Background. Several orthopaedic studies have found significant correlation between pre-operative psychological status and post-operative outcomes. The majority of research has focused on patients requiring lower limb and spine surgery. Few studies have investigated the effect of psychological status on the outcome of upper limb operations. We prospectively investigated the association between pre-operative psychological status and early postoperative shoulder pain and function in patients requiring arthroscopic subacromial decompression (ASAD) for impingement syndrome. Methods. A consecutive series of patients in 2009/10 completed questionnaires 2 weeks pre-operatively and 3 and 6 weeks post-operatively that assessed psychological state, shoulder function and pain. The hospital anxiety and depression scale, the Oxford shoulder score and a pain visual analogue scale assessed psychological status, shoulder function and shoulder pain, respectively. Data was analysed using non-parametric statistical methods. Results. Thirty-one patients participated (21 women; 10 men; mean age 54.6 years; age range 21–89 years). Preoperative anxiety was significantly associated with pre-operative shoulder pain (P < 0.05). Pre-operative psychological status did not correlate with post-operative shoulder pain or function. Greater pre-operative anxiety and depression were significantly associated with post-operative psychological distress (P < 0.05). Overall shoulder pain, function and psychological state improved significantly during the study (P < 0.05) regardless of pre-operative psychological status. Conclusion. Despite pre-operative associations between anxiety and shoulder pain, there were no associations between pre-operative psychological status and post-operative outcomes. Our results from a total of 31 patients suggest there is no justification for routinely assessing psychological status in patients with ‘uncomplicated’ impingement syndromes that require ASAD. The majority of patients benefit from ASAD both physically and psychologically regardless of psychological state. Therefore abnormal pre-operative psychological status should not be a justifiable reason for delaying or denying this effective operation

Introduction. The purpose of this study was to assess the rate of revision subacromial decompression and identify different pathologies. Materials/Methods. We analysed the patients who underwent Revision Arthroscopic Subacromial decompression from our prospective database of shoulder patients. Between April 2003 and Dec 2010, 797 patients underwent arthroscopic subacromial decompression. Patients who underwent any other procedure i.e. biceps tenotomy, capsular release, cuff repair were excluded from the study. Of these, 37 underwent a revision subacromial decompression (Revision rate 4.6%). The indication for revision procedure was persistent pain or restricted movements not responding to physiotherapy and injections. Results. We found that 1) Patients having cuff pathology i.e. partial tear or degenerate cuff were more likely to need a revision procedure (11/37 and 92/797, p = 0.001). 2) The rate of ACJ excision done for residual pain after primary subacromial decompression was similar to the rate of ACJ excision at the time of the primary procedure (7/37 vs. 100/797, p= 0.5). 3) Presence of Calcific deposits did not have any influence on the risk of having a revision procedure (2/37 and 12/797, p= 0.1). 4) Patients found to have synovitis in the primary procedure were more likely to need revision procedure (10/37 and 81/797, p = 0.001). 5) Presence of biceps tendonitis did not significantly affect the risk of having a revision procedure after arthroscopic subacromial decompression (3 /37 and 21 /797, p = 0.5). Conclusion. Our revision rate is similar to those published in literature. In our failed cases there was a trend for patients to have an associated partial rotator cuff tear and synovitis

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 Oxford Shoulder Score in patients undergoing primary total shoulder replacement (TSR). Patient-reported outcomes data were sourced from the Australian Orthopaedic Association National Joint Replacement Registry Patient-Reported Outcome Measures Program. These included pre- and 6-month post-operative Oxford Shoulder Scores and a rating of patient-perceived change after surgery (5-point scale ranging from ‘much worse’ to ‘much better’). Two anchor-based methods (using patient-perceived improvement as the anchor) were used to calculate the MCIC: 1) mean change method; and 2) predictive modelling, with and without adjustment for the proportion of improved patients. The analysis included 612 patients undergoing primary TSR who provided pre- and post-operative data (58% female; mean (SD) age 70 (8) years). Most patients (93%) reported improvement after surgery. The MCIC derived from the mean change method was 6.8 points (95%CI 4.7 to 8.9). Predictive modelling produced an MCIC estimate of 11.6 points (95%CI 8.9 to 15.6), which reduced to 8.7 points (95%CI 6.0 to 12.7) after adjustment for the proportion of improved patients. For patient-reported outcome measures to provide valuable information that can support clinical care, we need to understand the magnitude of change that matters to patients. Using contemporary psychometric methods, this analysis has generated MCIC estimates for the Oxford Shoulder Score. These estimates can be used by clinicians and researchers to interpret important changes in pain and function after TSR from the patient's perspective. We conclude that an increase in Oxford Shoulder Scores of at least 9 points can be considered a meaningful improvement in shoulder-related pain and function after TSR

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 Oxford Shoulder Score in patients undergoing primary total shoulder replacement (TSR). Patient-reported outcomes data were sourced from the Australian Orthopaedic Association National Joint Replacement Registry Patient-Reported Outcome Measures Program. These included pre- and 6-month post-operative Oxford Shoulder Scores and a rating of patient-perceived change after surgery (5-point scale ranging from ‘much worse’ to ‘much better’). Two anchor-based methods (using patient-perceived improvement as the anchor) were used to calculate the MCIC: 1) mean change method; and 2) predictive modelling, with and without adjustment for the proportion of improved patients. The analysis included 612 patients undergoing primary TSR who provided pre- and post-operative data (58% female; mean (SD) age 70 (8) years). Most patients (93%) reported improvement after surgery. The MCIC derived from the mean change method was 6.8 points (95%CI 4.7 to 8.9). Predictive modelling produced an MCIC estimate of 11.6 points (95%CI 8.9 to 15.6), which reduced to 8.7 points (95%CI 6.0 to 12.7) after adjustment for the proportion of improved patients. For patient-reported outcome measures to provide valuable information that can support clinical care, we need to understand the magnitude of change that matters to patients. Using contemporary psychometric methods, this analysis has generated MCIC estimates for the Oxford Shoulder Score. These estimates can be used by clinicians and researchers to interpret important changes in pain and function after TSR from the patient's perspective. We conclude that an increase in Oxford Shoulder Scores of at least 9 points can be considered a meaningful improvement in shoulder-related pain and function after TSR

Introduction. The conservative management of Sub-Acromial Impingement Syndrome (SAIS) of the shoulder includes both physiotherapy treatment and subacromial injection with local anaesthetic and steroids. The outcome from injection treatment has rarely been evaluated scientifically. Methods. Patients attending a designated shoulder clinic and diagnosed by an experienced shoulder surgeon as having a SAIS between January 2009 and December 2011 were considered for inclusion in the study. 67 of 86 patients screened completed the study (3 did not meet inclusion criteria; 9 declined to participate; 3 lost to follow-up; 4 developed frozen shoulder syndrome). Each patient had a pre-injection Oxford Shoulder Score (OSS) and was given one subacromial injection of 10ml 0.25% levobupivacaine(Chirocaine) + 40 mg triamcinolone(Kenalog) through the posterior route. Radiograph imaging was also assessed. Follow-up was carried out at 6 to 12 weeks post injection when OSS was repeated. A 6 month follow-up assessment to assess if the patient's improvement in functionality and absence of symptoms indicated that a subacromial decompression operation was not necessary. The percentage of patients showing improvement in OSS was calculated and the difference in OSS pre- and post-injection assessed using a Wilcoxon Signed Rank test. Results. The median OSS pre-injection was 29 (range 2–43) and post-injection was 40 (range 2–48) (p=< 0.001; z=−6.0; r=−0.5). 45/69 (71%) of patients benefited significantly from subacromial injection at 6 to 12 weeks post-injection. However only 28/53 (53%) benefited significantly from injection by 6 months post-injection. These results support the continued use of sub-acromial corticosteroid injections in the treatment of SAIS. 31% of these patients were subsequently treated with an arthroscopic subacromial decompression operation. Previous injection history had no impact on the results. Conclusions. We recommend that all patients with SAIS should be offered at least one subacromial injection before being considered for an arthroscopic subacromial decompression operation

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone

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 Oxford shoulder score preoperatively and twice post operatively (within 3 months and at one year). Results. In the RTA group all 13 patients showed improvement in their oxford score over one year. While the improvement was only Marginal (p= 0.08) at three months it was better at the end of a year (p=0.04). Comparatively in the cohort without the whiplash injury the improvement was more marked in the first three months (p=0.05) with significant improvement at the end of the year (p=0.03). The overall improvement in Oxford score was more in the cohort of patients who were not involved in a RTA as opposed to the RTA group (p= 0.05). Conclusion. The results of the study show that even though there was an improvement in shoulder scores after an arthroscopic subacromial decompression it was much slower and overall results were inferior in the RTA group as opposed to the controls and hence prognosis should be guarded when offering ASAD for patients with whiplash injury

Introduction. Adhesive capsulitis is a common condition causing painful limitation of shoulder movements. Hydrodistension is one of the techniques, is well recognised and has shown good outcomes. However, the results of hydro distension release in secondary adhesive capsulitis are not clear. Patients and Methods. This is a retrospective study on patients undergoing hydro distension release. Patients who had any surgical intervention were classed as secondary whilst the rest were included in the primary group. The hydro distension is a standard technique where in the senior author locates the gleno humeral joint using radio opaque dye, followed by injection of 20 mls 0.5% L-bupivacaine and 80 mg of Triamcinolone, this is followed by use of 60 mls saline to perform the hydro distension. Results. We included 86 shoulders in 80 patients who underwent the procedure. There were 46 females and 34 males, with average age of 51.07 years (range 35 – 75). Left side was involved in 42 shoulders and right in 44. 25 patients showed associated risk factors of which 17 patients had diabetes, 12 had hypercholesterolemia and 5 had underactive thyroid. 65 of the shoulders were in the primary group whilst 21 in the secondary group. In the secondary group the procedures included 8 arthroscopic subacromial decompression with ACJ excision, 7 had rotator cuff repairs, 4 had biceps labral procedure and 2 ORIF clavicle. 3/21 patients required further intervention in secondary group, whilst 10/65 in the primary group required further intervention. Patients who have history of inflammatory arthritides were found to have higher incidence of revision surgery and poorer outcomes. 85% patients in both groups had improvement in their function and range of movements and were happy with the outcome. Conclusion. Hydrodistension provides safe and predictive results in both primary and secondary adhesive capsulitis and should be considered as an option before any invasive procedure

The incidence of frozen shoulder (FS) as a complication of simple arthroscopic shoulder surgery has yet to be defined. A single-surgeon case series of patients undergoing arthroscopic subacromial decompression (ASD) or ASD with arthroscopic acromioclavicular joint (ACJ) excision was analysed to establish FS rate, this cohort was then compared to a matched group of primary FS patients. Retrospective analysis of 200 consecutive cases was undertaken. All procedures listed, performed and reviewed by the senior author. 96 underwent ASD and 104 underwent ASD and ACJ excision. 6-months follow-up minimum. Incidence of frozen shoulder was 5.21% (ASD) and 5.71% (ASD+ACJ excision). Mean age was 52.3 years (95% CI: 47.4 to 57.2) of the patients that developed FS, compared to 57.2 years (95% CI: 55.2 to 59.2) in the patients who did not and 52 years (95% CI: 50.7 to 53.3) in the primary FS cohort (n=136). 9.1% of post-operative FS were diabetic compared to 17.1% of primary FS. 63.6% were female in the post-operative FS group, 47.1% in the primary FS group. Our results suggest that the risk of FS following simple arthroscopic procedures is 5%, with no increased risk if the ACJ is also excised. This cohort has the same average age as a primary FS. There is a trend toward female sex and diabetes does not increase the risk

Aims. To determine whether a correlation exists between the clinical symptoms and signs of impingement, and the severity of the lesions seen at bursoscopy. Methods. Fifty-five consecutive patients who underwent arthroscopic subacromial decompression were analysed. Pre-operatively patients completed an assessment form consisting of visual analogue pain score, and shoulder satisfaction. The degree of clinical impingement was also recorded. At arthroscopy impingement was classified according to the Copeland-Levy classification. Clinical assessment and scoring was performed at 6 months post-operatively. Linear regression coefficients were calculated to determine if the degree of impingement at arthroscopy correlated with pre-operative pain, satisfaction and clinical signs of impingement. Results. Pre-op pain levels, shoulder satisfaction and the degree of clinical impingement did not correlate with severity of the lesions of the acromion and cuff. (Average Correlation co-efficient r2 = 0.018). There was no correlation between the improvement in the shoulders post-operatively and the severity of lesions (r2 = 0.008). Conclusion. There is no significant correlation between pain, clinical signs, or satisfaction and the severity of lesions seen at arthroscopy

Aim. The present study aimed to assess the accuracy of preoperative departmental ultrasound scans in identifying rotator cuff tears at our institution. Methods. Preoperative ultrasound scan reports were obtained from 64 consecutive patients who subsequently underwent arthroscopic subacromial decompression and/or rotator cuff repair. Data was collected retrospectively using our 2010 database. The ultrasound reports were compared with the arthroscopic findings. The presence or absence of partial and full thickness rotator cuff tears was recorded. Results. Ultrasound correctly identified 30/43 (70%) of all tears, 18/30 (60%) of full thickness tears but only 1/13 (8%) of partial tears seen at arthroscopy. Of the remaining 12 partial tears seen at surgery, 6 were misdiagnosed as full thickness tears on ultrasound and 6 were not picked up at all. Five partial thickness tears were repaired and the rest were debrided. If both full and partial thickness tears are counted as true positives, ultrasound had a sensitivity of 70%, a specificity of 67%, a positive predictive value of 81%, a negative predictive value of 51% and an overall accuracy of 69%. If only partial tears are counted as true positives sensitivity decreases to 8% and positive predictive value to 10%. Conclusion. In this series a preoperative departmental ultrasound scan identified 70% of the actual rotator cuff tears present at arthroscopy. However ultrasound was not accurate in identifying partial thickness tears or distinguishing them from full thickness defects. Due to this relatively low sensitivity, we question the usefulness of routine preoperative departmental ultrasound scans in the evaluation of suspected cuff tears

Purpose. There is minimal information on outcome of glenohumeral debridement for treatment of shoulder osteoarthritis (OA). The purpose of this study was to examine the outcome of this procedure with or without acromioplasty /resection of clavicle in subjective perception of disability and functional range of motion and strength at one year following surgery. Method. Prospectively collected data of patients with advanced OA of the glenohumeral joint who were not good candidates for shoulder arthroplasty due to young age, high activity level, or desire to avoid major surgery at the time of assessment were included. Arthroscopic debridement included removal of loose bodies, chondral flaps, and degenerative tissue. Resection of the lateral end of the clavicle or acromioplasty was performed as clinically indicated for management of osteoarthritis of the Acromioclavicular (AC) joint or subacromial impingement respectively. Disability at 12 months following surgery was measured by the American Shoulder and Elbow Surgeons (ASES) assessment form, Constant-Murley score (CMS), strength, and painfree range of motion in four directions. Results. Sixty-seven patients (mean age= 57, SD: 15 (range: 25–87), range: 35–86, 35 females, 32 males) were included in analysis. The average symptom duration was 5 years. Fifteen (22%) patients had left shoulder involvement with 37 (55%) having right shoulder problem and 15(22%) reporting bilateral complaints. The right shoulder was operated on in 41 (61%) patients. Fifty two (78%) patients had an associated subacromial decompression [49 (73%) had acromioplasty and 27 (40%) had resection of the lateral end of the clavicle with some procedures overlapping]. Paired student t-tests showed a statistically significant improvement in scores of ASES and CMS (p<0.001) and painfree range of motion (p=0.02) at 1 year follow-up. However, no change was observed in strength (p>0.05). Conclusion. Arthroscopic debridement with or without acromioplasty /resection of the lateral end of the clavicle improves disability and painfree range of motion in patients suffering from osteoarthritis of glenohumeral joint at one year following surgery

The indication for rotator cuff repair in elderly patients is controversial. Methods. Consecutive patients over the age of 70 years, under the care of a single surgeon, receiving an arthroscopic rotator cuff repair were reviewed. Predominantly, a single row repair was performed using one (34 cases) or two (30) 5mm Fastin, double-loaded anchors. Double-row repair was performed in four cases. Subacromial decompression and treatment of biceps pathology were performed as necessary. Data were collected from medical records, digital radiology archives and during clinic appointments. Pain, motion, strength and function were quantified with the Constant-Murley Shoulder Outcome Score, administered pre operatively and at 1-year post operatively. Ultrasound scans were performed at one year to document integrity of the repair. Results. Sixty-nine arthroscopic cuff repairs were identified in 68 patients. The mean age was 77 years (70–86). The median ASA grade was 2 (79%). The dominant side was operated on in 68% of cases. A range of tear sizes were operated on (5 small, 17 moderate, 29 large and 18 massive). The tendons involved in the tear also varied (supraspinatus 12, supra and infraspinatus 53, supraspinatus and subscapularis 2, supraspinatus infraspinatus and subscapularis 2). Re-rupture occurred in 20 cases (29%). The mean Constant score increased from 23 (95% CI 19–26) to 59 (54–64) (P< 0.001). Where the repair remained sound, Constant score improved 42 points (95%CI 36–48). If the cuff re-ruptured, constant score also increased on average 12 points (95% CI 2–21). Re-rupture rate was highest for massive cuff repairs: ten out of eighteen (56%). Conclusion. Arthroscopic rotator cuff repair in the elderly is a successful procedure. Approximately seven out of ten repairs remained intact after one year. Even where re-rupture occurs, a significant improvement in the Constant score was found

This clinical study was performed to establish the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after shoulder surgery. The incidence of venous thrombo-embolism complicating shoulder surgery is poorly described in literature. As VTE is a potentially fatal condition we wanted to make surgeons aware of the problem and to try to establish any risk factors contributing to it. We reviewed retrospectively clinical records of all patients who had any procedure performed on their shoulder between 2001 and 2009 in our institution. In operating theatre coding database we identified 920 patients. Their records were assessed for any admissions due to proven DVT or PE; we looked for any radiological results suggestive of or confirming venous thromboembolism. We identified 920 patients who had surgical procedure under GA on their shoulder. 126 patients had shoulder arthroplasty, other procedures commonly undertaken were: subacromial decompression, shoulder stabilization and shoulder manipulations. There was 1 fatal PE in this group – patient died within 48 hours following total shoulder replacement, post mortem revealed massive pulmonary embolism with no sing of neither upper nor lower limb DVT. There were 3 cases of symptomatic DVT confirmed by USS Doppler. No upper limb symptomatic DVT was identified. There were 7 patients who had negative tests for suspected thrombosis (2 negative tests for suspected PE, 5 negative tests for suspected DVT). There is very limited evidence in literature on VTE following upper limb surgery. Recent studies suggest that DVT incidence following arthroplasty is as high as 13%, with further 3% incidence of PE. In our study we examined occurrence of symptomatic VTE only. According to our results the incidence of symptomatic DVT following shoulder surgery is about 0.35% and symptomatic PE about 0.1 %. We did not manage to show any risk factors associated strongly with post operative DVT in our group. The prevalence of asymptomatic VTE is probably much higher and further research needs to be undertaken in that area. On base of our experience we would not recommend routine anticoagulation as a DVT prophylactic after shoulder surgery unless there are additional risk factors