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
Aims. Steroid injections are used for
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
The October 2014 Shoulder &
Elbow Roundup. 360 . looks at: PRP is not effective in tennis elbow; eccentric physiotherapy effective in
Data were collected on patients undergoing subacromial decompression (SAD) in our routine practice from 1998 to 2004. All patients had clinical signs of
Arthroplasty of the shoulder is a common procedure. Although there are many studies of the results of individual arthroplasty concepts, there is little published on the results of all shoulder replacements (with no exclusions) from a single centre. We analysed 120 elective shoulder replacements in 106 patients performed over a 5 year period in our unit. 77 were female and average age was 70 years. 85 procedures were for osteoarthritis, 10 cuff arthropathy, 8 post-traumatic arthritis. 65 patients underwent a resurfacing hemiarthroplasty, 25 stemmed hemiarthroplasty and 30 had total shoulder replacements (5 reverse polarity). Mean follow up was 1.6 years. There was a move away from resurfacing hemiarthroplasty towards stemmed total shoulder replacement over the study period. The overall incidence of complications was 25.8%, 19.2% occurring within 12 months of surgery: 4 replacements dislocated, there were 5 periprosthetic fractures, 2 patients developed deep infection (treated by debridement), 2 patients aseptic loosening, 11 developed
A modified Kessel trans-acromial approach has been utilised in our Unit for decompression and repair of associated rotator cuff tear for all advanced impingement syndrome (Stage III). This preliminary report aims to review our results, and to assess the complications of this approach. From 1996 to 1999, 22 consecutive patients who were treated surgically using a Trans-acromial approach for advanced impingement syndrome, were reviewed. The diagnosis of impingement syndrome was based on history, physical examination and Lignocaine impingement test, with either an ultrasound scan, arthrogram, or MRI. The modified trans-acromial approach was used involving splitting and raising a periosteal soft tissue flap over the acromion, followed by splitting the acromion in the coronal plane just behind the acromioclavicular joint, this allowed an extensive exposure of the rotator cuff and easy undercutting of the acromion. 20 patients were interviewed and examined specifically for this study, for an average follow up of 17 months. The other two patients were interviewed by telephone. The following parameters were studied: 1) functional assessment:[Constant’s Scoring system, and the UCLA Shoulder rating Scale. 2) Pain relief. 3) Patient satisfaction. 5) Return to preoperative activity. 6) Complication. The results were satisfactory in 17 patients (77%), and unsatisfactory in 5 pt (23%), one of which had cervical spondolysis, and two had new bony formation in the
The global economy has been facing a financial crisis. Healthcare costs are spiraling, and there is a projected £30 billion health funding gap by 2020 in the UK. What is happening in the UK is a reflection of a global problem. Rationing of healthcare is a topic of much discussion; as unless spending is capped, providing healthcare will become unsustainable. Who decides how money is spent, and which services should be rationed? In this article we aim to discuss the impact that rationing may have on orthopaedic surgery, and we will discuss our own experiences of attempts to ration local services.