The aim of this review is to address controversies
in the management of dislocations of the
Treatments of Chronic
Treatments of Chronic
The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the
The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the
Intra-articular punctures and injections are performed routinely on patients with injuries to and chronic diseases of joints, to release an effusion or haemarthrosis, or to inject drugs. The purpose of this study was to investigate the accuracy of placement of the needle during this procedure. A total of 76 cadaver
In an osteological collection of 3100 specimens, 70 were found with unilateral clavicular fractures which were matched with 70 randomly selected normal specimens. This formed the basis of a study of the incidence of arthritis of the
Introduction: Acromioclavicular (AC) joint injuries are common in both the sporting and working populations. Most injuries are grade I in severity and settle with an appropriate non-operative treatment program. Arthroscopic soft tissue debridement of the
Injuries to the
Aim: The purpose of this study was to evaluate the results after arthroscopic treatment of traumatic
Because there is little in the literature about specific presentation and examination methods for acromioclavicular (AC) joint pathology, we aimed to define and identify the most reliable tests. We identified and examined 30 patients with probable
Aims: Most of the orthopaedic literature on os acromiale (OA) is focused on corresponding clinical implication, such as impingement syndrome and rotator cuff tear; whilst, although it is present in 8% of subjects, scarce information is reported on the causes that may predispose to it. Our aim is to investigate whether the origin of OA is related to position of
The aim of this study was to establish a classification system for the
Management of highly displaced
Dislocation of the
Aims. To compare radiographic failure and re-operation rates of anatomical
coracoclavicular (CC) ligament reconstructional techniques with
non-anatomical techniques after chronic high grade acromioclavicular
(AC) joint injuries. . Patients and Methods. We reviewed chronic
This prospective, randomized, controlled trial compares patient outcome after non-operative care versus open reduction and tunneled suspension device fixation (ORTSD) for grade III or IV
Chronic instability of the
The LockDown device (previously called Surgilig)
is a braided polyester mesh which is mostly used to reconstruct the
dislocated
A distinctive and consistent pattern of degenerative change was seen in 560
The treatment of Grade III
Little has been written about the results of isolated
Aim: A prospective study designed to assess and evaluate the results of arthroscopic
Introduction. We present an all arthroscopic technique for modified Weaver Dunn reconstruction of symptomatic chronic type III
We report a prospective study of 46 patients with acute complete dislocation of the
Aims: To evaluate the functional outcome and patient satisfaction following the modified Weaver -Dunn procedure for the treatment of chronic
This study aimed to describe the morphology of the coracoid process and determine the frequency of commonly observed patterns. The second purpose was to determine the location of inferior tunnel exit with superior based tunnel drilling and the superior tunnel exit with inferior based tunnel drilling. A sample of 100 dry scapulae for the morphology aspect and 52 cadaveric embalmed shoulders for tunnel drilling were used. The coracoid process was described qualitatively and categorized into 6 different shapes. A transcoracoid tunnel was drilled at the centre of the base. Twenty-six shoulders were used for the superior-inferior tunnel drilling approach and 26 for the inferior-superior tunnel drilling approach. The distances to the margins of the coracoid process, from both the entry and exit points of the tunnel, were measured. Eight coracoid processes were of convex shape, 31 of hooked shape, 18 of irregular shape, 18 of narrow shape, 25 of straight shape, and 13 of wide shape. The mean difference for the distances between superior entry and inferior exit from the apex was Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation 3.65+3.51mm (p=0.002); 1.57+2.27mm for the lateral border (p=0.40) and 5.53+3.45mm for the medial border (p=0.001). The mean difference for the distances between inferior entry and superior exit from the apex was 16.95+3.11mm (p=0.0001); 6.51+3.2mm for the lateral border (p=0.40) and 1.03+2.32 mm for the medial border (p=0.045). The most common coracoid process shape observed was a hooked pattern. Both superior to inferior and inferior to superior tunnel drilling directed the tunnel from a more anterior and medial entry to a posterior-lateral exit. Superior to inferior drilling resulted in a more posteriorly angled tunnel. With inferior to superior tunnel drilling cortical breaks were observed at the inferior and medial margin of the tunnel.
We present 2 year results of a prospective natural history study of Type III Acromioclaviclular joint dislocation (ACJD) treated non-operatively. Previous natural history studies are compromised by inconsistent definitions of the grade of injury and non-validated scoring tools; they do not identify which patients will have ongoing symptoms. This trial documents the strength and subjective recovery over time, and identifies risk factors for poor outcome and need for surgery. Patients with Rockwood Type III ACJD received a standardised rehabilitation protocol (6 sessions of physiotherapy). Clinical assessment was performed at presentation, 3, 6, 12 and 24 months after injury, including isometric strength testing, pain (VAS/10) and subjective scores – Subjective percentage of normal (SPON), American Shoulder and Elbow (ASES), Oxford Shoulder Score (OSS) and Quick Disabilities of Arm Shoulder and Hand (qDASH). 28 male patients were recruited, 26 reached 12, and 9 to 24 months follow up. Two required surgery and one emigrated. The mean age was 39 (15 to 67). Initial mean pain was 3/10, SPON 51% (6–95) and strength was 76% of the other side. By 3 months mean subjective recovery was 70% and strength 90%. Strength recovered to 99% of normal by 12 months but subjective scores remained at mean 90%; by 24 months subjective scores were mean 94%. 2 patients had subjective scores <80%. There was a wide range of initial subjective scores and weakness after Type III ACJD. 95% of strength had recovered by 6 months and subjective scores recovered to 94% of normal by 24 months. 4 patients (14%) did poorly with 2 requiring surgery. Low initial subjective score and inability to abduct the arm at presentation were risk factors for a poor outcome.
We present an all arthroscopic technique for modified Weaver Dunn reconstruction of symptomatic chronic type III ACJ joint injuries. Over a one year period we performed 12 all arthroscopic modified Weaver-Dunn procedures. All patients had failed non-operative management for at least 6 months. The technique involved excision of the lateral end of clavicle, stabilisation with a suture cerclage technique from 2 anchors placed in the base of the coracoid and coracoacromial ligament transfer from the acromion to lateral end of clavicle. Post-operatively the patients were immobilised for six weeks, followed by an active rehabilitation programme and return to work and sports at 3 months. We have currently performed this technique in 12 patients, all male. The average age at operation was 25.8yrs at a mean interval of 11 months post injury. The mean Constant score preoperatively was 49 (44–54). The mean 3 month postoperative Constant score was 88.6 (84–96). There have been no complications, and the 2 professional sportsmen within our cohort returned to full contact at 3 months. Due to an irreducible clavicle, one patient required an open excision of lateral clavicle, with the rest of the procedure performed arthroscopically. Arthroscopic Weaver-Dunn has a number of advantages over the corresponding open procedure. It avoids the detachment of deltoid needed to gain exposure and also the morbidity from the wound. From our experience is that it enables patients to regain their function more rapidly with an earlier return to sporting activities. The early results from our initial experience have been excellent, with no complications. With this technique an anatomic reconstruction can be achieved with excellent cosmesis, low morbidity and potentially accelerated rehabilitation.
Osteolysis has been reported following ACJ reconstruction with a synthetic graft. We present the first study into its prevalence and pattern, and its effect on patient outcome. Patients who underwent treatment of an unstable ACJ injury using the Surgilig/LockDown implant were identified via our database. Patients were invited to attend a dedicated outpatient clinic for clinical examination, radiographic evaluation, and completion of outcome scoring. Patients who were unable to attend were contacted by telephone. 49 patients were identified. We assessed 21 clinically at a mean of 7 years post-procedure (range 3–11 years). All had radiographic evidence of distal clavicle and coracoid osteolysis. We did not observe progression of osteolysis from the final post-operative radiographs. A further 13 were contacted by phone. The mean Oxford Shoulder Score was 43 (range 31–48) and mean DASH score was 8.5 (range 3–71). The average Patient Global Impression of Change score was 6 (range 2–7). Six patients underwent removal of a prominent screw at a mean of 2 years after surgery; the pattern of osteolysis was no different in this group. All patients had comparable abduction, forward flexion and internal rotation to their uninjured shoulder. We did not observe any relationship between patient demographics, position of implant or etiology and the pattern of osteolysis. Osteolysis of the distal clavicle and/or coracoid is always seen following synthetic reconstruction of the ACJ using this implant, but is non-progressive. Range of shoulder movement is largely unaffected and patient outcomes remain high.
Aims. There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive
The June 2024 Shoulder & Elbow Roundup. 360. looks at: Reverse versus anatomical total shoulder replacement for osteoarthritis? A UK national picture; Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomized controlled trial; acid for rotator cuff repair: a systematic review and meta-analysis of randomized controlled trials; Metal or ceramic humeral head total shoulder arthroplasty: an analysis of data from the National Joint Registry; Platelet-rich plasma has better results for long-term functional improvement and pain relief for lateral epicondylitis: a systematic review and meta-analysis of randomized controlled trials; Quantitative fatty infiltration and 3D muscle volume after nonoperative treatment of symptomatic rotator cuff tears: a prospective MRI study of 79 patients; Locking plates for non-osteoporotic proximal humeral fractures in the long term; A systematic review of the treatment of primary
In older patients (>75 years of age), with an intact rotator cuff, requiring a total shoulder replacement (TSR) there is, at present, uncertainty whether an anatomic TSR (aTSR) or a reverse TSR (rTSR) is best for the patient. This comparison study of same age patients aims to assess clinical and radiological outcomes of older patients (≥75 years) who received either an aTSR or a rTSA. Consecutive patients with a minimum age of 75 years who received an aTSR (n=44) or rTSR (n=51) were prospectively studied. Pre- and postoperative clinical evaluations included the ASES score, Constant score, SPADI score, DASH score, range of motion (ROM) and pain and patient satisfaction for a follow-up of 2 years. Radiological assessment identified glenoid and humeral component osteolysis, including notching with a rTSR. Postoperative improvement for ROM and all clinical assessment scores for both groups was found. There were significantly better patient reported outcome scores (PROMs) in the aTSR group compared with the rTSR patients (p<0.001). Both groups had only minor osteolysis on radiographs. No revisions were required in either group. The main complications were scapular stress fractures for the rTSR patients and
Osteoarthritis (OA) is the most common disorder of the Sternoclavicular Joint (SCJ). In our case-control study, we evaluated the relationship between clavicular length and OA at the SCJ. CT scans of adults presenting to the Emergency Department of our hospital were examined to look for OA, defined as the presence of osteophytes, subchondral cysts, or cortical sclerosis at the SCJ. Medial-most and lateral-most points of the clavicle were marked on the slices passing through the SC and
Many surgical procedures have been put forth for the management of AC disruption none of them proved to be preferred surgical procedure. To provide better surgical stabilization and functional outcome for the management of
Aims. The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location. Methods. Scottish Morbidity Records were reviewed retrospectively between March 2014 and April 2018 to identify records for every admission to each NHS hospital. The Office of Population Censuses and Surveys (OPCS-4) surgical codes were used to identify patients undergoing primary ASD. Patients who underwent
The purpose of this study was to review the long-term outcomes of a previously reported prospective series of 46 type III acromioclavicular dislocations. These were treated surgically with temporary fixation of the
Introduction We have evaluated the early outcome of arthroscopic excision of the distal clavicle (Mumford procedure) for
The purpose of this study was to determine the motion pattern of the Acromio-Clavicular (AC) joint in a normal shoulder with the use of the new 4 Dimensional CT scan. From April 2010 till January 2011 fourteen healthy volunteers (4 female, 10 male)(mean age 42±11 years) with no previous history of shoulder complaints participated in this study. The 4D CT machine scans motion, allowing a 3D reconstruction of the shoulder joint and its movements. Patients were positioned supine with their arm elevated 90° in the sagittal plane. During the 7 seconds duration of the scan they adducted their arm at that level and then elevated their arm upwards resisted by the gantry for 4 seconds, in this way simulating the clinical Bell-van Riet test for AC pathology. In the transverse plane the mean
Airn: Treatment of
Posterior dislocation of the
In Neer type II (Robinson type 3B) fractures
of the distal clavicle the medial fragment is detached from the coracoclavicular
ligaments and displaced upwards, whereas the lateral fragment, which
is usually small, maintains its position. Several fixation techniques
have been suggested to treat this fracture. The aim of this study
was to assess the outcome of patients with type II distal clavicle
fractures treated with coracoclavicular suture fixation using three
loops of Ethibond. This prospective study included 14 patients with
Neer type II fractures treated with open reduction and coracoclavicular
fixation. Ethibond sutures were passed under the coracoid and around
the clavicle (UCAC loop) without making any drill holes in the proximal
or distal fragments. There were 11 men and three women with a mean
age of 34.57 years (29 to 41). Patients were followed for a mean
of 24.64 months (14 to 31) and evaluated radiologically and clinically
using the Constant score. Fracture union was obtained in 13 patients at
a mean of 18.23 weeks (13 to 23) and the mean Constant score was
96.07 (91 to 100). One patient developed an asymptomatic fibrous
nonunion at one year. This study suggests that open reduction and
internal fixation of unstable distal clavicle fractures using UCAC
loops can provide rigid fixation and lead to bony union. This technique avoids
using metal hardware, preserves the
Introduction: Since the first repair of coracoclavicular ligament complex in 1886 there have been more than sixty operative procedures described in the literature. Open methods of reduction and stabilization of
The February 2014 Shoulder &
Elbow Roundup. 360 . looks at: whether arthroscopic acromioplasty is a cost-effective intervention; shockwave therapy in cuff tear; whether microfracture relieves short-term pain in cuff repair; the promising early results from L-PRF augmented cuff repairs; rehabilitation following cuff repair; supination strength following biceps tendon rupture; whether longer is better in humeral components; fatty degeneration in a rodent model; and the controversial
Aims: We studied the prevalence of calciþc tendinopathy in asymptomatic subjects and the relationship between calciþc deposits and the anatomopathological characteristic of coracoacromial arch. Methods: 222 right-handed volunteers underwent x-ray examination of the right shoulder. We measured the acromiohumeral distance (AHD) and evaluated the acromion shape and the degenerative changes of the GH and
The December 2012 Shoulder &
Elbow Roundup. 360. looks at: whether allograft is biomechanically superior in large Hill-Sachs defects; glenoid bone loss in shoulder dislocators; repairing irreparable cuff tears;
Antegrade intramedullary nailing of fractures of the shaft of the humerus is reported to cause impairment of the shoulder joint. We have reviewed 33 patients with such fractures to assess how many had injuries to the ipsilateral shoulder. All had an MR scan of the shoulder within 11 days of injury. The unaffected shoulder was also scanned as a control. There was evidence of abnormality in 21 of the shoulders (63.6%) on the injured side; ten had bursitis of the subacromial space, five evidence of a partial tear of the rotator cuff, one a complete rupture of the supraspinatus tendon, four inflammatory changes in the
The aim of our study was to assess the use of the Clavicular Hook Plate in treating acromio–clavicular joint dislocations and fractures of the distal clavicle. The prospective study was carried out at two hospitals- a teaching hospital and a district general hospital. Between 2001 and 2004 a total of 37 patients with
Background. Nonsurgical treatment of
Crosby and Colleagues described 24 scapula fractures in 400 reverse shoulder arthroplasties and classified scapula fractures after reverse shoulder arthroplasty into 3 types. Type 1 – true avulsion fracture of acromion related to a thinned out acromion (post-acromioplaty or cuff arthropathy). A small bone fragment dislodges during reduction of RSA. Type 2 – Acromial fracture due to Acromio-clavicular (AC) joint arthrosis. They feel the lack of movement at the
Tightrope fixation is known method for reconstructing
Distal third clavicle (DTC) fractures are increasing in incidence. Due to their instability and nonunion risk, they prove difficult to treat. Several different operative options for DTC fixation are reported but current evidence suggests variability in operative fixation. Given the lack of consensus, our objective was to determine the current epidemiological trends in DTC as well as their management within the UK. A multicentre retrospective cohort collaborative study was conducted. All patients over the age of 18 with an isolated DTC fracture in 2019 were included. Demographic variables were recorded: age; sex; side of injury; mechanism of injury; modified Neer classification grading; operative technique; fracture union; complications; and subsequent procedures. Baseline characteristics were described for demographic variables. Categorical variables were expressed as frequencies and percentages.Aims
Methods
Thirty-three patients with impingement syndrome of the rotator cuff were studied before and at operation. It was shown that the rotator cuff lengthens and twists during elevation of the arm. Elevation is achieved by early glenohumeral abduction and continuous flexion and external rotation. The range of free rotation at the glenohumeral joint diminishes progressively during elevation. Rotator cuff impingement occurs towards the end of the early glenohumeral abduction. Excision arthroplasty of the
After shoulder arthroplasty many pain generators may continue to play a role and these might otherwise be missed in a patient where the post-operative radiograph looks fine. Such conditions might include pain from an adjacent location such as the
Acromioclavicular (AC) joint dislocations and fractures of the distal clavicle present challenging problems for the treating surgeon. We treated eight patients using a hook-shaped plate fixed to the distal clavicle and ‘hooked’ under the posterior acromion. In five patients the injury was a fractured distal clavicle and in three an
Radiographs of the shoulders of 84 asymptomatic individuals aged between 40 and 83 years were evaluated to determine changes in 23 specific areas. Two fellowship-trained orthopaedic radiologists graded each area on a scale of 0 to II (normal 0, mild changes I, advanced changes II). Logistic regression analysis indicated age to be a significant predictor of change (p <
0.05) for sclerosis of the medial acromion and lateral clavicle, the presence of subchondral cysts in the acromion, formation of osteophytes at the inferior acromion and clavicle, and narrowing and degeneration of the
We reviewed 36 patients (39 shoulders) who had undergone arthroscopic Mumford procedure via a two superior portal technique for isolated
The aim of the study was to prospectively review the incidence of shoulder injuries in a group of professional rugby union players and to identify any relationship between the injury and the causes, position of play, treatment and time to return to playing. An electronic database system was developed specifically to identify the objectives listed above with a view of reducing injury incidence and recurrence through identification of trends. The system was implemented in both Cardiff(2000–2003) and Llanelli(2005–2007) Rugby Football clubs. Extensive prospective data was collected by the team physiotherapists including: Type of injury(Orchard Coding), playing position, session, mechanism of injury and days lost per injury. Shoulder injuries represented 14% of all injuries sustained. Soft tissue injuries account for about 50% of the injuries and result in an average loss of five playing days.
This study looks at the outcomes of 112 full thickness rotator cuff tears treated by arthroscopic decompression, without repair of the rotator cuff, from 1994. The decision not to repair the tear was taken only if four criteria were met. First, if there was no clinical weakness on manual testing of the individual rotator cuff muscles, secondly, if there was full abduction, thirdly, if there was no riding up of the humeral head on the anteroposterior radiograph and fourthly, if there was well-developed ‘cable’ on arthroscopic visualisation of the rotator cuff. The mean age of the patients, 38% of whom were men, was 62 years (47 to 83). In 44% the right shoulder was operated on. There were 32% type-II acromions and 68% type-III. There were 58% C2 tears and 42% C3 tears. All had arthroscopic acromioplasty and
There is concern that intra-articular electrosurgical ablation may cause thermal soft tissue damage, particularly chondrolysis, if excessive temperatures are reached. The aim of this study was to determine whether the intra-articular temperature during arthroscopic subacromial decompression using a monopolar electrosurgical ablator remains below a safe level. Data was collected prospectively from consecutive shoulder arthroscopic subacromial decompressions performed at our institution. Shoulder arthroscopy was performed using three standard portals. Evaluation of the glenohumeral joint and subacromial space was performed in a standard manner. Soft tissue resection of the subacromial bursa was performed using a monopolar electrosurgical ablator probe with continuous integral suction. Additional procedures such as
Painful conditions of the acromioclavicular (AC) joint are common in South Africa, particularly among sportsmen. These conditions are often treated by open excision of the distal end of the clavicle, but an arthroscopic procedure offers many advantages. From February 1994 to February 2000, we performed 138 procedures. The mean age of patients ({71% men and 29% women) was 29 years (19 to 53). In cases of rotator cuff impingement, arthroscopic acromioplasty was followed by clavicular excision via the subacromial route. With a normal acromion and rotator cuff the
Aim: A comparison of two different techniques of acro-mioclavicular joint reduction in complete AC disruption. Methods: During 1992–2001, 59 patients (50 male; 9 female; average 32.3y), underwent surgical reconstruction for complete (Allman-Tossy III) AC dislocation. Fixation of the joint was achieved in all patients by double-banded coracoclavicular stabilization, using heavy nonabsorbable sutures in a double-banded ligamentous substitution manner. In 35 patients (group I) a temporary acromioclavicular fixation was done (with K-W, removable at 6th postoperative week), whereas in the rest 24 patients (group II) an additional fixation of the acromioclavicular disruption, with nonabsorbable sutures, without using K-W was performed. Results: Mean follow-up period was 6.4 years. Our results according to Constant-Murley score were excellent or very good in 25 patients (71.4%) of group I and 21 (87.5%) patients of group II. Loss of reduction (3), calcification (5) and superficial pin infection (2) were noted with greater frequency in patients of group I. Three of them reoperated because of K-W migration or breakage. Complications of group II included 1 superficial infection, 1 calcification with restriction of joint motion and 1 case with slight loss of reduction. Conclusions: Reduction of the
Background: Distal third fractures account for 10 to 15% of all clavicle fractures. Traditional management of displaced lateral third fractures has been with internal fixation. Several authors have reported higher rates of non-union and poor outcome in conservatively managed fractures. However, long term follow up of non-operated distal third fractures has shown comparable functional outcomes to those managed with internal fixation. The purpose of this retrospective study was to analyse the clinical and radiographic results of nonoperative treatment of displaced lateral clavicle fractures. Methods: Eighty six patients with displaced lateral end clavicle fractures were treated primarily with a sling for comfort. The fractures were classified as Neer type IIa in fifty patients, type IIb in twenty nine and type III in seven. Physiotherapy was begun after the sling was removed at an average of two weeks after the injury. Patients were evaluated with regard to shoulder function and general health using a modification of the Constant score and SF-36 respectively. All patients had a repeat radiographic exam at follow up. The average duration of follow up was six years (range two to ten years). Results: Fourteen patients developed symptoms severe enough to warrant surgery at between seven and twenty four months post-injury. Eleven had radiographically confirmed non-union and three had symptomatic osteoarthritis of the
Purpose: We present the results of subacromial decompression and repair of the rotator cuff through a minimal deltoid-on approach. Material and Method: Eighty-seven patients with longstanding shoulder pain were evaluated in two years (1999–2000) in our department. In sixty -eight of them symptoms were due to impigment syndrome. Eight patients with follow up time less than six months were excluded from this study, twenty were treated conservatively and the remaining forty (22 female, 18 male, mean age 50.3) underwent surgery. Three x-ray views were obtained in all patients, i.e. standard AP, true AP, and subacromial space projection. MRI was also obtained in all patients. MRI revealed calcific tendinitis in fifteen patients, osteophytes of the
Introduction and Aims: The authors have previously reported the comparison between MRI and arthroscopic diagnosis in a blinded prospective study in patients with shoulder impingement syndrome. The purpose of this investigation was to determine whether the radiologist’s MRI report provided to an arthroscopist upon completion of a standard diagnostic shoulder arthroscopy would result in changes to the initial arthroscopic findings. Method: Fifty-eight patients presenting with clinical signs and symptoms of shoulder impingement syndrome underwent an MRI one week prior to planned arthroscopic subacromial decompression. MRI scans were obtained following a standardised protocol. Images were read by one musculoskeletal radiologist. A standard diagnostic arthroscopy was performed. The anatomic and pathologic findings were documented intra-operatively by an independent observer. The arthroscopist was initially blinded to the MRI information until completion of the standard diagnostic arthroscopy. MRI results were then revealed to the surgeon. An arthroscopic re-evaluation was performed to resolve any discrepancies between MRI and the initial arthroscopic findings. Results: The percentage discordance between MRI and initial arthroscopic findings for each structure of interest was calculated along with the percentage change in diagnosis based upon the arthroscopic re-evaluation and the consequence of the change. Supraspinatus 55.2% discordance (n=32/58), 18.8% change in diagnosis (n=6/32), in one patient a change in the planned operation occurred from subacromial decompression to mini-open rotator cuff repair. Infra-spinatus 44.8% discordance (n=26/58), 3.8% change in diagnosis (n=1/26), and no consequence to planned treatment. Subscapularis 37.9% discordance (n=22/58), no change in diagnosis. Biceps tendon 62.3% discordance (n=33/53; five patients not adequately visualised on MRI), no change in diagnosis. Acromion type 50% discordance (n=26/52; five patients did not have a sub-acromial bursocopy and in one patient the acromion was not well visualised), 7.7% change in diagnosis (n=2/26) with no consequence to planned treatment.
Arthroscopic subacromial decompression for shoulder impingement syndrome is one of the commonest procedures performed by the shoulder surgeon. Although much has been written on this procedure since Ellman published in 1985, very little work has been carried out on the rate of recovery after surgery, despite this being one of the main concerns of the patient. This prospective study describes the early functional results after this procedure and the rate of recovery seen. Sixty-eight patients underwent arthroscopic subacromial decompression for shoulder impingement syndrome between January and November 2000. All patients had suffered pain for at least six months prior to surgery, and all were diagnosed on the basis of clinical findings, radiographic evidence, and a positive response to Neer’s impingement test, i.e. abolition of pain after an injection of local anaesthetic into the subacromial space. All patients were evaluated preoperatively, at three weeks and three months post operatively using the Constant score to obtain an objective assessment of shoulder function. Surgery was carried out via an arthroscopic technique using the Dyonics power shaver with the 4.5 mm Helicut blade (Smith &
Nephew). Immediate post operative physiotherapy was allowed, together with the encouragement of activities of daily living. Sixty-eight patients with a mean age of 45 years (range: 30–77 years) underwent surgery over a 10 month period. Male: female ratio was 60:40, and the lateral clavicle was affected in 33 cases, resulting in the need for an
The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula. We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification.Aims
Methods
The outcomes following nonoperative management of minimally displaced greater tuberosity (GT) fractures, and the factors which influence patient experience, remain poorly defined. We assessed the early patient-derived outcomes following these injuries and examined the effect of a range of demographic- and injury-related variables on these outcomes. In total, 101 patients (53 female, 48 male) with a mean age of 50.9 years (19 to 76) with minimally displaced GT fractures were recruited to a prospective observational cohort study. During the first year after injury, patients underwent experiential assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score and assessment of associated injuries using MRI performed within two weeks of injury. The primary outcome was the one-year DASH score. Multivariate analysis was used to assess the effect of patient demographic factors, complications, and associated injuries, on outcome.Aims
Methods
Multiple secondary surgical procedures of the shoulder, such as soft-tissue releases, tendon transfers, and osteotomies, are described in brachial plexus birth palsy (BPBP) patients. The long-term functional outcomes of these procedures described in the literature are inconclusive. We aimed to analyze the literature looking for a consensus on treatment options. A systematic literature search in healthcare databases (PubMed, Embase, the Cochrane library, CINAHL, and Web of Science) was performed from January 2000 to July 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The quality of the included studies was assessed with the Cochrane ROBINS-I risk of bias tool. Relevant trials studying BPBP with at least five years of follow-up and describing functional outcome were included.Aims
Methods
The aim of this study was to report the incidence of implant-related complications, further operations, and their influence on the outcome in a series of patients who underwent primary reverse total shoulder arthroplasty (RTSA). The prospectively collected clinical and radiological data of 797 patients who underwent 854 primary RTSAs between January 2005 and August 2018 were analyzed. The hypothesis was that the presence of complications would adversely affect the outcome. Further procedures were defined as all necessary operations, including reoperations without change of components, and partial or total revisions. The clinical outcome was evaluated using the absolute and relative Constant Scores (aCS, rCS), the Subjective Shoulder Value (SSV) scores, range of motion, and pain.Aims
Methods
The importance of mitigating pain for patients undergoing total shoulder arthroplasty is extremely relevant for purposes of being able to initiate early functional rehabilitation and activities of daily living. The process, however, does not commence after surgery but rather before surgery. Careful patient education and instruction, including pre-operative exercises to maximise mobility, strength and endurance within the limited range of motion is quite helpful. Adjunctive therapy includes preemptive ultrasound-guided intrascalene regional anesthesia, immediate post-operative peri-incisional injection of liposomal bupivacaine, post-operative use of waterproof Tegaderm. TM. dressing to allow warm showers early on in the rehabilitation period, peri-operative use of Cox 2 inhibitors and a gentle, therapist-guided passive exercise program focusing on relaxation techniques. This in combination with patient-controlled analgesic pumps, careful surgical technique providing adequate soft tissue releases and removal of potential pain generators such as the long tendon of the biceps and an arthritic
Clavicular hook plates have been used over the last decade in the treatment of lateral clavicular fractures with good rates of union reported throughout the literature. Fewer studies have reported the functional outcome of these patients and some have reported potential soft tissue damage post plate removal. We aimed to review the functional outcomes alongside union rates in patients treated with hook plates for lateral clavicular fractures. In this retrospective case series, 21 patients with traumatic lateral third clavicular fractures were included. 15 had Neer type II fractures, 4 Neer type III fractures, 1 patient had a Neer type I fracture and 1 radiograph was not able to be classified. All patients were treated with clavicular hook plates at the same district general hospital by five experienced surgeons between March 2010 and February 2015 adhering to the same surgical protocol. All patients had standard physiotherapy and post operative follow up. Plates were removed when radiological union was achieved in all but one patient who had the plate removed before union was achieved due to prolonged non-union. Patients were followed up post plate removal and evaluated clinically using the Oxford Shoulder Score. Their post plate radiographs were assessed by an independent radiologist and bony union documented. 21 patients were included. Mean age was 40 (range 14–63) with a male:female ratio of 17:4. Mean follow up was 5 months post injury (1–26 months). The hook plate remained in situ for a mean time of 4.3 months (2–16 months). One patient developed a post-operative wound infection treated with antibiotics, 2 patients developed adhesive capsulitis, one patient had not achieved bony union prior to hook plate removal at 16 months, however did achieve union 2 months post plate removal, two patients required revision plating. All patients achieved bony union eventually with good alignment and no displacement of the
The incidence of frozen shoulder (FS) as a complication of simple arthroscopic shoulder surgery has yet to be defined. A single-surgeon case series of patients undergoing arthroscopic subacromial decompression (ASD) or ASD with arthroscopic
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. Materials and Methods. We reviewed a group of patients with arthrosis of the glenohumeral joint who underwent humeral resurfacing, and who were at a minimum of two years post surgery. From January 2000 to March 2011, 51 humeral resurfacing procedures were performed in 49 patients. Patients were contacted for review, and assessed using patient reported outcome measures. An Oxford Shoulder score as well as a subjective satisfaction and outcome questionnaire was completed, as well as details regarding further surgery or revision. 2 patients had died, 11 patients were not contactable, and in 4 the medical files had been lost. In the remaining 32 shoulders, the average follow-up was 5.9 years. The mean age at time of surgery was 62.3 years (range 36 to 84). Results. Complications included 7 revisions (average 2.4 years post surgery), a further 2 patients await revision. There were 2 subscapularis tendon ruptures managed operatively. A further 2 patients required surgery – one for impingement and
We have reviewed 30 patients who had been treated conservatively for acromioclavicular dislocation between 1979 and 1982 at an average of 12.5 years after the injury. All except one had a good outcome as did five others contacted by telephone. In all patients reviewed the
Suturing of portals following arthroscopic shoulder surgery may be unnecessary. We carried out a randomised controlled trial to compare patients whose arthroscopic portals were closed by suturing and those that weren’t. We randomised 60 patients undergoing diagnostic shoulder arthroscopy, arthroscopic subacromial decompression and arthroscopic
Purpose. While reverse shoulder arthroplasty (RSA) corrects vertical muscle imbalance, it cannot restore the horizontal imbalance seen in cuff-deficient shoulders with combined loss of active elevation and external rotation (CLEER). We report the medium-term results of the modified latissimus dorsi/teres major tendon transfer (L'Episcopo procedure) associated with RSA, performed via a single deltopectoral approach. Method. Sixteen CLEER patients underwent the procedure and were followed up at a mean of 49 months (range, 36–70). All patients had lost spatial control of their arm, were unable to maintain neutral rotation, and had abnormal infraspinatus and teres minor muscles on imaging. Outcome measures included Constant score (CS), Subjective Shoulder Value (SSV), and ADLER score (activities of daily living requiring external rotation). Results. Fifteen patients were satisfied or very satisfied. There were significant improvements (p<0.05) in active elevation (72 degrees to 139 degrees), active external rotation (−24 degrees to 4 degrees), CS (27 to 64), ADLER score (5.0 to 23.8) and SSV (23% to 77%). Active internal rotation decreased from 6 to 3 points. Scapular notching was observed in 3 patients and spurs in 3 patients. One deep infection required two-stage revision of the prosthesis and the patient was disappointed with the result. One patient required reoperation (arthrolysis and
The clinical results following open reduction and internal fixation via a modified dorsal two-portal-approach in dislocated scapular neck and glenoid fractures should be evaluated. The approach with two dorsal portals to the glenoid, one cranially and one caudally of the infraspinatus muscle, is described. From 1.7.1992 until 30.06.2006, 37 patients (27 men, 10 women, mean age 53 years), 31 patients with glenoid fractures and 6 patients with unstable scapular neck fractures were operated on via the two-portal-approach. The reduction was controlled radiographically, the clinical results were analysed using the Constant-score. The mean follow-up was 68 (6–168) months. In 22 out of the 31 glenoid fractures the reduction was anatomically. The mean Constant-score revealed 81,1 (35–100) points. In one case an early postoperative wound infection could be cured by local revision and one patient developed an arthritis of the
The aim of this study is to prepare for the introduction of the world’s first nationwide registry of all rotator cuff tears proceeding to operative management. Patient’s are scored pre-operatively and again at six and 12 months post-op using the Flex SF functional scale, pain scales and work and activity levels. A questionnaire is filled out by the operating surgeon on the day of surgery detailing pathology and the operative methods used. This study is a New Zealand Shoulder and Elbow Society initiative begun in 2007. New Zealand is ideally suited with a small, cohesive group of orthopaedic surgeons. Rotator cuff surgery is advancing rapidly with changes in surgical approach from open to arthroscopic, and repair methods from bone tunnels to various choices of anchors. A wide range of surgical methods are used within New Zealand, presenting an opportunity to use the large numbers generated by a registry to give valuable information guiding future treatment. The operation day questionnaire includes information on tear size, surgical approach, repair methods, biceps and
68 patients underwent arthroscopic subacromial decompression for shoulder impingement syndrome. Patients were evaluated preoperatively, at 3 weeks and 3 months post operatively using the Constant score. Mean preoperative Constant score was 46. 5 (34–67), at 3 weeks 65. 8 (40–86), and at 3 months 82. 4 (50–99). There was no correlation between the impingement grade, presence of a cuff tear or
Disruption of the coraco-clavicular ligaments may be associated with either dislocation of the
With widely reported co-existence of impingement syndrome and
Distal clavicle fractures associated with coracoclavicular ligament disruption are potentially unstable. 1. Internal fixation of these fractures is often inadequate due to two anatomical problems:. Inadequate distal fragment size and. Displacement and instability consequent to ligament disruption. We hypothesize that a contour-matched locking plate coupled with a coracoclavicular ligament repair device would provide a potentially safe and minimally invasive method for adequate fixation. Between 2006 and 2008, 5 patients were surgically treated for non-comminuted distal clavicular fractures associated with coracoclavicular ligament disruption. The surgical technique consisted of. neutralization of muscular forces on the proximal fragment by using a minimally invasive ligament repair device (TightRope. ™. , Arthrex, FL), and. Internal fixation using a contour-matched locking plate (Distal radial locking plate, Synthes). Technical tips to optimize this new procedure are presented. Outcome measures consisted of. Constant shoulder score. Radiographic union. The retrospective follow-up period varied from 8 weeks to 24 months. A statistically significant improvement in the Constant score was observed in every patient. All patients progressed to satisfactory bony union. Plate removal was not necessary in any patient. Potential complications include screw penetration of the
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
Purpose of Study Disruption of the coraco-clavicular ligaments may be associated with either dislocation of the
This study was carried out to determine the incidence of shoulder injuries in the ipsilateral shoulder of patients who attended our unit with fractures of the humeral diaphysis. This was a prospective study. 22 patients with fractures of the humeral diaphysis had an early (within 10 days of injury) MRI scan of the shoulder. The contralateral shoulder was also scanned as an internal control. There were 10 male and 12 female patients. The average age was 45 years. 20 were treated non-operatively, and 2 had retrograde intra-medullary nailing of the humerus. 6 patients in our study had a symmetrical MRI scan. The remaining 16 patients had some acute abnormality evident in the ipsilateral shoulder. 11 patients had a significant subacromial bursitis. 2 of these patients had a tear of the supraspinatus tendon. 1 patient had an undisplaced fracture of the coracoid process. The remaining 4 patients had significant
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
This study is designed to assess and evaluate the results of arthroscopic
Introduction The value of collecting continuous prospective patient data, including operation records and outcome scores, is well known. In 1994, a systematic prospective patient data collection was initiated on all patients attending the Reading Shoulder Unit (RSU). Initially this was done with hand written records. In 1995 a Windows Access ® database was formulated on a portable laptop. This was used continuously through until September 2005 when an Internet web-based database was introduced. We present this collective data and trends in practice from a busy shoulder unit over this decade. Results Between 1995 and 2005, 10005 entries were made to the Reading Shoulder Unit database. 3233 patient visits to outpatient clinics were recorded. 6772 operations were recorded – this includes: arthroscopic decompressions (ASD) +
Aim: To evaluate the therapeutic effectiveness of steroid injection in