We have carried out a prospective double-blind randomised controlled trial to compare the efficacy of a single subacromial injection of the non-steroidal anti-inflammatory drug, tenoxicam, with a single injection of methylprednisolone in patients with subacromial impingement. A total of 58 patients were randomly allocated into two groups. Group A received 40 mg of methylprednisolone and group B 20 mg of tenoxicam as a subacromial injection along with lignocaine. The Constant-Murley shoulder score was used as the primary outcome measure and the Disability of Arm, Shoulder and Hand (DASH) and the Oxford Shoulder Score (OSS) as secondary measures. Six weeks after injection the improvement in the Constant-Murley score was significantly greater in the methylprednisolone group (p = 0.003) than in the tenoxicam group. The improvement in the DASH score was greater in the steroid group and the difference was statistically significant and consistent two (p < 0.01), four (p < 0.01) and six weeks (p < 0.020) after the injection. The improvement in the OSS was consistently greater in the steroid group than in the tenoxicam group. Although the difference was statistically significant at two (p < 0.001) and four (p = 0.003) weeks after the injection, it was not at six weeks (p = 0.055). Subacromial injection of tenoxicam does not offer an equivalent outcome to subacromial injection of corticosteroid at six weeks. Corticosteroid is significantly better than tenoxicam for improving shoulder function in tendonitis of the rotator cuff after six weeks.

The deltopectoral approach is a common approach for Shoulder joint replacements where a normal subscapularis tendon is divided. Despite meticulous attention to the subscapular repair, suboptimal return of function was found on clinical examination in 92% of patients (Miller S L: Journal of Shoulder & Elbow Surgery. 12(1): 29–34, February 2003). Therefore the aim was to study the integrity of the Subscapularis tendon in patients with Shoulder joint Replacements both clinical and ultrasound examination

Methods: A cohort of 25 subjects who had undergone Copeland Shoulder replacements through deltopectoral approach were included. All patients had same technique of tendon-to-tendon repair and postoperative rehabilitation. After ethics committee approval subjects were evaluated prospectively with Lift off test, Belly press test and the Constant score. Average follow-up was 29.6 months. An experienced Radiologist performed the Ultrasound examination

Results: Ultrasound examination showed 8 % (2 of 25) had full thickness rupture of subscapularis with 44% (11 of 25) showed mild to moderate atrophy of subscapularis muscle and 12%(3 of 25) severe atrophy. 20%(5 of 25) had Lift off test and Belly press test positive. 40%(10 of 25) had either or both of these tests positive. 60%(15 of 25) had clinical or radiological evidence of reduced function (Fisher exact test, P < 0.01). Constant score are 37.5 with full thickness tears compared to 59.4 with intact subsapularis tendon

Conclusion: Subscapularis tendon function following shoulder replacement had received poor attention. It is deficient in over 60% of patients with joint replacement through Deltopectoral approach with tendon-to-tendon repair. We therefore conclude for this study that alternative techniques of subscapularis tendon repair or alternative approaches to the shoulder joint need to be considered to improve the functional outcome in these patients

Objective: Senior author conducted two studies focusing on the age of presentation, Cobb angle at presentation and means of detection of adolescent idiopathic scoliosis in 1976 and 1985 respectively. We conducted another similar study in 1999 to compare the present situation with the previous two studies.

Design: Data was collected for 100 consecutive cases of adolescent idiopathic scoliosis which presented to the scoliosis clinic at The Middlesex Hospital, London from 1997 to 1999. the age of presentation, Cobb angle at presentation and the person who detected the deformity first were recorded. The patients were divided in following groups.

Group1 detected by family and friends.

Group2 detected by GP or by another doctor incidentally.

Group3 detected at school.

Group 4 detected by teachers.

Subjects: There were 81 female and 19 male patients with a mean age of 13.8 years.

Results: Group 1 consisted of 63% of the patients. Group 2 had 26% of the patients. Group 3 compromised of 8% of the patients and group 4 had 3% of the patients. Group 1 was the largest group and had increased since 1985 and 70% of the patients in this group had a Cobb angle greater than 40 degrees at presentation. It was also noted that group 3 had significantly dropped to 8% while in 1985 and in 1976 it was 10% and 32% respectively.

Conclusions: Our results represent a small sample from one center but it clearly shows that detection of scoliosis at school has dropped and majority of the cases are detected by family and friends often at a later stage with larger Cobb angles in excess of 40 degrees. Non-operative methods are ineffective with Cobb angles of this magnitude thus highlighting the importance of some means of early detection of scoliosis and producing greater awareness in the community.