The OJSM Hot Corner

Calcific tendinitis is a common, painful condition that can cause intense pain and dysfunction of the shoulder. However, in spite of its commonality, there is much we do not understand about it including why it occurs. One thing we do know is that, in most cases, the calcium will just go away, however we do not have any way to predict how long that may take to occur. A variety of treatment options are available to treat calcific tendinitis including several non-surgical options such as physical therapy, cortisone injections, and barbotage, as well as surgery. Because the natural history of calcific tendinitis is one of self-resolution, surgery is typically reserved for long-standing cases where non-surgical treatments have been tried and failed. Authors Ryan Gilbert, BA & Dr. Albert Lin, MD from University of Pittsburgh Medical Center join us to discuss their study looking at success rates of these 3 non-surgical options as well as the success rates for patients who opted for surgery as an initial treatment or after failing at least one non-surgical option. If you've failed one of the non-operative treatment, should you try another one or just go to surgery?

Lateral Extra-Articular Tenodesis (LET) has become an accepted adjunct to standard anterior cruciate ligament reconstruction to help provide additional rotational stability to the knee and lower the risk of re-tears. The classic situation to perform this surgery would be at the same time as an ACL reconstruction in a patient with a high degree of rotational instability or in a patient who has already had ACL surgery and re-torn. However, might there be a role for LET performed as a standalone procedure? A subset of patients following ACL surgery will have a knee that is very stable in the anterior-to-posterior (front-to-back) direction but continues to demonstrate some degree of rotational instability. Could an LET performed in isolation provide these patients with that additional rotational stability and thus lower their risk of another injury, or is that a crazy idea?
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The importance of the mind-body connection in Sports Medicine is well-established and continues to be a hot topic of study and conversation. This connection between psychological and physical is especially noted with ACL injuries, surgery, and rehabilitation. Dr. Brian M. Devitt, MD, PhD from UPMC Sports Surgery Clinic in Dublin, Ireland joins us to discuss his team's work examining psychological readiness and return to play rates in elite versus nonelite athletes. One might assume that the elite athlete, perhaps with more personal athletic identity and rehab resources would outperform the nonelite athlete, but does that actually play out?

The correct treatment for rotator cuff tears remains a matter of debate. The varying characteristics of cuff tears – symptomatic versus asymptomatic, tear size, tendon quality, the presence of fatty atrophy, etc. – makes generalizations about the best treatment approach difficult. One thing shoulder specialists agree on is that tear enlargement is problematic. A cuff tear that enlarges may turn a once fixable tear into an unfixable one.  Predicting which tears will enlarge and the rate at which they will is not an exact science. We welcome Dr. James Irrgang, PT, PhD, FAPTA & Dr. Luke Mattar, PhD from the University of Pittsburgh to discuss their study looking at tear propagation trends in patients with a symptomatic, isolated supraspinatus tears after 3 month of an initial trial of physical therapy.

Shoulder and elbow injuries in pitchers are as old as baseball itself. Measures to lower the risk of these injuries have been evolving for decades, with a nationalized though heterogenous effort from state to state implemented in the mid-2010s. Adherence to pitch counts and mandatory days of rest in between outings, for example, are common restrictions placed upon pitchers to try and keep them safe. Dr. Peter Kriz, MD and his team from Boston Children's Hospital look back to see if these policies made any impact. Have the pitching restriction regulations designed to keep pitchers safe actually worked?