Introduction: A Bradford sling is a device with which the arm can be held in an elevated position in the trauma or post-op elective setting to reduce swelling. It is marketed as a single use item but in many orthopaedic departments it is used multiple times before being discarded especially in the elective recovery setting. We asked the question ‘are there any microbiological implications to the re-use of Bradford slings?’ In our department Bradford slings were used in recovery for patients who had undergone hand surgery as a day-case. The sling would then cease to be used once it had become mechanically unusable.

Method: The Bradford slings employed in a one-month period by a single consultant working in the day surgery unit of the study hospital were examined. Prior to and following each use agar plates were inoculated by pressing the sling directly onto the plates. Two areas each of 5cm², one in the arm and one in the forearm section of the slings were defined and labeled proximal and distal. Aseptic technique was used to avoid contamination by the investigator but otherwise the slings were treated in the same fashion as usually they would be. Patients were all screened for MRSA and were all negative

Results: In a one-month period 6 slings were used between 2 and 7 times (mean 4) resulting in 96 inoculation events. 89 (92.7%) of these events yielded significant bacterial growth. Most of these colonies were coagulase-negative Staphylococcus or Bacillus, however coliforms were cultured 5 (5.2%) times and Staphylococcus Aureus twice (2%). Also all slings demonstrated bacterial growth immediately after removal of packaging prior to first use. Indeed one sling grew coliforms prior to its first use.

There were no incidences of wound infection at 6-week follow-up.

Conclusion: The re-use of the Bradford sling poses no threat to the elective post-op patient. Most of the organisms isolated were environmental organisms unlikely to cause infection. There would only be a significant risk of infection if a patient had an open wound. Interestingly none of the Bradford slings were sterile prior to use. This study demonstrates that there appears to be minimal risk to the patient in re-using slings, but the numbers in this study are limited and a larger study would be helpful in assessing the risk further.

We performed a prospective cohort study to investigate the comparability of subjective and objective assessment scores of shoulder function following surgery for rotator cuff pathology.

A consecutive series of 372 patients underwent surgery for rotator cuff disorders with post-operative follow up over 24 months. 248 patients only had subacromial decompression, whereas 124 patients had rotator cuff repair additionally (93 arthroscopic; 31 open). Assessments were made pre-operatively, and at 3, 6, 12, and 24 months post-operatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Oxford Shoulder Questionnaire (OSQ); and the Constant score, which was used as a reference. Standardisation calculations were performed to convert all scores into a 0 to 100 scale, with 100 representing a normal shoulder. The student’s t test was used to compare the mean score for each subjective tool (DASH and OSQ) with the objective score (Constant) at each time point. Pearson’s Correlation coefficient was used to analyse the changes with time post-operatively. The statistical tests were used for the individual surgery types as well as all surgeries collectively. The relationship between the DASH and the Constant score was strongly correlated in all types of surgery.

The relationship between the Oxford and Constant scores was similar, except in the open rotator cuff repair group. There was no statistical difference between the mean DASH and Constant scores for all interventions at any time point. A significant difference was seen between the mean Oxford and Constant scores for at least one time point in all but the open rotator cuff repair group.

We demonstrate that the DASH and Oxford scoring systems would be useful substitutes for the Constant score, eliminating the need for a trained investigator and specialist equipment required to perform the Constant score with the associated cost benefits.

We performed a prospective audit to investigate the comparability of subjective and objective assessment scores of shoulder function following surgery for rotator cuff pathology. A consecutive series of 372 patients underwent surgery for rotator cuff disorders with post-operative follow up over 24 months. 248 patients solely underwent subacromial decompression, whereas 124 had additional rotator cuff repair (93 arthroscopic; 31 open).

Assessments were made pre-operatively, and at 3, 6, 12, and 24 post-operative months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Oxford Shoulder Questionnaire (OSQ); and the Constant score, which was used as a reference. Standardisation calculations were performed to convert all scores into a 0 to 100 scale, with 100 representing a normal shoulder. The student’s t-test was used to compare the mean score for each subjective tool (DASH and OSQ) with the objective score (Constant) at each time point. Correlation coefficients (Pearson’s) were used to analyse the changes with time (post-operative course). Each statistical test was used for all surgeries collectively and for the individual surgery types.

The relationship between the DASH and the Constant score was robust in all types of surgery. The relationship between the Oxford and Constant was generally robust, except in the open rotator cuff group. There was no statistical difference between the mean DASH and Constant scores for all interventions at each time point. A significant difference was seen between the mean Oxford and Constant scores for at least one time point in all but the open rotator cuff repair group.

We demonstrate the DASH and Oxford scoring systems would be useful substitutes for the Constant score, obviating the need for the trained investigator and specialist equipment required to perform the Constant score, alongside the associated cost benefits. Further it provides evidence of service, aids appraisal and revalidation.

Introduction: We performed a prospective cohort study to investigate the comparability of subjective and objective assessment scores of shoulder function following surgery for rotator cuff pathology.

Materials and Methods: A consecutive series of 372 patients underwent surgery for rotator cuff disorders with post-operative follow up over 24 months. 248 patients solely underwent subacromial decompression, whereas 124 had additional rotator cuff repair (93 arthroscopic; 31 open). Assessments were made pre-operatively, and at 3, 6, 12, and 24 post-operative months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Oxford Shoulder Questionnaire (OSQ); and the Constant score, which was used as a reference. Standardisation calculations were performed to convert all scores into a 0 to 100 scale, with 100 representing a normal shoulder. The student’s t test was used to compare the mean score for each subjective tool (DASH and OSQ) with the objective score (Constant) at each time point. Correlation coefficients (Pearson’s) were used to analyse the changes with time (post-operative course). Each statistical test was used for all surgeries collectively and for the individual surgery types.

Results: The relationship between the DASH and the Constant score was robust in all types of surgery. The relationship between the Oxford and Constant was generally robust, except in the open rotator cuff group. There was no statistical difference between the mean DASH and Constant scores for all interventions at each time point. A significant difference was seen between the mean Oxford and Constant scores for at least one time point in all but the open rotator cuff repair group.

Conclusion: We demonstrate the DASH and Oxford scoring systems would be useful substitutes for the Constant score, obviating the need for the trained investigator and specialist equipment required to perform the Constant score, alongside the associated cost benefits.

The aim of this study was to establish a classification system for the acromioclavicular joint using cadaveric dissection and radiological analyses of both reformatted computed tomographic scans and conventional radiographs centred on the joint. This classification should be useful for planning arthroscopic procedures or introducing a needle and in prospective studies of biomechanical stresses across the joint which may be associated with the development of joint pathology.

We have demonstrated three main three-dimensional morphological groups namely flat, oblique and curved, on both cadaveric examination and radiological assessment. These groups were recognised in both the coronal and axial planes and were independent of age.

Objective: An open procedure has long been the gold standard for the repair of rotator cuff tears. Increasingly arthroscopic repair is taking the place of open surgery. This study is a comparative analysis of open and arthroscopic rotator cuff repair.

Methodology: 113 (57 female, 56 male; mean age 58 years) consecutive patients undergoing rotator cuff repair performed between 2003 and 2006 in one centre were studied prospectively. 92 were arthroscopic (48 female, 44 male; mean age 57 years) whilst 21 used a mini-open technique (9 female, 12 male; mean age 62). The determinant for which procedure was employed was solely clinical, whereby tears greater than 30mm dictated an open procedure. Assessments were made using the Oxford Shoulder Questionnaire (OSQ), DASH and Constant Scores pre-operatively, at three and six post-operative months, and six-monthly thereafter. Correlation coefficients (Pearson’s) were used to analyse and compare the post-operative course for each intervention, and the student’s t test was used to compare the mean scores for each treatment at each time point.

Results: Strong correlation was demonstrated between the rates of recovery with each surgery (Constant r=0.94; DASH r=0.96; OSQ r=0.94). Although the absolute scores were better for the arthroscopic group at each time-point with all assessment tools, these differences were statistically significant only pre-operatively with each score, and at one year with the Constant score.

Conclusion: Whilst the open repair group had poorer scores pre-operatively reflecting an initial difference in tear severity, the rates of improvement were identical with either treatment modality, as were the one year outcomes measured with the OSQ and DASH. This study demonstrates arthroscopic rotator cuff repair to be comparable with open, although we acknowledge that at one year a significant difference was evident with the Constant score.

To investigate the comparability of subjective and objective scores of shoulder function following surgery for rotator cuff pathology. From 2003 to 2006, 333 patients undergoing surgery for rotator cuff disorders were followed prospectively. 220 (66%) underwent solely subacromial decompression, whilst 113 (34%) had additional rotator cuff repair (92 arthroscopic; 21 mini-open). Assessments were made pre-operatively and six-monthly thereafter using the DASH score; Oxford Shoulder Questionnaire (OSQ); and Constant score, which was used as a reference. Standardisation calculations were used to convert all scores to a 0 to 100 scale (100 representing a normal shoulder). The student’s t test was used to compare the mean score for each subjective tool (DASH and OSQ) with the objective score (Constant). Correlation coefficients (Pearson’s) were used to analyse the post-operative course measured with subjective and objective tools for each intervention. Each statistical test was used for all surgeries collectively and the individual surgery types. There was no difference between the mean DASH and Constant scores. A significant difference was seen between the Oxford and Constant scores for at least one time point in each treatment group. Strong correlation was demonstrated between both subjective scores and the Constant. The mean Pearson correlation coefficient comparing the DASH and Constant was 0.96, whilst that for the Oxford and Constant was 0.89. The DASH and Constant scores provided identical results in terms of absolute values at a given time point, and with respect to rates of recovery. The relationship between the Oxford and Constant was less robust. In this study the DASH and Constant scores were indistinguishable, justifying the use of only the former for follow-up, obviating the need for a trained investigator required to perform a Constant score.

To compare the effectivity of arthroscopic and open stabilisation of the shoulder. Between 2003 and 2006, 100 patients (20 female, 80 male; mean age 32 years) undergoing glenohumeral stabilisation were followed prospectively. 28 were open (3 female, 25 male; mean age 30.7 years), 72 arthroscopic (17 female, 55 male; mean age 32.0 years). Assessments were made using the Constant, DASH, and Carter-Rowe (CR) scores, as well as the Oxford Shoulder Instability Questionnaire (OSIQ) pre-operatively, at three and six post-operative months, and six-monthly thereafter. The student’s t test was used to compare the mean scores at each time point. Correlation coefficients (Pearson’s) were used to compare the postoperative course with either intervention. In general the open group performed marginally less well than did the arthroscopic. However, the DASH score demonstrated less consistency both in this relationship, and the rate of post-operative recovery when compared with the other scoring systems. In the open surgery group the DASH revealed a deterioration from the pre-operative score at six months before subsequent improvement; in the arthroscopic group, this deterioration occurred at three months. However, these differences were not statistically significant regardless of the assessment tool employed. Strong correlation was demonstrated between the rates of recovery following either surgery (Constant r=0.99; OSIQ r=1.00; CR r=0.94). Again, this was not supported by the DASH (r= −0.868). The rates of improvement were identical with either treatment when measured with the Constant, OSIQ, and CR, whilst the DASH score yielded inconsistent results. No significant difference could be shown between open and arthroscopic surgery at any individual time point regardless of the assessment tool employed. We suggest that open and arthroscopic surgeries yield very similar outcomes.

A consecutive series of 372 patients who underwent surgery for disorders of the rotator cuff involving arthroscopic subacromial decompression and open or arthroscopic repairs of the cuff were prospectively investigated as to the comparability of subjective and objective assessment scores of shoulder function. Assessments were made before operation and at 3, 6, 12, 18 and 24 months after surgery using the Disabilities of the Arm, Shoulder, and Hand score, the Oxford shoulder score and the Constant-Murley score, which was used as a reference. All scores were standardised to a scale of 0 to 100 for comparison. Statistical analysis compared the post-operative course and the mean score for the subjective Disabilities to the Arm, Shoulder and Hand score and Oxford shoulder score, with the objective Constant score at each interval. A strong correlation was evident between both subjective scores and the Constant score. We concluded that both the subjective scores would be useful substitutes for the Constant score, obviating the need for a trained investigator and the specialist equipment required to perform the Constant score.