We report the results of arthroscopic subacromial decompression and debridement of the rotator cuff for chronic small- and medium-sized tears in 114 patients (118 shoulders) between two and five years after surgery. The mean Constant score was improved to 69.8, and 88 shoulders (74.6%) had a satisfactory outcome. Of patients under the age of 60 years the outcome was satisfactory in 59.3%, and in those over 60 years, in 87.5% (p < 0.001). An unsatisfactory outcome was related to manual work (p < 0.001) and a duration of symptoms of more than 12 months (p < 0.05). The outcome was not related to the size of the tear, the muscles involved or biceps pathology. Further surgery was required in 25 patients after a mean of 13.7 months (3 to 35); ten tears had progressed in size, but none became irreparable. There was no relationship between the increase in the size of the tear and its initial size, the muscles involved or the presence of biceps pathology. No tear became smaller with time

We present a retrospective study of 125 patients with an impacted valgus fracture (B1.1) of the proximal humerus. This fracture rarely occurs in young patients and is much more common in elderly fit subjects. All patients were documented prospectively and followed for one year. None was treated surgically. At one year, 80.6% of the patients had a good or excellent result, the quality of which depended on the age of the patient and the degree of displacement of the fracture. Mean outcome scores based on these two parameters are presented. A comparison with data from other studies suggests that operative fixation of these fractures is not necessary

We reviewed 12 patients with primary glenoid dysplasia. Ten were assessed clinically and two from case notes and radiographs. We identified two groups according to the age at onset of symptoms. The first (seven patients) consisted of boys and younger men, all of whom developed symptoms before the age of 40 years. All four children were free from pain, whereas the three adults in this group had varying degrees of this. Four patients had symptoms of instability. The second group consisted of older men (five patients) all of whom had noted the onset of symptoms, in the form of pain and stiffness, after the age of 40 years. All five had radiological evidence of osteoarthritis. Although the four children in our study had minimal symptoms, all eight adults had ongoing shoulder pain and dysfunction, despite a specific rehabilitation programme. Four patients required surgery; one had posterior stabilisation for instability and three arthroplasties of the shoulder for osteoarthritis

We studied 100 fresh human shoulders in cadavers (mean age 76 years), and the range of passive abduction (RPA) in 100 volunteers with normal shoulders and in 90 patients with instability of the joint, over a period of six years. The anatomical and clinical findings showed that passive abduction occurs within the glenohumeral joint only, is controlled by the inferior glenohumeral ligament and has a constant value in 95% of both shoulders in normal subjects. In patients with instability, 85% showed an RPA of over 105° with 90° in the contralateral shoulder. In the remaining patients a strongly positive apprehension test suggested a diagnosis of instability. An RPA of more than 105° is associated with lengthening and laxity of the inferior glenohumeral ligament