Athletes involved in repetitive overhead shoulder rotation demonstrate increased external rotation and decreased internal rotation range of motion. Deficits in internal rotation have been linked to the development of shoulder pathology. The purpose of this study is to determine if a posterior shoulder stretch program is effective in increasing dominant arm internal rotation and horizontal adduction range of motion in overhead athletes identified as having reduced mobility and posterior shoulder tightness.

Thirty-seven overhead athletes in volleyball, swimming and tennis, with internal rotation range of motion deficits greater than or equal to 15°, were randomised into intervention or control groups. The intervention group performed the “sleeper stretch” daily for eight weeks while the control group performed usual activities. Independent t-tests determined whether internal rotation and horizontal adduction range of motion differences between groups were significant and two-way repeated measures analysis of variance tests measured the rate of shoulder range of motion change. Reported shoulder pain and function were also obtained at each evaluation.

Significant differences were found between the intervention and control groups' internal rotation and horizontal adduction range of motion at eight weeks (p<0.001 and p=0.003 respectively) compared to baseline (zero weeks) (p=0.19 and p=0.82 respectively). Significant changes in internal rotation were detected in the intervention group at four weeks (p<0.001) with further adaptations noted at eight weeks. Horizontal adduction improved at a slower rate demonstrating significant changes at eight weeks (p=0.003). Reported shoulder pain and functional ability (p=0.002) were different between the study groups at eight weeks.

Overhead, collegiate-level athletes with an internal rotation deficit greater than or equal to 15° are able to significantly increase internal rotation and horizontal adduction range of motion by performing a posterior shoulder stretch exercise for eight weeks.

Clinical pathways are optimal patient care processes that have been developed to improve the quality of care for patients. Anecdotal evidence has suggested that patients presenting to the healthcare system with rotator cuff tears experience less than ideal quality care plagued by lengthy wait times, challenges in coordinating care, and inefficient use of healthcare resources. Therefore, diagnosis and treatment of patients with rotator cuff tears are in need of quality improvement through evidence-informed decision making. The purpose of this study is to develop a clinical pathway for patients presenting to the healthcare system with rotator cuff tears.

The following steps were taken in developing the clinical pathway: 1) a multidisciplinary expert panel was formed; 2) goals of the clinical pathway were identified by the panel; 3) the literature and current clinical practices for best practice were reviewed; 4) recommendations for treatment algorithms were developed using consensus methods.

The panel consisted of fourteen experts representing the two largest cities in Alberta, Canada (Edmonton and Calgary). The team consisted of at least one member from the clinical domains of sport medicine, orthopaedic surgery, athletic therapy, and physiotherapy. The first goal of the clinical pathway was to standardise screening, diagnosis, and physical examination of the patient. The second goal was to provide recommendations for appropriate investigations. The final goal was to map steps in the patients' care pathway including sequencing and timing recommendations for treatment and interventions. Best practices were reviewed by the panel and using a modified Delphi method, clinical pathways for three types of rotator cuff tears (acute, chronic, and acute-on-chronic) were developed.

A clinical pathway that reflected best practices was developed from the literature and experts. The clinical pathway for diagnosis and treatment of patients with rotator cuff pathology will help to standardised patient care, improve patient flow, reduce unnecessary interventions, reduce healthcare utilisation and costs, and improve the quality of patient care.

Purpose: Arthroscopic stabilization for post-traumatic anterior glenohumeral instability is designed to minimize soft tissue dissection while achieving similar or improved outcomes relative to open techniques. This study’s purpose was to determine the rate of post-operative recurrent instability and evaluate health related quality of life (HRQL) and shoulder range of motion (ROM) following arthroscopic Bankart repair using a bioabsorbable knotless implant.

Method: Forty-three patients were prospectively evaluated following arthroscopic anterior stabilization to assess for recurrent instability, HRQL, and shoulder ROM. Assessments were performed pre-operatively and 3, 6 and 12–24 months postoperatively. The HRQL measures included the Western Ontario Shoulder Instability Index (WOSI), the American Shoulder and Elbow Surgeons Score (ASES), and the Constant Score. Repeated measures ANOVA was utilized to evaluate ROM and HRQL.

Results: The mean WOSI score improved from 45.67±17.99 pre-operatively to 83.16±18.58 at final follow-up. The mean ASES scores improved from 80.1±13.06 pre-operatively to 92.25±15.08, while the Constant score improved from 77.52±16.11 pre-operatively to 85.18±26.76. At final follow-up, 4 of 43 patients (9.3%) had experienced recurrent instability. For these 4 subjects, the WOSI score was significantly lower at final follow-up than those who did not experience recurrent instability (61.73±5.76 versus 84.38±16.94). The ASES and Constant scores at final follow-up were not significantly different between these two groups.

Conclusion: Arthroscopic anterior stabilization using a bioabsorable tack led to a recurrent instability rate similar to previous reports, and resulted in improved HRQL and shoulder ROM. The WOSI score was better able to detect problems in HRQL related to instability than either the ASES or Constant score.

Purpose: Classification systems for orthopaedic injuries are used in clinical care and research to allow for communication about the diagnosis, prognosis, treatment, and outcome of fractures and dislocations. The inter-observer reliability of the Hotchkiss modification of the Mason classification system and the AO classification system were evaluated to assess their reliability in classifying radial head fractures.

Methods: Forty-three consecutive fractures with and without other associated injuries were identified from the practice of a single sub-specialist orthopaedic surgeon. Their radiographs were compiled and all identifying marks were hidden. Five observers classified the radiographs according to each classification system. Percent agreement was calculated pair-wise between observers for each system. The mean percent agreement and 95% confidence intervals were calculated for each system. Additionally, the systems were collapsed, with types II and III combined for the Hotchkiss system, and the final digit dropped for the AO system. The mean percent agreement and 95% confidence intervals were then recalculated.

Results: The percent agreement for the Hotchkiss modification of the Mason classification system was 72.3% (95% CI 65.8% to 78.9%). The percent agreement for the AO classification system was 37.7% (95% CI 30.5% to 44.9%). The percent agreement for the collapsed Hotchkiss system was 89.3% (95% CI 86.6% to 92.0%). The percent agreement for the collapsed AO system was 67.4% (95% CI 54.6% to 80.3%).

Conclusions: The inter-observer reliability for the AO classification system had a low percent agreement, possibly reflecting the complexity of the system. Collapsing the AO system improved the percent agreement, however it still could be considered fair. The inter-observer reliability for the Hotchkiss modification of the Mason classification system was higher. However, when the lower end of the 95% confidence interval is taken into consideration, the reliability of the system could be considered fair. Collapsing this system did improve the percent agreement into what could be considered a good range, suggesting that this system may be able to reliably identify fractures requiring operative treatment.

Funding : Other Education Grant

Funding Parties : Alberta Heritage Foundation for Medical Research