The musculoskeletal (MSK) profiles of water polo players and other overhead athletes has been shown to relate to injury and throwing performance (TP). There have been no robust studies conducted on the MSK profiles and the variables affecting TP amongst female, adolescent, elite water polo players. A prospective quantitative cohort design was conducted amongst eighty-three female adolescent, elite water polo players (range 14–19 years). All participants filled out the Kerlan-Jobe Orthopaedic Clinic questionnaire, followed by a battery of screening tests aimed to identify possible MSK factors affecting TP. Pain provocation tests, range of motion (ROM), upward scapula rotation (USR), strength and pectoralis minor length measurements were all included. Participants also performed throwing speed (TS) and throwing accuracy (TA) tests. All the data collected were grouped together and analysed using SPSS 28.0. The condition for statistical significance was set as p <0.05. Multi-collinearity was tested for among variables to find out inter-variable correlations. Finally, a multiple regression analysis was performed. The mean KJOC score was 82.55 ± 14.96. 26.5% tested positive for at least one of the impingement tests. The MSK profile revealed decreased internal rotation ROM, increased external rotation ROM, a downwardly rotated scapula, weak external rotators, weak serratus anterior strength, strong lower trapezius and gluteus medius strength and a shorter pectoralis minor length all on the dominant side. Age, pectoralis minor length, upper trapezius and serratus anterior strength as well as upward scapula rotation were all positively correlated with TS, while sitting height, upper trapezius and serratus anterior strength and glenohumeral internal rotation ROM were positively correlated with TA. Multiple MSK parameters were found to be related to TS and TA in elite, adolescent water polo players.
To investigate the incidence of post-operative ulna nerve symptoms in total elbow arthroplasty after full in-situ release. A retrospective review was completed of the medical records of eighty-three consecutive primary total elbow arthroplasties (TEA) performed between 2003 and 2012. Data analysed included the presence of pre-operative ulnar nerve (UN) symptoms, history of prior UN transposition, intra-operative management of the UN and presence of post-operative symptoms.Aim:
Methods:
To investigate the clinical outcomes of elbows with post-traumatic stiffness treated by open surgical release. A retrospective review was completed on thirty-five consecutively managed patients who underwent an open elbow release for post-traumatic stiffness between 2007 and 2012. Pre-operative and post-operative range of motion (ROM), pain scores and functional outcomes were recorded.Aim:
Methods:
Hypoplasia of the glenoid is a rare condition caused by incomplete ossification of the postero-inferior aspect of the developing glenoid. It may be isolated or associated with a more generalised condition. The clinical symptomatology is variable depending on the age at time of presentation. We performed a retrospective chart review of patients who presented with shoulder complaints, and in whom a radiographic diagnosis of glenoid hypoplasia had been made. From January 2002 to December 2012, 8 patients (9 shoulders) with radiological signs of glenoid hypoplasia were identified. The mean age at presentation was 39 years (range 23 to 77) and the mean symptom duration was 12.5 months (range 1 to 48).Introduction
Materials and Methods
Resurfacing of the glenohumeral joint has gained popularity since its first introduction in 1958. Advantages of resurfacing over conventional shoulder arthroplasty include preservation of humeral bone stock, closer replication of individual anatomy, reduction of periprosthetic fracture risk, non-violation of medullary canal, and ease of revision to a stemmed component if needed. We reviewed a group of patients with arthrosis of the glenohumeral joint who underwent humeral resurfacing, and who were at a minimum of two years post surgery. From January 2000 to March 2011, 51 humeral resurfacing procedures were performed in 49 patients. Patients were contacted for review, and assessed using patient reported outcome measures. An Oxford Shoulder score as well as a subjective satisfaction and outcome questionnaire was completed, as well as details regarding further surgery or revision. 2 patients had died, 11 patients were not contactable, and in 4 the medical files had been lost. In the remaining 32 shoulders, the average follow-up was 5.9 years. The mean age at time of surgery was 62.3 years (range 36 to 84).Introduction
Materials and Methods
To review the union rates, outcomes and complications of angular stable plating of lateral third clavicle fractures. Between 2007 and 2010 angular stable plates were used in the fixation for seventeen patients with displaced lateral third clavicle fractures (Allman Group II, Type 2). These were identified from surgical log books and operation codes. The surgical and clinical notes as well as X-rays were reviewed. The patients were contacted telephonically. An Oxford Shoulder Score and questions relating to plate removal, scar pain and return to activities were asked. Three patients were not contactable.Purpose:
Method:
This is a case series of a senior surgeon's experience; the purpose being to illustrate the problems encountered when using bio-absorbable anchors for various indications in shoulder surgery. A retrospective analysis of 7 patients' notes, radiology and arthroscopic findings between 2006 and 2010. There were 5 females and 2 males, with an average age of 50 years 3 months. The indications for using these anchors varied; 5 patients had rotator cuff repairs, 1 had a SLAP repair and the other had a Bankart repair. Patients complained of pain (3), a noisy shoulder (2), deformity (1) and symptoms similar to an infection (1). Average time from surgery to symptoms varied, with the shortest time being 3 months and the longest being 4 years 2 months. Some had dramatic MRI changes showing significant lysis around the anchors. Arthroscopic findings included anchor debris in the joint, loose anchors with significant defects and resultant irreversible cartilage damage.Method.
Results.
Total elbow replacement (TER) is one of the surgical options for treatment of severe haemophilic arthropathy of the elbow. There are only a few small series described in the literature. The goal of our study was to evaluate our cases and add these data to the known literature. A retrospective analysis of a series of 8 TER's (5 patients) was performed. Patients were seen in clinic and evaluated by physical examination, a VAS score for pain, the Mayo Elbow Performance Score (MEPS, 100 points=excellent) and X-rays of the affected elbow. Mean follow-up was 91 (4–236) months, and 103 months when we excluded a patient with only 4 months follow-up. Primary diagnosis was Hemophilia type A in 4 and von Willebrand disease in 1 patient. 2 patients were positive for Hepatitis C and 3 for HIV. Mean age at primary surgery was 46.7 (31.8–63.1) years.Purpose of study:
Methods:
Interposition arthroplasty is a salvage procedure for patients with severe osteoarthritis of the elbow where conservative treatment failed. It is mostly performed in younger patients where total joint replacement is contraindicated and an arthrodesis is unattractive. Although one of the oldest reconstructive options for elbow arthritis, the procedure is not without complications. There are only a few case series described in the literature. The purpose of our study is to review our cases and report their outcome. We retrospectively reviewed 18 consecutive cases of interposition arthroplasty between 2001 and 2010. 2 cases were excluded due to incomplete records. The mean patient age was 41.3 (19.4–58.6) years at time of surgery. The primary diagnosis was post-traumatic osteoarthritis in 11 cases and inflammatory osteoarthritis in 5 cases. The mean follow up was 4.7 (0.4–10) years. Pre- and post-operative pain and function was evaluated using the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS). The complications and the number of re-operations and revisions were recorded.Purpose:
Method.
We aimed to assess the short and medium term complications of patients who had undergone Latarjet procedures. We also compared this to a group of patients who over a similar period underwent an open Bankhart procedure to assess the complication profiles between the two groups. We retrospectively reviewed the notes and X-rays of all patients identified by surgical log books and or operation codes for instability. Eighty seven patients (88 shoulders) underwent Latarjet procedures between 2002 and 2010. Patients were phoned to obtain a telephonic Oxford shoulder score. There were 44 patients with 46 shoulders in the open Bankhart group.Purpose:
Method:
The purpose of this study was to follow up a cohort of South African doctors who had previously failed a validated musculoskeletal assessment tool, to examine the effect of a two-month Orthopaedic internship rotation on musculoskeletal competency. A validated competency examination in orthopaedic medicine was used as the assessment tool. Topics included fractures and dislocations, arthritis, basic anatomy and emergencies that require immediate referral to an orthopaedic surgeon. The questionnaire consists of twenty-five short-answer questions. A validated answer key and scoring system were used to mark the questionnaire. In a previous study, we found that 91 per cent of South African doctors in our study group, at the start of their internship, failed to demonstrate basic competency on the examination. We concluded that medical school preparation in orthopaedic medicine in South Africa is inadequate. We reapplied the examination at the end of 2011 to a study group of seventy-six first and second-year interns, to assess whether a two-month orthopaedic rotation during internship had a significant effect on musculoskeletal competency.Purpose
Methods
The outcomes of conservatively managed minimally displaced isolated greater tuberosity fractures are sparsely reported and the aim of this study was to look at the outcome of these fractures. Twenty-seven patients who had sustained a greater tuberosity fracture were identified. They were all managed by a single surgeon. All patients had a regime of initial immobilisation for 3 weeks followed by physiotherapy and range of motion exercises. They were all x-rayed at 1 week and 3 weeks after injury to monitor for any displacement. Four fractures occurred with an anterior dislocation. In seven patients the fracture was not visible on x-ray but was diagnosed on Ultrasound or MRI. Twenty-three of 27 patients were available for follow-up. For this follow up, the patients were telephonically contacted and the Oxford Shoulder Score (OSS) was completed to assess their outcome.Purpose of study
patients and methods
Single screw fixation for the management of slipped upper femoral epiphysis (SUFE) was introduced in 1984 and has been reported to have less chondrolysis and avascular necrosis (AVN) than previous methods using multiple pin fixation or osteotomy (Ward 1992). Two groups of patients were investigated. The first group of 55 hips (44 patients) were treated over a 27 year period (1963–1989). Forty four hips were treated with multiple pins and 11 hips with primary intra- or extracapsular osteotomy. These patients were followed up for an average of 8 years (3–27yrs). The second group of 88 hips (69 patients) were treated over a 6 year period (1999–2004). All were treated with single screw fixation and followed up for at least one year. The duration and severity of slip were found to be similar for both groups. In the second group 16 hips (20%) were unstable (unable to walk even with crutches). Instability had not been coined as a term in the first group. All serial radiographs were retrospectively reviewed for AVN and chondrolysis and correlated with clinical findings. In the first group AVN occurred in 8 hips (14.5%). Five (9%) were due to osteotomies, two (3.5%) due to manipulation and one (2%) due to pinning in the superior quadrant. Chondrolysis occurred in 14 hips (25%); eight (14%) at presentation and six (11%) due to persistent pin penetration. In the second group AVN occurred in two hips (2%). Both were unstable. Two of 16 unstable hips (12.5%) developed AVN. Chondrolysis occurred in 6 hips (7%); four (4.5%) at presentation and 2 (2.5%) due to persistent pin penetration. The authors conclude that single screw fixation is a safer technique than multiple pin fixation or osteotomy. AVN only occurred in unstable slips. Chondrolysis due to pin penetration is significantly reduced.
Seven patients with osteochondral defects of the humeral head were treated over a 3 year period (2002–2005). In six of the patients the diagnosis was made incidentally at time of arthroscopy with the seventh patient being diagnosed preoperatively. There were 5 males and 2 females with an average age of 48 years. Four patients had a history of trauma. The preoperative diagnosis was impingement in 5, supraspinatus partial thickness tear in one and an osteochondral defect in the seventh. Ultrasound revealed a supraspinatus partial thickness tear in one, fluid in the biceps grove in one, and was normal in the other 5. One patient had a MRI which showed a SLAP lesion. All patients had conservative treatment with subacromial injection with 2 patients having complete relief of pain, 2 having almost complete relief, and the other 4 having improvement but not complete relief of pain. Only 2 of the patients had a minor reduction in movement. At arthroscopy the osteochondral defect measured 1x 1 cm in four cases and 1 x 1,5 cm in the other 3. In all patients the osteochondral defect was debrided and the exposed bone abraded. Four patients had an acromioplasty, one had an acromioplasty and excision of the AC joint, one had a debridement only and the seventh patient had an acromioplasty, SLAP repair and debridement of a partial thickness supraspinatus tear. The follow-up averaged 24 months (6–58). The VAS improved from an average of 6,4 preoperatively to 1,2 postoperatively and the ASES improved from 47 preoperatively to 85 postoperatively. All patients were happy to have had the procedure. In conclusion, debridement and abrasion of osteochondral defect was an effective treatment in this series. Acromioplasty should be added when indicated.
Five patients with entrapment of the suprascapular nerve treated in a 7 year period (2000–2006) were reviewed. There were 4 males and 1 female with an average age of 35 years (15–59). The patients presented with non-specfic pain around the scapula and shoulder. Four of the patients had marked wasting and weakness of the supraspinatus and infraspinatus muscles. One patient had congenital non-union of the clavicles. One patient was a competitive pole vaulter but there was no apparent aetiological factor in the other 3. The diagnosis was confirmed with nerve conduction studies in all the patients. All underwent MRI scan which was normal in 4 patients and showed a cyst in the spinoglenoid notch in the 5th. Four patients had an open release of the suprascapular nerve, the patients whose MRI showed a cyst was found at surgery to have an abnormal vessel compressing the nerve. One patient had an arthroscopic release of the suprascapular nerve. Four patients were available for follow-up. The follow-up averaged 22 months (6–58). All patients had complete relief of pain and almost complete recovery of strength. In conclusion, the diagnosis of suprascapular nerve entrapment must be entertained when patients present with non-specific periscapular pain and wasting of the supraspnatus and infraspinatus muscles. MRI must be done to rule out cysts. Surgical release is successful and can be done arthroscopically.
Proximal humeral locked plates have been advocated as an improved option for treating displaced proximal humeral fractures. After a number of failures using other methods we moved to this option in 2003. We reviewed all patients treated with this method, since we started in 2004. 16 patients were available for follow up. Using the Simple Shoulder Test and the Oxford Shoulder Score we assessed their level of function and pain. X-rays were checked for loss of fixation and union. The average follow up was 13 months post-surgery; the average age was 61 years. Using Neer’s classification, seven had 2 part fractures, seven had 3 part fractures and two had 4 part fractures. All fractures united and the patients reported good shoulder function. None had loss of fixation. There were no cases of sepsis. There were two patients awaiting hardware removal and one patient has already had removal for subacromial impingement. The results in this limited series compare favourably with the reported literature and we had no loss of fixation compared to our previous treatment.
Over one year a bio-absorbable corkscrew was used in 19 rotator cuff repairs in 17 patients (10 men and seven women) with a mean age of 52 years (25 to 68). Seven were partial thickness tears. The 12 full thickness tears involved only the supraspinatus in all but four patients. Open surgery was performed on these four patients, who had an isolated subscapularis tear, an isolated teres minor tear, a combined supraspinatus and infraspinatus tear and a combined supraspinatus, infraspinatus and subscapularis tear. The remaining patients underwent arthroscopic repair. All patients had an acromioplasty and 13 had the acromioclavicular joint excised. Two patients had a concomitant SLAP repair. One corkscrew was used in 10 cases, two in six and three in two. The mean follow-up was 8 months (3 to 24). The mean Constant score at follow-up was 80. There were five complications (26%) in which the corkscrew or a fragment of it came loose in the subacromial space. Two patients required further surgery to remove the corkscrew. The corkscrew was found to be a useful device for rotator cuff repairs, but the complication rate was high.
Of 81 elbow replacements performed over a seven-year period, 11 were total elbow revision (TER) procedures, which were done on two men and nine women with a mean age of 61 years (40 to 70). Seven of the patients had rheumatoid arthritis, three had post-traumatic osteoarthritis and one had haemophilia. The reason for revision was aseptic loosening in eight patients and aseptic loosening with fracture in the other three. The prostheses revised were the Souter in eight patients, the Kudo in one, the GSB I in one and the Dee in one. In revision TER, one long stem Souter prosthesis was used, two Pretoria, one GSB 3 and seven Morrey. The mean time from primary to revision TER was 10 years (2 to 31). At a mean follow-up of 30 months (6 to 48), all except one patient were pain-free and the arc of flexion had increased by 30°. Complications included one dislocation, one radial nerve palsy, which recovered after six months, and one aseptic loosening. There were no cases of sepsis. Revision TER is a technically demanding procedure with a high risk of complications. In this series patient satisfaction was high. Our policy is to use a hinged prosthesis, preferably the Morrey, in revision TER.
We retrospectively reviewed the results of 21 patients (22 shoulders) who had surgery for os acromiale. The mean age of the 6 men and 15 women was 52 years. The dominant side was involved in 10 patients. The duration of symptoms ranged from one month to 13 years. Ten patients had a history of recent trauma. All presented with tenderness over the site of the os and signs of impingement. In three patients, signs of weakness suggested a rotator cuff tear, and three patients had tenderness over the acromioclavicular joint. Rotator cuff tears, four partial and eight full thickness, were present in 12 cases. Surgery included excision of the os in nine cases and fixation in 13. Ancillary procedures included acro-mioclavicular joint excision (eight), rotator cuff repair (eight), cuff debridement (three) and biceps tenodesis (one). At follow-up, which ranged from 5 months to 6 years, Constant and American Shoulder and Elbow Surgeons’ scores were assessed. The presence of a deltoid defect was noted and deltoid strength was measured. The mean Constant score at follow-up was 77. Deltoid strength was notably reduced in abduction but not in forward flexion. There were no cases of sepsis. Five cases required further surgery. In three, this involved removal of metal, but persistent pain necessitated one subsequent rotator cuff repair and one arthroscopic debridement of the subacromial space. The outcome of both fixation and excision was satisfactory, but the reoperation rate was higher in patients who underwent fixation. We advise arthroscopic excision of meso-acromion in the absence of a full thickness rotator cuff tear.
To determine the radiological signs and the ease of diagnosis on different views, we reviewed true antero-posterior, axillary and supraspinatus outlet views of 26 shoulders with os acromiale. The anteroposterior view shows sclerosis and ‘double oval’. The supraspinatus outlet view shows a ‘double’ acromion. The axillary view demonstrates the site of the pseudarthrosis and size of the os. The os acromiale was visible on the anteroposterior view in 25 cases, on the supraspinatus outlet in 20 cases and on the axillary view in 17 cases. It was visible in at least two views in 25 of the cases. The os was more often evident on the anteroposterior view, but more clearly seen on the axillary. A radiologist reported on 13 of the X-rays and missed the diagnoses in nine cases. In two cases, the surgeon missed the radiological diagnosis. There were 20 meso-acromions and two pre-acromions.
