Currently, the consensus regarding
The Latarjet procedure is a well described method to stabilize anterior shoulder instability. There are concerns of high complication rates, one of these being a painful shoulder without instability due to screw irritation. The arthroscopic changes in the shoulder at time of screw removal compared to those pre-Latarjet have not been described in the literature. We conducted a retrospective review of arthroscopic videos between 2015 and 2022 of 17 patients at the time of their Latarjet screw removal and where available (n=13) compared them to arthroscopic findings at time of index Latarjet. Instability was an exclusion criterion. X-rays prior to screw removal were assessed independently by two observers blinded to patient details for lysis of the graft. Arthroscopic assessment of the anatomy and pathological changes were made by two shoulder surgeons via mutual consensus. An intraclass correlation coefficient (ICC) was analyzed as a measure for the inter-observer reliability for the radiographs. Our cohort had an average age of 21.5±7.7 years and an average period of 16.2±13.1 months between pre- and post-arthroscopy. At screw removal all patients had an inflamed
Shoulder arthroplasty procedures continue to increase in prevalence and controversy still remains about the optimal method to manage the
Introduction & Background. Clinical outcome after reverse total shoulder arthroplasty (RTSA) can be influenced by technical and implant-related factors, so the purpose of this study was to investigate whether individualizing humeral retroversion and
Background. Long term success of any shoulder joint reconstruction procedure involving
There is a large and growing population of patients with shoulder arthritis that are over 70 years old. Many of these patients live alone and sling immobilization after shoulder arthroplasty is problematic. Other than improved internal rotation, there are limited benefits of anatomic shoulder arthroplasty compared to reverse arthroplasty. Anatomic arthroplasty is associated with longer OR time, longer recovery with need for assistance to allow the
It is undetermined which factors predict return to work following arthroscopic rotator cuff repair. We aimed to identify which factors predicted return to work at any level, and return to pre-injury levels of work 6 months post-arthroscopic rotator cuff repair. Multiple logistic regression analysis of prospectively collected demographic, pre-injury, preoperative, and intraoperative data from 1502 consecutive primary arthroscopic rotator cuff repairs, performed by a single surgeon, was performed to identify independent predictors of return to work, and return to pre-injury levels of work respectively, 6 months post-surgery. Six months post-rotator cuff repair, 76% of patients returned to work (RTW), and 40% returned to pre-injury levels of work (Full-RTW). RTW at 6 months was likely if patients were still working after their injuries, but prior to surgery (Wald statistic [W]=55, p<0.0001), were stronger in internal rotation preoperatively (W=8, p=0.004), had full-thickness tears (W=9, p=0.002), and were female (W=5, p=0.030). Patients who achieved Full-RTW were likely to have worked less strenuously pre-injury (W=173, p<0.0001), worked more strenuously post-injury but pre-surgery (W=22, p<0.0001), had greater behind-the-back lift-off strength preoperatively (W=8, p=0.004), and had less passive external rotation range of motion preoperatively (W=5, p=0.034). Patients who were still working post-injury, but pre-surgery were 1.6-times more likely to RTW than patients who were not (p<0.0001). Patients who nominated their pre-injury level of work as “light” were 11-times more likely to achieve Full-RTW than those who nominated “strenuous” (p<0.0001). Six months post-rotator cuff repair, a higher patient-rated post-injury, but pre-surgery level of work was the strongest predictor of RTW. A lower patient-rated pre-injury level of work was the strongest predictor of Full-RTW. Greater preoperative
Introduction:. The
Shoulder arthroplasty procedures continue to increase in prevalence, and controversy still remains about the optimal method to manage the
Subscapularis function following Total shoulder joint replacement has been a concern in recent literature. It has been postulated that lesser tuberosity osteotomy approach may have better Subscapularis function than transtendonous approach. To assess whether lesser tuberosity osteotomy vs.
Hemi shoulder arthroplasty is a rather successful procedure although revision surgery due to secondary glenoid erosion is reported in more than 25%. The downside of common shoulder arthroplasty is that in a deltopectoral approach the
The standard approach is through the deltopectoral interval. Among patients with prior incisions, one makes every effort to either utilise the old incision or to incorporate it into a longer incision that will allow one to approach the deltopectoral interval and retract the deltoid laterally. The deltopectoral interval is most easily developed just distal to the clavicle, where there is a natural infraclavicular triangle of fat that separates the deltoid and pectoralis major muscles even in very scarred or stiff shoulders. Typically, the deltoid is retracted laterally leaving the cephalic vein on the medial aspect of the exposure. The anterior border of the deltoid is mobilised from the clavicle to its insertion on the humerus. The anterior portion of the deltoid insertion together with the more distal periosteum of the humerus may be elevated slightly. The next step is to identify the plane between the conjoined tendon group and the
Subscapularis tenotomy (SST) has been the preferred approach for shoulder arthroplasty for decades but recent controversy has propelled lesser tuberosity osteotomy (LTO) as a potential alternative. Early work by Gerber suggested improved healing and better outcomes with LTO although
Total shoulder arthroplasty is becoming increasingly common. A biceps tenodesis or tenotomy has become a routine part of the operation. There are several advantages to a tenodesis or tenotomy. First, the long head of the biceps tendon is routinely pathologic. One study has shown that there are differences in gene expression and mechanical properties in the long head of the biceps tendon in the setting of glenohumeral joint arthritis. Clinically, we often see inflammation, tearing, adhesions, or other pathology. Second, it is largely accepted that the long head of the biceps tendon has minimal function at the shoulder. The biceps muscle primarily functions at the elbow. Therefore, there is little downside to performing a tenodesis if there is a chance of it generating pain after surgery. Another major reason to perform a tenodesis or a tenotomy is that the technique of total shoulder arthroplasty requires a
Introduction. Reverse shoulder arthroplasty (rTSA) increases the deltoid abductor moment arm length to facilitate the restoration of arm elevation; however, rTSA is less effective at restoring external rotation. This analysis compares the muscle moment arms associated with two designs of rTSA humeral trays during two motions: abduction and internal/external rotation to evaluate the null hypothesis that offsetting the humerus in the posterior/superior direction will not impact muscle moment arms. Methods. A 3-D computer model simulated abduction and internal/external rotation for the normal shoulder, the non-offset reverse shoulder, and the posterior/superior offset reverse shoulder. Four muscles were modeled as 3 lines from origin to insertion. Both offset and non-offset reverse shoulders were implanted at the same location along the inferior glenoid rim of the scapula in 20° of humeral retroversion. Abductor moment arms were calculated for each muscle from 0° to 140° humeral abduction in the scapular plan using a 1.8: 1 scapular rhythm. Rotation moment arms were calculated for each muscle from 30° internal to 60° external rotation with the arm in 30° abduction. Results. During abduction with the normal shoulder, the
Introduction. Posterior glenoid wear is common in glenohumeral osteoarthritis. Tightening of the
Purpose. Controversy exists regarding the optimal technique of
Aim. Two different techniques to release
The cellular mechanisms of tendinopathy remain unclear, particularly with respect to the role of inflammation in early disease. We have previously identified increased levels of inflammatory cytokines in an early human model of tendinopathy and sought to extend these studies to the cellular analysis of tissue. Purpose. To characterise inflammatory cell subtypes in early human tendinopathy we explored the phenotype and quantification of inflammatory cells in torn and control tendon samples. Design. Controlled laboratory study. Methods. Torn supraspinatus tendon and matched intact
When compared to magnetic resonance imaging (MRI), ultrasound (US) performed by experienced users is an inexpensive tool that has good sensitivity and specificity for diagnosing rotator cuff (RC) tears. However, many practitioners are now utilizing in-office US with little to no formal training as an adjunct to clinical evaluation in the management of RC pathology. The purpose of our study was to determine if US without formal training is effective in managing patients with a suspected RC tear. This was a single centre prospective observational study. Five fellowship-trained surgeons each examined 50 participants referred for a suspected RC tear (n= 250). Patients were screened prior to the consultation and were included if ≥ 40 years old, had an MRI of their affected shoulder, had failed conservative treatment of at least 6 months, and had ongoing pain and disability. Patients were excluded if they had glenohumeral instability, evidence of major joint trauma, or osteonecrosis. After routine clinical exam, surgeons recorded their treatment plan (“No Surgery”, “Uncertain”, or “Surgery”). Surgeons then performed an in-office diagnostic US followed by an MRI and documented their treatment plan after each imaging study. Interrater reliability was analyzed using a kappa statistic to compare clinical to ultrasound findings and ultrasound findings to MRI, normal and abnormal categorization of biceps, supraspinatus, and