the selection of patients for telemedicine visits and addressing their expectations and concerns regarding their visits will improve patients' preference for future telemedicine visits.

Purpose/UNASSIGNED:The purpose of this study is to evaluate the patient-reported outcomes of open Latarjet (OL) compared to arthroscopic Latarjet (AL) for anterior shoulder instability. Methods/UNASSIGNED:value of < .05 was considered to be statistically significant. Results/UNASSIGNED: = .84). Conclusion/UNASSIGNED:In patients with anterior shoulder instability, both the OL and AL are reliable treatment options, with a low rate of recurrent instability, and similar patient-reported outcomes.

»:For shoulder arthroplasty, regional anesthesia is safer when compared with general anesthesia. There is insufficient evidence to demonstrate the superiority of regional anesthesia with respect to pulmonary complications and hospital length of stay. »:Infiltration of the shoulder with local anesthetics offers no additional benefits compared with single-shot or continuous brachial plexus blocks for shoulder arthroplasty. »:There is high-quality evidence (Level I) demonstrating lower pain scores and lower perioperative opioid requirements after a continuous peripheral nerve block compared with a single-shot nerve block. However, catheter dislodgment and logistical issues with catheter insertion are impediments to the widespread usage of a continuous nerve block with an indwelling catheter. »:Liposomal bupivacaine is comparable with non-liposomal local anesthetic agents with respect to pain relief, the opioid-sparing effect, and adverse effects in the first 48 hours after total shoulder arthroplasty. »:Perioperative dexamethasone administration improves postoperative pain control, decreases perioperative opioid requirements, and reduces postoperative nausea.