Participation in a physical therapy program is considered one of the greatest predictors for successful conservative management of common shoulder disorders, however, adherence to standard exercise protocols is often poor (around 50%) and typically worse for unsupervised home exercise programs. Currently, there are limited tools available for objective measurement of adherence and performance of shoulder rehabilitation in the home setting. The goal of this study was to develop and evaluate the potential for performing home shoulder physiotherapy monitoring using a commercial smartwatch. We hypothesize that shoulder physiotherapy exercises can be classified by analyzing the temporal sequence of inertial sensor outputs from a smartwatch worn on the extremity performing the exercise. Twenty healthy adult subjects with no prior shoulder disorders performed seven exercises from a standard evidence-based rotator cuff physiotherapy protocol: pendulum, abduction, forward elevation, internal/external rotation and trapezius extension with a resistance band, and a weighted bent-over row. Each participant performed 20 repetitions of each exercise bilaterally under the supervision of an orthopaedic surgeon, while 6-axis inertial sensor data was collected at 50 Hz from an Apple Watch. Using the scikit-learn and keras platforms, four supervised learning algorithms were trained to classify the exercises: k-nearest neighbour (k-NN), random forest (RF), support vector machine classifier (SVC), and a deep convolutional recurrent neural network (CRNN). Algorithm performance was evaluated using 5-fold cross-validation stratified first temporally and then by subject. Categorical classification accuracy was above 94% for all algorithms on the temporally stratified cross validation, with the best performance achieved by the CRNN algorithm (99.4± 0.2%). The subject stratified cross validation, which evaluated classifier performance on unseen subjects, yielded lower accuracies scores again with CRNN performing best (88.9 ± 1.6%). This proof-of concept study demonstrates the feasibility of a smartwatch device and machine learning approach to more easily monitor and assess the at-home adherence of shoulder physiotherapy exercise protocols. Future work will focus on translation of this technology to the clinical setting and evaluating exercise classification in shoulder disorder populations

Introduction: Self-administered questionnaires are commonly used to evaluate functional and satisfaction results of different treatments applied. The objective of the study is to analyze the effect of the doctor-patient interview in the self-evaluation of the patient of the pain, level of function and satisfaction in different shoulder procedures. Material and Method: 95 consecutive patients were recruited. There were 70 females and 25 males. Mean age of 64,18 yo (20–88). There were 28 fracture cases, 37 cuff disorders, 6 instabilities and 21 gleno-humeral arthritis. 46 patients had received surgery while 49 did not. 24 patients were excluded because of wrong complementation of the questionnaire. All the patients were asked to fill 3 analogical scales (level of shoulder pain, level of shoulder function and satisfaction with the procedure) before and after the clinical visit. Non parametric values studied through U-Mann-Whitney. Results: Analyzing the whole series there were significant differences between the pain experienced in the shoulder before and after the visit (p=0,039). There were marginally significant differences between the level of function of the shoulder experienced before and after visit (p=0,061), and there were no differences in satisfaction with the procedure (p=0,462). If the cohort of patients that had received surgery is analyzed apart, there are significant differences in pain perception (p=0,05) and also in function perception (p=0,046) but no differences were noted with satisfaction even though patients tend to perceive more satisfaction after visit. Females significantly considered less pain after visit than males (p=0,034) and no differences were noted because of age, diagnosis or time elapsed since surgery. Conclusions: Globally, patients with shoulder disorders significantly consider to have less pain perception after clinical visit. Patients that had received surgery because of the shoulder disorder significantly perceive less pain and better shoulder function after visit. Satisfaction with the procedure tends to improve after visit but that is not significant. Even a simple analogical scale has a 25% drop-outs because of wrong complementation. When planning patient self-evaluation of pain and function the effect of the clinical visit has to be considered in order to avoid masking results

Purpose: Some of nowadays treatments in shoulder pathology are focused in pain drop, but is to be evidenced than pain is the most reliable item in shoulder patient’s quality of life. The purpose of this study is to analyze quality of life in patients affected of different shoulder pathologies and check how pain and movement influence quality of life perception (QLP). Material And Methods: 134 patients correctly filled the shoulder functional Constant score and the SF-36 score. Patients were classified by age, sex, labor status, level of education and diagnosis. There were 56 men (41,79%) and 78 women (58,21%). Mean age was 53,77 (18–85). Amongst them, 74 patients were classified as subacromial syndrome, 19 as fractures, 29 degenerative pathology and 12 as shoulder instability. Student’s T test was performed to study quantitative variables. Qualitive variables were studied using ANOVA test. Impact of pain and mobility on patients’ quality of life was assessed by Rho-Spearman’s test. Statistical regression coefficient was used to evaluate the impact of pain and mobility in perceived quality of life. Results: There were statistically significant differences amongst age, sex and diagnosis groups (p< 0,001). Patients older than 65 years old significatively (p< 0.001) perceived worst quality of life. Women and patients affected by a degenerative disorder significatively perceived worst quality of life (p< 0.001). A relationship between movement and quality of life was founded (linear trend). In patients with preserved range of motion, changes in pain perception significatively affected PQL (p< 0,001), meanwhile patients with poor range of motion, changes in pain perception did not affect PQL (p> 0,001). The regression coefficient for pain related to SF-36 Physical component scale was 0,629 (IC: 0,301–0.958), meanwhile the regression coefficient for external rotation is 1,196 (IC: 0,693–1,699), giving thus a predominant effect of extenal rotation in PQL. Conclusion/Discussion: Age, sex and etiology of shoulder disorder determine different perceptions of quality of life independently of the shoulder functional scoring. Range of motion significatively affect QLP independently of the level of pain. Pain affects QLP in patients whom range of motion is preserved. External rotation is the most important item affecting QLP. Factors determining quality of life perception should be taken into account when planning surgery strategies for different shoulder disorders

Summary Statement. We measured scapulothoracic motions during humeral abduction with different humeral rotations in healthy subjects and whole cadaver models and clarified that humeral rotation significantly influenced scapular kinematics. Introduction. Scapular dyskinesis has been observed in various shoulder disorders such as impingement syndrome or rotator cuff tears. However, the relationship between scapular kinematics and humeral positions remains unclear. We hypothesised that humeral rotation would influence scapular motions during humeral abduction and measured scapular motion relative to the thorax in the healthy subjects and whole cadavers. Methods. Healthy Subjects: Twenty-four shoulders of twelve healthy subjects without shoulder disorders were enrolled. Three electromagnetic sensors were attached on the skin over the sternum, scapula and humerus. Scapular motions during scapular plane abduction (abduction) were measured. The measurements were performed with four hand positions, palm up, thumb up, palm down and thumb down. The elbow was kept extended in all measurements. Each measurement took 5 seconds and repeated three times. Cadavers: Twelve shoulders from 6 fresh whole cadavers were used. A cadaver was set in sitting position on a wooden chair without interrupting scapular motions. Electromagnetic sensors were attached on the thorax, scapula and humerus rigidly with transcortical pins. The elbow was kept in extended position by holding the forearm and the arm was moved passively. The measurements were performed during scapular plane abduction and scapular kinematics were measured in four hand positions, 1: thumb up, 2; palm up, 3; palm down, 4; thumb down as well as the healthy subjects. Each measurement took 5 seconds and repeated three times. Data Analysis: The coordinate system and rotation angles of the thorax, scapula and humerus were decided following ISB recommendation. A one-way analysis of variance was used to test the differences in 4 arm positions. Dunnet's multiple post hoc tests were used to identify the difference between thumb up model (neutral rotation) and other three arm positions. Results. Scapular posterior tilt increased during palm up abduction (healthy subjects −2.0° to 0.1°, cadaver −3.2° to −1.4° at 120° of abduction). During thumb-down abduction, scapular posterior tilt decreased (healthy subjects −4.1° to −8.0° at 110° of abduction, cadaver −3.2° to −8.6° at 120° of abduction) and scapular upward rotation increased (healthy subjects 21.0° to 26.1° at 110° of abduction, cadaver 25.3° to 31.1° at 120° of abduction). Thumb down abduction demonstrated no significant difference from thumb up position. Discussion. Scapular motions measured in healthy subjects and cadaver models showed similar patterns indicating that surface markers on the healthy subjects could track scapular motions successfully as bone markers in cadaver models. Humeral external rotation increased scapular posterior tilt and humeral internal rotation increased scapular anterior tilt and upward rotation. This suggests that position of the greater and lesser tuberosity and tension of the joint capsule caused scapular tilt and scapular upward rotation. Kinematic changes caused by humeral rotations were observed in earlier phase of abduction in healthy subjects than in cadaver models. This suggests that healthy subjects set scapular position beforehand not to increase subacromial pressure. Conclusion. Humeral rotation significantly influenced scapular kinematics. Assessment for these patterns is important for evaluation of shoulder pathology associated with abnormal scapular kinematics

Reverse shoulder arthroplasty is becoming a frequent treatment of choice for patients with shoulder disorders. Complication rates after reverse shoulder arthroplasty may be three-fold that of conventional total shoulder arthroplasty especially in high risk patient populations and diagnoses like revision arthroplasty, fracture sequelae, and severe glenoid bone loss. Complications include component malposition, stiffness, neurological injury, infection, dislocation or instability, acromial or scapular spine fractures, scapular notching, and loosening of implants. Recognition of preoperative risk factors and appropriate 3D planning are essential in optimizing patient outcome and intraoperative success. Failure of reverse shoulder arthroplasty is a significant challenge requiring appropriate diagnosis of the failure mode. The most common neurological injuries involve the brachial plexus and the axillary nerve due to traction, manipulation of the arm, aberrant retractor placement, or relative lengthening of the arm. Intraoperative fractures are relatively uncommon but include the greater tuberosity, acromion, and glenoid. Tuberosity fracture can be repaired intraoperatively with suture techniques, glenoid fractures may be insignificant rim fractures or jeopardise baseplate fixation and require abandoning RSA until glenoid fracture ORIF heals and then a second stage RSA. Periprosthetic infection after RSA ranges from 1 to 10% and may be higher in revision cases and frequently is Propionibacterium acnes and Staphylococcus epidermidis. Dislocation was one of the most common complications after RSA approximately 5% but with increased surgeon experience and prosthetic design, dislocation rates are approaching 1–2%. An anterosuperior deltoid splitting approach has been associated with increased stability as well as subscapularis repair after RSA. Scapular notching is the most common complication after RSA. Notching may be caused by direct mechanical impingement of the humerosocket polyethylene on the scapular neck and from osteolysis from polyethylene wear. Sirveaux classified scapular notching based on the defect size as it erodes behind the baseplate towards the central post. Acromial fractures are infrequent but more common is severely eroded acromions from CTA, with osteoporosis, with excessive lengthening, and with superior baseplate screws that penetrate the scapular spine and create a stress riser. Nonoperative care is the mainstay of acromial and scapular spine fractures. Recognizing preoperative risk factors and understanding component positioning and design is essential to maximizing successful outcomes

Subacromial bursa fibrosis are linked to rotator cuff lesion with shoulder stiffness; however, the mechanism underlying this shoulder disorder remain elusive. MicroRNA-29s (miR-29s) are emerging fibrosis inhibitor targeting fibrogenic matrices during tissue fibrosis. This study is aimed to investigate clinical relevance and function of miR-29 signalling to subacromial bursa homeostasis in shoulder stiffness. Subacromial bursa in patients with rotator cuff lesion with or without shoulder stiffness who required open acromioplasty were harvested for assessing fibrosis histopathology using Manson's trichrome staining. Expressions of proinflammatory cytokines, fibrotic matrices, and miR-29s were quantified using RT-PCR and in situ hybridization. Range of motion and pain scores of the stiffness group were higher than those of non-stiffness group. Upregulated proinflammatory cytokines (IL-1β, IL-6, and TNF-α) and fibrotic matrices (collagen 1α1, 3α1, and 4α1) but decreased miR-29a and b expression existed in the stiffness group. Affected tissues exhibited severe fibrotic matrix accumulation, synovial hyperangiogenesis, hyperplasia, and strong miR-29a transcripts. In vitro, IL-1β rather than IL-6 and TNF-α decreased miR-29a expression of subacromial bursa fibroblasts. miR-29a knockdown escalated fibrotic matrix expression, whereas forced miR-29a expression alleviated the IL-1β-induced fibrotic matrix expression. Of interest, miR-29a transgenic mice displayed moderate responses to supraspinatus and infraspinatus tenotomy-induce fibrosis and gait irregularity of affected shoulders. Weak miR-29 signalling causes excessive fibrosis and remodelling in subacromial bursa and ultimately increases the prevalence of shoulder stiffness. This study reveals a new mechanistic underlying shoulder stiffness and highlights that sustained miR-29a potentially ameliorates the severity and function of stiff shoulder

We report a long term experience on massive rotator cuff tears treated by the means of a nonresorbable transosseously fixed patch combined with a subacromial decompression. From December 1996 until August 2002, a total of 41 patients were treated with a synthetic interposition graft and subacromial decompression. All patients had a preoperative ultrasound evidence of a primary massive full-thickness tear that was thought to be irreparable by simple suture. All patients were evaluated pre- and postoperatively using the Constant and Murley score, DASH questionnaire, Simple Shoulder Test, VAS scale for pain, ultrasound and plain radiographs. The patients consisted of 23 men and 18 women aged 51–80 years (mean 67 years). We had a lost of follow up of 6 patients. One patient had a total shoulder arthroplasty at 7.7 years and one patient had a redo with a new synthetic graft at 9.6 years. They were followed up for a mean of 7.2 years. Their mean preoperative Constant and Murley score improved from 25.7 preoperatively to 69.6. Similar improvements were seen with the DASH score (56.6 to 23.3), SST (1.2 to 7.9) and VAS scale (75.4 to 14.1). Anatomically, the repair resulted in mean acromio-humeral interval of 6.6 mm. Ultrasound showed a further degeneration of the rotator cuff with tears posteriorly from the interposition graft. In 67.7% of all patients the graft was continuous present. Histology – obtained from one patient scheduled for a reversed shoulder arthroplasty- showed partial ingrowth of peri-tendinous tissue. Despite ongoing degeneration of the cuff in nearly half our population, restoring a massive rotator cuff defect with a synthetic interposition graft and subacromial decompression can give significant and lasting pain relief with a significant improvement of ADL, range of motion and strength. Role of ultrasonography in shoulder pathology: Consistency with clinical and operative findings K. W. Chan, G. G. McLeod Department of Trauma and Orthopaedic Surgery, Perth Royal Infirmary, Perth PH1 1NX, United Kingdom. Shoulder disorders are common and main causes of shoulder pain with/without functional deficit include adhesive capsulitis (frozen shoulder), impingement syndrome and rotator cuff pathology. The sensitivity and specificity of ultrasonography have been reported as 80% and 100% respectively in the literature. We carried out a retrospective case note review of patients that underwent ultrasonography of shoulder, comparing the radiological findings with clinical diagnosis and operative findings. 58 patients, 36 male and 22 female attended the orthopaedic outpatient clinic with painful shoulder and underwent ultrasonography of shoulder during the period of study. Mean age of patients is 55 (range 28 to 78 years old). 33 patients had ultrasonography of right shoulder, 20 patients had ultrasonography of left shoulder while 5 patients had ultrasonography of both shoulders. 79% (50/63) of the ultrasonography findings were consistent with clinical diagnosis. 17 patients had normal findings on ultrasonography and were discharged fully. 25 patients with clinical and radiological diagnosis of biceps tendon tear, calcifying tendinosis and partial/full thickness rotator cuff tear were treated conservatively. 19% (4/21) of patients with diagnosis of calcifying tendinosis had decompression surgery. 38% (8/21) of patients with diagnosis of partial/full thickness rotator cuff tear had decompression surgery + rotator cuff repair. The degree of rotator cuff tear in operative findings for 6 out of 8 patients (75%) that underwent decompression surgery +/− rotator cuff repair were consistent with ultrasonography findings. 4 patients had inconclusive ultrasonography findings and had magnetic resonance imaging to further confirm the pathology. We conclude that ultrasonography should be used as the first line of investigation in aiding the clinical diagnosis and management of shoulder disorders as it is non-invasive and cost effective. The sensitivity of ultrasonography in detecting shoulder pathology is 75% from this study

Aims

The Oxford Shoulder Score (OSS) is a 12-item measure commonly used for the assessment of shoulder surgeries. This study explores whether computerized adaptive testing (CAT) provides a shortened, individually tailored questionnaire while maintaining test accuracy.

BACKGROUND:. Few studies have evaluated at a medium-term follow-up the use of semiconstrained reverse shoulder arthroplasty (RSA) for primary glenohumeral osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy excluding any other shoulder disease. Moreover, data on patients' quality of life after this surgery are lacking. METHODS:. In this prospective cohort study, 80 patients were evaluated after an RSA for either primary osteoarthritis, massive rotator cuff tear, or cuff tear arthropathy with the Constant-Murley score (CMS), ROM, and Short Form Health Survey (SF-36). A radiologic assessment was performed pre- and postoperatively. RESULTS:. At a mean 5-year follow-up, the cumulative survival rate was 97.3% and significant improvements in the CMS and ROM were observed when compared with the baseline values. The CMS was 93.2% of the sex- and age-matched normal values. The postoperative SF-36 scores showed no significant differences compared with normative data. Younger patients and subjects with worse preoperative conditions achieved the greatest benefit after RSA. A 70% scapular notching rate was noted and the length of follow-up was found to be associated with the severity of scapular notching. CONCLUSIONS:. This study introduces new predictors for surgical outcomes, and it shows that patients who had undergone RSA a mean of 5 years earlier exhibit similar functionality and health-related quality of life with respect to healthy controls

Purpose. Total shoulder arthroplasty (TSA) has become a successful treatment option for degenerative shoulder disease. With the increasing incidence in primary TSA procedures during the last decades, strategies to improve implant longevity become more relevant. Implant failure is mainly associated with mechanical or biological causes. Chronic inflammation as a response to wear particle exposure is regarded as a main biological mechanism leading to implant failure. Metal ions released by fretting and corrosion at modular taper connections of orthopedic implants can cause cell-mediated hypersensitivity reactions and might lead to aseptic loosening. Modularity is also commonly used in total shoulder replacement. However, little is known about metal ion exposure in patients following TSA. The objective of this study was to determine in-vivo blood metal ion levels in patients after TSA and to compare blood metal ion levels to control subjects without metal implants. Methods. A total of 19 patients with anatomical total shoulder prosthesis (TSA group) and 20 patients with reverse total shoulder prosthesis (RSA group) who underwent unilateral total shoulder replacement at our hospital between March 2011 and December 2014 with no other metal implant or history of environmental metal ion exposure were recruited for analysis of blood metal ion concentrations of cobalt (Co), chromium (Cr) and titanium (Ti) at a mean follow-up period of 2.3 years (0.7–4.3). For comparison of metal ion concentrations blood samples were obtained in a healthy control group of 23 subjects without metal implants. Ethical approval and informed consent of each patient were obtained for this study. Results. Median cobalt ion levels were 0.14µg/l (range 0.03–0.48) in the TSA group, 0.18 µg/l (0.10–0.66) in the RSA group and 0.11µg/l (0.03–0.19) in the control goup. Median chromium ion levels were 0.34µg/l (0.09–1.26) in the TSA group, 0.48µg/l (0.17–2.41) in the RSA group and 0.14µg/l (0.04–0.99) in the control goup. Median titanium ion levels were 0.86µg/l (0.10–1.64) in the TSA group, 1.31µg/l (0.75–4.52) in the RSA group and 0.62µg/l (0.32–2.14) in the control goup. There was a statistically significant difference in chromium and titanium ion concentrations between both study groups and the control group (see figure 1–3). Conclusion. Patients with unilateral total shoulder replacement demonstrated elevated blood metal ion concentrations. Median blood metal ion levels were higher in the RSA group compared to the TSA group, which could be attributable to the modularity of the reverse total shoulder system. However, overall metal ion levels were relatively low compared to those seen in patients with metal-on-metal total hip replacements. The role of local metal ion exposure in the development of aseptic loosening or hypersensitivity reactions associated with total shoulder arthroplasty should be further investigated. For figures/tables, please contact authors directly.

To investigate the relationship between age and the Constant score: A formula to correct for age. Method and results Healthy volunteers from the King’s College Hospital population with no previous shoulder disease were assessed using the constant score.270 healthy shoulders were tested. The subjects’ ages ranged from 16 to 83 with a mean age of 44.3. The scores ranged from 60 to 100 with a mean score of 82.3. Pearson correlation analysis gave us a trend or slope of −0.1. Corrected score= actual score −[(age-44)( −0.1)]. Conclusion We concluded that the constant score decreases with age at a rate of one point per decade and that in order to compare subjects’ scores in a standardised way this correction should be applied

Introduction: Shoulder surface replacement arthroplasty has been established for several decades as a mean to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. The surface replacement may offer some advantages over the stemmed prostheses. Purpose: The purpose of the study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with a degenerative arthritis. Patients and Methods: The study was conducted on 76 patients with degenerative joint disease of the shoulder that were operated on between 1999 and 2006. The patients were prospectively followed up clinically and radiologically for a mean of 26.2 months (range, 9–80 months). There were 41 female and 35 male shoulders. The mean age was 64.4 years (range, 54–86). The mean operative time was 42 minutes (range, 27–62 minutes). The clinical assessment was performed with the Constant score Results: The constant score significantly improved from a mean of 16.32 points preoperatively to 68.72 points postoperatively. The average pain score increased from 0.2 points to 10.2 points. The average ROM score increased from 9.22 points to 24.73 points. The humeral offset increased from 24.2mm to 29.2mm. Conclusion: The shoulder surface replacement arthroplasty shows good mid-term results in patients with degenerative shoulder disease

Aims

This study aims to describe a new method that may be used as a supplement to evaluate humeral rotational alignment during intramedullary nail (IMN) insertion using the profile of the perpendicular peak of the greater tuberosity and its relation to the transepicondylar axis. We called this angle the greater tuberosity version angle (GTVA).

Reverse shoulder arthroplasty (RSA) is increasingly performed recently. The patients seeking internet as a source of information may get misleading and a false sense of expectation. This study aimed at analysing patient information on internet and establish list of available quality websites to safely recommend to the patients. The study analysed 310 websites from 10 top search engines exploring the quality of patient information using an assessment tool. Search engines used were metasearch (Metacrawlers and Mamma), general search (Google, Altavista, Yahoo, MSN, AOL, Lycos) and health search engines (Medhunt and Excite Health). The study was undertaken by two independent researcher over a four-week period in November 2011. Each Website was evaluated according to RSA-specific content using a point value system with shoulder disease and surgery specific key words on an ordinal scale. Adequacy of the content was analysed in regard with description of diagnosis, procedure, alternate options, postoperative protocol, complications and prognosis. Excluding the repetitions 104 websites were analysed for accessibility, relevance, authenticity, adequacy of patient information and accountability. The median time since update was 12 months. More than 90% of the websites were found to be of poor quality. Only 25% sites targeted mainly people with shoulder problems. 8% of websites were from non profit organisations. Most of these websites were promoting either their service 80 (76%) or some product 12 (11%). The strength of association between two reviewers was very high (r = 0.899). Intra-rater reliability was significant (r = 0.955) with p level < 0.01. The reading level of most of websites were too high for average consumers. There is need for government organizations and professional societies to regulate the information provided by Internet. Until long-term data are available, patients should be warned when using the Internet as a source for health care information

The use of shoulder ultrasound in clinic is a way of decreasing the time patients have to wait til definitive treatment is started. Although ultrasound is used in clinic by some surgeons, we are not aware of anyone specifically looking at the total cost implications and the impact on waiting times. We therefore prospectively assessed the outcome of a one-stop shoulder assessment service set up by a new Consultant Orthopaedic Surgeon in a busy unit. All new patients were assessed by the Consultant, who then performed an ultrasound if indicated. Treatment or further investigation was then instituted based on the findings. The time taken and accuracy of the scans, the number of patients seen, impact on waiting times, total savings and patient satisfaction were assessed. We based cost calculations from data that included capital, structural, maintenance and staffing costs gained from the Department of Health and the hospital management. We found that 65% of all shoulder patients required ultrasound, and these were performed in an average of 2.7 minutes, with no significant overrunning of the clinic. The sensitivity for the detection of full thickness rotator cuff tears was 88% and specificity was 89%. Four patients needed further ultrasonography by a specialist musculoskeletal radiologist. All patients reported high satisfaction rates. We calculated the cost saving over a year of two shoulder surgeons performing ultrasound in a similar setting was between £200,000 and £500,000 depending on the figures you used. We believe ultrasound is a quick, easy, cheap imaging process for the diagnosis of soft tissue shoulder diseases. When performed at the first consultation by the surgeon it offers the advantages of high patient satisfaction rates, shorter waiting times, and significant cost savings. Should all shoulder surgeons be performing ultrasound in clinic?

Aims

An objective technological solution for tracking adherence to at-home shoulder physiotherapy is important for improving patient engagement and rehabilitation outcomes, but remains a significant challenge. The aim of this research was to evaluate performance of machine-learning (ML) methodologies for detecting and classifying inertial data collected during in-clinic and at-home shoulder physiotherapy exercise.

Total shoulder arthroplasty is a well-established and widely accepted method of treatment for a variety of shoulder disorders, loosening of the glenoid prosthesis is the main complication in total shoulder arthroplasty, it is highly dependent on the quality of the glenoid cancellous bone. Very little is known about mechanical properties of this cancellous bone. The objectives of this study were to determine the mechanical properties (elastic modulus and strength) of glenoid cancellous bone in the axial, coronal and sagittal planes including regional variation using a uniaxial compression test. To our knowledge, this kind of study was not done before. Eleven scapulas were obtained from six fresh-frozen, unembalmed human cadavers (mean age eighty-eight years). Eighty-two cubic cancellous bone specimens of 6×6×6mm3 were used for mechanical testing in the three planes. The test was a uniaxial compression along each direction, Elastic modulus and strength were determined from the stress-strain curve. Apparent density was also calculated. The study showed significant differences in the mechanical properties with anatomic location and directions of loading. Young modulus and strength were found to be significantly higher at the posterior part of the glenoid with the weakest properties at the antero-inferior part. Cancellous bone was found to be anisotropic with higher mechanical properties in the latero-medial direction (perpendicular to the articular surface of the glenoid). The apparent density was on average equal to 0.29 g/cm3 with the higher values at the posterior and superior part of the glenoid. Good correlation between apparent density and elastic modulus was found only in the sagittal plane but not in the coronal and axial plane, the overall correlation was low (r2 = 0.22, p< 0.0001) which emphasizes the role of trabecular bone architecture in predicting mechanical properties. The mechanical properties determined in this study provide input data for finite element method analyses and may help to assist in uncemented shoulder prosthesis design

Aim: To describe accurately the contributions of glenohumeral (GH) and scapulothoracic (ST) joints in shoulder movements in normal male adult subjects, aged 20–30 years. Methods: We recorded data with a Polhemus magnetic tracking device (Kaiser Aerospace and Electronics Co., Vermont). Receivers were taped on landmarks, over the sternum, scapula and humerus. The movements that were studied were elevation in the sagittal plane, abduction in the scapular plane and lowering the arm from these positions. We collected data from 26 male subjects (52 shoulders), aged 20–30 years, with no history of shoulder problems. Repeatability data were obtained in 16 subjects. The data can be expressed in a number of ways, including plotting the ratio of GH/ST movement versus overall shoulder movement. Polynomial equations to fit these curves describe movement patterns. We have developed software to calculate cumulative averaging of data. Results: Both GH and ST movements contribute to shoulder movement throughout the ranges studied. Although the shapes of the movement curves were fairly consistent, there were some non-conforming curves and variations. As the arm is abducted the mean ratio of GH/ST movement increases to approximately 3/1. Adduction produces curves that nearly mirror image the abduction curves. Flexion and extension curves tend to be flatter with a mean GH/ST ratio of 2–3/1, throughout the range. The reproducibility data shows satisfactory fits to initial curves. Conclusions: We have developed a method to describe shoulder movement that provides new information regarding normal shoulder movements. This method can be applied to study patients with shoulder disorders

A powered, randomised control trial was instigated to evaluate the advantages of subacromial injection of Methylprednisolone over conservative treatment in the management of partial rotator cuff injuries of the shoulder. Consecutive patients with possible partial rotator cuff tears were reviewed at 1 week. Inclusion criteria for a diagnosis of partial rotator cuff tear included; traumatic mechanism, greater tuberosity tenderness, painful arc, and complete resolution of disability post-Bupivicaine block. Exclusion criteria included; age < 16 years, chronic shoulder disease, acromioclavicular tenderness, and abnormal shoulder radiograph. Patients were randomly allocated to receive either 1 immediate subacromial injection of 40mg Methylprednisolone (group S) or no injection (group N). Initial outcomes measured were; visual analogue pain score (0–10) and active abduction (nearest 5°), repeated at 3, 6, and 12 weeks. All patients were instructed in analgesia usage and given identical shoulder exercises. Of 279 patients reviewed over 3 years, 90 met the inclusion criteria (6/90 patients were lost to follow-up). 50 patients were randomised to group S, 40 to group N. Mean pain score improvement at 12 weeks was comparable (S=4.95, N=4.44) (p> 0.1, CI=0.16–0.86). In patients aged > 40 years group S had significantly higher mean improvement in abduction at completion (64.28°) compared to group N (34.63°) (p< 0.02, CI 1.29–58.01). Conversely in patients aged < 40 years group S had lower mean improvements in abduction (40.55°) compared to group N (77.73°), though this was not statistically significant (p=0.1, CI 2.06–72.29). Methylprednisolone injection is more efficacious than conservative treatment alone in some patients. This benefit appears age-dependent and consequently such treatment should be reserved for patients aged > 40 years

Purpose: The hand-to-forehead test is a new subjective and objective test for anterior shoulder instability. This test is performed preoperatively under general anaesthesia and involves a quantifiable patient-controlled apprehension test and an objective quantitative test of anterior stability. Material and methods: Between January 1998 and April 2000, 135 patients (97 men and 38 women), mean age 25 years, age range 16–40 years, candidates for surgery for anterior instability of the shoulder (115 Latarget, 14 Bankart, 6 capsular shift) were tested. A control group of 300 candidates free of any shoulder disorder for other surgery were also tested. Results: the Apprehension test was positive in 95 of the operated patients and negative in 40. Mean angle was 160° (90–180°). The test was always negative in patients with an underlying hyperlaxity (18 patients). The test was positive in 20 controls and negative in 270. Test sensitivity was 72%, specificity 92.5%, positive predictive value 42%, (prevalence 1.5%) and negative predictive value 86%. Reproducibility was 80%. The objective test was positive in 125 of the operated patients and negative in 10. The value was 2++ in 55% of the cases. In the control group, the objective test was positive in 28 and negative in 272. The sensitivity of the objective test was 95%, specificity 90%, positive predictive value 55% and negative predictive value 95%. Reproducibility was 92%. Discussion: The purpose of the hand-to-forehead test is to express the instability as perceived by the patient and to exteriorise anterior laxity without reproducing true anterior displacement. Excepting cases with underlying hyperlaxity, this test does not appear to be inflenced by different injuries subsequent to recurrent anterior dislocation. (no significant difference between glenoid bone lesions, Broca lesions or Malgaigne notches). Conclusion: This new test provides a reliable objective assessment of anterior instability of the shoulder using a quantifiable combination of classical apprehension and laxity tests. It is a supplementary diagnostic tool for difficult cases and a useful aid for pre- and postoperative evaluation of these patients