Glutamate regulates the expression of apoptosis-related genes and triggers the apoptosis of fibroblasts in rotator cuff tendons. Subacromial bursitis is always accompanied by symptomatic rotator cuff tear (RCT). However, no study has been reported on the presence of glutamate in subacromial bursa and on its involvement of shoulder pain in patients who had RCT. The purposes of this study were to determine whether the glutamate expression in subacromial bursa is associated with the presence of RCT and with the severity of shoulder pain accompanying RCT. Subacromial bursal tissues were harvested from patients who underwent arthroscopic rotator cuff tendon repair or glenoid labral repair with intact rotator cuff tendon. Glutamate tissue concentrations were measured, using a glutamate assay kit. Expressions of glutamate and its receptors in subacromial bursae were histologically determined. The sizes of RCT were determined by arthroscopic findings, using the DeOrio and Cofield classification. The severity of shoulder pain was determined, using visual analog scale (VAS). Any associations between glutamate concentrations and the size of RCT were evaluated, using logistic regression analysis. The correlation between glutamate concentrations and the severity of pain was determined, using the Pearson correlation coefficient. Differences with a probability <0.05 were considered statistically significant. Glutamate concentrations showed significant differences between the torn tendon group and the intact tendon group (P = 0.009). Concentrations of glutamate significantly increased according to increases in tear size (P < 0.001). In histological studies, the expressions of glutamate and of its ionotropic and metabotropic receptors have been confirmed in subacromial bursa. Glutamate concentrations were significantly correlated with pain on VAS (Rho=0.56 and P =0.01). The expression of glutamate in subacromial bursa is significantly associated with the presence of RCT and significantly correlated with its accompanying shoulder pain. Acknowledgements: This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A3A01018955 and 2017R1D1A1B03035232)

Os acromiale is a developmental defect caused by failure of fusion of the anterior epiphysis of the acromion between the ages of 22 and 25. The prevalence of os acromiale in the general population ranges from 1.4% to 15%. Os acromiale has been reported as a contributory factor to shoulder impingement symptoms and rotator cuff injuries, despite being a common incidental observation. In this retrospective study, we examined the prevalence of os acromiale in black African patients with shoulder pain. We retrospectively reviewed the clinical records, radiographs, and magnetic resonance imaging (MRI) scans of 119 patients who presented with atraumatic and minor traumatic shoulder pain at a single institution over a one-year period. Anteroposterior, scapula Y-view, and axillary view plain images were initially evaluated for the presence of os acromiale, and this was corroborated with axial MRI image findings. Patients with verified os acromiale had their medical records reviewed to determine their first complaint and the results of their clinical examination and imaging examination. Radiographs and MRI on 24 patients (20%) revealed an osacromiale. This cohort had a mean age of 59.2 years, and there were significantly more females (65%) than males. Meso-acromion was identified as the most prevalent type (n=11), followed by pre-os acromion (n=7). All patients underwent bilateral shoulder x-rays, and 45 percent of patients were found to have bilateral meso- acromion. Most patients (70%) were reported to have unstable os acromiale with subacromial impingement symptoms, and nine patients (36%) had confirmed rotator cuff tears based on clinical and Mri findings. Surgery was necessary for 47% of the 24 patients with confirmed Os acromiale (arthroscopic surgery, n=7; open surgery, n=1) in order to treat their symptoms. The prevalence of os acromiale in our African patients with atraumatic shoulder symptoms is greater than that reported in the general population. Os acromiale is a rare condition that should always be considered when evaluating shoulder pain patients

Nowadays it is well known that both a clinical examination and an imaging investigation (MRI/CT scans) are useful in order to provide surgeons with complete informations about the proposed treatment for shoulder pain. The purpose of this study was to evaluate the diagnostic sensitivity of the Neer, Hawkins, Jobe, Lift-off and Infraspinatus tests in diagnosing rotator cuff tears and compare this with what was found during surgery. From 2001 to 2003, data from 430 patients who underwent shoulder open surgery, performed by a single surgeon, were documented. The results showed that the Jobe test has a sensitivity of 97.5% and positive prognostic value (PPV) of 80.3% and negative prognostic value (NPV) of 90.9% for the presence of a supraspinatus lesion; the Neer, Hawkins and Yokum tests have a sensitivity close to 95% for assessing subacromial bursitis; the Lift-off and Infraspinatus tests have a sensitivity close to 70% for assessing the degree of lesion and identify a severe lesion with a NPV over 83%. The Lift-off and Infraspinatus tests also provide information concerning muscular trophism and concerning retraction and degeneration of tendons. According to our results, clinical evaluation of shoulder pain should be supported by imaging investigations for diagnosis of rotator cuff tear

Aims: The purpose of this study is to examine the relationship between synovitis and shoulder pain in rotator cuff disease. Methods: Thirty-nine patients with rotator cuff disease were candidates. Subacromial synovium around the greater tuberosity and glnohu-meral synovium around the rotator interval were harvested for specimens during operation. The expression levels of inflammatory cytokine mRNA of interleukin-1β and its naturally occurring antagonists (secreted and intracellular interleukin-1 receptor antagonists) were measured by reverse transcription plolymerase chain reaction (RT-PCR). The cytokine-mRNAs producing cells were identified by RT- in situPCR. For control specimens, subacromial bursae were obtained from 10 patients with anterior instability of the shoulder that exhibited no signs of subacromial impingement. All specimens were obtained with patient’s informed consent. The level of shoulder pain was evaluated in each patients before the operation with a visual analogue scale: 0 as no pain, 5 as moderate, and 10 as severe. Results:The expression levels of the cytokine-mRNAs in the subacromial bursa well correlated to the level of shoulder pain, but not those in the glenohumeral joint. A variety of the cells (synovial and inflamatory cells) produced the cytokines at the protein and gene level in both subacromial and glenohuemeral synovium. Conclusions: Subacromial bursa is the site associated the shoulder pain caused by rotator cuff disease, and targeting the subacromial bursa for treatment leads to successful pain relief in patients with the disease

Aims. The primary aim of this study was to assess the feasibility of recruiting and retaining patients to a patient-blinded randomized controlled trial comparing corticosteroid injection (CSI) to autologous protein solution (APS) injection for the treatment of subacromial shoulder pain in a community care setting. The study focused on recruitment rates and retention of participants throughout, and collected data on the interventions’ safety and efficacy. Methods. Participants were recruited from two community musculoskeletal treatment centres in the UK. Patients were eligible if aged 18 years or older, and had a clinical diagnosis of subacromial impingement syndrome which the treating clinician thought was suitable for treatment with a subacromial injection. Consenting patients were randomly allocated 1:1 to a patient-blinded subacromial injection of CSI (standard care) or APS. The primary outcome measures of this study relate to rates of recruitment, retention, and compliance with intervention and follow-up to determine feasibility. Secondary outcome measures relate to the safety and efficacy of the interventions. Results. A total of 53 patients were deemed eligible, and 50 patients (94%) recruited between April 2022 and October 2022. Overall, 49 patients (98%) complied with treatment. Outcome data were collected in 100% of participants at three months and 94% at six months. There were no significant adverse events. Both groups demonstrated improvement in patient-reported outcome measures over the six-month period. Conclusion. Our study shows that it is feasible to recruit to a patient-blinded randomized controlled trial comparing APS and CSI for subacromial pain in terms of clinical outcomes and health-resource use in the UK. Safety and efficacy data are presented. Cite this article: Bone Jt Open 2024;5(7):534–542

Aims. Steroid injections are used for subacromial pain syndrome and can be administered via the anterolateral or posterior approach to the subacromial space. It is not currently known which approach is superior in terms of improving clinical symptoms and function. This is the protocol for a randomized controlled trial (RCT) to compare the clinical effectiveness of a steroid injection given via the anterolateral or the posterior approach to the subacromial space. Methods. The Subacromial Approach Injection Trial (SAInT) study is a single-centre, parallel, two-arm RCT. Participants will be allocated on a 1:1 basis to a subacromial steroid injection via either the anterolateral or the posterior approach to the subacromial space. Participants in both trial arms will then receive physiotherapy as standard of care for subacromial pain syndrome. The primary analysis will compare the change in Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include the change in OSS at six and 12 months, as well as the Pain Numeric Rating Scale (0 = no pain, 10 = worst pain), Disabilities of Arm, Shoulder and Hand questionnaire (DASH), and 36-Item Short-Form Health Survey (SF-36) (RAND) at three months, six months, and one year after injection. Assessment of pain experienced during the injection will also be determined. A minimum of 86 patients will be recruited to obtain an 80% power to detect a minimally important difference of six points on the OSS change between the groups at three months after injection. Conclusion. The results of this trial will demonstrate if there is a difference in shoulder pain and function after a subacromial space steroid injection between the anterolateral versus posterior approach in patients with subacromial pain syndrome. This will help to guide treatment for patients with subacromial pain syndrome. Cite this article: Bone Jt Open 2024;5(9):729–735

Purpose: We report a new pathological entity involving the long head of the biceps tendon (LHBT). In this entity, the hypertrophic LHBT becomes incarcerated in the joint during limb elevation, leading to shoulder pain and blockage. Material and methods: Twenty-one patients were identified. These patients presented hypertrophy of the intra-articular portion of the LHBT with tendon incarceration at limb elevation. The diagnosis was confirmed during open surgery (n=14) or arthroscopy (n=7). All cases were diagnosed in patients with an associated cuff tear. Treatment consisted in resection of the intra-articular portion of the LHBT and appropriate treatment of the cuff. Results: All patients had anterior shoulder pain and deficient anterior flexion because of the incarcerated tendon. An intra-operative dynamic test consisted in raising the arm with the elbow extended, providing objective proof of the tendon trapped in the articulation in all cases. The positive “hour glass” test produce a fold then incarceration of the tendon between the humeral head and the glenoid cavity. Tendon resection after tenodesis (n=19) or biopolar tenotomy (n=2) yielded immediate recovery of passive complete anterior flexion. The Constant score improved from 38 points preoperatively to 76 points at last follow-up. Discussion: The “hour glass” long biceps tendon is caused by hypertrophy of the intra-articular portion of the tendon which becomes unable to glide in the bicipital groove during anterior arm flexion. 10°–20° defective motion, pain at the level of the bicipital groove, and images of a hypertrophic tendon are good diagnostic signs. The “hour glass” LGBT must not be confused with retractile capsulitis. The definitive diagnosis is obtained at surgery with the “hour glass” test which shows a fold and incarceration of the tendon during anterior flexion with an extended elbow. Simple tenotomy is insufficient to resolve the blockage. The intra-articular portion of the tendon must be resected after bipolar tenotomy or tenodesis. Conclusion: Systematic search for “hour glass” LHBT should be undertaken in patients with persistent anterior shoulder pain of unexplained origin associated with deficient anterior arm flexion

Aim of Study: To evaluate the efficacy of pulsed radio-frequency ablation to the suprascapular nerve in patients with chronic shoulder pain secondary to cuff tear arthropathy. Methods: Twelve patients with chronic shoulder pain secondary to cuff tear arthropathy were recruited following ethics approval. Mean age 68 yrs (60–83 yrs). The suprascapular notch was identified under image intensifier and the suprascapular nerve lesioned with pulsed radiofrequency ablation for 120 seconds. Patients were assessed with the Oxford and Constant Shoulder scores, Visual Analogue pain score and sleep score pre, 3 and 6 months post procedure. Statistical analysis was undertaken using the Friedman test (non parametric analysis of variance). Results: Ten patients had an improvement in the visual analogue pain score and Constant score, 11 in the Oxford score and all an improvement in sleep pattern. Conclusions: Shoulder pain was reduced in 10 out 12 patients up to 6 months post procedure. This procedure may be a useful adjunct in elderly patients with painful cuff tear arthropathy who are not suitable for surgery

Purpose: The aim of this study was to evaluate the arthroscopic findings and treatment of chronic shoulder pain after minimally displaced greater tuberosity (GT) fractures. Material and Methods: Arthroscopy was performed in 12 patients (8m, 4f; mean age of 36 years) with more than 6 months of shoulder pain after sustaining a minimally displaced GT fracture (inferior to 5 mms). 4 cases were associated with anterior shoulder dislocation. Results: Varied pathologic findings, some of them unsuspected, were observed in all cases, both at subacromial and glenohumeral level:. 5 cases of subacromial impingement secondary to protrusion of the proximal portion of the GT; 2 of them associated with Pasta lesion. 3 cases of unstable – non united bony fragments at subacromial level. 4 cases of isolated Pasta lesions, 2 pure tendinous and 2 “bony” with unstable osteocondral fragments. All lesions were arthroscopically treated: GT tuber-oplasty, repair of Pasta lesions, suture fixation of GT fragments. After minimum follow-up of one year, Constant and Simple Shoulder Test scores were significantly improved. Conclusions: Arthroscopy proved to be very useful to assess the varied etiologic factors for chronic shoulder pain in undisplaced GT fractures. Arthroscopic techniques are effective in managing GT malunions and tendinous and bony Pasta lesions

The study investigated if suprascapular nerve(SSN) rhizolysis could give effective and longlasting pain relief to patients with chronic shoulder pain(massive cuff tears and /or osteoarthritis) some with significant comorbidity, who did not wish for or were unable to withstand surgery. Sixty two patients(12 male, 50 female, mean age 74years) with longstanding moderate to severe shoulder joint pain(massive rotator cuff tears, osteoarthritis, rheumatoid arthritis), who had failed conventional non-operative management and who were unsuitable for further shoulder surgery, were assessed for radiofrequency(RF) rhizolysis to the SSN. Most patients reported significant anaesthetic co-morbidity. All patients had received full orthopaedic or rheumatological assessment with investigations including Xray, ultrasound and MRI scan. Ninety-five percent of patients had undergone a SSN block which had afforded > 50% pain reduction for three to six months. The suprascapular notch was identified with Xray control. The SSN was located with 100 Hz and 2 Hz stimulation of an insulated 50mm needle. Once localised, 5 mls of 2% lignocaine was injected and a radiofrequency thermocoagulation lesion undertaken at 700C for 90 seconds. Eighty-five percent of patients reported> 50% pain relief still present at six months (as reported by VAS score). No serious adverse side effects were reported (pneumothoraces, haematomas, infection, neurological deficits). RF rhizolysis of the SSN may be a useful treatment for the group of patients with chronic shoulder pain for whom surgery is not an option

Introduction: Previous studies have reported controversial associations between exercise and neck or shoulder pains in adolescents. In this study we evaluated the relationships between physical activity or sedentary activities and neck or occipital pain (NOP) or shoulder pain (SP) in a representative sample of adolescents. Methods: The study population consisted of adolescents belonging to the Northern Finland Birth Cohort 1986 (n=5993). Associations of physical activity level, total sitting time, and different kinds of sedentary activities with NOP and SP were analyzed at 15–16 years of age using logistic regression. “Reporting NOP and SP” (not seeking medical help) and “Consultation for NOP and SP” were assessed separately in girls, but were combined in boys because of low prevalence of “Consultations”. Results: Almost half of the girls and one third of the boys reported NOP or SP, and 5% of girls and 2% of boys reported “Consultation for NOP or SP” during the past six months. High level of physical activity associated with increased prevalence of both “Consultation for NOP” and “Consultation for SP” in girls, but not in boys. Prolonged sitting was associated with high prevalence of NOP and SP in girls, and NOP in boys. Of various sedentary activities, TV watching and reading books associated with NOP in girls, whereas playing or working with a computer associated with NOP in boys. In girls, TV watching also associated with “Reporting SP”. Discussion: Both prolonged sitting and high level of physical activity seem to be related to NOP and SP among adolescents

INTRODUCTION. This study describes the prevalence of pain, functional loss and rotator cuff tears (RCTs) in a general population cohort. It is the first multidisciplinary assessment in such a cohort. METHODS. The Chingford cohort is a 19-year old longitudinal population study comprising 1003 women aged between 44 and 67 at baseline. To date 183 consecutive subjects (366) shoulders have been interviewed about their shoulders. Myometric strength assessment and high-definition ultrasound examination (US) have been performed on all shoulders. Additionally pain thresholds and perceptions of pain have been tested using quantitative sensory testing (QST) and a number of validated questionnaires, including the illness attitudes scale and the pain detect score. RESULTS. The population prevalence of at least one full-thickness RCT was 24%, with 19% being unilateral and 5% bilateral. Of the 366 shoulders: 56% had no tendon abnormality on ultrasound: Of which, 68% were asymptomatic, 23% had pain, and 24% had functional loss. 20% had abnormalities of the tendon-bone attachment: Of which, 56% were asymptomatic, 35.6% had pain and 36.1% had functional loss. 9% had a partial-thickness RCT: Of which, 53% were asymptomatic, 29% had pain and 38% had functional loss. 7% had a full-thickness RCT (less than 2cm): Of which, 58% were asymptomatic, 29% had pain and 29% had loss of function. 8% had a full-thickness RCT (greater than 2cm): Of which, 38% were asymptomatic, 55% had pain and 48% had functional loss. The pain and functional loss was significantly greater in the abnormal tendon-bone attachment group, and the full-thickness RCT (greater than 2cm) group, compared to those with no abnormality on high-definition ultrasound examination. Strength testing showed progressive weakness through all disease stages. Pain thresholds from the QST data will be presented. DISCUSSION. In a unique normal population-cohort study 44% of patients were found to have some form of degenerative tendon abnormality on high-definition ultrasound. Of these significant pain and/or loss of function was found in 48% of shoulders. High-definition US has allowed us to identify a group of tendons with an abnormality at the tendon bone interface. The pain and functional loss increases at this early stage and then only further increases once a tear is greater than 2cm. However over 50% remain asymptomatic

Aims

The aims of this study were to compare the use of resources, costs, and quality of life outcomes associated with subacromial decompression, arthroscopy only (placebo surgery), and no treatment for subacromial pain in the United Kingdom National Health Service (NHS), and to estimate their cost-effectiveness.

Introduction

Osteoarthritis of the glenohumeral joint leads to global degeneration of the shoulder and often results in humeral or glenoid osteophytes. It is established that the axillary neurovascular bundle is in close proximity to the glenohumeral capsule. Similar to other compressive neuropathies, osteophytic impingement of the axillary nerve could result in axillary nerve symptoms. The purpose of this study was to compare the proximity of the axillary neurovascular bundle to the inferior humerus in shoulders to determine distance of the neurovascular bundle as the osteophyte (goat's beard) of glenohumeral osteoarthritis develops.

Aims. Frozen shoulder is a common, painful condition that results in impairment of function. Corticosteroid injections are commonly used for frozen shoulder and can be given as glenohumeral joint (GHJ) injection or suprascapular nerve block (SSNB). Both injection types have been shown to significantly improve shoulder pain and range of motion. It is not currently known which is superior in terms of relieving patients’ symptoms. This is the protocol for a randomized clinical trial to investigate the clinical effectiveness of corticosteroid injection given as either a GHJ injection or SSNB. Methods. The Therapeutic Injections For Frozen Shoulder (TIFFS) study is a single centre, parallel, two-arm, randomized clinical trial. Participants will be allocated on a 1:1 basis to either a GHJ corticosteroid injection or SSNB. Participants in both trial arms will then receive physiotherapy as normal for frozen shoulder. The primary analysis will compare the Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include OSS at six and 12 months, range of shoulder movement at three months, and Numeric Pain Rating Scale, abbreviated Disabilities of Arm, Shoulder and Hand score, and EuroQol five-level five-dimension health index at three months, six months, and one year after injection. A minimum of 40 patients will be recruited to obtain 80% power to detect a minimally important difference of ten points on the OSS between the groups at three months after injection. The study is registered under ClinicalTrials.gov with the identifier NCT04965376. Conclusion. The results of this trial will demonstrate if there is a difference in shoulder pain and function after GHJ injection or SSNB in patients with frozen shoulder. This will help provide effective treatment to patients with frozen shoulder. Cite this article: Bone Jt Open 2023;4(3):205–209

Aims. Rotator cuff tear (RCT) is the leading cause of shoulder pain, primarily associated with age-related tendon degeneration. This study aimed to elucidate the potential differential gene expressions in tendons across different age groups, and to investigate their roles in tendon degeneration. Methods. Linear regression and differential expression (DE) analyses were performed on two transcriptome profiling datasets of torn supraspinatus tendons to identify age-related genes. Subsequent functional analyses were conducted on these candidate genes to explore their potential roles in tendon ageing. Additionally, a secondary DE analysis was performed on candidate genes by comparing their expressions between lesioned and normal tendons to explore their correlations with RCTs. Results. We identified 49 genes in torn supraspinatus tendons associated with advancing age. Among them, five age-related genes showed DE in lesioned tendons compared to normal tendons. Functional analyses and previous studies have highlighted their specific enrichments in biological functions, such as muscle development (e.g. myosin heavy chain 3 (MYH3)), transcription regulation (e.g. CCAAT enhancer binding brotein delta (CEBPD)), and metal ion homeostasis (e.g. metallothionein 1X (MT1X)). Conclusion. This study uncovered molecular aspects of tendon ageing and their potential links to RCT development, offering insights for targeted interventions. These findings enhance our understanding of the mechanisms of tendon degeneration, allowing potential strategies to be made for reducing the incidence of RCT. Cite this article: Bone Joint Res 2024;13(9):474–484

Aims. Rotator cuff disease (RCD) can considerably decrease quality of life. Here, we investigated whether health-related quality of life (HRQoL) influences the need for surgery in patients with RCD. Methods. We performed an analysis of 417 patients with symptomatic RCD who were recruited from two hospitals between June 2008 and December 2014 to be randomized to receive non-surgical or surgical treatment. After a three-month rehabilitation period, 36-Item Short-Form Health Survey questionnaire (SF-36), shoulder pain (visual analogue scale (VAS)), and shoulder function (Constant-Murley score) data were available from 191 still-symptomatic patients who were eligible for surgery. A control group was formed from 87 excluded patients who were no longer eligible for surgery due to relief of symptoms. Results. Mean pain on the VAS was 51.3 (SD 20.1) in the patients eligible for surgery and 41.7 (SD 21.2) in the control group. The following domains of the SF-36 were associated with being eligible for surgery in univariate analyses: bodily pain, general health, vitality, social functioning, and emotional wellbeing. In multivariate analysis, only bodily pain was associated with pursuing surgical treatment. The RCD population’s values for physical role, bodily pain, and physical functioning were poorer compared to the values of the general population. Conclusion. Lower HRQoL, as indicated by the lower bodily pain score on the SF-36, was associated with the decision to undergo surgical treatment in patients with RCD. Therefore, HRQoL should be considered when determining treatment options for RCD. Cite this article: Bone Jt Open 2024;5(9):793–799

The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. Many techniques have been described. To widen the availability of this treatment we investigate whether an anatomical landmark technique can be easily learned by novice injectors to provide efficacious blockade. Five injectors were recruited with varying experience; from the novice medical student to an orthopaedic consultant. Five torsos (10 shoulders) were used. A single page of written instruction and illustration of the Dangoisse landmark technique was provided prior to injection of a Thiel embalmed cadaver bilaterally. A pre-mixed injectate with blue dye was used. Cadavers were dissected and the presence or absence of dye staining reported by 3 observers and a consensus agreement reached. Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders were found to have adequate staining of the suprascapular nerve directly, or its distal branches, in a manner which would provide adequate anaesthesia. The inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k=0.87) for staining distally. The technique was easily performed by novice injectors with a 100% success rate. We demonstrate that this technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. The main risks are ineffective block (10% in this series) and of intravascular injection. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider array of patients

Introduction. Anterior shoulder instability results in labral and osseous glenoid injuries. With a large osseous defect, there is a risk of recurrent dislocation of the joint, and therefore the patient must undergo surgical correction. An MRI evaluation of the patient helps to assess the soft tissue injury. Currently, the volumetric three-dimensional (3D) reconstructed CT image is the standard for measuring glenoid bone loss and the glenoid index. However, it has the disadvantage of exposing the patient to radiation and additional expenses. This study aims to compare the values of the glenoid index using MRI and CT. Method. The present study was a two-year cross-sectional study of patients with shoulder pain, trauma, and dislocation in a tertiary hospital in Karnataka. The sagittal proton density (PD) section of the glenoid and enface 3D reconstructed images of the scapula were used to calculate glenoid bone loss and the glenoid index. The baseline data were analyzed using descriptive statistics, and the Chi-square test was used to test the association of various complications with selected variables of interest. Result. The glenoid index calculated in the current study using 3D volumetric CT images and MR sagittal PD images was 0.95±0.01 and 0.95±0.01, respectively. The CT and MRI glenoid bone loss was 5.41±0.65% and 5.38±0.65%, respectively. When compared, the glenoid index and bone loss calculated by MRI and CT revealed a high correlation and significance with a p-value of <0.001. Conclusions. The study concluded that MRI is a reliable method for glenoid measurement. The sagittal PD sequence combined with an enface glenoid makes it possible to identify osseous defects linked to glenohumeral joint damage and dislocation. The values derived from 3D CT are identical to the glenoid index and bone loss determined using the sagittal PD sequence in MRI

Glenoid bone grafting in reverse total shoulder arthroplasty (RTSA) has emerged as an effective method of restoring bone stock in the presence of complex glenoid bone loss, yet there is limited published evidence on efficacy. The aim of this study was to conduct an analysis of clinical and radiographic outcomes associated with glenoid bone grafting in primary RTSA. Patients who underwent a primary RTSA with glenoid bone grafting were retrospectively identified from the databases of two senior shoulder surgeons. Inclusion criteria included minimum of 12 months clinical and/or radiographical follow up. Patients underwent preoperative clinical and radiographic assessment. Graft characteristics (source, type, preparation), range of movement (ROM), patient-reported outcome measures (Oxford Shoulder Scores [OSS]), and complications were recorded. Radiographic imaging was used to analyse implant stability, graft incorporation, and notching by two independent reviewers. Between 2013 and 2021, a total of 53 primary RTSA procedures (48 patients) with glenoid bone grafting were identified. Humeral head autograft was used in 51 (96%) of cases. Femoral head allograft was utilised in two cases. Depending on the morphology of glenoid bone loss, a combination of structural (corticocancellous) and non-structural (cancellous) grafts were used to restore glenoid bone stock and the joint line. All grafts were incorporated at review. The mean post-operative OSS was significantly higher than the pre-operative OSS (40 vs. 22, p < 0.001). ROM was significantly improved post-operatively. One patient is being investigated for residual activity-related shoulder pain. This patient also experienced scapular notching resulting in the fracturing of the inferior screw. One patient experienced recurrent dislocations but was not revised. Overall, at short term follow up, glenoid bone grafting was effective in addressing glenoid bone loss with excellent functional and clinical outcomes when used for complex bone loss in primary RTSA. The graft incorporation rate was high, with an associated low complication rate