There are many types of treatment used to manage the frozen shoulder, but there is no consensus on how best to manage patients with this painful and debilitating condition. We conducted a review of the evidence of the effectiveness of interventions used to manage primary frozen shoulder using the
The outcome of an anatomical shoulder replacement
depends on an intact rotator cuff. In 1981 Grammont designed a novel
large-head reverse shoulder replacement for patients with cuff deficiency.
Such has been the success of this replacement that it has led to
a rapid expansion of the indications. We performed a systematic
review of the literature to evaluate the functional outcome of each
indication for the reverse shoulder replacement. Secondary outcome
measures of range of movement, pain scores and complication rates
are also presented.
Follow-up radiographs are usually used as the
reference standard for the diagnosis of suspected scaphoid fractures. However,
these are prone to errors in interpretation. We performed a meta-analysis
of 30 clinical studies on the diagnosis of suspected scaphoid fractures,
in which agreement data between any of follow-up radiographs, bone scintigraphy,
magnetic resonance (MR) imaging, or CT could be obtained, and combined
this with latent class analysis to infer the accuracy of these tests
on the diagnosis of suspected scaphoid fractures in the absence
of an established standard. The estimated sensitivity and specificity
were respectively 91.1% and 99.8% for follow-up radiographs, 97.8%
and 93.5% for bone scintigraphy, 97.7% and 99.8% for MRI, and 85.2%
and 99.5% for CT. The results were generally robust in multiple
sensitivity analyses. There was large between-study heterogeneity
for the sensitivity of follow-up radiographs and CT, and imprecision
about their sensitivity estimates. If we acknowledge the lack of a reference standard for diagnosing
suspected scaphoid fractures, MRI is the most accurate test; follow-up
radiographs and CT may be less sensitive, and bone scintigraphy
less specific.
The management of radial nerve palsy associated with fractures of the shaft of the humerus has been disputed for several decades. This study has systematically reviewed the published evidence and developed an algorithm to guide management. We searched web-based databases for studies published in the past 40 years and identified further pages through manual searches of the bibliography in papers identified electronically. Of 391 papers identified initially, encompassing a total of 1045 patients with radial nerve palsy, 35 papers met all our criteria for eligibility. Meticulous extraction of the data was carried out according to a preset protocol. The overall prevalence of radial nerve palsy after fracture of the shaft of the humerus in 21 papers was 11.8% (532 palsies in 4517 fractures). Fractures of the middle and middle-distal parts of the shaft had a significantly higher association with radial nerve palsy than those in other parts. Transverse and spiral fractures were more likely to be associated with radial nerve palsy than oblique and comminuted patterns of fracture (p <
0.001). The overall rate of recovery was 88.1% (921 of 1045), with spontaneous recovery reaching 70.7% (411 of 581) in patients treated conservatively. There was no significant difference in the final results when comparing groups which were initially managed expectantly with those explored early, suggesting that the initial expectant treatment did not affect the extent of nerve recovery adversely and would avoid many unnecessary operations. A treatment algorithm for the management of radial nerve palsy associated with fracture of the shaft of the humerus is recommended by the authors.
