The musculoskeletal (MSK) profiles of water polo players and other overhead athletes has been shown to relate to injury and throwing performance (TP). There have been no robust studies conducted on the MSK profiles and the variables affecting TP amongst female, adolescent, elite water polo players.

A prospective quantitative cohort design was conducted amongst eighty-three female adolescent, elite water polo players (range 14–19 years). All participants filled out the Kerlan-Jobe Orthopaedic Clinic questionnaire, followed by a battery of screening tests aimed to identify possible MSK factors affecting TP. Pain provocation tests, range of motion (ROM), upward scapula rotation (USR), strength and pectoralis minor length measurements were all included. Participants also performed throwing speed (TS) and throwing accuracy (TA) tests.

All the data collected were grouped together and analysed using SPSS 28.0. The condition for statistical significance was set as p <0.05. Multi-collinearity was tested for among variables to find out inter-variable correlations. Finally, a multiple regression analysis was performed.

The mean KJOC score was 82.55 ± 14.96. 26.5% tested positive for at least one of the impingement tests. The MSK profile revealed decreased internal rotation ROM, increased external rotation ROM, a downwardly rotated scapula, weak external rotators, weak serratus anterior strength, strong lower trapezius and gluteus medius strength and a shorter pectoralis minor length all on the dominant side.

Age, pectoralis minor length, upper trapezius and serratus anterior strength as well as upward scapula rotation were all positively correlated with TS, while sitting height, upper trapezius and serratus anterior strength and glenohumeral internal rotation ROM were positively correlated with TA.

Multiple MSK parameters were found to be related to TS and TA in elite, adolescent water polo players.

Aim:

To investigate the incidence of post-operative ulna nerve symptoms in total elbow arthroplasty after full in-situ release.

Aim:

To investigate the clinical outcomes of elbows with post-traumatic stiffness treated by open surgical release.

Introduction

Hypoplasia of the glenoid is a rare condition caused by incomplete ossification of the postero-inferior aspect of the developing glenoid. It may be isolated or associated with a more generalised condition. The clinical symptomatology is variable depending on the age at time of presentation.

Introduction

Resurfacing of the glenohumeral joint has gained popularity since its first introduction in 1958. Advantages of resurfacing over conventional shoulder arthroplasty include preservation of humeral bone stock, closer replication of individual anatomy, reduction of periprosthetic fracture risk, non-violation of medullary canal, and ease of revision to a stemmed component if needed.

Purpose:

To review the union rates, outcomes and complications of angular stable plating of lateral third clavicle fractures.

This is a case series of a senior surgeon's experience; the purpose being to illustrate the problems encountered when using bio-absorbable anchors for various indications in shoulder surgery.

Purpose of study:

Total elbow replacement (TER) is one of the surgical options for treatment of severe haemophilic arthropathy of the elbow. There are only a few small series described in the literature. The goal of our study was to evaluate our cases and add these data to the known literature.

Purpose:

Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome.

Purpose:

We aimed to assess the short and medium term complications of patients who had undergone Latarjet procedures. We also compared this to a group of patients who over a similar period underwent an open Bankhart procedure to assess the complication profiles between the two groups.

Purpose

The purpose of this study was to follow up a cohort of South African doctors who had previously failed a validated musculoskeletal assessment tool, to examine the effect of a two-month Orthopaedic internship rotation on musculoskeletal competency.

Purpose of study

The outcomes of conservatively managed minimally displaced isolated greater tuberosity fractures are sparsely reported and the aim of this study was to look at the outcome of these fractures.

Single screw fixation for the management of slipped upper femoral epiphysis (SUFE) was introduced in 1984 and has been reported to have less chondrolysis and avascular necrosis (AVN) than previous methods using multiple pin fixation or osteotomy (Ward 1992). Two groups of patients were investigated. The first group of 55 hips (44 patients) were treated over a 27 year period (1963–1989). Forty four hips were treated with multiple pins and 11 hips with primary intra- or extracapsular osteotomy. These patients were followed up for an average of 8 years (3–27yrs). The second group of 88 hips (69 patients) were treated over a 6 year period (1999–2004). All were treated with single screw fixation and followed up for at least one year.

The duration and severity of slip were found to be similar for both groups. In the second group 16 hips (20%) were unstable (unable to walk even with crutches). Instability had not been coined as a term in the first group. All serial radiographs were retrospectively reviewed for AVN and chondrolysis and correlated with clinical findings. In the first group AVN occurred in 8 hips (14.5%). Five (9%) were due to osteotomies, two (3.5%) due to manipulation and one (2%) due to pinning in the superior quadrant. Chondrolysis occurred in 14 hips (25%); eight (14%) at presentation and six (11%) due to persistent pin penetration. In the second group AVN occurred in two hips (2%). Both were unstable. Two of 16 unstable hips (12.5%) developed AVN. Chondrolysis occurred in 6 hips (7%); four (4.5%) at presentation and 2 (2.5%) due to persistent pin penetration.

The authors conclude that single screw fixation is a safer technique than multiple pin fixation or osteotomy. AVN only occurred in unstable slips. Chondrolysis due to pin penetration is significantly reduced.

Seven patients with osteochondral defects of the humeral head were treated over a 3 year period (2002–2005). In six of the patients the diagnosis was made incidentally at time of arthroscopy with the seventh patient being diagnosed preoperatively. There were 5 males and 2 females with an average age of 48 years. Four patients had a history of trauma. The preoperative diagnosis was impingement in 5, supraspinatus partial thickness tear in one and an osteochondral defect in the seventh. Ultrasound revealed a supraspinatus partial thickness tear in one, fluid in the biceps grove in one, and was normal in the other 5. One patient had a MRI which showed a SLAP lesion. All patients had conservative treatment with subacromial injection with 2 patients having complete relief of pain, 2 having almost complete relief, and the other 4 having improvement but not complete relief of pain. Only 2 of the patients had a minor reduction in movement. At arthroscopy the osteochondral defect measured 1x 1 cm in four cases and 1 x 1,5 cm in the other 3. In all patients the osteochondral defect was debrided and the exposed bone abraded. Four patients had an acromioplasty, one had an acromioplasty and excision of the AC joint, one had a debridement only and the seventh patient had an acromioplasty, SLAP repair and debridement of a partial thickness supraspinatus tear.

The follow-up averaged 24 months (6–58). The VAS improved from an average of 6,4 preoperatively to 1,2 postoperatively and the ASES improved from 47 preoperatively to 85 postoperatively. All patients were happy to have had the procedure.

In conclusion, debridement and abrasion of osteochondral defect was an effective treatment in this series. Acromioplasty should be added when indicated.

Five patients with entrapment of the suprascapular nerve treated in a 7 year period (2000–2006) were reviewed. There were 4 males and 1 female with an average age of 35 years (15–59). The patients presented with non-specfic pain around the scapula and shoulder. Four of the patients had marked wasting and weakness of the supraspinatus and infraspinatus muscles. One patient had congenital non-union of the clavicles. One patient was a competitive pole vaulter but there was no apparent aetiological factor in the other 3.

The diagnosis was confirmed with nerve conduction studies in all the patients. All underwent MRI scan which was normal in 4 patients and showed a cyst in the spinoglenoid notch in the 5^th. Four patients had an open release of the suprascapular nerve, the patients whose MRI showed a cyst was found at surgery to have an abnormal vessel compressing the nerve. One patient had an arthroscopic release of the suprascapular nerve.

Four patients were available for follow-up. The follow-up averaged 22 months (6–58). All patients had complete relief of pain and almost complete recovery of strength.

In conclusion, the diagnosis of suprascapular nerve entrapment must be entertained when patients present with non-specific periscapular pain and wasting of the supraspnatus and infraspinatus muscles. MRI must be done to rule out cysts. Surgical release is successful and can be done arthroscopically.

Proximal humeral locked plates have been advocated as an improved option for treating displaced proximal humeral fractures. After a number of failures using other methods we moved to this option in 2003.

We reviewed all patients treated with this method, since we started in 2004. 16 patients were available for follow up. Using the Simple Shoulder Test and the Oxford Shoulder Score we assessed their level of function and pain. X-rays were checked for loss of fixation and union. The average follow up was 13 months post-surgery; the average age was 61 years. Using Neer’s classification, seven had 2 part fractures, seven had 3 part fractures and two had 4 part fractures.

All fractures united and the patients reported good shoulder function. None had loss of fixation. There were no cases of sepsis. There were two patients awaiting hardware removal and one patient has already had removal for subacromial impingement.

The results in this limited series compare favourably with the reported literature and we had no loss of fixation compared to our previous treatment.

Over one year a bio-absorbable corkscrew was used in 19 rotator cuff repairs in 17 patients (10 men and seven women) with a mean age of 52 years (25 to 68). Seven were partial thickness tears. The 12 full thickness tears involved only the supraspinatus in all but four patients. Open surgery was performed on these four patients, who had an isolated subscapularis tear, an isolated teres minor tear, a combined supraspinatus and infraspinatus tear and a combined supraspinatus, infraspinatus and subscapularis tear. The remaining patients underwent arthroscopic repair. All patients had an acromioplasty and 13 had the acromioclavicular joint excised. Two patients had a concomitant SLAP repair. One corkscrew was used in 10 cases, two in six and three in two.

The mean follow-up was 8 months (3 to 24). The mean Constant score at follow-up was 80. There were five complications (26%) in which the corkscrew or a fragment of it came loose in the subacromial space. Two patients required further surgery to remove the corkscrew.

The corkscrew was found to be a useful device for rotator cuff repairs, but the complication rate was high.

Of 81 elbow replacements performed over a seven-year period, 11 were total elbow revision (TER) procedures, which were done on two men and nine women with a mean age of 61 years (40 to 70). Seven of the patients had rheumatoid arthritis, three had post-traumatic osteoarthritis and one had haemophilia. The reason for revision was aseptic loosening in eight patients and aseptic loosening with fracture in the other three. The prostheses revised were the Souter in eight patients, the Kudo in one, the GSB I in one and the Dee in one. In revision TER, one long stem Souter prosthesis was used, two Pretoria, one GSB 3 and seven Morrey. The mean time from primary to revision TER was 10 years (2 to 31).

At a mean follow-up of 30 months (6 to 48), all except one patient were pain-free and the arc of flexion had increased by 30°. Complications included one dislocation, one radial nerve palsy, which recovered after six months, and one aseptic loosening. There were no cases of sepsis.

Revision TER is a technically demanding procedure with a high risk of complications. In this series patient satisfaction was high. Our policy is to use a hinged prosthesis, preferably the Morrey, in revision TER.

We retrospectively reviewed the results of 21 patients (22 shoulders) who had surgery for os acromiale.

The mean age of the 6 men and 15 women was 52 years. The dominant side was involved in 10 patients. The duration of symptoms ranged from one month to 13 years. Ten patients had a history of recent trauma. All presented with tenderness over the site of the os and signs of impingement. In three patients, signs of weakness suggested a rotator cuff tear, and three patients had tenderness over the acromioclavicular joint. Rotator cuff tears, four partial and eight full thickness, were present in 12 cases.

Surgery included excision of the os in nine cases and fixation in 13. Ancillary procedures included acro-mioclavicular joint excision (eight), rotator cuff repair (eight), cuff debridement (three) and biceps tenodesis (one).

At follow-up, which ranged from 5 months to 6 years, Constant and American Shoulder and Elbow Surgeons’ scores were assessed. The presence of a deltoid defect was noted and deltoid strength was measured. The mean Constant score at follow-up was 77. Deltoid strength was notably reduced in abduction but not in forward flexion. There were no cases of sepsis. Five cases required further surgery. In three, this involved removal of metal, but persistent pain necessitated one subsequent rotator cuff repair and one arthroscopic debridement of the subacromial space.

The outcome of both fixation and excision was satisfactory, but the reoperation rate was higher in patients who underwent fixation. We advise arthroscopic excision of meso-acromion in the absence of a full thickness rotator cuff tear.

To determine the radiological signs and the ease of diagnosis on different views, we reviewed true antero-posterior, axillary and supraspinatus outlet views of 26 shoulders with os acromiale.

The anteroposterior view shows sclerosis and ‘double oval’. The supraspinatus outlet view shows a ‘double’ acromion. The axillary view demonstrates the site of the pseudarthrosis and size of the os.

The os acromiale was visible on the anteroposterior view in 25 cases, on the supraspinatus outlet in 20 cases and on the axillary view in 17 cases. It was visible in at least two views in 25 of the cases. The os was more often evident on the anteroposterior view, but more clearly seen on the axillary. A radiologist reported on 13 of the X-rays and missed the diagnoses in nine cases. In two cases, the surgeon missed the radiological diagnosis. There were 20 meso-acromions and two pre-acromions.

We report on six men and two women (mean age 42.5 years) who had sustained posterior dislocation of the shoulder in motor vehicle accidents (three), falls (two), equestrian accidents (two), cycling accidents (one) and in a fainting spell (one). In four patients, the dislocation was the only injury, but two had humeral shaft fractures, one a humeral neck fracture and the fourth a glenoid and humeral shaft fracture. The mean delay to diagnosis was 14 weeks (2 to 21).

In three patients a medical officer, a general practitioner and a radiologist missed the dislocations, but in five orthopaedic surgeons missed them. Four patients had only anteroposterior radiographs of their shoulder taken, one had anteroposterior and lateral scapular views, and three had anteroposterior and lateral radiographs of the humerus.

Four patients underwent hemi-arthroplasties and the other four open reduction and McLaughlin procedures.

Though rare, posterior dislocations are often missed. Careful examination, especially in the absence of external rotation, can eliminate this. In the presence of a fracture, a dislocation or injury to the joint above and below must be excluded. Anteroposterior and lateral scapular views alone are inadequate in trauma cases and an axillary or modified axillary view should be done. If there is any doubt, CT should be performed.

We retrospectively reviewed 10 children treated for tuberculosis of the elbow over a 21-year period from 1979 to 1999.

The mean age at diagnosis was 5.5 years (1 to 11). The median duration of symptoms was 10 weeks (l week to 18 months). The patients presented mainly with swelling of the elbow joint due to synovitis. Radiological appearances of the elbow at presentation were assessed according to Kerri and Martini’s classification. One elbow was stage I (osteopoenia), eight were stage II (osteopoenia and erosions) and one stage III (joint space narrowing).

Open biopsy was performed on all patients. There was positive histology (caseating granuloma) and/or positive culture in eight patients. Of the two patients with non-specific histology and negative culture, one was found on chest radiograph to have tuberculosis involvement and the other healed on anti-tuberculosis therapy. All patients were treated with rifampicin, isoniazide and pyrazinamide for nine months. No synovectomy was done. Postoperatively all patients were immobilised in a backslab and then actively mobilised.

At a mean follow-up of three years (1 to 10), patients were assessed according to a modification of Kerri and Martini’s classification. Seven of the eight stage-I or stage-II patients had an excellent result (full range of movement) or good result (loss of less than 30% of range of movement). One stage-II patient had a fair result (loss of range of movement of 30% to 50%). The stage-III patient had a poor result (loss of more than 50% of range of movement).

We concluded that elbows with stage-I and stage-II disease (synovitis) have a good outcome. Anti-tuberculosis chemotherapy is effective in the treatment of stage-I and stage II disease. Synovectomy is unnecessary.

Of 44 patients (55 hips) with slipped upper femoral epiphysis treated from 1963 to 1989, 13 (14 hips) developed chondrolysis. Eight hips had chondrolysis at the time of presentation, all in female patients who were either coloured or black and who had moderate or severe slips. The other six hips had persistent pin penetration of the joint; in five of these the pin penetrated the anterosuperior quadrant of the head. Removal of penetrating pins resulted in improvement in pain in all six hips and in the range of movement in four. Chondrolysis did not develop in any of 11 hips with transient intraoperative pin penetration. In hips with chondrolysis maximum joint-space narrowing developed within the first year; improvement in joint space and range of movement continued for up to three years after maximal involvement. At an average follow-up of 13.3 years no patient had pain but five hips were stiff.