Saturday, March 6, 2010

“Henry Ford Hospital study: Shoulder function not fully restored after surgery (EurekAlert!)” plus 2 more

“Henry Ford Hospital study: Shoulder function not fully restored after surgery (EurekAlert!)” plus 2 more


Henry Ford Hospital study: Shoulder function not fully restored after surgery (EurekAlert!)

Posted: 06 Mar 2010 12:27 PM PST

[ Back to EurekAlert! ] Public release date: 6-Mar-2010
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Contact: Maria Seyrig
mseyrig1@hfhs.org
313-874-4039
Henry Ford Health System

Shoulder motion after rotator cuff surgery remains significantly different when compared to the patient's opposite shoulder, according to Henry Ford Hospital researchers.

In the study, researchers used X-rays providing a 3D view of motion of the arm bone in relation to the shoulder blade, to compared motion in the shoulders of 14 patients who had arthroscopic surgical repair of tendon tears and no symptoms in their other shoulders.

Researchers analyzed the motion of both shoulders at three, 12 and 24 months after surgery, looking at changes in shoulder motion and shoulder strength.

"Although patient satisfaction is generally very high after surgical repair of a torn rotator cuff, the data suggest that long-term shoulder function in particular, shoulder strength and dynamic joint stability may not be fully restored in every patient," says Michael Bey, Ph.D., director of the 3,000-sq.-ft. Herrick Davis Motion Analysis Lab at Henry Ford Hospital.

Dr. Bey will present the results Saturday at the Orthopaedic Research Society's annual meeting in New Orleans.

"We found that the motion pattern of the repaired shoulder is significantly different than the patient's opposite shoulder," says Dr. Bey. "These differences in shoulder motion seem to persist over time in some patients."

According to the American Academy of Orthopaedic Surgeons, rotator cuff tears are a common cause of pain and disability among adults, especially among those over age 40. The rotator cuff is comprised of four muscles and several tendons that create a covering around the top of the upper arm bone. The rotator cuff holds the bone in and enables the arm to rotate.

The rotator cuff can be torn from a single injury but most tears result from overuse of the muscles and tendons over years. Those at especially high risk are those who engage in repetitive overhead motions. Common treatments include anti-inflammatory medication, steroid injections, physical therapy and surgery.

Dr. Bey explains that the study findings suggest that restoring normal joint mechanics may not be necessary in order to achieve a satisfactory clinical outcome.

"Our study suggests that surgery may restore normal shoulder strength but doesn't necessarily restore normal shoulder motion," says Dr. Bey. "It could be, however, because the shoulder pain goes away, there is value in surgery."

The study was done using a high-speed biplane X-ray system, one of only three in the country, which allows researchers to measure the position of bones and joints in the body during motion to within half a millimeter.

"The biplane X-ray system allows us to investigate subtle nuances of shoulder function that cannot be detected with conventional laboratory techniques," explains Dr. Bey.

Next steps for Henry Ford researchers include looking at physical therapy vs. surgery, and investigating improved or different techniques for treating rotator cuff tears.

Dr. Bey is also presenting results from another study at the conference which looks at the condition of the shoulder prior to surgery.

"What further complicates our understanding of rotator cuff tears is that we have also shown that there are subtle yet important differences in shoulder function between the dominant and non-dominant shoulder of healthy volunteers," says Dr. Bey. "These ongoing studies are aiding in our understanding of both the origin and treatment of rotator cuff tears."

Funding: National Institutes of Health and Henry Ford Hospital.



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Botanical Art: Daffodils (The Capital)

Posted: 06 Mar 2010 05:17 PM PST

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Non-drug techniques reduce pain in hospitalized patients (PhysOrg)

Posted: 06 Mar 2010 01:09 AM PST

The study shows that an inpatient integrative medicine program can have a significant impact on pain in an environment where continues to be a major challenge, and traditional medications can have negative consequences.

"Roughly 80 percent of patients report moderate to severe pain levels after surgery," says Gregory Plotnikoff, M.D., one of the study's authors and medical director of the Penny George Institute for Health and Healing at Abbott Northwestern Hospital.

"We struggle to provide effective pain control while trying to avoid the adverse effects of opioid medications, such as respiratory depression, nausea, constipation, dizziness and falls."

The study included 1,837 cardiovascular, medical, surgical, orthopedics, spine, rehabilitation, oncology, and women's health patients at Abbott Northwestern between January 1, 2008, and June 30, 2009. They scored their pain verbally on a zero-to-ten scale before and after treatments.

The treatments included non-pharmaceutical services: mind body therapies to elicit the relaxation response, acupuncture, acupressure, massage therapy, healing touch, music therapy, aromatherapy, and reflexology.

The study, "The Impact of Integrative Medicine on Pain Management in a Tertiary Care Hospital" was published March 5 in the Journal of Patient Safety.

"Earlier studies narrowly focused on whether specific integrative therapies manage pain in either cancer or surgical patients," says Jeffery A. Dusek, Ph.D., research director for the George Institute.

"Our real-world study broadly shows that these therapies effectively reduce pain by over 50 percent across numerous patient populations. Furthermore, they can be clinically implemented in real time, across, and under the operational and financial constraints within an acute care hospital."

Dusek says future research will focus on defining appropriate intervention doses, duration of pain relief, and developing profiles of which patients are most likely to respond to nonpharmacologic treatments. Reductions in total hospitalization costs, medication use and adverse events will be quantified in future prospective research using the electronic medical record.

"I think we will find that integrative approaches to management during the hospital stay will improve patient satisfaction and outcomes, and we will see cost savings from patients using fewer drugs and experiencing fewer adverse events," said Lori Knutson, RN, BSN, HN-BC, executive director of the George Institute.

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