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;