Letter to the Editor
Relevance of a normal ultrasound study in patients with non-traumatic acute shoulder pain
Importancia de la ecografía normal en pacientes con dolor agudo de hombro de origen no traumático
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A) Aspecto de las regiones supraclaviculares del paciente varón de 78 años, en el que se aprecia clara simetría del triángulo supraclavicular derecho respecto del izquierdo. B) Radiografía de tórax del mismo paciente en la que se observa una masa pulmonar posteriormente filiada como un carcinoma epidermoide. C) Radiografía de tórax posteroanterior de una mujer de 50 años con dolor agudo de hombro, en la que se aprecia un neumotórax completo del hemitórax derecho sin desviación mediastínica.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Antonio Guillen Astete, Veronica Garcia Garcia, Monica Luque Alarcon" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carlos Antonio" "apellidos" => "Guillen Astete" ] 1 => array:2 [ "nombre" => "Veronica" "apellidos" => "Garcia Garcia" ] 2 => array:2 [ "nombre" => "Monica" "apellidos" => "Luque Alarcon" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574319301832" "doi" => "10.1016/j.reumae.2018.10.024" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => 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patients with non-traumatic acute shoulder pain" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "509" "paginaFinal" => "510" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Antonio Guillen Astete, Veronica Garcia Garcia, Monica Luque Alarcon" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Carlos Antonio" "apellidos" => "Guillen Astete" "email" => array:1 [ 0 => "cguillen.hrc@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Veronica" "apellidos" => "Garcia Garcia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Monica" "apellidos" => "Luque Alarcon" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario Clínico San Carlos, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Importancia de la ecografía normal en pacientes con dolor agudo de hombro de origen no traumático" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Photo 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1878 "Ancho" => 2500 "Tamanyo" => 333635 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with acute shoulder pain and normal ultrasound scan results. (A) Appearance of the supraclavicular regions of the male patient aged 78 years old, clearly showing the asymmetry of the right supraclavicular triangle in comparison with the left one. (B) Thoracic X-ray image of the same patient, showing a pulmonary mass subsequently identified as epidermoid carcinoma. (C) Posteroanterior X-ray image of a 50-year-old woman with acute shoulder pain, showing a complete pneumothorax of the right hemithorax without mediastinal deviation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Non-traumatic acute shoulder pain occupies an important place within emergency hospital visits, accounting for about 7% of all visits due to locomotor system problems.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Ultrasound scan is an extremely useful tool in the study of this complaint, complementing the preparation of a correct clinical history and detailed physical examination, permitting easily accessed confirmatory etiological identification with a precision comparable to that of magnetic resonance imaging.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In general terms the most frequent cause of chronic shoulder pain is tendon disease (or tendinopathy). This definition covers all disease that alters fibrous tendon architecture.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a> While partial and complete tendon tears are often found in elderly patients, with or without fatty muscular degeneration, tendinosis tends to be found more often in younger patients (defined as the presence of changes in echogenicity in the fibrous structure or thickening of part or all of the tendon), or partial tears that break the continuity of the fibres.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3–5</span></a> Structural changes, fundamentally tendinous ones, can be detected in patients with acute or chronic omalgia, while in acute cases it is far more common to observe bursitis or bleeding in the biceps sheath.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> Nevertheless, it is rare to encounter cases of acute shoulder pain in which the ultrasound scan of the shoulder is normal. In our recent experience we have identified 10 cases of patients with acute omalgia and normal shoulder ultrasound scan results whose final diagnoses were especially alarming. We believe it is relevant to report these cases due to their clinical importance (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Two patients, both males aged 65 and 78 years old, had visited due to shoulder pain with mechanical characteristics. Both of them had been examined radiologically and they had received conservative treatment, with rest and first level analgesics. The 78-year-old male had asymmetry of the right supraclavicular triangle, corresponding to the painful shoulder (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B). After a normal ultrasound scan of the shoulder, both patients were found to have primary tumours of the lung.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">A 50-year-old Asiatic woman visited due to right shoulder pain. The physical examination and ultrasound scan of the shoulder were both normal. Given the lack of correspondence between the intensity of the symptoms and the normality of the ultrasound scan an X-ray was taken which showed right pneumothorax (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two patients, a 55-year-old man and a woman of the same age and both immunocompetent, originally visited due to recent mechanical omalgia. They were eventually diagnosed as cases of sternoclavicular septic arthritis. Both cases were exhaustively described beforehand.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> A third patient, a 48-year-old male, with a history of infection by human immunodeficiency virus and in antiretroviral treatment had sternoclavicular septic arthritis 2 weeks after having commenced with ipsilateral omalgia that a week afterwards led to study of the shoulder by ultrasound scan that was reported as normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Three patients, 2 men aged 40 and 22 years old, and a woman aged 45 years old, whose cases were described beforehand by our group,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> visited due to acute shoulder pain with major functional repercussion. In all 3 cases the ultrasound scan report was normal. After neurophysiological studies they were diagnosed with Parsonage–Turner syndrome (PTS). Recently, a 60-year-old male patient who had recently received an anti-tetanus vaccination with immunoglobulin, had the same symptoms with normal results of ultrasound scan of the shoulder. The electrophysiological study was compatible with PTS. In our accumulated experience from 2011 to 2017, the volume of normal ultrasound scan reports corresponding to patients who visited the emergency department with acute shoulder pain (arbitrarily considered to have evolved during less than 3 weeks, due to the characteristics of the demand for care in our hospital) represents about 7% of all ultrasound explorations. The 10 cases we describe in this letter represent approximately one third of our normal number of normal reports. We believe that it is important to underline that in cases of acute omalgia, after a detailed clinical history and meticulous physical examination, that a normal ultrasound scan report should be followed by a broader diagnostic study, given that some differential diagnoses of shoulder pain with normal ultrasound scan results require prompt therapeutic intervention.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Guillen Astete CA, Garcia Garcia V, Luque Alarcon M. Importancia de la ecografía normal en pacientes con dolor agudo de hombro de origen no traumático. Reumatol Clin. 2020;16:509–510.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Photo 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1878 "Ancho" => 2500 "Tamanyo" => 333635 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients with acute shoulder pain and normal ultrasound scan results. (A) Appearance of the supraclavicular regions of the male patient aged 78 years old, clearly showing the asymmetry of the right supraclavicular triangle in comparison with the left one. (B) Thoracic X-ray image of the same patient, showing a pulmonary mass subsequently identified as epidermoid carcinoma. (C) Posteroanterior X-ray image of a 50-year-old woman with acute shoulder pain, showing a complete pneumothorax of the right hemithorax without mediastinal deviation.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age (years), sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final diagnosis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diagnostic medium \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lung cancer, small cell \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radiology, anatomopathology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Epidermoid lung carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radiology, anatomopathology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Spontaneous pneumothorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Radiology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sternoclavicular septic arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microbiology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sternoclavicular septic arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microbiology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sternoclavicular septic arthritis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microbiology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parsonage–Turner syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurophysiology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parsonage–Turner syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurophysiology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45, female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parsonage–Turner syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurophysiology \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parsonage–Turner syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurophysiology \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2436699.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Summarised description of cases of shoulder pain with a normal ultrasound scan.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of non-traumatic musculoskeletal pathology as main complaint and its impact in a emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 71 | 33 | 104 |
| 2024 September | 72 | 36 | 108 |
| 2024 August | 75 | 48 | 123 |
| 2024 July | 61 | 24 | 85 |
| 2024 June | 84 | 35 | 119 |
| 2024 May | 73 | 52 | 125 |
| 2024 April | 69 | 23 | 92 |
| 2024 March | 65 | 24 | 89 |
| 2024 February | 62 | 27 | 89 |
| 2024 January | 54 | 23 | 77 |
| 2023 December | 46 | 27 | 73 |
| 2023 November | 59 | 38 | 97 |
| 2023 October | 69 | 21 | 90 |
| 2023 September | 92 | 28 | 120 |
| 2023 August | 60 | 12 | 72 |
| 2023 July | 72 | 22 | 94 |
| 2023 June | 73 | 23 | 96 |
| 2023 May | 79 | 31 | 110 |
| 2023 April | 58 | 17 | 75 |
| 2023 March | 78 | 34 | 112 |
| 2023 February | 63 | 39 | 102 |
| 2023 January | 65 | 26 | 91 |
| 2022 December | 84 | 43 | 127 |
| 2022 November | 66 | 37 | 103 |
| 2022 October | 89 | 42 | 131 |
| 2022 September | 68 | 41 | 109 |
| 2022 August | 58 | 36 | 94 |
| 2022 July | 62 | 49 | 111 |
| 2022 June | 77 | 43 | 120 |
| 2022 May | 56 | 38 | 94 |
| 2022 April | 65 | 42 | 107 |
| 2022 March | 80 | 58 | 138 |
| 2022 February | 61 | 39 | 100 |
| 2022 January | 77 | 38 | 115 |
| 2021 December | 62 | 44 | 106 |
| 2021 November | 37 | 38 | 75 |
| 2021 October | 52 | 62 | 114 |
| 2021 September | 34 | 45 | 79 |
| 2021 August | 29 | 29 | 58 |
| 2021 July | 23 | 19 | 42 |
| 2021 June | 28 | 34 | 62 |
| 2021 May | 34 | 36 | 70 |
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