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Article ; Online: SIRVA: Shoulder injury related to vaccine administration.

Jenkins, Paul J / Duckworth, Andrew D

2023 Volume 105-B, Issue 8, Page(s) 839–842

Abstract: Shoulder injury related to vaccine administration (SIRVA) is a prolonged episode of shoulder dysfunction that commences within 24 to 48 hours of a vaccination. Symptoms include a combination of shoulder pain, stiffness, and weakness. There has been a ... ...

Abstract	Shoulder injury related to vaccine administration (SIRVA) is a prolonged episode of shoulder dysfunction that commences within 24 to 48 hours of a vaccination. Symptoms include a combination of shoulder pain, stiffness, and weakness. There has been a recent rapid increase in reported cases of SIRVA within the literature, particularly in adults, and is likely related to the mass vaccination programmes associated with COVID-19 and influenza. The pathophysiology is not certain, but placement of the vaccination in the subdeltoid bursa or other pericapsular tissue has been suggested to result in an inflammatory capsular process. It has been hypothesized that this is associated with a vaccine injection site that is "too high" and predisposes to the development of SIRVA. Nerve conduction studies are routinely normal, but further imaging can reveal deep-deltoid collections, rotator cuff tendinopathy and tears, or subacromial subdeltoid bursitis. However, all of these are common findings within a general asymptomatic population. Medicolegal claims in the UK, based on an incorrect injection site, are unlikely to meet the legal threshold to determine liability.
MeSH term(s)	Adult ; Humans ; COVID-19 ; Shoulder Injuries/etiology ; Rotator Cuff ; Shoulder Joint ; Shoulder Pain ; Bursitis ; Vaccination
Language	English
Publishing date	2023-08-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.105B8.BJJ-2023-0435
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Article ; Online: The incidence of surgical intervention following a suspected scaphoid fracture.

Ryan, Paul J / Duckworth, Andrew D / McEachan, Jane E / Jenkins, Paul J

Bone & joint open

2024 Volume 5, Issue 4, Page(s) 312–316

Abstract: Aims: The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the ... ...

Abstract	Aims: The underlying natural history of suspected scaphoid fractures (SSFs) is unclear and assumed poor. There is an urgent requirement to develop the literature around SSFs to quantify the actual prevalence of intervention following SSF. Defining the risk of intervention following SSF may influence the need for widespread surveillance and screening of SSF injuries, and could influence medicolegal actions around missed scaphoid fractures. Methods: Data on SSF were retrospectively gathered from virtual fracture clinics (VFCs) across a large Scottish Health Board over a four-year period, from 1 January 2018 to 31 December 2021. The Bluespier Electronic Patient Record System identified any surgical procedure being undertaken in relation to a scaphoid injury over the same time period. Isolating patients who underwent surgical intervention for SSF was performed by cross-referencing the unique patient Community Health Index number for patients who underwent these scaphoid procedures with those seen at VFCs for SSF over this four-year period. Results: In total, 1,739 patients were identified as having had a SSF. Five patients (0.28%) underwent early open reduction and internal fixation (ORIF). One patient (0.06%) developed a nonunion and underwent ORIF with bone grafting. All six patients undergoing surgery were male (p = 0.005). The overall rate of intervention following a SSF was 0.35%. The early intervention rate in those undergoing primary MRI was one (0.36%), compared with three in those without (0.27%) (p > 0.576). Conclusion: Surgical intervention was rare following a SSF and was not required in females. A primary MRI policy did not appear to be associated with any change in primary or secondary intervention. These data are the first and largest in recent literature to quantify the prevalence of surgical intervention following a SSF, and may be used to guide surveillance and screening pathways as well as define medicolegal risk involved in missing a true fracture in SSFs.
Language	English
Publishing date	2024-04-17
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.54.BJO-2023-0059.R1
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Article ; Online: Patient-directed follow-up for the clinical scaphoid fracture.

Chaturvedi, Abhishek / Russell, Heather / Farrugia, Matthew / Roger, Mark / Putti, Amit / Jenkins, Paul J / Feltbower, Stephen

Bone & joint open

2024 Volume 5, Issue 2, Page(s) 117–122

Abstract: Aims: Occult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. ... ...

Abstract	Aims: Occult (clinical) injuries represent 15% of all scaphoid fractures, posing significant challenges to the clinician. MRI has been suggested as the gold standard for diagnosis, but remains expensive, time-consuming, and is in high demand. Conventional management with immobilization and serial radiography typically results in multiple follow-up attendances to clinic, radiation exposure, and delays return to work. Suboptimal management can result in significant disability and, frequently, litigation. Methods: We present a service evaluation report following the introduction of a quality-improvement themed, streamlined, clinical scaphoid pathway. Patients are offered a removable wrist splint with verbal and written instructions to remove it two weeks following injury, for self-assessment. The persistence of pain is the patient's guide to 'opt-in' and to self-refer for a follow-up appointment with a senior emergency physician. On confirmation of ongoing signs of clinical scaphoid injury, an urgent outpatient 'fast'-wrist protocol MRI scan is ordered, with instructions to maintain wrist immobilization. Patients with positive scan results are referred for specialist orthopaedic assessment via a virtual fracture clinic. Results: From February 2018 to January 2019, there were 442 patients diagnosed as clinical scaphoid fractures. 122 patients (28%) self-referred back to the emergency department at two weeks. Following clinical review, 53 patients were discharged; MRI was booked for 69 patients (16%). Overall, six patients (< 2% of total; 10% of those scanned) had positive scans for a scaphoid fracture. There were no known missed fractures, long-term non-unions or malunions resulting from this pathway. Costs were saved by avoiding face-to-face clinical review and MRI scanning. Conclusion: A patient-focused opt-in approach is safe and effective to managing the suspected occult (clinical) scaphoid fracture.
Language	English
Publishing date	2024-02-09
Publishing country	England
Document type	Journal Article
ISSN	2633-1462
ISSN (online)	2633-1462
DOI	10.1302/2633-1462.52.BJO-2023-0119.R1
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Article ; Online: Functional outcome after nonoperative management of minimally displaced greater tuberosity fractures and predictors of poorer patient experience.

Makaram, Navnit S / Khan, L A K / Jenkins, Paul J / Robinson, C M

The bone & joint journal

2023 Volume 105-B, Issue 5, Page(s) 534–542

Abstract: The outcomes following nonoperative management of minimally displaced greater tuberosity (GT) fractures, and the factors which influence patient experience, remain poorly defined. We assessed the early patient-derived outcomes following these injuries ... ...

Abstract	The outcomes following nonoperative management of minimally displaced greater tuberosity (GT) fractures, and the factors which influence patient experience, remain poorly defined. We assessed the early patient-derived outcomes following these injuries and examined the effect of a range of demographic- and injury-related variables on these outcomes. In total, 101 patients (53 female, 48 male) with a mean age of 50.9 years (19 to 76) with minimally displaced GT fractures were recruited to a prospective observational cohort study. During the first year after injury, patients underwent experiential assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score and assessment of associated injuries using MRI performed within two weeks of injury. The primary outcome was the one-year DASH score. Multivariate analysis was used to assess the effect of patient demographic factors, complications, and associated injuries, on outcome. The mean DASH score improved from 42.3 (SD 9.6) at six weeks post-injury, to 19.5 (SD 14.3) at one-year follow-up (p < 0.001), but outcomes were mixed, with 30 patients having a DASH score > 30 at one year. MRI revealed a range of associated injuries, with a full-thickness rotator cuff tear present in 19 patients (19%). Overall, 11 patients (11%) developed complications requiring further operative intervention; 20 patients (21%) developed post-traumatic secondary shoulder stiffness. Multivariate analysis revealed a high-energy mechanism (p = 0.009), tobacco consumption (p = 0.033), use of mobility aids (p = 0.047), a full-thickness rotator cuff tear (p = 0.002), and the development of post-traumatic secondary shoulder stiffness (p = 0.035) were independent predictors of poorer outcome. The results of nonoperative management of minimally displaced GT fractures are heterogeneous. While many patients have satisfactory early outcomes, a substantial subgroup fare much worse. There is a high prevalence of rotator cuff injuries and post-traumatic shoulder stiffness, and their presence is associated with poorer patient experience. Furthermore, patients who have a high-energy injury, smoke, or use walking aids, have worse outcomes.
MeSH term(s)	Humans ; Male ; Female ; Middle Aged ; Rotator Cuff Injuries/diagnostic imaging ; Rotator Cuff Injuries/therapy ; Prospective Studies ; Treatment Outcome ; Shoulder Fractures/diagnostic imaging ; Shoulder Fractures/therapy ; Joint Diseases ; Patient Outcome Assessment
Language	English
Publishing date	2023-05-01
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2697156-2
ISSN	2049-4408 ; 2049-4394
ISSN (online)	2049-4408
ISSN	2049-4394
DOI	10.1302/0301-620X.105B5.BJJ-2022-1142.R1
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Zs.A 6989: Show issues

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Article ; Online: Previous vibration exposure in patients undergoing surgical treatment of Dupuytren's contracture.

Stirling, Paul H C / Jenkins, Paul J / McEachan, Jane E

The Journal of hand surgery, European volume

2020 Volume 45, Issue 5, Page(s) 525–527

MeSH term(s)	Dupuytren Contracture/surgery ; Humans ; Occupational Exposure ; Physical Therapy Modalities ; Risk Factors ; Vibration
Language	English
Publishing date	2020-01-30
Publishing country	England
Document type	Letter
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/1753193420903675
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Article ; Online: The impact of socioeconomic deprivation on patients undergoing surgery for Dupuytren's disease.

Stirling, Paul H C / Jenkins, Paul J / McEachan, Jane E

The Journal of hand surgery, European volume

2020 Volume 45, Issue 9, Page(s) 993–995

MeSH term(s)	Dupuytren Contracture/surgery ; Fascia ; Fibroblasts ; Humans ; Socioeconomic Factors
Language	English
Publishing date	2020-06-14
Publishing country	England
Document type	Letter
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/1753193420930160
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Article ; Online: Self-Perceived Hand Normality Before and After Surgical Treatment of Dupuytren Contracture.

Stirling, Paul H C / Jenkins, Paul J / Clement, Nicholas D / Duckworth, Andrew D / McEachan, Jane E

The Journal of hand surgery

2021 Volume 46, Issue 5, Page(s) 403–408

Abstract: Purpose: To describe patients' self-reported hand normality before and after surgery for Dupuytren contracture and to determine whether this metric could be used as an adjunct to determine the success of surgery.: Methods: Preoperative and 1-year ... ...

Abstract	Purpose: To describe patients' self-reported hand normality before and after surgery for Dupuytren contracture and to determine whether this metric could be used as an adjunct to determine the success of surgery. Methods: Preoperative and 1-year postoperative Quick-Disabilities of the Arm, Shoulder, and Hand and EuroQol 5-Dimensions 5-level scores were collected prospectively over 5 years. Patients were asked "How normal is your hand?" Scores were recorded on a 100-point visual analog scale. Outcomes were available for 296 patients (77%). Results: Median hand normality score improved significantly from 50 to 86 after surgery. Effect size of the change in normality was 1.2 SDs. The change in normality score correlated significantly with the Quick-Disabilities of the Arm, Shoulder, and Hand score. No significant floor or ceiling effects were observed. Conclusions: This study introduced the concept of self-perceived hand normality in Dupuytren disease. Hand normality improved after surgery for Dupuytren disease, and this score performed favorably compared with preexisting outcome measures, which suggests it may be a useful adjunct to gauge the success of surgery. Clinical relevance: This study introduces the concept of self-perceived hand normality in patients undergoing surgery for Dupuytren disease and quantifies improvement observed after surgery.
MeSH term(s)	Dupuytren Contracture/surgery ; Hand/surgery ; Humans ; Pain Measurement ; Shoulder ; Treatment Outcome
Language	English
Publishing date	2021-03-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	605716-0
ISSN	1531-6564 ; 0363-5023
ISSN (online)	1531-6564
ISSN	0363-5023
DOI	10.1016/j.jhsa.2021.01.022
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Zs.A 1431: Show issues

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Article ; Online: Regarding "Surgical treatment of displaced middle-third clavicular fractures: a prospective, randomized trial in a working compensation population".

Jenkins, Paul J / Brooksbank, Andrew J

Journal of shoulder and elbow surgery

2015 Volume 24, Issue 11, Page(s) e320–1

Language	English
Publishing date	2015-11
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	1170782-3
ISSN	1532-6500 ; 1058-2746
ISSN (online)	1532-6500
ISSN	1058-2746
DOI	10.1016/j.jse.2015.07.021
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Article ; Online: The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release.

Maempel, Julian F / Jenkins, Paul J / McEachan, Jane E

The Journal of hand surgery, European volume

2019 Volume 45, Issue 2, Page(s) 147–152

Abstract: We studied whether mental health status is significantly correlated to patient reported functional outcomes and satisfaction after carpal tunnel release. Over a 7-year period, 809 patients completed Short Form-12 (SF-12) questionnaires which allowed ... ...

Abstract	We studied whether mental health status is significantly correlated to patient reported functional outcomes and satisfaction after carpal tunnel release. Over a 7-year period, 809 patients completed Short Form-12 (SF-12) questionnaires which allowed calculation of the SF-12 mental component summary 1 year postoperatively, 780 (96%) completed a satisfaction questionnaire and 777 (96%) completed a QuickDisabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Median QuickDASH score was 55 preoperatively (interquartile range [IQR] 28) and 14 postoperatively (IQR 32). A total of 674 patients were satisfied. Patients with mental disability had worse QuickDASH scores (median 34, IQR 41) and a higher incidence of dissatisfaction (52/245, 21%) than those without mental disability (n = 9, IQR 20, 10%, both
MeSH term(s)	Carpal Tunnel Syndrome/surgery ; Disability Evaluation ; Hand ; Health Status ; Humans ; Patient Satisfaction ; Personal Satisfaction ; Surveys and Questionnaires ; Treatment Outcome
Language	English
Publishing date	2019-08-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/1753193419866400
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Article ; Online: A cost-utility analysis of open A1 pulley release for the treatment of trigger finger.

Stirling, Paul H C / Clement, Nicholas D / Jenkins, Paul J / Duckworth, Andrew D / McEachan, Jane E

The Journal of hand surgery, European volume

2020 Volume 45, Issue 10, Page(s) 1083–1086

Abstract: The United Kingdom National Institute for Health and Care Excellence considers a procedure to be cost-effective if the cost per quality-adjusted life year gained falls below a threshold of £20,000-£30,000 (€22,600-33,900; US$24,600-$36,900). This study ... ...

Abstract	The United Kingdom National Institute for Health and Care Excellence considers a procedure to be cost-effective if the cost per quality-adjusted life year gained falls below a threshold of £20,000-£30,000 (€22,600-33,900; US$24,600-$36,900). This study used cost per quality-adjusted life year methodology to determine the cost-utility ratio of A1 pulley release. Pre- and postoperative EuroQol 5 Dimensions 5 Likert scores were collected prospectively over 6 years from 192 patients. The median pre- and postoperative indices derived from the EuroQol 5 Dimensions 5 Likert scores were significantly different at 0.77 and 0.80. The mean life expectancy was 21 years. The mean number of quality-adjusted life years gained was 1 per patient. The mean cost-utility ratio per patient was £32,308 (€36,508; US$39,730) and £16,154 (€18,254; US$19,869) at 1 and 2 years, respectively. Provided the benefit of surgery was maintained over the remaining life expectancy, the cost-utility ratio decreased to £1537 (€1737; US$1891) per patient. A1 pulley release is cost-effective provided the benefit is maintained for 2 years. The procedure is also associated with a statistically significant improvement in quality of life.
MeSH term(s)	Cost-Benefit Analysis ; Humans ; Quality of Life ; Quality-Adjusted Life Years ; Trigger Finger Disorder/surgery ; United Kingdom
Language	English
Publishing date	2020-05-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2272801-6
ISSN	2043-6289 ; 1753-1934
ISSN (online)	2043-6289
ISSN	1753-1934
DOI	10.1177/1753193420926420
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