The optimal treatment for frozen shoulder remains a subject of debate, within the orthopedic and rehabilitative communities, primarily due to the complexity of the pathology and the lack of consensus on therapeutic protocols, which range from conservative physical therapy to invasive surgical intervention. In this clinical landscape, noninvasive modalities have gained considerable traction for their potential to accelerate functional recovery and alleviate debilitating pain. The aim of this study was to evaluate the 12‐month long‐term results of focal extracorporeal shockwave therapy (f‐ESWT) in the treatment of idiopathic frozen shoulder. We prospectively collected data from 77 patients (42 females, 35 males; mean age: 57 years) suffering from idiopathic frozen shoulder between January 2021 and September 2022. The median number of f‐ESWT sessions performed was 6 (range: 2–10). Forty‐three patients received f‐ESWT treatment within 3 months of symptom onset. Patients were assessed at baseline, at the end of treatment, and at 2‐, 6‐, and 12‐month follow‐up intervals using the Constant–Murley Score (CMS), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Visual Analog Scale (VAS). A statistically significant improvement of CMS and reduction of DASH and VAS were observed from the baseline values to posttreatment evaluations ( p < 0.001). Serial measurements revealed a bimodal trend of clinical improvements: a significant statistical difference from baseline values to both the end of the treatment and at the 2‐month follow‐up, followed by a clinical plateau up to a final, statistically significant improvement at the 12‐month follow‐up. Patients who initiated f‐ESWT within 3 months of symptom onset, as well as those who underwent fewer than seven sessions, exhibited significantly lower DASH values at the 2‐month follow‐up ( p = 0.013). In conclusion, satisfactory clinical outcomes of f‐ESWT for idiopathic frozen shoulder can be expected at 12 months, particularly for patients starting treatment early (within 3 months of onset) and receiving fewer than seven sessions.
Introduction The increasing demand for primary (pTKA) and revision total knee arthroplasty (rTKA) has been well documented, with previous literature projecting growth through the year 2030. However, the COVID‐19 pandemic introduced a significant disruption to healthcare delivery, and its long‐term impact on arthroplasty volume trends remains unclear. This study examines the trajectory of pTKA and rTKA volumes in a high‐volume private orthopedic practice before and after the pandemic to assess potential lasting effects. Methods This retrospective observational study included 11,589 pTKA and 857 rTKA procedures performed between January 1, 2018, and December 31, 2023. Quarterly volumes were analyzed using segmented interrupted time‐series regression, with Q2 2020 (April–June) defined as the interruption. Models estimated the preinterruption trend, immediate level change, change in slope, and postinterruption trend using Newey–West standard errors. Sensitivity analyses excluded Q2 2020, modeled it as a temporary shutdown, and adjusted for calendar‐quarter seasonality. Results The preinterruption pTKA trend was +1.30 procedures per quarter (95% CI, −6.61–9.21; p = 0.735). At Q2 2020, pTKA volume decreased immediately by 90.33 procedures (95% CI, −156.21–−24.45; p = 0.010). The postinterruption slope was +11.67 procedures per quarter (95% CI, 4.93–18.40; p = 0.002); however, the change from the preinterruption slope was not statistically significant (+10.37 procedures per quarter; 95% CI, −2.08–22.82; p = 0.098). The positive postrecovery pTKA slope persisted after excluding Q2 2020. No significant immediate level or slope changes were identified for rTKA, including a postinterruption slope of +0.63 procedures per quarter (95% CI, −0.68–1.93; p = 0.328). Conclusion Within this single private orthopedic practice, the pandemic interruption was associated with an immediate reduction in pTKA volume followed by a positive postinterruption trend. However, the formal change from the pre‐interruption slope was not statistically significant, and no significant trend changes were identified for rTKA. These findings represent temporal associations and may also reflect deferred care, outpatient migration, expanded ambulatory capacity, and other contemporaneous practice or policy changes.
Introduction:Finger amputation significantly impairs hand function and self-image. When surgical reconstruction or replantation is not possible, a finger prosthesis can provide cosmetic and functional benefits. However, conventional prostheses are limited by poor retention and lack of sensation. In this study, we evaluate an alternative method using osseointegrated dental implants to anchor finger prostheses, which provide stable fixation and, in turn, improve function and sensory feedback. Method:Four patients with traumatic amputations of a single finger each (thumb, index, middle, and ring fingers) underwent a two-stage surgical procedure. In the first stage, a titanium dental implant was placed into the medullary canal of the residual bone. After a three-month osseointegration period, a second-stage surgery attached a skin-penetrating abutment. Finally, a custom-made, color-matched silicone prosthesis was secured to the abutment. Outcomes were evaluated through clinical and radiographic follow-up, along with patient-reported satisfaction. Results:Three of four patients achieved successful osseointegration by three months. One thumb reconstruction was complicated by nonunion and implant loosening, requiring implant removal. One superficial abutment-site infection resolved with conservative treatment. Functional outcomes were favorable, with improved grip and pinch strength, preserved joint motion, enhanced sensibility, and high patient satisfaction with cosmetic and functional results. Conclusion:Osseointegrated dental implants may offer a feasible option for retention of digital prostheses in selected patients. Although short-term outcomes were encouraging, complications can occur, and careful patient selection and biomechanical planning are essential. Larger studies with longer follow-up are needed to confirm long-term safety, durability, and implant survival.
Purpose:Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, with surgical decompression as the definitive treatment for refractory or severe cases. With the evolution of surgical techniques, from open carpal tunnel release (OCTR) to endoscopic (ECTR) and ultra-minimally invasive ultrasound-guided approaches, there remains a need for a comprehensive comparative evaluation. This review aims to critically assess contemporary surgical modalities for CTS and to provide an evidence-based framework for patient-centered surgical decision-making. Methods:A structured narrative review was conducted using PubMed/MEDLINE, Scopus, Cochrane Library, and Web of Science, covering studies from 1985 to February 2026. Eligible studies included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses reporting clinical outcomes of OCTR, ECTR, and ultrasound-guided techniques. Outcomes assessed included symptom relief, functional scores, complications, recurrence, return to work, and cost-effectiveness. Data were synthesized thematically due to heterogeneity. Results:OCTR and ECTR demonstrate comparable long-term symptom relief and functional outcomes. ECTR offers advantages in early postoperative recovery, including reduced pain and faster return to work. Ultra-minimally invasive ultrasound-guided techniques show promising early outcomes and accelerated recovery in selected patients, though long-term data remain limited. Complication rates are low across techniques and are influenced more by surgical expertise and completeness of release than by approach alone. Economic analyses suggest early recovery may offset higher procedural costs in working populations. Conclusion:Long-term outcomes of CTS surgery are broadly equivalent across techniques when adequate decompression is achieved. The surgical approach should be individualized based on disease severity, patient factors, occupational demands, and surgeon expertise. Further high-quality, long-term comparative studies are needed to define the role of emerging ultra-minimally invasive techniques.
Introduction:Diagnosis-Related Groups (DRGs) have become the basis of the Center of Medicare & Medicaid Services (CMS) hospital reimbursement system. Wide variability of patient factors and procedures bundled into a single DRG may contribute to significant cost variation and limited usefulness when analyzing economic performance. This investigation sought to analyze variation in hip and femur fracture inpatient costs as assessed by DRG and Current Procedural Terminology (CPT) codes. Materials and Methods:Patients age ≥ 18 treated with operatively managed fractures of the hip and femur at a Level 1 trauma center from 2019 to 2021 were retrospectively reviewed. Patients categorized as DRG 480, with major comorbidity/complication; 481, with comorbidity/complication; and 482, without comorbidity/complication were eligible. Seven common CPT codes were analyzed after exclusion of patients with low frequency CPT codes (< 50 instances). The primary outcome was total direct costs by DRG and CPT codes. Total direct costs were compared among CPT codes within each DRG using an ANOVA model. Costs were also compared among DRGs for each CPT code. Secondary outcomes include comparison of total direct costs by surgeon within DRG and within each CPT code. Results:A total of 896 patients were analyzed. Significant variation in costs was observed among different DRGs for specific CPTs (p < 0.001). Similarly, notable variation in total direct costs was recorded among different CPTs within each given DRG (p < 0.001). Although cost variations were observed between surgeon and DRG (p < 0.001), no significant interaction was observed once specific procedural (CPT) data were included in the model (CPT 27245: F = 1.077, p = 0.378; CPT 27506: F = 0.934, p = 0.504). Conclusions:While direct costs are influenced by the complexity of DRG assignment within the hip and femur fracture DRG family, the data may be limited in its applicability given the heterogeneity of patients and procedures captured within each DRG. Evaluating costs using a DRG-CPT combination, instead of DRG alone, may provide a more comprehensive and accurate understanding of costs of care. Level of Evidence:Economic and Decision Analyses Level III.
