Introduction. We aim to assess whether radiographic characteristics of the greater tuberosity fragment can predict rotator cuff tears inpatients with anterior shoulder dislocations combined with an isolated fracture of the greater tuberosity. Methods. A retrospective single-centre case series of 61 consecutive patients that presented with anterior shoulder dislocations combined with an isolated fracture of the greater tuberosity between January 2018 and July 2022. Inclusion criteria: patients with atraumatic anterior shoulder dislocation associated with an isolated fracture of the greater tuberosity with a minimum follow-up of 3-months. Exclusion criteria: patients with other fractures of the proximal humerus or glenoid. Rotator cuff tears were diagnosed using magnetic resonance or ultrasound imaging. Greater tuberosity fragment size and displacement was calculated on plain radiographs using validated methods. Results. The case series was composed of 22 men and 39 women with a mean age of 65 years (29 - 91 years). The mean follow-up was 15months and median follow up 8.5 months (3 – 60 months). A rotator cuff tear was diagnosed in 14 patients (16%) and involved the supraspinatus (13), infraspinatus (4) and subscapularis (2). Full-thickness tears occurred in 6 patients and partial-thickness tears in 8patients. The mean time from initial injury to rotator cuff tear diagnosis was 5 months (2 – 22 months). The mean greater tuberosity fragment length was 23.4 mm in rotator cuff tear patients versus 32.6 mm in those without a tear (p = 0.006, CI: -15 - -2). The mean greater tuberosity. fragment width was 11.1 mm in rotator cuff tear patients versus 17.8 mm in those without a tear (p = 0.0004, CI: -10 - -2). There was no significant difference in the super inferior and anteroposterior fragment displacement between the two groups. Conclusion. In patients with shoulder dislocations combined with an isolated fracture of the greater tuberosity, rotator cuff tears are associated with a smaller sized greater tuberosity fragment

PURPOSE. We performed an anatomical study to clarify humeral insertions of coracohumeral ligament (CHL) and superior glenohumeral ligament (SGHL) and their relationship with subscapularis tendon. The purpose of our study was to explain the « Comma Sign » observed in retracted subscapularis tears treated by arthroscopy. MATERIAL AND METHODS. 20 fresh cadaveric shoulders were dissected by wide delto-pectoral approach. After removal the deltoid and posterior rotator cuff, we removed humeral head on anatomical neck. So we obtained an articular view comparable to arthroscopical posterior portal view. We looked for a structure inserted on subscapularis tendon behind SGHL. By intra-articular view we removed SGHL and CHL from the medial edge of the bicipital groove, then subscapularis tendon from lesser tuberosity. We splitted the rotators interval above the superior edge of subscapularis tendon and observed the connections between subscapularis tendon, CHL and SGHL. RESULTS. 6 shoulders had massive cuff tears and were excluded. No ligamentous structure was visible between rotators interval and subscapularis tendon by simple intra and extra-articular examination. After removal of LGHS humeral insertion, no structure showed vertical attach on tendon yet. But after removal of subscapularis tendon from lesser tuberosity and medial traction we saw constantly a fibers bundle directly inserted onto supero-lateral edge of subscapularis tendon. DISCUSSION/CONCLUSION. Most authors agree about existence of CHL and SGHL and their bone insertions, whereas relations between themselves and subscapularis tendon aren't so well defined. We constantly found an effective link between subscapularis tendon and a fibers bundle mainly coming from LCH. It layed into supero-lateral edge of subscapularis tendon and could be seen only by medial traction of it. This ligamentous structure yields the « Comma Sign » in subscapularis tendon tears. This study confirms our clinical datas

Introduction. Many literatures regarding more specific tests to diagnose the supraspinatus tendon injuries and the best rehabilitation methods to strengthen the supraspinatus have been published. However, conflicting results have been reported. 2-deoxy-2-[18F] fluoro-D-glucose (FDG) positron emission tomography (PET) has been recently used to assess skeletal muscle activities in various fields. Purpose. To evaluate & compare the metabolic activities of deltoid & rotator cuff muscles after the full-can & empty-can exercises using PET-CT. Materials and Methods. Ten healthy volunteers (age 27–34/mean 29.8 ± 2.7) with no history of shoulder pain and diabetes mellitus participated in this study. After FDG injection, both arms were maintained in the position of empty can and full can for ten minutes respectively. PET-CT was performed at forty minutes after the injection. The maximum standardized uptake value (SUV) was measured in the anterior, middle and posterior deltoid, supraspinatus, subacapularis and infraspinauts on the entire axial images. Results. The middle deltoid and subscapularis showed significantly greater activity during the empty-can exercise than during the full-can exercise (P=.006 and P=.003 respectively). The muscular activity of the supraspinatus also increased during the empty-can exercise than during the full-can exercise, although no statistical difference existed between two exercises. Six cases of eight cases who had increased activity of the subscapularis had increased activity in superior one half of the subscapularis than in lower one half of it, although there is no significant difference between two portions. Conclusion. The Empty-can exercise requires more strength of the middle deltoid, subscapularis and supraspinatus to keep the arm in internal rotation. The increased activity of the middle deltoid and subscapularis muscles after the empty-can exercise can make the empty-can test less specific to the supraspinatus muscle. The empty-can test can induce pain and weakness due to the subscapularis pathology. The full-can test can be used to test the function of the supraspinatus with the least amount of surrounding middle deltoid and subacapularis muslce activity

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.

We evaluated the results of Cementless Surface Replacement Arthroplasty (CSRA) of the shoulder in 67 patients with advanced glenohumeral destruction who have an intact rotator cuff. Between november 2002 and december 2008, 70 CSRA (32 Copeland/ Biomet and 38 SMRR/ Lima) were implanted in 67 patients. A deltopectoral approach was used in 34 cases and an anterosuperior approach in 36 cases. Patients were assessed using Constant score, a patient satisfaction score and a detailed radiographic analysis. The mean follow up was 3.4 years (range 1 to 7.5 years). The mean Constant score improved preoperatively from 17.6 points (range 2–55) to an average postoperative score of 66.1 (range 13–91). The pain score improved from 1.13 points (range 0–6) to 12.3 points (range 3–15). The forward flexion and external rotation improved from 71° (range 20 to 140) and 0° (range −40 to +45) to 143° (range 60 to180) and 34.4° (range −20 to +60) respectively. Complications included: 1 subscapularis detachment, 5 secondary rotator cuff tear, 1sepsis, 3 patients with shoulder stiffness. No shift in implant position was observed. 11 humeral components developed radiolucencies at the prosthesis-bone interface. The radiographic analysis involved a system of dividing the prosthesis/bone interface into 5 zones. The best clinical results were significantly achieved in patients with necrosis compared with osteoarthritis (Constant Score, ant. elevation, ext. Rotation). Using regression analysis we found that changes in the head-shaft angle position of the implant (valgus/varus placement of the CSRA) significantly predicted the age and sex adjusted Constant score. When the inclination angle of the humeral head decreases, the adjusted Constant score increases. In the same model, we also found that the lateral offset of the humerus significantly predicted the adjusted Constant score. When the lateral offset of the humerus decreases, the adjusted Constant score increases. The medialization of the glenoid significantly and negatively predicted the Constant score. Conclusion. CSRA of the shoulder outcomes have been comparable with those of stemmed arthroplasties. Radiolucent lines occur with follow up and most of the time located in the S1 area. Glenoid wear and humeral head lateralization negatively impact the clinical score. Cementless Shoulder resurfacing is a viable alternative to conventional shoulder arthroplasty