X-ref For other Roundups in this issue that cross-reference with Shoulder & Elbow see: Research Roundup 4, 6.
Is it the shoulder or the brain?
Predicting post-surgical outcomes is notoriously tricky. A good surgeon is not just technically gifted, but will always pick ‘winners’ on which to operate. That said, understanding the causes of poor outcomes is incredibly (and increasingly) important. A study team in Birmingham (USA) set out to solve the thorny question of whether or not the outcomes of shoulder surgery are affected by psychological distress, and if psychological distress in itself is associated with alteration in the perception of symptoms.1 The study team used the Shoulder Pain and Disability Index (SPADI), a validated score administered to 139 patients, all with a primary shoulder diagnosis. In addition, the patients completed a range of psychological tests including catastrophising and depression scales. Of perhaps most interest here is the result of the multivariate analysis which was performed to explain variation in the SPADI score as a primary outcome. Amazingly, the outcomes as measured by the SPADI score were not related to the primary diagnosis. However, there was a relationship between the SPADI score and catastrophic thinking, lower self-efficacy, higher body mass index, disability and retirement status. This is an interesting paper that again highlights to us here at 360 the importance of psychological factors, both in presenting symptomatology and evaluating outcomes.
Is an external rotation sling really needed?
Following a series of studies from Itoy and colleagues based in Japan, it has become commonplace in some centres to apply an external rotation splint following anterior dislocation of the shoulder treated with closed reduction with the intention of reducing recurrence. Although the proponents of the method argue that it reduces the need for surgical stabilisation, patients quite frankly hate the slings. Holding your arm in external rotation makes sleeping, eating and even walking …