| 1. |
- Björnsson Hallgren, Hanna Cecilia, 1976-
(författare)
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Treatment of subacromial pain and rotator cuff tears
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Shoulder pain is very common, affecting 14-21 % of the population at some time during their lifetime. The aims of this thesis were to improve the understanding of various aspects concerning the pathogenesis and treatment of subacromial pain and rotator cuff tears. Patients and healthy individuals were examined and compared in five studies:Study I) Seventy patients were retrospectively examined, clinically and with ultrasound, 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at surgery. Ultrasound showed significantly fewer rotator cuff tears compared to the prevalence of asymptomatic tears reported in the literature for the same age group. This indicates that arthroscopic subacromial decompression might protect the rotator cuff.Study II) Forty-two patients were retrospectively examined, clinically and with ultrasound, 39 months (mean) after an acute rotator cuff repair. All patients had pseudoparalysis after trauma, a full thickness tear and no previous history of shoulder symptoms. A delay in surgical treatment of three months and the number of tendons injured did not affect the outcome. Age affected outcome negatively.Study III) Plasma samples from 17 patients with cuff tears and 16 plasma samples from healthy age- and gender-matched controls were collected and analysed regarding the levels of matrix metalloproteinases and their inhibitors, TIMP1-4. Elevated levels of TIMP-1 were found in the patients with cuff tears compared to controls. Higher levels of TIMP-1, TIMP-3 and MMP-9 were found in patients with full-thickness tears compared to patients with partial-thickness tears.Study IV) Ninety-seven patients with longstanding subacromial pain, on the waiting-list for arthroscopic subacromial decompression, were prospectively randomised to specific shoulder exercises or control exercises for three months. Thereafter they were clinically examined and asked if they still wanted surgery. The specific shoulder exercises focusing on eccentric exercise for the rotator cuff and scapula stabilisers were found to be effective in reducing subacromial pain and improving shoulder function, thereby reducing the need for surgery.Study V) All patients including those operated, in Study IV were re-examined after one year using clinical assessment scores. The option of surgery was continuously available up to the one-year follow-up. Ultrasound and radiological examinations performed at inclusion were analysed in relation to the choice of surgery. The positive effects of the specific exercise programme were maintained after one year and significantly fewer patients in this group chose surgery. Surgery was significantly more often chosen by patients who had a low baseline shoulder score, and/or a full thickness rotator cuff tear. All patients showed significant improvement in the clinical scores one year after inclusion or one year after surgery.These results support the concept that subacromial pain has a multifactorial aetiology and that the first line of treatment should be specific shoulder exercises. When conservative treatment fails, an acceptable result can be achieved with arthroscopic subacromial decompression. The rotator cuff status is important to consider when treating and studying these patients.
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| 2. |
- Holmgren, Theresa, 1974-
(författare)
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Exercise treatment of patients with long-standing subacromial pain
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Subacromial pain is the most common problem among patients with shoulder complaints seeking primary care. The recommended treatment for these patients is primarily non-surgical with a focus on exercise treatment. If this treatment fails arthroscopic subacromial decompression (ASD) followed by exercise treatment is recommended. Surgical treatment with ASD has increased substantially in Sweden in recent years even though studies comparing exercise treatment with surgery report equally positive results. Still, there is a need of evidence based preand postoperative exercise treatments, standardised and described in detail, to guide treatment of these patients in clinical practice.The overall aim of this thesis was to evaluate the efficacy of pre- and postoperative exercise strategies on shoulder function and how the preoperative strategy affects the need for surgery in patients with long-standing subacromial pain.This thesis comprises four papers which are based on two randomised controlled trials. In study A, patients were randomised after ASD surgery to either physical therapist (PT) supervised strength-endurance exercises for the rotator cuff and scapula stabilisers or to home-based movement exercises for a period of three months. Shoulder function and pain, health related quality of life and return to work was evaluated for 6 months (paper I). In study B, patients on the waiting list for surgery were randomised to either specific exercise strategy with strengthendurance exercises for the rotator cuff and the scapula stabilisers or to control exercises with movement exercises for the neck and shoulders for a period of three months. After completing the exercise program and also after 12 months, shoulder function and pain, need for surgery and health related quality of life was evaluated. Baseline shoulder function, rotator cuff status and radiological findings were analysed in relation to the choice of surgery (paper II, III). The minimal important clinical change (MIC) of the Constant-Murley (CM) score, used as primary outcome in this thesis, was determined by using a visual anchor-based MIC distribution method (paper IV).Six months after ASD surgery, patients who performed PT-supervised strength-endurance exercises improved significantly more in shoulder function and pain compared to patients who had performed home-based movement exercises (paper I). Patients on the waiting list for surgery who performed specific strength-endurance exercises had significantly greater improvements in shoulder function and pain compared to patients performing movement exercises (paper II). A significantly lower proportion of those performing specific strength-endurance exercises chose surgery at the three- and 12 months follow-ups (paper II, paper III). Low baseline values in shoulder function and pain measured with the CM score and/or having a full thickness rotator cuff rupture were associated with an increased risk of choosing surgery (paper III). Regarding the CM score, a change between 17-24 points seems to be clinically important for patients with long-standing subacromial pain (paper IV).Supervised strength-endurance exercises seem to be more effective than home-based movement exercises after ASD surgery. For patients on the waiting list for surgery, the specific strategy of strength-endurance exercises was effective in improving shoulder function and pain and the need for surgery was reduced at 12 months. Low baseline values for shoulder function and pain measured with the CM score and/or having a full thickness rotator cuff tear seem to be predictors for choosing surgery. The CM score is able to detect the MIC in individual patients with long-standing subacromial pain when the rotator cuff is intact. In all patients with longstanding subacromial pain, the MIC value was dependent on the subgroup as well as the choice of statistical analysis.
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| 3. |
- Nestorson, Jens, 1969-
(författare)
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Arthroplasty in Elbow Fracture Treatment
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Open reduction and internal fixation is the treatment of choice for distal humeral fractures. Stable fixation is required to allow early mobilisation and to reduce the risk of poor functional results. In an elderly patient with osteoporotic bone and with a comminuted intra-articular fracture stable internal fixation can be difficult to achieve. In these cases elbow arthroplasty is an option.An irreparable radial head fracture can be treated by excision or replacement. The indications for the respective procedure are unclear since reports include an array of different associated soft-tissue and bony injuries.The aim of this thesis was to evaluate the use, complication rates and functional outcome of elbow arthroplasty as primary treatment for complex distal humeral fractures and assess the usefulness of radial head replacement in Mason IV fracture dislocations.50 patients, aged 56-89 years were treated for a distal humeral fracture with primary hemi-arthroplasty using the Kudo© humeral component or the Latitude® prosthesis. The functional outcome was assessed retrospectively. The majority of the 50 patients treated with a primary hemi-arthroplasty for a distal humeral fracture had a good or excellent functional result and regained a functional arc of movement of at least 100 degrees at medium term follow-up. There were six patients suffering secondary surgery and two with persistent ulnar nerve symptoms. Wear of the olecranon fossa was seen, mainly in the eight patients treated with a non-anatomical implant (Kudo®). Functional results were comparable to total elbow arthroplasty and open reduction and internal fixation (ORIF) for distal humeral fractures. The use of implants that are more anatomical seemed to reduce the degree of olecranon wear but long-term results are lacking.The nationwide use of primary arthroplasty for a distal humeral fracture between 1999 and 2014 was examined using three different registers. The survival rates in relation to prosthetic desing, age and sex were investigated using Cox regression analysis and number of adverse events recorded.In total 405 patients were treated with primary arthroplasty for a distal humeral fracture. The mean age at surgery was 75 years and the mean observation time was 67 months. Eighteen patients had undergone revision surgery and another 26 patients suffered an adverse event, 24 of which required secondary surgery.Increasing age reduced the risk for revision and there was no significant difference in survival between total- and hemi arthroplasty. The cumulative survival rate at 5 years was 99% (CI 98-100) and at 10 years 90% (CI 85-96). Elbow arthroplasty as primary treatment for distal humeral fractures produced reliable results with regards to revision surgery and adverse events.18 patients, age 19-79 years, treated with radial head replacement, and 14 patients, age 29-70 years, treated with radial head resection, for a Mason IV fracture dislocation were retrospectively reviewed.There were no significant differences in functional outcome in patients treated with replacement or excision for a Mason IV fracture dislocation. The rate of secondary surgery was higher in patients treated with replacement and ulno-humeral osteoarthritis was more pronounced in patients treated with radial head excision but follow-up was longer in these patients. Functional results were not improved by using radial head arthroplasty for Mason IV fracture dislocation. Secondary osteoarthritis is a concern in patients treated with excision but did not affect functional outcome after a mean follow-up time of 108 months.
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| 4. |
- Moloney, Maria
(författare)
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Ulnar fractures and ligament injuries of the wrist
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Falling over on an outstretched hand with the wrist extended is a common accident that can cause a multitude of injuries in the wrist. Research has mainly focused on distal radius fractures while injuries of the distal ulna and adjacent ligaments have taken a back seat. If not treated adequately, these injuries may result in ulnar-sided wrist pain, sometimes referred to as the “black box” of hand surgery. The distal radio-ulnar joint (DRUJ) enables forearm rotation where the radio-carpal unit rotates around the fixed ulna, stabilised most importantly by the triangular fibrocartilage complex (TFCC). Painless rotation and stability of the forearm under load is important for upper limb function. If full function is to be restored after wrist injury, it is important to treat not only injury to the radius but also those to the ulna and TFCC.The aims of this thesis were to evaluate the long-term results of TFCC injury repair, and contribute to our knowledge on fractures of the distal ulna, their epidemiology, radiographic classification and results of treatment.The long-term outcome of 47 patients with a foveal TFCC tear was evaluated by patient-rated wrist evaluation (PRWE) and radiography 20 years after open repair. The median PRWE score was 22.6 (7-48.5), and 34 % had had further surgery after the initial repair, half of these due to recurrence of DRUJ instability. Signs of osteoarthritis were seen in the radiocarpal joint in 17.5 % and in the DRUJ in 34 %. Higher PRWE scores were seen in patients with osteoarthritis or those who had undergone further surgery. Radio-carpal osteoarthritis was less frequently seen in patients who had undergone initial arthroscopy. This study highlights the importance of arthroscopy in identifying associated injuries. Twenty years after foveal TFCC tear repair patient reported outcomes were similar to those of distal radius fractures.Apart from fractures of the styloid process, distal ulna fractures are rare. All distal ulna fractures in the county of Östergötland 2010-2012 were identified. A total of 766 fractures were found (incidence 74/100 000 person-years), the majority of which were fractures of the ulnar styloid process(79%) usually caused by a fall from standing height. Most patients were female (76%), mean age at the time of injury was 63 years and 92 % had a concomitant distal radius fracture. Second after styloid fractures were fractures of the ulnar neck. A retrospective study of 96 patients with 97 fractures of the distal ulna (excluding the styloid) showed that 40 % were treated by internal fixation. The median PRWE score was 15, with significantly worse scores in patients with an internally fixed distal ulna fracture compared to patients not operated. When classifying these fractures according to AO/OTA 2018, transverse extra-articular fractures (2U3A2.3) had a significantly better outcome when not treated surgically, and these probably do not require internal fixation if the distal radius provides stability and alignment. All 97 fractures were classified by three independent observers according to three classification systems: Biyani, AO/OTA 2007, and AO/OTA 2018. Classification was repeated after a minimum of 3 weeks. Reliability and reproducibility were calculated. The reliability was judged as fair for AO/OTA 2007, and moderate for Biyani and AO/OTA 2018. The reproducibility was moderate for all three systems. These results together with the observers´ opinion that Biyani is an easier system to use, leads us to conclude that a slightly modified Biyani-system together with improved radiological techniques that provide more information about the fracture pattern, may well improve accuracy, reliability and reproducibility.A better classification of distal ulna fractures could help us in the evaluation of new and existing treatments as well as providing the information necessary for designing treatment algorithm. After careful consideration, internal fixation is probably the treatment of choice for certain types of fracture, but this needs further investigation.
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| 5. |
- Ranebo, Mats, 1970-
(författare)
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Rotator Cuff Tears : Short- and long-term aspects on treatment outcome
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Rotator cuff tear is a common disorder and there is a lack of knowledge of appropriate treatment and consequences of different treatment modalities. The overall aim of this thesis was to examine short- and long-term results of rotator cuff tear treatment.In Paper I we did a retrospective 21 to 25-year follow-up of a consecutive series of patients with partial and full-thickness rotator cuff tears, treated with acromioplasty without cuff repair. The cuff status had been documented in a specific perioperative protocol in all patients at the index operation. We did x-ray, ultrasonography and clinical scores with Constant score and Western Ontario Rotator Cuff index (WORC) at follow-up. We identified 111 patients with either a partial or a full-thickness tear, but at follow-up 21 were deceased and 11 were too ill from medical conditions unrelated to their shoulder. Out of the remaining 78 eligible patients, 69 were examined (follow-up rate 88 %) and they had a mean age at the index operation of 49 years (range 19-69 years). Forty-five had a partial tear and 24 a full-thickness tear at the index operation. At follow-up, 74% of patients with full-thickness tear had cuff tear arthropathy grade 2 or more according to the arthropathy classification of Hamada (grade 1 to 5) and 87% had developed tear progression (i.e. a larger tear). Corresponding numbers in those with a partial tear was 7 % arthropathy and 42 % tear progression, and the differences between the full-thickness group and the partial tear group was significant for both outcome measures (P<0.001 for both analyses). In those with arthropathy, the mean Constant score was 47 (standard deviation [SD], 23), the mean age and gender-adjusted Constant score 62 (SD, 27) and the mean WORC 58 % (SD, 26). Patients with a partial tear at follow-up had mean Constant score and WORC within the normal range. In multivariable analysis with logistic regression, having a full-thickness tear at the index operation was a risk factor for arthropathy (odds ratio [OR] 37.8; 95% confidence interval [CI], 8.2-175.0) and for tear progression (OR 6.09; 95% CI, 1.41-26.29).In Paper II we examined the contralateral shoulder in the same patients as in paper I and with the same methodology. Sixty-one patients were examined and 38 had had a partial tear at the index operation 21-25 years ago and 23 a full-thickness tear. The overall rate of contralateral full-thickness tears was 50.8 %, which is higher than the 16-35 % rate found in previous studies of newly diagnosed cuff patients. The rate of contralateral full-thickness tear ranged from 13.6 % in patients with a partial tear in the index shoulder at follow-up, to 90 % in patients with a full-thickness tear and arthropathy in the index shoulder. There was a significant correlation regarding conditions between shoulders in the same patient, with a Spearman coefficient of 0.72 for the number of ten-dons with a full-thickness tear, 0.31 for Hamada grade of arthropathy and 0.65 for Constant score. The number of tendons with a full-thickness tear in the index shoulder at follow-up was a risk factor for a contralateral full-thickness tear (OR 3.28; 95% CI, 1.67-6.44) in a multi-variable logistic regression model. We also found that cuff tear arthropathy was significantly more common in patients who had undergone an acromioplasty (P<0.001), a finding which is not confirmatory but may generate a hypothesis.Paper III addressed 17 to 20-year results after operation with a synthetic interposition graft for irreparable cuff tears. We used X-ray, ultrasonography and clinical scores at follow-up. We identified a consecutive series of 13 patients, one of whom was deceased at follow-up. Ten of the remaining 12 participated in a complete follow-up and 2 did only x-ray examination. Nine out of 12 (75 %; 95% CI, 43-95 %) had cuff tear arthropathy Hamada grade 2 or more in the index shoulder at follow-up. The mean Constant score was 46 (SD, 26) and the mean WORC 59 % (SD, 20). Seven out of 12 had contralateral cuff tear arthropathy, and the difference in frequency of arthropathy between shoulders was not statistically significant (P=0.667).In Paper IV we tested whether early repair of small cuff tears, involving mainly supraspinatus, would give a superior clinical result com-pared to physiotherapy without repair in a prospective randomised trial with 12 months follow-up. We used Constant score as the primary out-come, and WORC, EQ-VAS and Numerical Rating Scale for pain (NRS) as secondary outcomes. We also aimed at assessing the rate of tear progression in unrepaired shoulders and the healing rate in repaired shoulders by Magnetic Resonance Imaging (MRI) performed at 12 months. With a high grade of follow-up (100 % for 12 months Constant score and 95 % for 12 months MRI), the repair group had a 12 months median Constant score of 83 (Quartile range [QR], 25) and the conservative group 78 (QR, 22). This between-group difference in medians of 4.5 (95% CI,-5 to 9; P=0.68) was not statistically significant and we did not detect any significant differences in the secondary outcomes at 12 months. The retear rate was 6.5 % in repaired patients and 29 % of unrepaired patients had a tear enlargement >5 mm.The results in this thesis indicate that patients with small, traumatic, full-thickness tears of mainly supraspinatus have no clinical benefit of early surgical repair compared to physiotherapy alone, but in the long-term, patients with full-thickness tears have an increased risk of tear progression, cuff tear arthropathy and low clinical scores. These results are especially important in the treatment decision of repair or not in younger patients. Having a full-thickness tear is also a risk factor for having a contralateral cuff tear, a phenomenon that underlines the importance of endogenous factors in the development of rotator cuff tears. If a cuff tear is not repairable to bone, the addition of a synthetic inter-position graft does not seem to prevent cuff tear arthropathy.
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| 6. |
- Svernlöv, Birgitta
(författare)
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Treatment of Epicondylalgia and Nerve Entrapments around the Elbow
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Disorders causing pain in the elbow region is a common problem and is one of the most frequent forms of work-related health problems. These conditions are thus of major importance from the public health point of view, as well as from that of the suffering individual. Both sensory and motor function may be impaired, particularly in cases where a nerve is involved, resulting in severely impaired hand function.“Tennis elbow” (lateral epicondylalgia) has been found to be the second most frequently diagnosed musculoskeletal disorder of the upper extremity in the primary health-care setting. “Golfer’s elbow” (medial epicondylalgia) is not that commonly encountered. It has been stated that tennis or golfer’s elbow syndromes are self-limiting. Even so, clinical experience has shown that there are a few cases where symptoms have a painful and long-lasting course, resistant to many forms of therapy. The outcomes of frequently adopted management regimes for treatment of epicondylalgia or nerve entrapments around the elbow were examined in the following five studies:I: A randomised, prospective study of 38 patients with tennis elbow (lateral epicondylalgia). Groups were assigned to eccentric exercises or stretching. Eccentric exercise gave somewhat better results.In a second part of the study, a 4-year follow-up of 127 patients who used eccentric exercises for tennis elbow was performed. Patients showed decreased pain and increased grip-strength after 3 months treatment. At the time of publication this study was the first to examine eccentric exercises for this condition.II: A retrospective analysis of long-term results from 51 patients treated with surgical release of the common extensor origin because of “chronic tennis elbow”. Eighty-seven per cent of the patients rated themselves as completely recovered or improved.III: A randomised, prospective study of 70 patients with ulnar neuropathy in the forearm (cubital tunnel syndrome). Groups assigned the commonly recommended elbow brace at night or nerve gliding exercises were compared with a control group (information only). The majority of patients improved considerably, both subjectively and objectively, after a 3 months period, regardless of group. The study thus showed the effectiveness of information and expectance, and that orthosis or nerve gliding exercises added nothing further to the result.IV: A retrospective study of 205 patients treated with surgery for suspected nerve entrapment in the forearm. Followup, almost 4 years later, demonstrated a subjective improvement in two of three patients, but only 3% experienced complete relief of all symptoms.V: A prospective long-term study on 20 patients with golfer’s elbow (medial epicondylalgia) treated with eccentric exercises over 3 months. The results showed decreased pain and increased gripstrength. This is the first study published on the management of this disorder with eccentric exercises.
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| 7. |
- Johansson, Kajsa, 1971-
(författare)
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Patients with subacromial pain : Diagnosis, treatment and outcome in primary care
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med avhandlingen var att beskriva diagnostiken och utvärdera handläggningen i primärvård av patienter med subacromial smärta.Avhandlingen omfattar fyra studier.I den första studien användes ett frågeformulär och resultaten beskriver hur distriktsläkare och distriktssjukgymnaster i ett svenskt län diagnosticerar och handlägger primärvårdspatienter med subacromial smärta.Den andra studien beskriver distriktsläkares och distriktssjukgymnasters tilltro till effekten av olika behandlingsmetoder för dessa patienter. Med utgångspunkt från de tilltrodda behandlingsmetoderna genomfördes en systematisk litteraturöversikt.Den tredje studien utvärderar intra- och interbedömar reliabilitet för ett styrketest som ingår i ett utvärderingsinstrument ‘the Constant-Murley shoulder assessment’.Den avslutande studien är en randomiserad klinisk studie som utvärderar och jämför effekten av två behandlingsstrategier, akupunktur och ultraljud, båda i kombination med hemträning.Distriktsläkare och distriktssjukgymnaster visade sig använda en likartad diagnostik. Det troligaste valet av behandling för distriktsläkare var antiinflammatoriska läkemedel och kortisoninjektion i den subacromiala bursan och för distriktssjukgymnaster rörelseträning samt ergonomiska åtgärder.Dock var de flesta behandlingsalternativen troliga val, vilket tolkas som en osäkerhet om behandlingarnas effekt.Med utgångspunkt från de behandlingsmetoder som distriktsläkare och distriktssjukgymnaster tilltrodde som effektiva för patienter med subacromial smärta, genomfördes en systematisk kritisk litteraturöversikt. Fyrtio studier inkluderades och deras evidensnivå utvärderades. Endast kortisoninjektion i den subacromiala bursan visade sig ha definitiva bevis för effekt. Akupunktur visade sig ha troliga bevis för effekt och ultraljudsbehandling konkluderades som ineffektivt för patienter med subacromial smärta. Det förelåg en låg grad av samstämmighet mellan tilltro och tillgängliga vetenskapliga bevis.En digital dynamometer kan ersätta den konventionella fjädervågen i det standardiserade styrketestet. En nästan perfekt överensstämmelse vad gäller både intra- och interbedömarreliabilitet vid test av unga skulderfriska personer, oberoende av om en ”håll emot-” eller ”dragteknik” användes eller om medel- eller maxvärden användes vid beräkningen av överensstämmelse.I den randomiserade kliniska studien inkluderades 85 patienter. Tre utvärderingsinstrument, kombinerade i resultatanalysen, utvärderade förändringen under en uppföljningsperiod på 12 månader tillsammans med patienternas subjektiva skattning av resultatet.Resultaten visade att akupunktur i kombination med hemträning är att föredra. Båda behandlingsgrupperna förbättrades signifikant och fortsatte förbättras över tid oberoende av behandling. De flesta patienter uppnådde ett tillfredställande behandlingsresultat efter 12 månader. Åtminstone tre fjärdedelar i varje behandlingsgrupp skattade sig mycket förbättrade eller helt återställda. Detta tolkas som en behandlingseffekt i kombination med naturalförloppet.Avhandlingen har beskrivit handläggningen i primärvård av patienter med subacromial smärta och har bidragit med vetenskapliga bevis för distriktsläkare att behandla med kortisoninjektion i subacromiala bursan och för distriktssjukgymnaster att behandla med akupunktur kombinerat med hemträning.
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| 8. |
- Kadum, Bakir, 1976-
(författare)
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Total Shoulder Arthroplasty : clinical and radiological studies on the implant positioning and fixation
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Shoulder arthroplasty surgery has shown remarkable progress during the last few decades. A number of factors affect postoperative range of motion, pain and prosthetic durability. Among these factors, the length of the lever arm and joint stability is the ones that can be altered by the selected prosthetic component. It is uncertain how much of the normal anatomy needs to be re-established. Stemless prostheses with total reliance on metaphyseal fixation were introduced in France in 2004 (TESS, Zimmer Biomet). The goals were to avoid stem-related complications. Stemless implants have other potential benefits, including the ability to restore shoulder anatomy.Study I: This is a prospective cohort study of 49 patients with one of two versions of the TESS prosthesis (anatomical or reverse) with clinical and radiological follow-up ranging from 9–24 months. The TESS prosthesis showed short-term results that were comparable with other shoulder prosthetic systems.Study II: This is a prospective comparative non-randomised study of 37 patients (40 shoulders) who underwent TESS reverse shoulder arthroplasty (RSA) with a follow-up ranging from 15–66 months. We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. Glenoid overhang influenced the occurrence of scapular notching (SN).Study III: This is a radiological study showing that CT had a good reliability and reproducibility in estimating LHO.Study IV: This is a prospective radiological study of 69 patients (70 shoulders) with primary osteoarthritis (OA) who had undergone stemless total anatomical shoulder arthroplasty (TSA). This study showed that stemless anatomical TSA could be useful in restoring shoulder anatomy.Study V: This is a prospective study of 44 patients with OA who had undergone stemless anatomical TSA with a clinical and radiological follow up ranging from 12 – 50 months. Our study showed that LHO reconstruction close to the anatomy of a healthy contralateral shoulder improved shoulder function. Stemless anatomical TSA help to restore LHO. Increasing LHO may have a negative effect on shoulder function at three months but had no effect at 12 months. The main conclusions of this thesis are:1. TSA (anatomic and reverse) using stemless humeral components is reliable if bone quality is adequate. The complication rate is comparable with other shoulder prosthetic systems.2. Glenoid overhang decreased complications in RSA.3. LHO measurement on AP radiographs is less reliable and underestimates the distance when compared with CT.4. Stemless TSA could be of help in reconstructing shoulder anatomy.5. Shoulder reconstruction close to the anatomy of a healthy contralateral shoulder improves shoulder function.
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| 9. |
- Scheer, Johan, 1967-
(författare)
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Periulnar Injuries Associated with Distal Radius Fractures
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Residual dysfunction after a fracture of the distal radius is most often mild but may give rise to significant impairment especially in the younger active population. The symptoms often manifest around the distal ulna when loading the hand or rotating the forearm. In this region are found articular and soft tissue connections running from the distal ulna to the distal radius as well as to the ulnar side of the carpus. The aims of this thesis were to investigate the effects of distal radius fractures on the structures about the distal ulna and to what extent malunion and ulnar soft tissue lesions affect function. Both patients and cadaver specimens were used in the five different studies.In a retrospective study of 17 malunited distal radius fractures supination impairment improved significantly by correction of the skeletal malunion. This highlights the importance of distal radioulnar joint congruity for forearm rotation in a subset of cases.The pathomechanisms of injury to the triangular fibrocartilage complex (TFCC) were studied. In a cadaveric distal radius fracture model different restraining properties and injury patterns were investigated. Similar patterns of injury were then observed in 20 patients with a displaced distal radius fracture. It was found that a TFCC injury can be expected with dorsal displacement of the distal radius fragment of 32o or more from the anatomically correct position. The distribution of a TFCC injury apparently differs depending on the size of an associated ulnar styloid fracture. In cases of an intact ulnar styloid or a concomitant tip fracture (Type 1) the first stage of injury seems to be extensor carpi ulnaris subsheath separation from the distal ulna and the dorsal radioulnar ligament. Thereafter follows a disruption of the deep insertions into the fovea of the ulna starting from the palmar and extending dorsally and radially. An extensive injury can be detected with a novel non-invasive test called the ‘bald ulnar head test’, which is performed under anaesthesia.Diagnosis of an acute TFCC injury is difficult using non-invasive methods. In a prospective study of 48 patients, CT scanning to detect pathologic subluxation was found to be of little use in both acute and chronic cases, and is therefore not endorsed on this indication. A radioulnar stress test, which in previous studies has correlated well to a deep TFCC injury, was found to be highly reliable but not to correspond with significant disability in self-administered questionnaires of functional outcome two years or more after injury. This indicates that the subset of patients possibly benefiting from acute repair must be identified by other means.
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| 10. |
- Willermark, Sara, 1988-, et al.
(författare)
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Where do we go from here? Didactic and organizational questions after the pandemic
- 2022
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Ingår i: ICERI2022 Proceedings. - Valencia : The International Academy of Technology, Education and Development. - 9788409454761 ; , s. 1144-1151
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Konferensbidrag (refereegranskat)abstract
- COVID-19 changed the educational landscape as we know it. Due to the radical transformation of schooling, there is an imminent question of what lessons have been made and which transformations ‘will stick’ and become the ‘new normal’ after the obvious threats of the pandemic subsided [1]. There is a stream of research that addresses experiences from the pandemic [2-4]. In this study, we focus on the experiences of upper secondary schools in Sweden. The purpose of this paper is to synthesize teachers' and school leaders' experiences from the pandemic and, based on that, address implications for practice for future schooling. We conduct a meta-analysis of four studies within a research project in Sweden [5-8] where the data consists of surveys and workshops with teachers and school leaders and explores their experiences of the pandemic. The results show that Sweden has worked well in an international context, at the same time there are distinct differences regarding teachers' and school leaders' perceptions of what work effort was required, the result of the teaching, and its consequences. Contribution includes synthesizing experiences from the pandemic and pointing out its implications for future education. © Copyright 2022, IATED Academy
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