This study aims to correlate Oxford shoulder score (OSS) to EQ5D score in healthy patients presenting to a shoulder clinic with shoulder pain.

OSS and EQ5D scores were collected prospectively from 101 consecutive patients presenting with shoulder pain in a shoulder clinic at one specialist centre. Patients with ASA > 2 and other significant joint arthritis were excluded from the study. Scores were collected from electronic patient records. Spearman's rho correlation of oxford shoulder scores and EQ5D scores was completed.

Mean age of subjects was 51.8 (range 19.1–81.9) years, 55 of 101 subjects were men (54%). Median OSS was 26 (range 3–48) and median EQ5D score was 0.76 (range 0–0.76). Correlation for all patients was 0.624 (Sig p<0.001).

This study demonstrates a strong correlation between Oxford shoulder scoring and EQ5D in a fit and well shoulder surgery clinic population. It is possible that Oxford shoulder scores may be a useful indicator of quality of life in healthy shoulder clinic patients presenting with shoulder pain.

Introduction

Clavicle fractures accounting for 3–5% of all adult fractures are usually treated non-operatively. There is an increasing trend towards their surgical fixation.

Surgical options in the treatment of acute acromio-clavicular joint (Rockwood Type III and IV) dislocations are many and controversial. We evaluated our technique using TIGHTROPE connecting the base of the coracoid to the proximal fragment of the clavicle. Between March 2006 and December 2006, ten young and active adult patients with acute ACJ dislocations were treated with arthroscopically assisted ARTHREX TIGHTROPE fixation. The dislocation was reduced with traction and manual reduction with the patient in beach-chair position. The base of the coracoid was identified and isolated using a radiofrequency ablator placed through the anterior portal while visualizing through the lateral portal. An ACL guide was placed percutaneously supero-medial to the coracoid over the distal with the inferior end of the ACL guide placed through a posterior portal, approximated against the prepared base of the coracoid. The Arthrex Tightrope braided fibre-wire was introduced through the pre-drilled distal clavicle passed to the base of the coracoid and manually tensioned to achieve stable reduction. Standard rehabilitation protocol was utilised as for internal fixation of distal clavicular fractures. Patients were evaluated clinically using Constant Score, which ranged from 75 to 83 and radiologically at 6 weeks and 3 months. We present the functional results and the technical difficulties faced highlighting on the probable reasons for failure of fixation in two of our early patients who had revision fixations. We also describe the additional intra-operative techniques used in the last few patients to prevent such complications and achieve a secure reduction. We conclude that Arthroscopic Reconstruction of dislocated Acromio-Clavicular joint using TIGHTROPE may require additional repair of the ligaments in carefully selected patients to prevent failure of fixation.

We have conducted a prospective study to assess the mid-term clinical results following arthroscopic repair of the rotator cuff. Patients were evaluated using the Constant score, subjective satisfaction levels and post-operative ultrasound scans.

Of 115 consecutive patients who underwent arthroscopic repair of the rotator cuff at our institution, 102 were available for follow-up. The mean period of follow-up was for 35.8 months (24 to 73). The mean age of the patients was 57.3 years (23 to 78). There were 18 small (≤ 1 cm in diameter), 44 medium (1 cm to 3 cm in diameter), 34 large (3 cm to 5 cm in diameter) and six massive (> 5 cm in diameter) tears. There was a statistically significant increase in the size of the tear with increasing age (p = 0.0048).

The mean pre-operative Constant score was 41.4 points (95% confidence interval, 37.9 to 44.9), which improved to 84.5 (95% confidence interval, 82.2 to 86.9). A significant inverse association (p = 0.0074), was observed between the size of the tear and the post-operative Constant score, with patients having smaller tears attaining higher Constant scores after repair. Post-operatively, 80 patients (78.4%) were able to resume their occupations and 84 (82.4%) returned to their pre-injury leisure activities. Only eight (7.8%) of 102 patients were not satisfied with the outcome.

Recurrent tears were detected by ultrasound in 19 (18.6%) patients, and were generally smaller than the original ones. Patients with recurrent tears experienced a mean improvement of 31.6 points (95% confidence interval, 23.6 to 39.6) in their post-operative Constant scores. Those with intact repairs had significantly improved (p < 0.0001) Constant scores (mean improvement 46.3 points, 95% confidence interval, 41.9 to 50.6). Patient satisfaction was high in 94 cases (92%), irrespective of the outcome of the Constant score. Recurrent tears appear to be linked to age-related degeneration.

Arthroscopic repair of the rotator cuff leads to high rates of satisfaction (92%) and good functional results, albeit with a recurrence rate of 18.6% (19 of 102).

The purpose of this study is to report the 1 to 5 year results of arthroscopic Rotator Cuff repairs.

Between November 2001 to May 2003, 115 consecutive patients were operated (73 males and 42 females) with arthroscopic repair. 13 patients were lost to follow up, leaving 102 patients available for follow up. Patients were evaluated using the Constant score, satisfaction levels and ultrasound scan to evaluate cuff integrity. Failures were defined as dissatisfied patients and those who had had a re-operation. Re-tear rate was recorded.

The mean follow up time was 23.8 months (range 12–61). Mean age was 57.3 years (range 23–78). 47% had a history of trauma. There were 107 patients (95.5%) with full thickness tears and 5 (4.5%) had partial thickness tears. Of the full thickness tears, 8 (7.6%) were massive in size, 36 (34%) large, 44 (41.5%) medium and 18(17%) small. Isolated Supraspinatus (SSP) tear was recorded in 83.5% and subscapularis tear in 7 %. A combination of SSP tear with infraspinatus and teres minor was found in 9.6%.

86% had Acromioplasty (ASD) with or without an AC joint excision arthroplasty. Two patients had Bankart repairs in addition at the time of cuff repair.

The mean pre op Constant score was 40.9 points (95% CI 37.3 to 44.5), which had improved to 84.8 (CI 82.2 to 86.9) at last follow-up. 78% returned to same work and 82% returned to pre injury leisure activity. There were 20 re-tears (19.6%). eight of the 102 patients were not satisfied. Five of these patients had revision operation.

Arthroscopic cuff repair shows high satisfaction rate (92%) and good functional results with 20% re-tear rate, while offering all the advantages of arthroscopic surgery.

The aim of this study was to define the microcirculation of the normal rotator cuff during arthroscopic surgery and investigate whether it is altered in diseased cuff tissue.

Blood flow was measured intra-operatively by laser Doppler flowmetry. We investigated six different zones of each rotator cuff during the arthroscopic examination of 56 consecutive patients undergoing investigation for impingement, cuff tears or instability; there were 336 measurements overall.

The mean laser Doppler flowmetry flux was significantly higher at the edges of the tear in torn cuffs (43.1, 95% confidence interval (CI) 37.8 to 48.4) compared with normal cuffs (32.8, 95% CI 27.4 to 38.1; p = 0.0089). It was significantly lower across all anatomical locations in cuffs with impingement (25.4, 95% CI 22.4 to 28.5) compared with normal cuffs (p = 0.0196), and significantly lower in cuffs with impingement compared with torn cuffs (p < 0.0001).

Laser Doppler flowmetry analysis of the rotator cuff blood supply indicated a significant difference between the vascularity of the normal and the pathological rotator cuff. We were unable to demonstrate a functional hypoperfusion area or so-called ‘critical zone’ in the normal cuff. The measured flux decreases with advancing impingement, but there is a substantial increase at the edges of rotator cuff tears. This might reflect an attempt at repair.

Arthroscopic Rotator cuff repair is gaining popularity in recent years; however, the results of arthroscopic repairs are yet to be reported. Between November 2001 to May 2003, 115 consecutive patients were operated (73 males and 42 females) with arthroscopic repair. 13 patients were lost to follow up, leaving 102 patients available for follow up.

The mean follow up time was 23.8 months (range 12–61). There were 107 patients (95.5%) with full thickness tears and 5 (4.5%) had partial thickness tears. Of the full thickness tears, 8 (7.6%) were massive in size, 36 (34%) large, 44 (41.5%) medium and 18(17%) small.

Mean age was 57.3 years (range 23–78). 47% had a history of trauma.

Mainly Supraspinatus (SSP) tear was recorded in 83.5% and isolated subscapularis tear in 7%. A combination of SSP tear with infraspinatus and teres minor minor (posterior tear) was found in 9.6%.

86% had Acromioplasty (ASD) with or without an AC joint excision arthroplasty. Two patients had Bankart repairs in addition at the time of cuff repair.

Patients were evaluated using the Constant score, satisfaction levels and ultrasound scan to evaluate cuff integrity. Failures were defined as dissatisfied patients and those who had had a re-operation. Re-tear rate was recorded.

The mean pre op Constant score was 40.9 points (95% CI 37.3 to 44.5), which had improved to 84.8 (CI 82.2 to 86.9) at last follow-up. 78% returned to same work and 82% returned to pre injury leisure activity. There were 20 ultrasound demonstrated re-tears (19.6%). However, the majority of patients with radiological re-tears had good function, pain relief and were satisfied. Eight of the 102 patients were not satisfied. Five of these patients had revision operation.

Arthroscopic cuff repair shows high satisfaction rate (92%) and good functional results while offering all the advantages of arthroscopic surgery.

Introduction: Laser Doppler Flowmetry (LDF) is an established technique for the measurement of perfusion in tissues, which has been applied in animal and human studies. Despite many studies the implications of perfusion and blood flow abnormalities in the rotator cuff (RC) in vivo are not clearly understood. This study aims to assess the blood flow in the normal and diseased RC using Laser Doppler Flowmetry (LDF) technique.

Methods: With Ethics approval and informed consent patients undergoing arthroscopy for impingement or cuff tear (diseased cuff) or for shoulder instability (normal cuff) were recruited. Following diagnostic arthroscopy and bursoscopy measurements of the blood flux in the RC using the LDF were made at 6 points. Five of these were in the cuff over a 4 cm² area from the insertion at the greater tuberosity (A,E – @ Tuberosity level, C-Muscelotendinous junction, B,D – between the two) and one (F) in the deep surface. Diseased RC were subgrouped into mild (B1), moderate (B2) and severe (B3- cuff tear) impingement grades (Copeland-Levy Classification). The arthroscopy, grading, and probe placement were made by the two senior authors. LDF flux (unit of measurement of the perfusion – LDFf) was recorded over 30 seconds at each measurement point. The mean of these readings was calculated.

Results: 56 patients were recruited. 35 Males (62.5%) and 21 Females (37.5%).

336 measurements were recorded.

The observed mean LDFf was 32.8 (27.4–38.1; 95% CI) , 25.4 (22.4–28.5) and 43.1 (37.8–48.4; 95% CI) For Normal, Impingement and Tear cases, respectively (p< 0.0001, One-way ANOVA).

The LDFf was lowest in the Impingement without tear grade (B2) with a statistically significant increase at the edges of a cuff tear.

Conclusion: Preliminary recordings of LDF show changes are in keeping with current knowledge of the pathology. LDFf decreases with advancing impingement, being least affected in the musculotendinous junction. There is a substantial increase in LDFf at the edges of RC tears. This might reflect an attempted reparative response.

The Constant-Murley score has gained wide acceptance for evaluation of shoulder function. The strength component of the Constant score accounts for 25 out of 100 points. It has been criticized for lack of consistency in defined measurement method.

The aim of this study was to evaluate the effect of various variables on the strength component measurement of the Constant score.

Material & Methods We conducted a series of experiments using a digital force gauge (EZ force). We evaluated the effect of strength measurements with 1) patient in sitting & standing positions 2) strength gauge fixed to an immobile platform or hanging free fixed to the floor by the examiners foot 3) patient’s arm in 45 degrees and 90 degrees of abduction 4) plane of elevation in frontal or scapular plane and 5) patient making a fist or keeping the palm open during the test. These experiments were done in groups of 20 patients. We have compared as well this device and the Isobex Myometer.

Results No statistical differences were found between individual measurements with regard to patient’s position (standing-sitting), device setting (Fixed –Hanging), position of the arm in varying degrees of abduction or the plane of elevation. Strength assessment obtained when patient made a fist compared to open palm was found to be higher (p=0.006). The measurements showed good intra-observer reliability.

The readings of the EZ force and the Isobex myometer were comparable.

Conclusions It seems that the shoulder strength measurements as part of the Constant functional score may be performed with the patient sitting or standing, with the arm at varying degrees of abduction and in different planes of elevation without causing any significant deviation in the measurement.

No influence was found as well to the device being either fixed to an immobile platform or fixed to the floor by the examiner’s foot. These make these measurements easy to perform and reproducible using the newly designed digital force gauge (EZ force).

Aim: Despite many studies the implications of perfusion and blood flow abnormalities in the rotator cuff (RC) in vivo are not clearly understood. Laser Doppler Flowmetry (LDF) is an established technique for the measurement of perfusion in tissue, which has been applied in animal and human studies. This study aims to evaluate Laser Doppler Flowmetry (LDF) as a technique for the assessment of blood flow in the normal and diseased RC.

Methods: With Ethics committee approval and informed consent patients undergoing arthroscopy for impingement or cuff tear (diseased cuff) and instability (normal cuff – BO) were recruited. Following diagnostic arthroscopy and bursoscopy measurements of the LDF in the RC tear were made at 6 points. Five of these were in the cuff over a 4 cm. 2 are from the insertion at the greater tuberosity and one in the deep surface.

Diseased RC were sub grouped into mild (B1), moderate (B2) and severe (*B3 – cuff tear) impingement grades (Copeland – Levy Classification). The arthroscopy, grading, and probe placement were made by the senior authors. LDF flux (LDFf) was recorded over 30 seconds at each measurement point. The mean of these readings was then calculated (LDF flux – an arbitrary unit of measurement of the perfusion).

Results: 35 patients were recruited. 210 measurements were recorded, in 6 anatomical locations. The mean LDFf was 34.1 in diseased RC and 55.3 in normal RC (p=0.0002). The mean LDFf was 52.2 in severe (RC tear) impingement and 30.3 in mild and moderate impingement’s (p< 0.0001).

The LDFf was lowest in the moderate grade with a significant increase at the edges of a cuff tear.

Conclusion: Preliminary recording of LDFf show changes are in keeping with current knowledge of the pathology. LDFf decreases with advancing impingement. There is an increase in LDFf at the edges of RC tears. This might reflect a reparative response.

Aims: Prosthesis malpositioning and inadequate cement mantles have been shown to adversely affect outcomes in cemented total hip arthroplasty. Although this has been extensively studied and reported for anteroposterior (AP) radiographs, we have found a paucity of literature concerning lateral radiographs which this study addresses. Methods: We analysed radiographs of 100 patients (Group I) with cemented Charnley total hip replacements (52 ßanged, 48 round back) performed through the lateral approach to determine the relationship between stem positioning and cement mantles in both AP and lateral radiographs. The measurements were made by a single observer and the data was analysed using chi squared tests to compare categorical data. Results: The most common stem malpositioning was seen in the lateral radiographs with þfty þve percent of stems directed 4 or more degrees from anterior to posterior (A to P). In contrast on the AP radiographs 18% of stems were directed from medial to lateral (Varus) and 3% of stems were directed from lateral to medial (Valgus) 4 or more degrees. There was no relationship between the different malpositions. Adequate resection of the posterior femoral neck gave better alignment of the stem in the lateral radiograph (p< 0.001). The ßanged stems were signiþcantly more in varus as compared to round back stems (p< 0.01). Cement mantles were most often deþcient in Gruen zone 12. There was a strong association between sagittal malpositioning and deþcient zones 12 and 9 (p< 0.001). Conclusions: This study demonstrates that sagittal mal-positioning of the stem is most important and surgical technique has a signiþcant inßuence on the same.

Decompression of the carpal tunnel is a common surgical procedure. Although the incidence of the carpal tunnel syndrome increases with age, there is no clear information available on the outcome of surgery in relation to age. We studied prospectively 87 consecutive patients who underwent decompression, using a validated self-administered questionnaire, and found that improvement in symptoms and function decreased with increasing age. This was most marked in patients over the age of sixty years.