Aims. The main objective of this study was to examine whether the
This study aims to correlate
While clinically important improvements in Oxford Shoulder Scores have been defined for patients with general shoulder problems or those undergoing subacromial decompression, no threshold has been reported for classifying improvement after shoulder replacement surgery. This study aimed to establish the minimal clinically important change (MCIC) for the
While clinically important improvements in Oxford Shoulder Scores have been defined for patients with general shoulder problems or those undergoing subacromial decompression, no threshold has been reported for classifying improvement after shoulder replacement surgery. This study aimed to establish the minimal clinically important change (MCIC) for the
The use of scoring systems for surveillance of post-operative outcomes is increasing. However, the methodology of this follow-up is not universal. We set out to assess whether a postal
Aims. The aim of this study was to develop and evaluate machine-learning-based computerized adaptive tests (CATs) for the Oxford Hip Score (OHS), Oxford Knee
Aims. Early large treatment effects can arise in small studies, which lessen as more data accumulate. This study aimed to retrospectively examine whether early treatment effects occurred for two multicentre orthopaedic randomized controlled trials (RCTs) and explore biases related to this. Methods. Included RCTs were ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation), a two-arm study of surgery versus non-surgical treatment for proximal humerus fractures, and UK FROST (United Kingdom Frozen Shoulder Trial), a three-arm study of two surgical and one non-surgical treatment for frozen shoulder. To determine whether early treatment effects were present, the primary outcome of
Aims. The
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
Aims. Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome. Methods. Between 1998 and 2018, 424 consecutive patients were treated with primary ORPF for proximal humerus fracture. ADROM was offered to symptomatic patients with a healed fracture at six months postoperatively. Patients were followed up retrospectively with demographic data, fracture characteristics, and complications recorded. Active range of motion (aROM),
Aims. The use and variety of stemless humeral components in anatomical total shoulder arthroplasty (TSA) have proliferated since their advent in 2004. Early outcomes are reassuring but independent mid-term results are scarce. This independent study reports a consecutive series of 143 Eclipse stemless shoulder prostheses with a minimum five-year (5 to 10) follow-up. Methods. Outcomes of 143 procedures undertaken for all indications in 131 patients were reviewed, with subset analysis of those for osteoarthritis (OA) (n = 99). The primary outcome was the
The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures A total of 250 patients presenting within three weeks of sustaining a displaced proximal humeral fracture involving the surgical neck were recruited at 32 acute NHS hospitals in the United Kingdom between September 2008 and April 2011. Of the 125 participants, 109 received surgery (fracture fixation or humeral head replacement) as per randomization. Data were included for 101 and 67 participants at six-month and five-year follow-up, respectively. Oxford Shoulder Scores (OSS) collected at six, 12, and 24 months and at three, four, and five years following randomization was plotted against time to surgery. Long-term recovery was explored by plotting six-month scores against five-year scores and agreement was illustrated with a Bland-Altman plot.Aims
Methods
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
Abstract. Aim. The aim of this study was to present the results of treatment of displaced lateral clavicle fractures by an arthroscopically inserted tightrope device (‘Dogbone’, Arthrex). Methods. We performed a retrospective series of our patients treated with this technique between 2015 and 2019. Patients were identified using the ‘CRS Millennium’ software package and operation notes/clinic letters were analysed. We performed an
Aims. Reverse total shoulder arthroplasty (rTSA) can be used in complex cases when the glenoid requires reconstruction. In this study, a baseplate with composite bone autograft and a central trabecular titanium peg was implanted, and its migration was assessed for two years postoperatively using radiostereometric analysis (RSA). Methods. A total of 14 patients who underwent a rTSA with an autograft consented to participate. Of these, 11 had a primary rTSA using humeral head autograft and three had a revision rTSA with autograft harvested from the iliac crest. The mean age of the patients was 66 years (39 to 81). Tantalum beads were implanted in the scapula around the glenoid. RSA imaging (stereographic radiographs) was undertaken immediately postoperatively and at three, six, 12, and 24 months. Analysis was completed using model-based RSA software. Outcomes were collected preoperatively and at two years postoperatively, including the
We assessed the predictive value of the macroscopic and detailed microscopic appearance of the coracoacromial ligament, subacromial bursa and rotator-cuff tendon in 20 patients undergoing subacromial decompression for impingement in the absence of full-thickness tears of the rotator cuff. Histologically, all specimens had features of degenerative change and oedema in the extracellular matrix. Inflammatory cells were seen, but there was no evidence of chronic inflammation. However, the outcome was not related to cell counts. At three months the mean
Aims. Stemless humeral implants have been developed to overcome stem-related complications in total shoulder arthroplasty (TSA). However, stemless implant designs may hypothetically result in less stable initial fixation, potentially affecting long-term survival. The aim of this study is to investigate early fixation and migration patterns of the stemless humeral component of the Simpliciti Shoulder System and to evaluate clinical outcomes. Methods. In this prospective cohort study, radiostereometric analysis (RSA) radiographs were obtained in 24 patients at one day, six weeks, six months, one year, and two years postoperatively. Migration was calculated using model-based RSA. Clinical outcomes were evaluated using the visual analogue scale (VAS), the
Aims. Long-term outcomes following the use of human dermal allografts in the treatment of symptomatic irreparable rotator cuff tears are not known. The aim of this study was to evaluate these outcomes, and to investigate whether this would be a good form of treatment in young patients in whom a reverse shoulder arthroplasty should ideally be avoided. Methods. This prospective study included 47 shoulders in 45 patients who underwent an open reconstruction of the rotator cuff using an interposition GraftJacket allograft to bridge irreparable cuff tears, between January 2007 and November 2011. The
Aims. Reverse total shoulder arthroplasty (RTSA) using trabecular metal (TM)-backed glenoid implants has been introduced with the aim to increase implant survival. Only short-term reports on the outcomes of TM-RTSA have been published to date. We aim to present the seven-year survival of TM-backed glenoid implants along with minimum five-year clinical and radiological outcomes. Methods. All consecutive elective RTSAs performed at a single centre between November 2008 and October 2014 were reviewed. Patients who had primary TM-RTSA for rotator cuff arthropathy and osteoarthritis with deficient cuff were included. A total of 190 shoulders in 168 patients (41 male, 127 female) were identified for inclusion at a mean of 7.27 years (SD 1.4) from surgery. The primary outcome was survival of the implant with all-cause revision and aseptic glenoid loosening as endpoints. Secondary outcomes were clinical, radiological, and patient-related outcomes with a five-year minimum follow-up. Results. The implant was revised in ten shoulders (5.2%) with a median time to revision of 21.2 months (interquartile range (IQR) 9.9 to 41.8). The Kaplan-Meier survivorship estimate at seven years was 95.9% (95% confidence interval (CI) 91.7 to 98; 35 RTSAs at risk) for aseptic mechanical failure of the glenoid and 94.8% (95% CI 77.5 to 96.3; 35 RTSAs at risk) for all-cause revision. Minimum five-year clinical and radiological outcomes were available for 103 and 98 RTSAs respectively with a median follow-up time of six years (IQR 5.2 to 7.0). Median postoperative
Aims. The Mathys Affinis Short is the most frequently used stemless total shoulder prosthesis in the UK. The purpose of this prospective cohort study is to report the survivorship, clinical, and radiological outcomes of the first independent series of the Affinis Short prosthesis. Methods. From January 2011 to January 2019, a total of 141 Affinis Short prostheses were implanted in 127 patients by a single surgeon. Mean age at time of surgery was 68 (44 to 89). Minimum one year and maximum eight year follow-up (mean 3.7 years) was analyzed using the
Abstract. Background. To determine the long-term survival outcomes of Copeland Resurfacing Hemiarthroplasty (CRHA) performed by a single surgeon series. Methods. A retrospective cohort study which looked at patients who underwent CRHA over 6 years. Re-operations including revisions with component exchange taking place in our hospital and at local centres were reviewed.
Proximal humerus fracture dislocations are amongst the most severe proximal humerus injuries, presenting a challenging management problem. The aim of this study was to report on the long-term outcomes of the management of proximal humerus fracture dislocations. Patients with a proximal humerus fracture dislocation managed at a Level 1 trauma centre from January 2010 to December 2018 were included. Patients with an isolated tuberosity fracture dislocation or a pathological fracture were excluded. Outcome measures were the
In recent years, use of anatomic stemless total shoulder arthroplasty (AsTSA) has increased. Despite evidence to suggest good mid-term results at 2-year follow-up there is a paucity of evidence for longer term follow-up. This study aimed to investigate outcomes at a minimum of 5 years post-operatively following primary AsTSA. This study is a retrospective case series of all patients who underwent a Mathys Affinis AsTSA from July 2010 (first case) to August 2018 (to allow minimum 5-year follow-up). Clinical outcomes included revision rate, range of motion and patient reported outcomes (Oxford Shoulder Score and Numerical Satisfaction Score). Radiological outcome was assessment of radiolucent lines for Lazarus grading. A total of 105 stemless TSAs were implanted. Five patients underwent revision (4.8%). Seventy-five AsTSA's were included in the final study for analysis of 5-year outcomes. Median follow-up time was 6.1 years. Median age was 69 years old and 81% were female.
Sub-acromial decompression surgery (SAD) has been widely used to treat shoulder impingement. Its validity has been questioned in multi-centric clinical trials and dissatisfaction rates can be high (35%). It is difficult to predict which patients will benefit operatively as research into predictive factors is limited. The study aim was to conduct a root-cause analysis of reasons for dissatisfaction in a cohort of operated patients. All patients with SAD dissatisfaction in the local Upper Limb database between 2015-19 (n=74/296) formed our study cohort. Patients were
In Australia nearly two-thirds of arthroplasty procedures are performed in the private setting, which is disproportionate to the dimensioning 43.5% of the population with private health cover. The rapid growth of shoulder arthroplasty surgery will be absorbed by both private and public sectors. This study aimed to assess the influence of healthcare setting on elective shoulder arthroplasty outcomes, defined by revision rate, and functional measures. Data was collected on all primary procedures performed from 2004 – 2019 within a regional area of Victoria, Australia. Patients were categorised into private or public settings. Trauma cases for acute proximal humerus fractures were excluded. The primary outcome of revision surgery was recorded as a cumulative percentage, and survival analysis conducted to calculate a hazard ratio (HR). Functional outcomes were measured through range-of-motion (ROM) and multiple validated patient-reported-outcome-measures (PROMs). 458 patients were identified in the study: 290 private and 168 public. There was no difference in the revision rate (3.8% private, 4.8% public), with an adjusted HR of 1.25 (p=0.66) for public compared to private. Baseline and post-operative functional measures were significantly greater in the private setting for ROMs and PROMs analysis, in particular post-operative QuickDASH (15.9±14.7 to 32.7±23.5; p<0.001) and
A consecutive series of 372 patients who underwent surgery for disorders of the rotator cuff involving arthroscopic subacromial decompression and open or arthroscopic repairs of the cuff were prospectively investigated as to the comparability of subjective and objective assessment scores of shoulder function. Assessments were made before operation and at 3, 6, 12, 18 and 24 months after surgery using the Disabilities of the Arm, Shoulder, and Hand
The aim of this study was to determine the functional outcome and rate of re-tears following mini-open repair of symptomatic large and massive tears of the rotator cuff using a two-row technique. The 24 patients included in the study were assessed prospectively before and at a mean of 27 months (18 to 53) after surgery using the Constant and the
A fracture of the tuberosity is associated with 16% of anterior glenohumeral dislocations. Manipulation of these injuries in the emergency department is safe with less than 1% risk of fracture propagation. However, there is a risk of associated neurological injury, recurrent instability and displacement of the greater tuberosity fragment. The risks and outcomes of these complications have not previously been reported. The purpose of this study was to establish the incidence and outcome of complications associated with this pattern of injury. We reviewed 339 consecutive glenohumeral dislocations with associated greater tuberosity fractures from a prospective trauma database. Documentation and radiographs were studied and the incidence of neurovascular compromise, greater tuberosity fragment migration and intervention and recurrent instability recorded. The mean age was 61 years (range, 18–96) with a female preponderance (140:199 male:female). At presentation 24% (n=78) patients had a nerve injury, with axillary nerve being most common (n=43, 55%). Of those patients with nerve injuries 15 (19%) did not resolve. Greater tuberosity displacement >5mm was observed in 36% (n=123) of patients with 40 undergoing acute surgery, the remainder did not due to comorbidities or patient choice. Persistent displacement after reduction accounted for 60 cases, later displacement within 6 weeks occurred in 63 patients. Recurrent instability occurred in 4 (1%) patients. Patient reported outcomes were poor with average EQ5D being 0.73, QDASH score of 16 and
Aim. Clavicular osteotomy was described as an adjunct to deltopectoral approach for improved exposure of the glenohumeral joint. This study aims to present contemporary outcomes and complications associated with the routine use of clavicular osteotomy by a single surgeon in a regional setting within New Zealand. Methods. A retrospective case series of patients who have undergone any shoulder arthroplasty for any indication between March 2017 to August 2022. This time period includes all patients who had clavicular osteotomy(OS) and patients over an equal time period prior to the routine use of osteotomy as a reference group (N-OS).
There is very limited literature describing the outcomes of management for proximal humerus fractures with more than 100% displacement of the head and shaft fragments as a separate entity. This study aimed to compare operative and non-operative management of the translated proximal humerus fracture. A prospective cohort study was performed including patients managed at a Level 1 trauma centre between January 2010 to December 2018. Patients with 2, 3 and 4-part fractures were included based on the degree of translation of the shaft fragment (≥100%), resulting in no cortical contact between the head and shaft fragments. Outcome measures were the
The purpose of this study is to report the clinical and radiological outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up. After ethical approval (reference: 17/YH/0318), patients were identified and invited to participate in this observational study. Inclusion criteria included: 1) severe glenoid bone loss necessitating the need for custom implants; 2) patients with definitive glenoid and humeral components implanted more than 2 years prior; 3) ability to comply with patient reported outcome questionnaires. After seeking consent, included patients underwent clinical assessment utilising the
Abstract. Background. The influence of diagnosis on outcomes after reverse shoulder arthroplasty (RSA) is not completely understood. The purpose of this study was to compare clinical outcomes of different pathologies. Methods. A total of 78 RSAs were performed for the following diagnoses: (1) rotator cuff tear arthropathy(RCA), (2) massive cuff tear(MCT) with osteoarthritis(OA), (3) MCT without OA, (4) arthritis, (5) acute proximal humerus fracture. Mean follow up 36 months (upto 5 years) Range of motion,
The Delta total shoulder replacement is a reversed, semi-constrained prosthesis and is recommended for the management of rotator cuff arthropathy and other difficult reconstructive shoulder problems. It was initially advised to use this prosthesis in patients older than 75. There were reports saying the complication rates of this prosthesis are high and patients' satisfaction and functional outcome is far from being satisfactory. In our study we wanted to evaluate results and complications of reverse shoulder arthroplasty in practice of single surgeon. In our study we reviewed patients who had reverse shoulder arthroplasty performed between 2001 and 2009. We evaluated them clinically and radiologically. We measured functional outcome using Constant score, we used
Aims. The aim of this study was to investigate the influence of age on the cost-effectiveness of arthroscopic rotator cuff repair. Patients and Methods. A total of 112 patients were prospectively monitored for two years after arthroscopic rotator cuff repair using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the
Abstract. Shoulder replacements have evolved and current 4th generation implants allow intraoperative flexibility to perform anatomic, reverse, trauma, and revision shoulder arthroplasty. Despite high success rates with shoulder arthroplasty, complication rates high as 10–15% have been reported and progressive glenoid loosening remains a concern. Objectives. To report medium term outcomes following 4th generation VAIOS® shoulder replacement. Methods. We retrospectively analysed prospectively collected data following VAIOS® shoulder arthroplasty performed by the senior author between 2014–2020. This included anatomical (TSR), reverse(rTSR), revision and trauma shoulder replacements. The primary outcome was implant survival (Kaplan-Meier analysis). Secondary outcomes were Oxford Shoulder Scores (OSS), radiological outcomes and complications. Results. 172 patients met our inclusion criteria with 114 rTSR, 38 anatomical TSR, and 20 hemiarthroplasty. Reverse TSR- 55 primary, 31 revision, 28 for trauma. Primary rTSR- 0 revisions, average 3.35-year follow-up. Revision rTSR-1 revision (4.17%), average 3.52-year follow-up. Trauma rTSR- 1 revision (3.57%), average 4.56-year follow-up OSS: Average OSS improved from 15.39 to 33.8 (Primary rTSR) and from 15.11 to 29.1 (Revision rTSR). Trauma rTSR-Average post-operative OSS was 31.4 Anatomical TSR38 patients underwent primary anatomical TSR, 8 were revisions following hemiarthroplasty. In 16/38 patients, glenoid bone loss was addressed by bone grafting before implantation of the metal back glenoid component. Mean age at time of surgery was 68.3 years (53 – 81 years). Mean follow-up was 34 months (12 – 62 months). The average
Abstract. Background/Objectives. The incidence of reverse total shoulder replacement (rTSR) implantation is increasing globally, but apprehension exists regarding complications and associated challenges. We retrospectively analysed the senior author's series of rTSR from a tertiary centre using the VAIOS shoulder system, a modular 4th generation implant. We hypothesised that the revision rTSR cohort would have less favourable outcomes and more complications. Methods. 114 patients underwent rTSR with the VAIOS system, over 7 years. The primary outcome was implant survival. Secondary outcomes were
The purpose of this study is the evaluate the net promotor score of arthroscopic subacromial decompression and rotator cuff repair. The Friends and Family Test, a variant of the Net Promoter Score, was adapted for the National Health Service to evaluate overall patient satisfaction and how likely patients are to recommend an intervention. It ranges from −100 to 100. Positive scores indicate good performance. This study quantifies the scores in 71 patients at 1 year following arthroscopic sub acromial decompression and rotator cuff repair. All of the procedures were performed by 1 consultant shoulder specialist. The patient filled out a shoulder questionnaire pre-operatively, at 6 months and 1 year. The score was 72 for subacromial decompression (n = 32) and 85 for rotator cuff repair +/− decompression (n = 39).
The aim of this study was to observe the macroscopic and microscopic appearance of the Coracoacromial ligament and Subacromial bursa during Subacromial decompression and correlate it with the outcome at 3 months. Twenty patients with Subacromial Impingement without Rotator Cuff tear and five patients with large/massive irreparable Rotator Cuff tears who underwent a Subacromial Decompression. Patients with other shoulder pathology were excluded. Patients completed an
Aim: To assess the clinical and functional outcome of proximal humeral fractures (2,3 and 4 parts) fixation with PHILOS (Proximal Humeral interlocked Osteosynthesis) plate using Oxford and DASH scoring system. Methods: Forty-eight consecutive patients were treated with PHILOS plate from the complex proximal humeral fractures. One senior surgeon, using PHILOS plates, operated all patients. The patients were regularly assessed clinically, and plain radiographic evaluation was performed for fracture healing, avascular necrosis, and implant failure. Clinical outcome was measured using
Contoured locking plates are commonly used to fix the proximal humerus fractures. Their long-term results are unknown. We present long-term radiological and functional outcome of three and four part fractures of the proximal humerus treated with PHILOS plate. We prospectively analysed 53 consecutive three and four part proximal humerus fractures treated with PHILOS plate between 2002 and 2007. Patients were assessed using
Shoulder resurfacing arthroplasty is a bone conserving option for patients with glenohumeral arthritis. We report the early results of this procedure at our unit with a minimum follow up of 2 years (mean follow up of 36 months). A historical analysis of prospectively collected clinical data was reviewed on a consecutive series of 22 patients (mean age of 73 years) with end stage gleno-humeral arthrosis who had undergone humeral resurfacing hemiarthroplasty performed by a single surgeon. Pain and function were assessed using the
Purpose:. To review the union rates, outcomes and complications of angular stable plating of lateral third clavicle fractures. Method:. Between 2007 and 2010 angular stable plates were used in the fixation for seventeen patients with displaced lateral third clavicle fractures (Allman Group II, Type 2). These were identified from surgical log books and operation codes. The surgical and clinical notes as well as X-rays were reviewed. The patients were contacted telephonically. An
Massive tears of the supraspinatus of the rotator cuff lead to painful loss of movement. The literature supports repair of these tears for young healthy individuals, however they present a surgical challenge with historically poor results from both athroscopic and standard open techniques. Prof Bunker has developed a surgical technique for massive rotator cuff tears with a Grammont Osteotomy of the spine of the acromion, when standard surgical techniques will not allow the necessary exposure: the so called “Full Monty”. Patients were entered in to a prospective study to obtain the functional benefit of this procedure. Each patient had a pre-operative American Shoulder Elbow
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
Background. Nonsurgical treatment of Acromioclavicular joint dislocations is well established. Most patients treated conservatively do well, however, some of them develop persistent symptoms. We have used two different surgical reconstruction techniques for Chronic ACJ dislocation stabilization. The study evaluates the effectiveness of a braided polyester prosthetic ligament and modified Weaver-Dunn reconstruction methods. Methods. 55 patients (mean age 42) with Chronic Acromioclavicular joint dislocation were included in this study. They were treated either by a modified Weaver-Dunn method or a braided polyester prosthetic ligament. Patients were assessed using
Mid-shaft humeral fractures in adults are common these days and often present with a management dilemma between operative and non-operative treatment. This study evaluates the outcome of such fractures treated non-operatively over a span of 10 years. In this retrospective study, a review of case notes and radiographs of patients whose mid-shaft humerus fractures were treated non-operatively between 1994 and 2004 was done. Those younger than 16 years and/or who had surgery primarily were excluded. Various factors including patient demographics, mechanism of injury, AO fracture classification and time to union were studied. Mean patient follow-up was 4 years and 6 months. The
Glenohumeral dislocation is complicated with a greater tuberosity fracture in 16% of cases. Debate regarding the safety of closed reduction in the emergency department exists, with concerns over fracture propagation during the reduction manoeuvre. The study aim was to report the results of closed reduction, identify complications and define outcome for these injuries. 188 consecutive glenohumeral dislocations with a tuberosity fracture were identified from a prospective database from 2014–2017. 182 had an attempted closed reduction under appropriate sedation using standard techniques, five were manipulated in theatre due to contra-indications to sedation. Clinical, radiographic and patient reported outcomes, in the form of the QuickDASH and
Adhesive capsulitis of the shoulder is a common debilitating condition with prevalence in the order of 2 to 5%. Whilst it is usually a self-limiting condition, patients are typically not willing, nor are they able, to wait to the end of the recovery phase. A number of treatment strategies have been described. Manipulation under anaesthesia can significantly increase motion in all planes, but carries a significant risk of fracture. Capsular release also significantly improves motion with fewer potential side effects. We hypothesise that performing an arthroscopic excision of the abnormal capsulitis tissue will give better results with least risk of recurrence. Data was collected both retrospectively and prospectively for patients undergoing this procedure. Range of motion and
Controversy surrounds the management of displaced
three- and four-part fractures of the proximal humerus. The percutaneous
Resch technique of stabilisation involves minimal soft-tissue dissection
and a reduced risk of stiffness and avascular necrosis. However,
it requires a second operation to remove Kirschner wires and the
humeral block. We describe a modification of this technique that
dispenses with the need for this second operation and relies on
a sequential pattern of screw placement. We report the outcome of
32 three- or four-part fractures of the proximal humerus treated
in this way at a mean follow-up of 3.8 years (2 to 8)). There were
14 men and 18 women with a mean age of 56 years (28 to 83). At final
follow-up the mean
Introduction. Snapping scapula symptoms occur due to disruption of the smooth gliding motion between scapula and thoracic cage. Patients present with pain in the scapulothoracic area aggravated by overhead and repetitive shoulder movements. It is often associated with audible and palpable crepitus, clicking, crunching, grating or snapping sensation. Open or arthroscopic scapulothoracic surgical treatment is an option when non-operative treatment modalities fail. The aim of our study was to assess the outcome of scapulothoracic arthroscopic treatment in patients with painful snapping scapula. Methods. Eight patients underwent scapulothoracic arthroscopic treatment for painful snapping scapula. Pre-operatively, all these patients had a trial of conservative treatment modalities for at least 6 months, consisting of activity modification, analgesia and physiotherapy for restoration of normal scapulothoracic kinematics. All patients had a temporary pain relief following a local anaesthetic and steroid injection. We graded the crepitus from 0 to 3 - 0 being no crepitus, 1 being palpable but not audible crepitus, 2 being soft audible crepitus and 3 being loud crepitus. Operations were performed with the patients in either prone or semi-prone position. The arm was placed in the “chicken wing” position (arm in full internal rotation with the hand placed on the back), so that the scapula lifted up from the chest wall. Two portals along the medial border of scapula were used for arthroscopy and instrumentation. In two cases a superior portal was also used. Outcome was assessed by pre and postoperative visual analogue score (VAS) and
The treatment of massive rotator cuff tears remains controversial. There is lack of studies comparing patient-reported outcomes (PROM) of arthroscopic massive rotator cuff repairs (RCR) against large, medium and small RCRs. Our study aims to report the PROM for arthroscopic massive RCR versus non-massive RCR. Patients undergoing an arthroscopic RCR under a single surgeon over a 5-year period were included. Demographic data were recorded. Pre-operative Quick-DASH and
The management of patients with massive irreparable rotator cuff tears (RCT) has traditionally proved challenging. This prospective study was undertaken with the aim to assess the overall functional outcome following the use of human dermal allograft in the reconstruction of massive irreparable RCT. 15 patients were included in the study, having a median age of 63 years. All patients underwent open reconstruction of massive irreparable RCT. None of the selected patients had evidence of significant gleno-humeral arthritis. All patients were evaluated pre- and post- operatively by the treating surgeon, and followed up for 12 months. The same physiotherapy protocol was prescribed for all patients. Initial and follow-up assessments were done at regular intervals using the Oxford and quick-DASH scoring systems. A very high patient satisfaction rate, with substantial improvement in pain and function was noted. There was substantial improvement in
Introduction. The use of reverse total shoulder arthroplasty (RSA) is becoming increasingly common in the treatment of rotator cuff arthropathy. Standard RSA technique involves medialising the centre of rotation (COR) maximising the deltoid lever arm and compensating for rotator cuff deficiency. However reported complications include scapular notching, prosthetic loosening and loss of shoulder contour. As a result the use of Bony Increased Offset Reverse Shoulder Arthroplasty (BIO-RSA) has been gaining in popularity. The BIO-RSA is reported to avoid these complications by lateralising the COR using a modified base plate, longer central post and augmentation with cancellous bone graft harvested from the patients humeral head. Objectives. This study aims to compare the outcome in terms of analgesic effect, function and satisfaction, in patients treated with standard RSA and BIO-RSA. Methods. All cases were performed in a single centre by one of two upper limb consultant orthopaedic surgeons over a consecutive 2-year period. At time of listing for operation, the decision as to whether to undertake a bony-increased offset reverse total shoulder was made. Standard deltopectoral approach was performed. Standard and Bony increased offset Tournier reverse was the implant of choice (BIO-RSA). All patients underwent a standardised rehabilitation programme. Standard follow up was clinical review with radiographs at 2 weeks, 6weeks and 3months. Retrospective data was collected using case notes on patient reported stausfaction and
Introduction. Reverse total shoulder replacement is performed for the treatment of rotator cuff arthropathy, massive irreparable cuff tears and failed shoulder hemiarthroplasty with irreparable rotator cuff tears. The aim of this study was to assess the clinical and radiological outcome of single surgeon series of Equinoxe® reverse total shoulder replacement at a district general hospital. Materials/Methods. Consecutive patients who underwent Equinoxe® reverse total shoulder replacement at our unit from Jun 2008 to Dec 2010 were retrospectively reviewed. Indications for surgery, complications and radiological outcomes were assessed.
Aims. The aim of this study was to analyse human muscle tissue before
and after rotator cuff repair to look for evidence of regeneration,
and to characterise the changes seen in the type of muscle fibre. Patients and Methods. Patients were assessed pre-operatively and one year post-operatively
using the
Purpose. The evolution of locked anatomical clavicular plating in combination with evidence to suggest that fixation of clavicle fractures yields better outcome to conservative treatments has led to an increasing trend towards operative management. There is no evidence however to compare early fixation with delayed reconstruction for symptomatic non- or mal-union. We hypothesize that early intervention yields better functional results to delayed fixation. Methods. Between August 2006 and May 2010, 97 patients were managed with operative fixation for their clavicular fracture. Sixty eight with initial fixation and 29 delayed fixation for clavicular non- or mal-union. Patients were prospectively followed up to radiographic union, and outcomes were measured with the
Introduction: Clavicle fractures represent 5% of fractures in adults and almost 44% of shoulder injuries and are usually treated none operatively with good results. However significantly displaced fractures can be associated with high non-union rate and there is a lack of consensus on when surgical treatment is indicated for such fractures. The aim of this study was to identify guidelines for surgical intervention, safer surgical approach and outcome of surgical intervention. Method: A retrospective audit of all clavicle fractures managed surgically over past 5 years (March 2004 to 2009) in a district general hospital. Case notes were reviewed to study the surgical indication, surgical approach, patient satisfaction and oxford should score and need for metal work removal. In all 35 patients (29 male) underwent surgery for significant fracture displacement with shortening, manual workers and keen sportsmen at the time of injury. The infraclavicular approach was used in 21 patients and 14 patients had direct incision approach. Radiological union was achieved in all patients after an average of 13.26(8–24) weeks. Six patients required plate removal at 6 months following surgery, infraclavicular (2 patients) &
direct approach (4 patients). All patients returned to their original occupation at average 2.55 months. The
Large and massive rotator cuff tears can cause persistent pain and significant disability. These tears are often chronic with substantial degeneration of the involved tendons. Surgical treatment is challenging and the functional outcome after repair less predictable then for smaller tears. The aim of this study was to determine the functional outcome and rate of re-rupture after mini-open repair of symptomatic large and massive rotator cuff tears using a modified two-row technique. Twenty-four patients, who were operated on under the care of a single surgeon between 2003 and 2006, were included in this study. Patients were assessed prospectively before and at a mean of 27 months after surgery using Constant
The function of the shoulder joint has traditionally been evaluated based on range of motion (ROM) in predefined anatomical planes and also by using functional scores, which assessed shoulder function based on the ability to conduct certain activities of daily living (ADLs). However, measuring ROM only in terms of flexion-extension, abduction-adduction and internal-external rotation may under-account for the 3-dimensional mobility of the shoulder joint. Furthermore, functional scores, such as the
Aim. We present the medium-term clinical results of a reverse total
shoulder arthroplasty with a trabecular metal glenoid base plate. Patients and Methods. We reviewed 125 consecutive primary reverse total shoulder arthroplasties
(RTSA) implanted in 124 patients for rotator cuff arthropathy. There
were 100 women and 24 men in the study group with a mean age of
76 years (58 to 89). The mean follow-up was 32 months (24 to 60).
No patient was lost to follow-up. Results. There were statistically significant improvements in the mean
range of movement and
Background: The incidence of proximal humeral fractures is increasing with time. There is continuing debate about the indications for surgical intervention for this relatively common injury. Baseline data on functional outcome is essential in order to study the effect of surgical intervention. Functional outcome scores provide reliable and valid judgments of health status and the benefits of treatment. During our preparation of a study proposal on this topic to the Health Technology Assessment Program recently, we noted the lack of such data on outcome scores in the current literature. Aim: To assess the functional outcome using the Constant and Oxford scores in patients treated conservatively for proximal humeral fractures. Methods: We prospectively studied 103 consecutive patients who were treated conservatively for proximal humeral fractures. Patient demographics, fracture type (Neer), hand dominance and comorbidity were recorded. Constant and
Impingement syndrome in the shoulder has generally been considered to be a clinical condition of mechanical origin. However, anomalies exist between the pathology in the subacromial space and the degree of pain experienced. These may be explained by variations in the processing of nociceptive inputs between different patients. We investigated the evidence for augmented pain transmission (central sensitisation) in patients with impingement, and the relationship between pre-operative central sensitisation and the outcomes following arthroscopic subacromial decompression. We recruited 17 patients with unilateral impingement of the shoulder and 17 age- and gender-matched controls, all of whom underwent quantitative sensory testing to detect thresholds for mechanical stimuli, distinctions between sharp and blunt punctate stimuli, and heat pain. Additionally
We have carried out a prospective double-blind randomised controlled trial to compare the efficacy of a single subacromial injection of the non-steroidal anti-inflammatory drug, tenoxicam, with a single injection of methylprednisolone in patients with subacromial impingement. A total of 58 patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and group B 20 mg of tenoxicam as a subacromial injection along with lignocaine. The Constant-Murley shoulder score was used as the primary outcome measure and the Disability of Arm, Shoulder and Hand (DASH) and the
If a modular convertible total shoulder system
is used as a primary implant for an anatomical total shoulder arthroplasty,
failure of the prosthesis or the rotator cuff can be addressed by
converting it to a reverse shoulder arthroplasty (RSA), with retention
of the humeral stem and glenoid baseplate. This has the potential
to reduce morbidity and improve the results. . In a retrospective study of 14 patients (15 shoulders) with a
mean age of 70 years (47 to 83) we reviewed the clinical and radiological
outcome of converting an anatomical shoulder arthroplasty (ASA)
to a RSA using a convertible prosthetic system (SMR system, Lima,
San Daniele, Italy). . The mean operating time was 64 minutes (45 to 75). All humeral
stems and glenoid baseplates were found to be well-fixed and could
be retained. There were no intra-operative or early post-operative
complications and no post-operative infection. The mean follow-up was 43 months (21 to 83), by which time the
mean visual analogue scale for pain had decreased from 8 pre-operatively
to 1, the mean American Shoulder and Elbow Surgeons Score from 12
to 76, the mean
Objectives: The aim of this study was a clinical and radiological evaluation of 68 shoulders operated with the Delta reverse-ball-and-socket total shoulder prosthesis by the senior author with a mean follow-up of 42 months. Methods: This is a retrospective study in one consecutive series of 68 shoulders, operated by the senior author, which were clinically assessed using the Constant score for pain, Constant
We have compared the outcome of hemiarthroplasty of the shoulder in three distinct diagnostic groups, using survival analysis as used by the United Kingdom national joint registers, patient-reported outcome measures (PROMs) as recommended by Darzi in the 2008 NHS review, and transition and satisfaction questions. A total of 72 hemiarthroplasties, 19 for primary osteoarthritis (OA) with an intact rotator cuff, 22 for OA with a torn rotator cuff, and 31 for rheumatoid arthritis (RA), were followed up for between three and eight years. All the patients survived, with no revisions or dislocations and no significant radiological evidence of loosening. The mean new
Aim: To study the long term results of rotator cuff repair in patients over the age of 65. Introduction: Although some patients with rotator cuff tears are asymptomatic, the majority have a combination of pain, weakness and restricted function. Whilst this affects the lifestyle of all patients, in the elderly these symptoms can make the difference between independent living and the need for assistance or sheltered accommodation. Method: The present study has looked at a consecutive series of 24 patients all of them over 65 years, who underwent rotator cuff surgery between 1993 and 1997. Outcome has been assessed using two validated scoring systems – the
The treatment of massive chronic tears is problematic. The re-tear rate following surgery for extensive cuff tears remains high, and there is little consensus regarding optimum treatment. To investigate the outcome of a cohort of patients who had open repair of an extensive cuff tear using the Leeds Kuff patch as an augment. A retrospective cohort study of consecutive patients with a massive cuff tear who had surgery in our regional elective orthopaedic centre over a two year period from January 2015 to Dec 2016. All patients followed identical rehabilitation protocols, supervised by physiotherapists with an interest in the shoulder. Outcomes assessment was undertaken at a minimum of 12 months by a registrar or physiotherapist who was not part of the treating team. Pre-op data collection included; range of motion, pain
The aim of this study was to investigate genetic influences on the development and progression of tears of the rotator cuff. From a group of siblings of patients with a tear of the rotator cuff and of controls studied five years earlier, we determined the prevalence of tears of the rotator cuff with and without associated symptoms using ultrasound and the
A total of 92 patients with symptoms for over
six months due to subacromial impingement of the shoulder, who were
being treated with physiotherapy, were included in this study. While
continuing with physiotherapy they waited a further six months for
surgery. They were divided into three groups based on the following
four clinical and radiological criteria: temporary benefit following
steroid injection, pain in the mid-arc of abduction, a consistently positive
Hawkins test and radiological evidence of impingement. Group A fulfilled
all four criteria, group B three criteria and group C two criteria.
A total of nine patients improved while waiting for surgery and
were excluded, leaving 83 who underwent arthroscopic subacromial
decompression (SAD). The new
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
The combination of an irreparable tear of the rotator cuff and destructive arthritis of the shoulder joint may cause severe pain, disability and loss of independence in the aged. Standard anatomical shoulder replacements depend on a functioning rotator cuff, and hence may fail in the presence of tears in the cuff. Many designs of non-anatomical constrained or semi-constrained prostheses have been developed for cuff tear arthropathy, but have proved unsatisfactory and were abandoned. The DePuy Delta III reverse prosthesis, designed by Grammont, medialises and stabilises the centre of rotation of the shoulder joint and has shown early promise. This study evaluated the mid-term clinical and radiological results of this arthroplasty in a consecutive series of 50 shoulders in 43 patients with a painful pseudoparalysis due to an irreparable cuff tear and destructive arthritis, performed over a period of seven years by a single surgeon. A follow-up of 98% was achieved, with a mean duration of 39 months (8 to 81). The mean age of the patients at the time of surgery was 81 years (59 to 95). The female to male ratio was 5:1. During the seven years, six patients died of natural causes. The clinical outcome was assessed using the American Shoulder and Elbow
The shoulder is the least constrained of all joints of the body and is more susceptible to injury including dislocation. The rate of recurrent instability following primary stabilization procedure at 10 years of follow-up ranged from 3.4 to 35 %. We describe the outcomes of 74 patients who underwent knotless arthroscopic anterior stabilisation using 1.5 mm Labral Tape with 2.9mm Pushlock anchors for primary anterior instability. We performed a retrospective analysis of patients who underwent surgery for post-traumatic recurrent anterior instability for 2 years by a single surgeon. Patients with glenoid bone loss, >25% Hill Sachs lesion, posterior dislocation, paediatric age group and multidirectional instability were excluded from this study. Over 90% of our case mix underwent the procedure under regional block anaesthesia and was discharged on the same day. The surgical technique and post-operative physiotherapy was as per standard protocol. Outcomes were measured at 6 months and 12 months. Of the 74 patients in our study, we lost 5 patients to follow up. Outcomes were measured using the
Background. Functional outcomes of conservatively managed, valgus impacted proximal humeral fractures are poor. Operative fixation can improve results but can be technically challenging. We prospectively assessed outcomes following fixation of valgus unstable proximal humeral fractures with a novel hybrid fixed angle blade plate, at a minimum of 12 months follow up. Methods. A new hybrid fixed angle blade plate design (Fx Plate, Exactech, Gainesville, USA) was used by the senior author to treat patients with displaced and potentially valgus unstable proximal humeral fractures, at our institution between November 2012 and March 2014. The study was approved by the research and development department. Outcomes were prospectively assessed using the Oxford and Constant shoulder scores and quality of life was assessed using the SF-36 questionnaire. Radiographs were taken at regular intervals to assess fracture healing. Results. In total 12 patients were identified and included in the study. All patients had comminution of the medial calcar, with potentially valgus unstable fracture patterns. Six of the patients had two-part displaced fractures, whereas six had three and four-part fractures. One patient died for reasons unrelated to surgery and three others were lost to follow up. Average follow up after surgery was 15.4 months (Range 12–20 months). At final follow up the average
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),
Pain is a common presenting symptom of patients with shoulder conditions, yet there has been little work done to accurately describe its distribution and nature. We studied all patients attending the Royal Devon and Exeter Hospital shoulder clinic from August 2012 – 2013. Patients completed a questionnaire detailing their
Introduction. The new era of shoulder arthroplasty is moving away from long stemmed, cemented humeral components to cementless, stemless and metaphyseal fixed implants and to humeral resurfacing. The early clinical results and functional outcome of stemless shoulder arthroplasty is presented. Methods. A retrospective single-surgeon series of stemless shoulder prostheses implanted from 2011 to 2013 at our institution was evaluated. Perioperative complications, Theatre time and length of hospital stay (LOS) were recorded. Postoperative radiographic and clinical evaluation including measurement of joint mobility, the
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
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. Materials and Methods. We performed a retrospective chart review of patients who presented with shoulder complaints, and in whom a radiographic diagnosis of glenoid hypoplasia had been made. From January 2002 to December 2012, 8 patients (9 shoulders) with radiological signs of glenoid hypoplasia were identified. The mean age at presentation was 39 years (range 23 to 77) and the mean symptom duration was 12.5 months (range 1 to 48). Results. The diagnoses encountered included: impingement with rotator cuff tendonitis (2 shoulders), rotator cuff dysfunction with biceps tendonitis (1 shoulder), a SLAP lesion (2 shoulders), calcific tendonitis (1 shoulder), a posterior labral tear (1shoulder), multidirectional instability (1 shoulder), and adhesive capsulitis (1 shoulder). Of these nine, six shoulders were managed non-operatively and three were managed surgically, all with satisfactory results. The mean follow-up period was 30 months (range 5 to 60) and the mean
The Global Conservative Anatomic Prosthesis (Global CAP) is an uncemented press fit humeral resurfacing implant developed by DePuy. We report a single surgeon series of Global CAP prostheses implanted in Norwich. 103 procedures were carried out between 2006 and 2011, in 93 patients. Mean age was 72 years (range 43 to 90). Patients were followed up for a mean 8 months (range 0 to 56). Pre-operative
We evaluated the long-term survival and patient reported outcome of the Copeland mark III humeral resurfacing hemi-arthroplasty (Biomet, Warsaw, Indiana). At a UK District General Hospital 95 shoulder replacements in 85 patients were performed from 1994 to 2003 (mean age 68.9). At the time of follow-up (mean of 12 years, range 8.7–18.0) 49 patients had survived. This study group were posted
Management of irreparable rotator cuff tears is challenging and controversial. Surgeons have been utilising biological tissue scaffolding to augment repairs, but there are concerns regarding viability and function. We wished to investigate this viability and clinical outcome in a small group of patients. All procedures were performed by a single surgeon over a three-year period. Inclusion criteria were patients with large cuff tears and failure of non-operative treatment. Exclusion criteria were patients with glenohumeral arthritis and where cuff repair could not be successfully performed. Open rotator cuff repair followed by augmentation with Graft Jacket® Regenerative Tissue Matrix (Wright Medical) was performed in all patients. A structured cuff repair physiotherapy protocol was then followed. Follow-up was at six months and at minimum twenty-four months post-operatively where Constant scores (CS) and
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. 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.Aims
Methods
Manipulation under anaesthetic (MUA) is an established treatment for frozen shoulder. Frozen shoulder may coexist with other shoulder conditions, whose treatment may differ from MUA. One such condition is calcific tendonitis. Only one study to date documents treatment of patients with frozen shoulder and concurrent calcific tendinitis. The objective was to demonstrate that MUA and injection is a satisfactory treatment for concurrent diagnosis of frozen shoulder and calcific tendinitis. Patients with a clinical diagnosis of frozen shoulder and radiological evidence of calcific tendinitis were prospectively recruited from Jan 1999 – Jan 2009. Treatment by MUA and injection was performed. Clinical examination, Oxford Shoulder Scores and need for further treatment were used as outcome measures. Fourteen patients (median age 53.5 years) were identified with frozen shoulder and concurrent calcific tendinitis. Significant improvement in both
Eighty-eight consecutive patients with symptomatic rotator cuff tears were entered in to a prospect study with a novel technique of open double row repair using a ‘Capstan’ screw technique. The medial row has standard anchors, but the lateral suture row is a 35mm × 6.5mm ‘Capstan' screw. This allows up to 28 suture bridges to be taken from the medial row to the lateral row compressing the footprint and spreading the load. This creates a very robust repair or ‘bulletproof repair’. This was used for medium to large isolated supraspinatus tears. Each patient had a pre and post operative
Distension arthrography of the glenohumeral joint was adopted as a mainstream treatment for adhesive capsulitis before any randomised controlled trials were performed. Interpretation of the effectiveness of this procedure rests on data from cohort studies of which there are few of high quality. Papers reporting on the long-term results have either excluded diabetic patients or failed to report on patient orientated outcomes. We present a prospective cohort study of 51 patients with adhesive capsulitis of the shoulder who had a distension arthrogram performed by a single radiologist as a primary intervention. We included diabetic patients. Range of movement (ROM),
We undertook a prospective randomised trial to determine the outcome of locked intramedullary fixation vs. plating of displaced shortened mid-shaft clavicle fractures. The primary outcome measure was the Constant shoulder score, while secondary outcome measures included the
Frozen shoulder is a common condition that affects the working population. The longevity and severity of symptoms often results in great economic burden to health services and absence from work. This prospective cohort study aimed to investigate whether early intervention with arthroscopic capsular release resulted in improvement of symptoms and any potential economic benefit to society. Patients were recruited prospectively. Data was gathered by way of questionnaire to ascertain demographics, previous primary care treatment and absence from work.
Introduction. Massive rotator cuff tears in the patient who is too young for a reverse shoulder replacement are a challenging situation. A technique using a ‘Grammont osteotomy’ of the acromion has been developed to allow a comprehensive approach, the so called “Full Monty”. Aim. To document the functional outcome of patients undergoing an acromial osteotomy for the repair of massive tears of the supraspinatus. Methods. Ten patients undergoing this procedure where entered in to the study. The mean age of the patients was 57 years (+/−16) and all bar one were male. Each patient had a pre-operative American Shoulder Elbow
Malformation and hypoplasia of the clavicle can result in pain, impaired function, restricted shoulder movement, subjective feeling of instability and cosmetic deformity. There are no reports of clavicle lengthening by osteotomy and distraction osteogenesis (DO). This is a retrospective review of 5 patients (7 clavicles) who underwent clavicle lengthening by DO using a monolateral external fixator for clavicular hypoplasia. There were 3 males and 2 females with mean age 15 years (9 to 23) and mean follow-up 21 months (8 to 51). Preoperative diagnoses included Klippel-Feil syndrome, cleidocranial dysplasia with torticollis, congenital myopathy and Noonans syndrome and obstetric brachial plexus injury. Mean length gained was 31 mm (15 to 41) which represens an average of 24.7% of overall bone length. Mean time in fixator was 174 days (161 to 263) and mean external fixation index was 56 days/cm. Two patients required internal fixation following fixator removal to consolidate union and one required additional internal fixation for atrophic regenerate. Mean preoperative
Arthritis of the glenohumeral joint accompanied by an irreparable tear of the rotator cuff can cause severe pain, disability and loss of function, particularly in the elderly population. Anatomical shoulder arthroplasty requires a functioning rotator cuff, however, reverse shoulder arthroplasty is capable of addressing both rotator cuff disorders and glenohumeral deficiencies. The Aequalis Reversed Shoulder Prosthesis design is based on two bio-mechanical principles by Grammont; a medialized center of rotation located inside the glenoid bone surface and second, a 155 degree angle of inclination. Combined, they increase the deltoid lever arm by distalizing the humerus and make the prosthesis inherently stable. 24 consecutive primary reverse total shoulder arthroplasties were performed by a single surgeon for arthritis with rotator cuff compromise and 1 as a revision for a failed primary total shoulder replacement between December 2009 and October 2012. Patients were assessed postoperatively with the use of the DASH
Reverse total shoulder arthroplasty (RTSA) provides a surgical alternative to conventional shoulder arthroplasty in the rotator cuff deficient shoulder. Short term data has shown consistent improvements in pain and function but higher complication and failure rates have also been reported. The aims of this study were to identify the early and late complications of RTSA, to establish the frequency of glenoid notching, and to assess the post-operative functional outcomes. 21 patients (22 joints) treated with RTSA at Glasgow Royal Infirmary (GRI) between April 2006 and October 2010 were retrospectively reviewed. Indications for surgery included cuff tear arthropathy, revision hemiarthroplasty and fracture malunion. Complication rates were obtained by analysis of follow up data from Bluespier and case notes. Glenoid notching was graded from x-rays by multiple observers using the Sirveaux classification. Outcome was assessed using the
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. Method:. We retrospectively reviewed the notes and X-rays of all patients identified by surgical log books and or operation codes for instability. Eighty seven patients (88 shoulders) underwent Latarjet procedures between 2002 and 2010. Patients were phoned to obtain a telephonic
Manipulation under anaesthetic (MUA) for the treatment of frozen shoulder is well established and effective however timing of surgery remains controversial. Intervention before 9 months has previously been shown to be associated with improved outcome. We test this theory by measuring
The effect of timing of a manipulation under
anaesthetic (MUA) and injection of corticosteroid and local anaesthetic for
the treatment of frozen shoulder has attracted little attention
to date. All studies describe a period of conservative treatment
before proceeding to an MUA. Delay has been associated with a poorer
outcome. We present a retrospective review of a prospectively collected,
single-surgeon, consecutive series of 246 patients with a primary
frozen shoulder treated by MUA within four weeks of presentation.
The mean duration of presenting symptoms was 28 weeks (6 to 156),
and time to initial post-operative assessment was 26 days (5 to
126). The
Background. Frozen Shoulder is a common condition which causes significant morbidity in people of working age. The 2 most popular forms of surgical treatment for this condition are Manipulation under Anaesthesia (MUA) or MUA plus Arthroscopic Capsular Release (ACR). Both treatment modalities are known to give good results, but no-one has compared the two to see which is better. Aim. To compare the outcome in patients with primary frozen shoulder, who are treated by either MUA or MUA plus ACR. Methods. 56 patients with primary frozen shoulder were treated by either MUA or MUA plus ACR. Each patient had their American Shoulder and Elbow Score (ASES), and their
Introduction. Whiplash injury following rear shunt Road traffic accident (RTA) has been associated with impingement syndrome of shoulder. However, the results of arthroscopic subacromial decompression (ASAD) for this group of patients have never been compared to the non accident group. In our study we aim to compare the results of ASAD in these patients to a group who did not sustain whiplash injury. Materials/Methods. Thirteen patients with impingement syndrome following rear shunt RTA were followed up (2004–09). After failed conservative management for at least 6 months ASAD was performed. This group was compared with a control group (not involved in an RTA) of 13 consecutive patients (age and sex matched). All patients were assessed with
We report a retrospective review of outcome after shoulder hemiarthroplasty for proximal humerus fractures. All patients managed with shoulder hemiarthroplasty for proximal humerus fractures between 1997 and 2008 were included. Clinical notes were reviewed and surviving patients completed postal
Scapulothoracic fusion (STF) for painful winging
of the scapula in neuromuscular disorders can provide effective pain
relief and functional improvement, but there is little information
comparing outcomes between patients with dystrophic and non-dystrophic
conditions. We performed a retrospective review of 42 STFs in 34
patients with dystrophic and non-dystrophic conditions using a multifilament
trans-scapular, subcostal cable technique supported by a dorsal
one-third semi-tubular plate. There were 16 males and 18 females
with a mean age of 30 years (15 to 75) and a mean follow-up of 5.0
years (2.0 to 10.6). The mean