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Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_II | Pages 165 - 165
1 Apr 2005
Swan MC Smith RLC Emery RJH
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Aim: As the shoulder and elbow joints share a common objective – spatial positioning of the hand – can the Modified Constant Score of shoulder function be applied to function at the elbow?

Method & Results: All patients with isolated elbow pathology over an eighteen-month period were assessed. Acute fractures and patients with shoulder and/or wrist pathology were excluded. Upper limb function was assessed using the Modified Constant Score and the Mayo Elbow Performance Index. A total of 48 patients with a variety of elbow pathologies were assessed. The mean patient age was 47.8 years, and 26 patients were male. The correlation between the two scoring systems was highly significant (correlation 0.91, t = < 0.001)

Conclusion: The Modified Constant Score may be used as an assessment of both shoulder and elbow function.


The Journal of Bone & Joint Surgery British Volume
Vol. 85-B, Issue 4 | Pages 594 - 599
1 May 2003
Reilly P Amis AA Wallace AL Emery RJH

Differential strain has been proposed to be a causative factor in failure of the supraspinatus tendon. We quantified the strains on the joint and bursal sides of the supraspinatus tendon with increasing load (20 to 200 N) and during 120° of glenohumeral abduction with a constant tensile load (20 to 100 N).

We tested ten fresh frozen cadaver shoulders on a purpose-built rig. Differential variable reluctance extensometers allowed calculation of the strain.

Static loading to 100 N or more increased strains on the joint side significantly more than on the bursal side. During glenohumeral abduction an increasing and significant difference in strain was measured between the joint and bursal sides of the supraspinatus tendon, which reached a maximum of 10.6% at abduction of 120°. The joint side strain of 7.5% reached values which were previously reported to cause failure.

Differential strain causes shearing between the layers of the supraspinatus tendon, which may contribute to the propagation of intratendinous defects that are initiated by high joint side strains.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 4 | Pages 696 - 696
1 Jul 1997
BANKES MJK EMERY RJH


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 3 | Pages 458 - 461
1 May 1997
Rossouw DJ McElroy BJ Amis AA Emery RJH

Repair of the rotator cuff requires secure reattachment, but large chronic defects cause osteoporosis of the greater tuberosity which may then have insufficient strength to allow proper fixation of the tendon. Recently, suture anchors have been introduced, but have not been fully evaluated.

We have investigated the strength of suture-to-anchor attachment, and the use of suture anchors in repairs of the rotator cuff either to the greater tuberosity or the lateral cortex of the humerus. The second method gave a significant increase in the strength of the repair (p = 0.014).

The repairs were loaded cyclically and failed at low loads by cutting into bone and tendon, casting doubt on the integrity of the repair in early mobilisation after surgery. Repairs with suture anchors did not perform better than those with conventional transosseous attachment.