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      Shoulder motion decreases as body mass increases in patients with asymptomatic shoulders

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          Abstract

          Background

          Higher complication rates are reported after shoulder arthroplasty in obese patients. Understanding the effect of body mass index (BMI) on range of motion (ROM) in asymptomatic shoulders may be useful in evaluating clinical outcomes for patients of varying BMIs presenting with shoulder pathology. The purpose of this study is to investigate patient characteristics, in particular BMI, that may affect ROM outcomes after shoulder arthroplasty.

          Methods

          Individuals aged 18 years or older (mean 57.21 ± 16.27 years) were recruited with asymptomatic shoulder presentation and without history of shoulder injury. A total of 224 shoulders were grouped into 4 BMI categories, and ROM was measured with a goniometer. Analysis was performed between patient demographics and ROM.

          Results

          Analyzed continuously, BMI negatively correlated with ROM for internal rotation (IR; r = −0.511, P < .01), forward elevation (FE; r = −0.418, P < .01), and external rotation (ER; r = −0.328, P < .01). ROM analyzed by BMI category revealed a dose effect of BMI vs ROM. Obese patients demonstrated a significant decrease in IR whereas morbidly obese patients had significant decreases for all ranges: IR ( r = −0.469, P < .01), FE ( r = −0.452, P < .01), and ER ( r = –0.33, P < .01). Normal- and overweight patients revealed no significant correlations with ROM.

          Conclusion

          As BMI is negatively correlated with ROM of the asymptomatic shoulder, patients with higher BMIs may be predisposed to diminished outcomes postoperatively. These baseline correlations will allow surgeons to make postoperative expectations and anticipate poorer outcomes of shoulder ROM in obese patients.

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          Most cited references21

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          Prevalence of Obesity Among Adults and Youth: United States, 2015-2016.

          Obesity is associated with serious health risks. Monitoring obesity prevalence is relevant for public health programs that focus on reducing or preventing obesity. Between 2003–2004 and 2013–2014, there were no significant changes in childhood obesity prevalence, but adults showed an increasing trend. This report provides the most recent national estimates from 2015–2016 on obesity prevalence by sex, age, and race and Hispanic origin, and overall estimates from 1999–2000 through 2015–2016.
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            Adhesive capsulitis of the shoulder and diabetes: a meta-analysis of prevalence.

            adhesive capsulitis (AC) results in progressive painful restriction in range of movement and can reduce function and quality of life. Whilst it has been associated with diabetes mellitus (DM), there is considerable variation in the reported prevalence of AC in the diabetic population. The aim of this study is to determine through meta-analysis the prevalence of AC in DM and examine whether it is influenced by type of DM or insulin therapy. We also aim to further establish the prevalence of DM in patients presenting with AC.
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              Current Trends in the Use of Shoulder Arthroplasty in the United States.

              Reverse total shoulder arthroplasty (rTSA) has become increasingly popular since its introduction to the United States. The purpose of this study was to assess the current trends and use of rTSA, anatomic total shoulder arthroplasty (aTSA), and hemiarthroplasty (HA) from 2011 to 2014. Shoulder arthroplasty data from the National (Nationwide) Inpatient Sample database were analyzed for the years 2011 to 2014 using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. For each procedure, use and patient and hospital characteristics were identified. Shoulder arthroplasties increased by 24% between 2011 and 2014, to 79,105 procedures. The proportion of arthroplasties that were aTSA did not change substantially (44% for both years; P=.0585), while the proportion that were rTSA surpassed aTSA in 2014, increasing from 33% to 46% (P<.0001). Use of rTSA topped use of aTSA by 2013 for Medicare patients. The proportion that were HA procedures declined from 23% to 11% (P<.0001). The use of rTSA for fracture increased from 26% to 58% (P<.0001) of all arthroplasties for this indication, while the use of HA for fracture decreased from 69% to 40% (P<.0001). Orthopedists performed rTSA more often than aTSA for Medicare patients by 2013 and the general population by 2014. The use of rTSA for fracture has grown significantly, with rTSA being performed more frequently than HA for this indication. [Orthopedics. 2018; 41(3):e416-e423.].
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                Author and article information

                Contributors
                Journal
                JSES Int
                JSES Int
                JSES International
                Elsevier
                2666-6383
                27 June 2020
                September 2020
                27 June 2020
                : 4
                : 3
                : 438-442
                Affiliations
                [1]Medical University of South Carolina, Charleston, SC, USA
                Author notes
                []Corresponding author: Josef K. Eichinger, MD, 96 Jonathan Lucas St, CSB 708, Charleston, SC 29425, USA. Joe.eichinger@ 123456gmail.com
                Article
                S2666-6383(20)30056-6
                10.1016/j.jseint.2020.04.004
                7479022
                32939465
                d63965d4-40a5-4087-8b03-bcf59d891d0f
                © 2020 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Categories
                Basic Science

                bmi,rom,range of motion,shoulder arthroplasty,body mass index,complications,obesity,outcomes

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