Introduction: Preliminary data suggest that immobilization in external rotation may be effective in lowering the incidence of recurrence after first traumatic shoulder dislocation, with a zero reoccurrence rate reported at 15 months follow-up. The purpose of the present study was to ascertain whether this method could lower the incidence of recurrent dislocation in a young, very physically active population.

Methods: In an IRB approved prospective study, young males who sustained first traumatic shoulder dislocation were randomized to be treated for four weeks either using a traditional internal rotation brace or a new device which immobilizes the shoulder at 15 to 20 degrees of external rotation. Subjects were then treated according to a standard physical therapy protocol. Follow-up was done at five time points in the first year post dislocation. Subjects with clinically stable shoulders resumed full activity after three months. Differences in outcome were assessed by the chi square test.

Results: Thirty nine subjects participated in the study. Thirty of them were soldiers. Twenty four subjects were treated with external rotation braces. At follow-up of between 4 to 28 months, a new dislocation was documented in 8 of the 24 subjects immobilized in external rotation (33%) and in 5 of the 15 subjects immobilized in internal rotation (33 %). No statistical difference (p=1.0) was found between the instability rates of the two treatment groups.

Discussion: The present study indicates that even in a short-term follow-up the technique of immobilizing a first dislocation in external rotation was not effective in lowering the incidence of recurrent shoulder dislocations in a young, physically active population.

Introduction The accuracy of ultrasonography has been reported to be high in diagnosing full thickness rotator cuff tears if measurements are made in both in the coronal and sagital planes. The purpose of this study is to determine how well pre-operative shoulder ultrasound rotator tear measurements when performed only in the coronal plane, the common practice in Israel, predicts the intra-operative surgical findings.

Materials and Methods Fifty consecutive patients who underwent open rotator cuff repairs were included in the study. All patients underwent a pre-operative ultrasound by the same experienced musculoskeletal ultrasoundist. Rotator cuff tears were measured in the coronal plane only. This was compared with the tear size measured intra-operatively. Regression analysis was done between the two variables.

Results The mean size of rotator cuff tears as determined by ultrasonography was 15.56±8.07mm and the measure size of the tears intraoperatively was 27.94±9.8 mm. The result of the regression analysis of the two variables was R2= 0.268405 for the first 25 patients and R2= 0.310309 for the second 25 patients.

Discussion Using ultrasound it is easy to visualize the extent of rotator tears in the coronal plane, but more time consuming to measure the extent in the sagital plane, where the tear may have its greatest extension. Ultrasound measurements tear measurements in this study, made only in the coronal plane correlated poorly with intraoperative findings and only minimally improved over the time course of the study.

Conclusion Proper assessment of a possible candidate for a rotator cuff repair should include an ultrasound with the tear size measured specifically in both the coronal and sagital planes.

Introduction: When subjected to strain or strain rates are higher than usual, the bone remodels to repair microdamage and to strengthen itself. During the initial resorption phase of remodeling, the bone is transitorily weakened and microdamage can accumulate leading to stress fracture.

Methods: To determine whether short –term suppression of bone turnover using bisphosphonates can prevent the initial loss of bone during the remodeling response to high bone strain and strain rates and potentially prevent stress fractures, we conducted a randomized, double blind, placebo-controlled trial of 324 new infantry recruits known to be at high risk for stress fracture. Recruits were given a loading dose of 30 mg of residronate or placebo daily for 10 doses during the first two weeks of basic training and then a once a week maintenance dose for following 12 weeks. Recruits were monitored by biweekly orthopedic examinations during 15 weeks of basic training for stress fractures. Bone scans for suspected tibial and femoral stress fractures and radiographs for suspected metatarsal stress fractures were used to verify stress fracture occurrence.

Results: By the intension to treat analysis and per protocol analysis, there was no statistically significant difference in the tibial, femoral, metatarsal, or total stress fracture incidence between the treatment group and the placebo.

Discussion: We conclude that prophylactic treatment with residronate in a training population at high risk for stress fracture using a maintenance dosage for the treatment of osteoporosis does not lower stress fracture risk.