Abstract:
BACKGROUND:Shoulder injury from vaccination was approved for automatic compensation from the Vaccine Injury Compensation Program (VICP)-a federal government program started in 1988 to shield the manufacturers of childhood vaccines from liability. The approval was made on the basis of case reports rather than experimental evidence. This, combined with the addition of influenza vaccination to the VICP in 2005 (which broadened coverage to include adults) and other social factors, was associated with a rapid rise in the number of claims of shoulder injury from vaccination over the last decade, which now account for more than half of all claims to the VICP. Given the high prevalence of newly symptomatic sources of shoulder pain such as rotator cuff tendinopathy, combined with the high prevalence of annual influenza vaccinations, there is a substantial risk of overlap leading to the post hoc ergo propter hoc fallacy ("after this, therefore because of this") contributing to misdiagnosis and inappropriate management of patients that perceive injury from vaccination. Records of medical care after a large number of vaccinations have a good chance of detecting serious shoulder pathology, even it is uncommon, which would result in an increased prevalence of visits for shoulder problems and specific types of shoulder pathology. QUESTIONS/PURPOSES:Is there a difference in the proportion of visits for shoulder pain within 3 months before and after vaccination among students and faculty receiving an influenza vaccination in the shoulder? METHODS:We studied people who were vaccinated for influenza between 2009 and 2018 at a university health service. During the study period, a comprehensive billing database identified 24,206 influenza vaccinations administered to 12,870 people (median age 20 years, range 16-77; 57% women). We had 80% power to detect a 0.1% increase in the proportion of shoulder problems after vaccination compared with before vaccination. Visits with coded ICD-9 shoulder diagnoses were identified from the electronic medical record. We compared the proportion of shoulder evaluations within 3 months before and 3 months after vaccination. RESULTS:With the numbers available, the proportion of visits for shoulder problems were not different before (1.1% [52 of 4801]) and after vaccination (1% [40 of 3977], risk ratio 1.1 [95% CI 0.8 to 1.5]; p = 0.72). Among all vaccinations, 49% (11,834 of 24,206) were preceded or followed by an appointment within 3 months before (20% [4801 of 24,206]), after (16% [3977]), or both before and after (13% [3056]) vaccine administration, and 1.4% (170) of these visits were related to a shoulder issue. The most common reason for shoulder-related appointments was atraumatic shoulder pain (79% [134 of 170]). CONCLUSIONS:Shoulder symptoms sufficient to seek care are notably common, even among relatively young adults, and are not more common after vaccination. Although this does not rule out an important rare pathology specific to vaccination, it seems important to consider the potential harms of assuming, based largely on chronology, that persistent shoulder pain after vaccination-something expected to be common based merely on the anticipated frequency of overlap of vaccination and common shoulder problems-represents harm from vaccine. LEVEL OF EVIDENCE:Level III, therapeutic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Gonzalez AI,Kortlever JTP,Moore MG,Ring DCdoi
10.1097/CORR.0000000000001215subject
Has Abstractpub_date
2020-10-01 00:00:00pages
2343-2348issue
10eissn
0009-921Xissn
1528-1132journal_volume
478pub_type
杂志文章abstract::Loading of the lunate in patients with Kienböck's disease and a negative ulnar variance provide the rationale for a radial shortening osteotomy. This osteotomy decreases forces transmitted from the radius to the lunate. We retrospectively reviewed 12 patients with Kienböck's disease who had 13 radial shortening osteot...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/BLO.0b013e318041d309
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Radial head alignment is the key to determine elbow reduction after treatment of subluxations or Monteggia fractures. The radiocapitellar ratio (RCR) quantifies the degree of subluxation, by evaluating radial head alignment with the capitellum of the humerus; this ratio is reproducible when measured on true ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-3027-2
更新日期:2013-08-01 00:00:00
abstract::Ninety-two patients with IIB osteosarcoma of the extremities were treated with intraarterial (IA) cisplatinum (CDDP) followed by surgery [amputation (61.6%) or resection with endoprosthesis (38.4%)]. Postoperative chemotherapy alternating adriamycin and CDDP was used. The total three-year survival was 62.1%, and the d...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-09-01 00:00:00
abstract::During a consensus conference in Fall, 1998, the Academic Orthopaedic Society identified the values and qualities of professionalism as defined by its members. One hundred eighty-six respondents rated 20 characteristics and values describing professionalism, based on the extent to which they believed each item was app...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200009000-00015
更新日期:2000-09-01 00:00:00
abstract::The results of 65 consecutive revision total knee arthroplasties performed for mechanical failure were reviewed. Fifty-nine of the knees were followed for an average of five years (range, 2-10 years). The types of implants used included: total condylar, posterior stabilized, total condylar III, and the kinematic rotat...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-01-01 00:00:00
abstract::Certain deformities of the hip joint seem to predispose the hip to the development of osteoarthrosis. Successful surgical correction of these deformities before the onset of osteoarthrosis requires accurate characterization of the anatomic deviations from normal as the first step in planning corrective osteotomy. Thre...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract::Whether a preoperative long leg radiograph taken with the patient standing helps the surgeon reproduce a normal mechanical axis after total knee arthroplasty is unknown. The purpose of the current study was to evaluate whether a preoperative long leg radiograph helps to restore normal limb alignment after total knee a...
journal_title:Clinical orthopaedics and related research
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003086-200211000-00032
更新日期:2002-11-01 00:00:00
abstract::The optimal method of fixation during periacetabular osteotomy is unknown. Periacetabular osteotomies were created on both sides of six whole pelves from fresh cadavers and were fixed randomly either with three long 4.5-mm cortical screws from the iliac crest to the osteotomized fragment (iliac fixation) or with two s...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200210000-00032
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:Amphotericin B is a highly hydrophobic antifungal used for orthopaedic infections. There is disagreement about whether amphotericin B is released when it is loaded in polymethylmethacrylate (PMMA). It is unknown how much a poragen will increase amphotericin B release or decrease the compressive strength of t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-011-1928-5
更新日期:2011-11-01 00:00:00
abstract::The present study evaluated cortical porosity and thickness of intact rat femora 12 weeks after intramedullary reaming and nailing. The right femora were reamed and received either flexible polyacetal nails or rigid stainless steel nails. A third group was reamed but not nailed. The left femora were used as controls. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1989-09-01 00:00:00
abstract::Progressive heterotopic ossification leads to ankylosis of the major joints in patients who have fibrodysplasia ossificans progressiva. Joint subluxation has not been recognized widely in patients with this disease. The clinical records and radiographs of 79 patients with fibrodysplasia ossificans progressiva were rev...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1998-01-01 00:00:00
abstract:BACKGROUND:Many patients change hospitals for revision total joint arthroplasty (TJA). The implications of changing hospitals must be better understood to inform appropriate utilization strategies. QUESTIONS/PURPOSES:(1) How frequently do patients change hospitals for revision TJA? (2) Which patient, community, and ho...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,多中心研究
doi:10.1007/s11999-014-3515-z
更新日期:2014-07-01 00:00:00
abstract:UNLABELLED:The treatment and prognosis of labral tears of the hip depend primarily on whether there is concomitant injury of the adjacent acetabular articular cartilage. We asked whether a delamination cyst on the preoperative plain radiographs correlated with delamination of the acetabular articular cartilage at the t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0564-1
更新日期:2009-04-01 00:00:00
abstract::Roentgenographic analysis showed that centrifugation significantly reduced the gross and regional porosity of the cement compared with hand-mixed controls in a simulated total hip arthroplasty model. Static failure test of the prosthetic system demonstrated that the centrifuged cement had significantly greater strengt...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:Studies suggest, even when controlling for disease severity, socioeconomic status, education, and access to care, racial and ethnic minorities receive lower-quality health care and have worse perceived pain and function before and after total joint arthroplasty. QUESTION/PURPOSES:We evaluated the influence ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-011-1841-y
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Successful brace treatment entails good control of scoliosis with avoidance of surgery. However, achieving curve regression may be an even better radiological result than prevention of curve progression for patients with adolescent idiopathic scoliosis. Vertebral remodeling may occur with well-fitted braces....
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000000989
更新日期:2020-02-01 00:00:00
abstract::Delay in surgical intervention has been reported to enhance the process of fracture healing. Quantitative observations or experimental osteotomies were made to investigate the mechanical for such enhancement. Eight mongrel dogs with bilateral radial osteotomies were prepared with immediate plate fixation on the right ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-03-01 00:00:00
abstract:BACKGROUND:The failure rate of tendon-bone healing after repair of rotator cuff tears remains high. A variety of biologic- and cell-based therapies aimed at improving rotator cuff healing have been investigated, and stem cell-based techniques have become increasingly more common. However, most studies have focused on t...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-015-4218-9
更新日期:2015-05-01 00:00:00
abstract::A histologic study of vertebral end plates was performed on young rats' tails subjected to intensive passive motion. Seven six-week-old rats had two-hour motion cycles daily, for two months. Histologic changes of proximal caudal vertebrae in the experimental group were compared with those of a control group of seven r...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-06-01 00:00:00
abstract::A 28-year-old woman with fascioscapulohumeral muscular dystrophy was treated with a one-stage bilateral scapulothoracic fusion. At operation, cortical allografts with screw fixation for anchorage were used, supplemented with autologous cancellous bone. A proper balance and symmetry of the shoulder girdle can be restor...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-12-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-09-01 00:00:00
abstract::Pathologic fractures of the proximal femur secondary to benign bone tumors often are difficult to treat because of specific anatomic features of this region and the aggressiveness of the tumors. Between 1986 and 1996, 11 patients presented with a pathologic fracture of the proximal femur secondary to a benign bone tum...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200112000-00032
更新日期:2001-12-01 00:00:00
abstract::The acute and repetitive impact and torsional joint loading that occurs during participation in sports can damage articular surfaces causing pain, joint dysfunction, and effusions. In some instances, this articular surface damage leads to progressive joint degeneration. Three classes of chondral and osteochondral inju...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-200209000-00004
更新日期:2002-09-01 00:00:00
abstract::The Jehovah's Witnesses do not accept allogeneic blood transfusion or certain types of autologous blood transfusion and, therefore, present the orthopaedic surgeon with a challenge in the management of perioperative blood loss. Accepting a patient who is a Jehovah's Witness as a surgical candidate requires the surgeon...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199912000-00026
更新日期:1999-12-01 00:00:00
abstract:UNLABELLED:To augment cement-bone bonding, we interposed hydroxyapatite granules at the cement-bone interface (bioactive bone cement technique). Hydroxyapatite granules (2-3 g) were smeared on the bone surface of the acetabulum and femur just before cementing. We used porous hydroxyapatite granules 300 to 500 microm in...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-007-0057-7
更新日期:2008-02-01 00:00:00
abstract::The influence of suturing on cell infiltration into the meniscus and surrounding tissue is not well known. Histologic changes in the meniscus after suturing and prediction of histologic changes using magnetic resonance imaging were studied. Forty knees in 20 mongrel dogs were studied using four types of 4-0 suture mat...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200106000-00031
更新日期:2001-06-01 00:00:00
abstract::Theoretical consideration of the factors involved in maintaining vascular equilibrium and experimental evidence in animals and man indicate that at high tissue pressures there may be a sharp decline in blood flow and, in certain situations, complete cessation of blood flow even at tissue pressures below mean arterial ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-197511000-00004
更新日期:1975-11-01 00:00:00
abstract::Distal radial fractures in patients who are younger than the age when osteoporosis usually develops are different from fractures in the elderly. Arthroscopy has revealed these fractures often have a complex pattern of fracture related chondral and ligament injuries in the wrist. In Lund, Sweden, of the 92 distal radia...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200007000-00031
更新日期:2000-07-01 00:00:00
abstract::The histopathologic changes leading to rotator cuff rupture are gradual and progressive. Incomplete tears can be observed in the articular or bursal surface. These partial lesions are infrequently demonstrated with arthrography or bursography. Although structural variations in cuff integrity can be demonstrated with u...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1990-05-01 00:00:00
abstract::Ectopic bone formation (EBF) is a well-known complication of total hip arthroplasty (THA). The etiology and pathogenesis are still obscure. An analysis of 119 consecutive patients with 129 primary THAs was performed to identify factors predisposing to ectopic bone formation, its frequency, and its effect on the result...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1988-03-01 00:00:00