Like athletes, musicians are vulnerable to musculoskeletal injuries that can be career ending or have a severe negative financial impact. All ages are affected, with a peak incidence in the third and fourth decades. Women are slightly more likely to be affected than men. It is incumbent upon orthopaedic surgeons to be able to complete a thorough physical assessment, be aware of the risk factors associated with musculoskeletal symptoms in musicians, and have a detailed knowledge of the specific syndromes they suffer and their appropriate treatment.

In this paper we review the common hand injuries that afflict musicians and discuss their treatment.

Cite this article: Bone Joint J 2013;95-B:146–50.

The sternoclavicular joint is vulnerable to the same disease processes as other synovial joints, the most common of which are instability from injury, osteoarthritis, infection and rheumatoid disease. Patients may also present with other conditions, which are unique to the joint, or are manifestations of a systemic disease process. The surgeon should be aware of these possibilities when assessing a patient with a painful, swollen sternoclavicular joint.

1. Two cases of syphilitic involvement of the spinal column are described, illustrating the presentation and pathology of the disease.

2. The possibility of increased incidence of syphilitic disorders of bone and joint is considered in the light of recent statistics, and the need for awareness of the disease in its various forms is emphasised.

3. The problems of diagnosis are discussed.

A study has been made of 800 consecutive arthroscopic examinations of the knee with special emphasis on the changes in management that resulted. Of 614 knees that would have been operated upon if arthroscopy had not been available, open operation was avoided in 32 per cent, a different operation was done or planned in 27 per cent, and there was no important change in the remaining 41 per cent. Of 186 knees that would have been treated conservatively if arthroscopy had not been available, the examination resulted in some immediate benefit to 30 per cent of the patients. There were no wound infections after arthroscopy alone, and the known incidence of incorrect interpretation was 1.4 per cent.

1. A critical analysis of the findings in 200 knees examined by arthroscopy at least one year previously has been carried out to assess its value in the management of a wide variety of disorders.

2. Arthroscopy is a practical and valuable procedure with minimal associated morbidity or complications.

3. The increased accuracy of diagnosis helps to avoid unnecessary operations and to base methods of treatment on a better knowledge of the pathology.

We analysed the complications encountered in 102 consecutive patients who had posterolateral lumbosacral fusion performed with transpedicular screw and rod fixation for non-traumatic disorders after a minimum of two years. Of these, 40 had spondylolysis and spondylolisthesis, 42 a degenerative disorder, 14 instability after previous laminectomy and decompression, and six pain after nonunion of previous attempts at spinal fusion without internal fixation. There were 75 multilevel and 27 single-level fusions.

There were 76 individual complications in 48 patients, and none in the other 54. The complications seen were screw misplacement, coupling failure of the device, wound infection, nonunion, permanent neural injury, and loosening, bending and breakage of screws. Screw breakage or loosening was more common in patients with multilevel fusions (p < 0.001). Screws of 5 mm diameter should not be used for sacral fixation.

Forty-six patients had at least one further operation for one or several complications, including 20 fusion procedures for nonunion. The high incidence of complications is a disadvantage of this technically-demanding method.

Displacement and blurring of the soft-tissue shadows about the hip has been described in several conditions, particularly in transient synovitis. A study was made between such displacements and the posture commonly adopted by an "irritable hip". Examination of radiographs of normal hips, and of those in cases of transient synovitis and Perthes' disease showed that the appearance of "capsular swelling" is related to the position of lateral rotation and abduction. This was confirmed by anatomical dissections of the lateral plane, which appears to be an intermuscular plane lying anterior to the hip, and an explanation is given for the blurring which may accompany its lateral displacement. "Capsular swelling" appears to be a radiological artefact.

1. The treatment of contractures at the hip secondary to poliomyelitis by Soutter's muscle slide or by Yount's fasciotomy gives excellent results. So does high femoral osteotomy, but it is not superior to the other two and should therefore be kept in reserve as a supplementary operation for the completion of correction of a deformity so gross as not to be wholly remediable by division of the soft parts.

2. Subluxation of the hip occurs only if the paralysis comes on during the first eighteen months of life and is a product not of severe paralysis but of unbalanced and often slight weakness of muscles. Correction of the invariable valgus deformity of the femoral neck by osteotomy is followed by relapse; acetabuloplasty too is unreliable. The most promising remedy seems to be some form of acetabuloplasty combined with transplantation of an iliopsoas of adequate strength into the greater trochanter. The indications for arthrodesis are few, but the results of this operation are good.

3. In the few patients with abductor weakness and little else the dipping gait may be abolished by iliopsoas transplantation.

1. A patient is described who developed hypothermia shortly after being rendered tetraplegic by a fracture of the cervical spine.

2. The causes and prevention of hypothermia or hyperpyrexia in tetraplegia are discussed.

Dysfunction of the distal radio-ulnar joint caused by traumatic, congenital and inflammatory onditions is usually treated by excision of the head of the ulna. This operation can induce ulnar carpal shift, with complications such as instability with poor grip, pain and clumsiness of the wrist, if the lower articular surface of the radius is normally inclined, or overinclined towards the ulna.

These complications can be avoided by use of an operation producing pseudarthrosis of the distal part of the ulna, with fusion of the radio-ulnar joint (Lauenstein) if there is dislocation, radio-ulnar discrepancy or arthritis, or without fusion (Baldwin) if the joint, in spite of keeping normal articular surfaces, has its movement blocked by malunion of a radial fracture.

Disorders of the pisotriquetral joint are well recognised as the cause of pain on the ulnar side of the wrist. The joint is not usually examined during routine arthroscopy because it is assumed to have a separate joint cavity to the radiocarpal joint, although there is often a connection between the two. We explored this connection during arthroscopy and in fresh-frozen cadaver wrists and found that in about half of the cases the pisotriquetral joint could be visualised through standard wrist portals. Four different types of connection were observed between the radiocarpal joint and the pisotriquetral joint. They ranged from a complete membrane separating the two, to no membrane at all, with various other types of connection in between. We recommend that inspection of the pisotriquetral joint should be a part of the protocol for routine arthroscopy of the wrist

Aims

The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any infection, revision, or reoperation.

We investigated the association of Dupuytren’s contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire. Dupuytren’s contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytren’s contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa. Smoking increases the risk of developing Dupuytren’s contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily

There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI.

Cite this article: Bone Joint J 2022;104-B(5):532–540.