Nitin B. Jain

Background: Fatty infiltration and muscle atrophy strongly influence clinical outcomes in patients with rotator cuff tears. Emerging quantitative techniques integrated with brightness‐mode ultrasound and shear wave elastography (SWE) have been used to evaluate soft tissue morphology and mechanical properties. Objective: To evaluate integrative B‐mode ultrasound and SWE as a potential tool to quantify rotator cuff muscle quality. Methods: Twenty participants (a total of 32 shoulders) with and without rotator cuff tears were included in this study. Shear wave speed (SWS) was measured in SWE‐mode and cross‐sectional area (CSA) was measured in B‐mode with a linear transducer. Muscle strength was measured using a hand‐held dynamometer. Psychometric properties were calculated for SWS and CSA under both passive and active conditions. Results: The SE of measurement and minimum detectable difference for the SWS of supraspinatus in shoulders with rotator cuff tears were 0.195 and 0.541 m/s, respectively. The SE of measurement and minimum detectable difference for the CSA of supraspinatus in shoulders with rotator cuff tears were 0.265 and 0.733 cm ² , respectively. Correlation analysis between passive mean SWS and CSA revealed a strong correlation (r = 0.652, p = .003) for the supraspinatus. Conclusion: These findings demonstrate a strong positive correlation between SWS and CSA of the supraspinatus in participants with rotator cuff tears but not the infraspinatus or in asymptomatic participants. Assessment of SWS and CSA under passive conditions yields superior psychometric properties compared to active conditions. However, the lack of association between SWS and strength limits the clinical utility of SWE to quantify rotator cuff muscle quality.

Purpose: The purpose of this study was to analyze national trends in knee and shoulder arthroscopy to identify seasonal and annual variability using the Healthcare Cost and Utilization Project-Nationwide Ambulatory Surgery Sample (HCUP-NASS) dataset. Methods: Estimated national rates of ambulatory knee and shoulder arthroscopy were analyzed using HCUP-NASS data from 2016 to 2021. Time trend plots were generated to identify potential seasonal trends in these procedures. Results: There was a decreasing trend in the number of procedures (shoulder arthroscopy, rotator cuff repair [RCR], knee arthroscopy, meniscal repair [MR]/meniscectomy, and anterior cruciate ligament reconstruction [ACLR]) done from 2016 to 2021. There were an estimated 264,987 (95% confidence interval [CI] = 251,205 to 276,770) patients who underwent shoulder arthroscopy and 381,125 (95% CI = 362,555 to 399,696) patients who underwent knee arthroscopy in 2021, as compared with 345,892 (95% CI = 326,224 to 365,559) patients who underwent shoulder arthroscopy and 521,912 (95% CI = 496,905 to 546,919) patients who underwent knee arthroscopy in 2016. Male patients showed markedly higher rates of shoulder arthroscopy, RCR, knee arthroscopy, MR, and ACLR procedures as compared with female patients, whereas female patients showed markedly higher rates of knee arthroscopy done without MR and ACLR. Shoulder and knee arthroscopy rates peaked in the 55 to 75-year-old age group. In addition, both procedures were most frequently done in December and had the lowest utilization in the month of July. Conclusion: There was a nonlinear decrease in the estimates of shoulder arthroscopy, RCR, MR/meniscectomy, knee arthroscopy, and anterior cruciate ligament reconstruction procedures from 2016 to 2021, with peaks in 2016 and 2019, and a low point in 2020. There are notable variations in rates of knee and shoulder arthroscopy procedures by age and sex. Clinical relevance: Recent data on commonly done ambulatory orthopaedic arthroscopies are important for policy makers and for understanding utilization trends.

Objective: Glenohumeral (GH) osteoarthritis (OA) is the third most common large joint disease, after hip and knee OA. This study aimed to identify risk factors for GH OA. Methods: We used data from the Dallas Shoulder cohort, including individuals aged 40–85. Those with confirmed GH OA based on X-ray were cases, and those without were controls. Univariate, least absolute shrinkage and selection operator and multivariate analyses identified risk factors, including age, body mass index (BMI), sex, work-related shoulder problems, shoulder disability, dislocation, previous trauma, surgery, smoking, hypertension, diabetes, depression, heart disease, OA, night pain and overall sleep quality. Results: A total of 1827 cases and 1556 controls were identified for GH OA. In univariate analysis, significant associations with GH OA were found for increasing age (>40 to ≤50: OR 3.29, 95% CI 2.44 to 4.45; >50 to ≤60: OR 5.90, 95% CI 4.49 to 7.77; >60 to ≤70: OR 12.18, 95% CI 9.22 to 16.08 and >70: OR 16.54, 95% CI 12.47 to 21.94), higher BMI (≤19: OR 1.44, 95% CI 1.01 to 2.04; >25 to ≤30: OR 1.57, 95% CI 1.32 to 1.86; >30 to ≤35: OR 1.85, 95% CI 1.54 to 2.22 and >35: OR 1.77, 95% CI 1.28 to 2.45), prior shoulder injury (OR 1.30; 95% CI 1.12 to 1.50), shoulder surgery history (OR 0.71; 95% CI 0.57 to 0.87), shoulder pain at night (OR 1.35; 95% CI 1.07 to 1.70) and hypertension (OR 0.70; 95% CI 0.60 to 0.81). In multivariate analysis, significant associations remained for age (>40 to ≤50: OR 2.99, 95% CI 2.21 to 4.06; >50 to ≤60: OR 5.48, 95% CI 4.14 to 7.23; >60 to ≤70: OR 11.22, 95% CI 8.44 to 14.88 and >70: OR 16.65, 95% CI 12.45 to 22.17), BMI (≤19: OR 1.49, 95% CI 1.01 to 2.20; >25 to ≤30: OR 1.45, 95% CI 1.20 to 1.77; >30 to ≤35: OR 1.70, 95% CI 1.39 to 2.09 and >35: OR 1.78, 95% CI 1.25 to 2.55) and previous shoulder trauma (OR 0.80; 95% CI 0.68 to 0.94). Conclusion: We identified increasing age and higher BMI as factors associated with GH OA. Due to the large sample size, many risk factors were assessed. Since the shoulder is not a weight-bearing joint, the BMI-GH OA link is likely molecular and systemic, warranting further investigation. Level of evidence: Prognostic level III.

Background/Objectives: Over 18 million orthopedic procedures were performed in the United States in 2022 with pharmacological management being the primary mode of analgesia. Percutaneous neuromodulation in the form of temporary peripheral nerve stimulation (tPNS) may provide a new method of postsurgical analgesia devoid of systemic side effects and the potential for substance addiction. tPNS can also be used for chronic pain long after surgery. Methods: The initial literature search of PubMed/MEDLINE, Web of Science, and Cochrane was conducted on September 21, 2023, and repeated on May 23, 2025. Included studies had patients over 18 years of age with implanted tPNS in the first 2 years following orthopedic surgery of the knee, shoulder, hip, foot, or ankle. Results: Eleven articles of nine distinct studies were found: eight articles from six randomized trials and three articles from three case series. Seven publications assessed implanted tPNS in the acute perioperative phase, and four publications assessed implanted tPNS for chronic postoperative pain. This systematic review’s aim was to compile current literature on the safety and efficacy of percutaneous tPNS both immediately after orthopedic surgery and for longer‐term postsurgical persistent pain. This collection of evidence suggests using percutaneous tPNS is safe and may reduce pain and postoperative opioid consumption. Conclusions: This emerging treatment may reduce postoperative pain and opioid consumption, is safe, and warrants further robust trials. Future studies with robust, multimodal treatment designs are needed to specifically delineate the role of tPNS within the context of current pain management.

Objective: The primary goal of this study is to evaluate the relationship between Body Mass Index (BMI) and muscle atrophy in individuals with rotator cuff tears. Methods: This study consists of patients with rotator cuff tears identified by MRI from two independent cohorts, the Rotator Cuff Outcomes Workgroup (ROW) and the Multicenter Orthopaedic Outcomes Network (MOON). Presence of atrophy (yes/no) and severity of atrophy (as an ordinal variable) were assessed on MRI by expert physicians. We used multivariable regression models to evaluate the relationship between BMI and muscle atrophy while adjusting for age and sex in each study, conducted sensitivity analyses for full-thickness tear and combined results using inverse variance-weighted meta-analysis. Results: A total of 539 patients (MOON=395, ROW=144) from the combined cohorts had MRI data available on muscle atrophy. Among these patients, 246 (46%) had atrophy of at least one of the muscles of the rotator cuff and 282 (52%) had full-thickness tears. In meta-analysis across both cohorts, each 5 kg/m² increase in BMI was associated with a 21% (aOR=1.21, 95% CI=1.02, 1.43) increased odds of having muscle atrophy among individuals with any tear size, and 36% (aOR=1.36, 95% CI=1.01–1.81) increased odds among individuals with full-thickness tear. Conclusions: Higher BMI was associated with significantly higher odds of muscle atrophy in patiens with rotator cuff tears. More study is needed to unders1tand why and how this relationship exists, as well as whether interventions to reduce BMI may help improve outcomes for these patients. Level of Evidence: III.