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PubMed2005

Modification of the Constant-Murley shoulder score-introduction of the individual relative Constant score Individual shoulder assessment.

The Constant-Murley shoulder assessment score has proven to be a valuable diagnostic instrument. Thus, in the literature it has been mentioned that the clinical accuracy of this score varies especially when comparing patients in larger, inhomogeneous patient groups. The "relative Constant score" (CS(rel)) tries to minimize these problems by using reference parameters out of healthy age and gender related control groups. The authors of this study tried to show that it is even more accurate to use the functional performance of the uninjured collateral shoulder of the same individual as reference, introducing the "individual relative Constant score" (CS(indiv)). The CS(indiv) and the CS(rel) were compared for 125 consecutive patients with shoulder disorders, and a group of 125 healthy volunteers as a control group. In a non-parametric comparison of the reciever operating characteristics the CS(indiv) shows the higher ability to discriminate between patients and healthy volunteers (p=0.004). This indicates that the individual relative Constant score gives a more accurate view about the functional result for shoulder disorders. It is expected to be more reliable for larger and incoherent patient populations, because specific interindividual differences, regarding the patient's age, gender and constitution are eliminated as well as other individual physiological parameters.

Adult↗
PubMed2006

The role of repair tension on tendon to bone healing in an animal model of chronic rotator cuff tears.

Rotator cuff tendon tears are one of the most common shoulder injuries. Although surgical repair is typically beneficial, re-tearing of the tendons frequently occurs. It is generally accepted that healing is worse for chronic tears than acute tears, but the reasons for this are unknown. One potential cause may be the large tensions that are sometimes required to repair chronically torn tendons back to bone (i.e., repair tension). Therefore, the objective of this study was to utilize an animal model of chronic rotator cuff repairs to investigate the role of increased repair tension on tendon to bone healing. We hypothesized that an increase in repair tension would be related to detrimental changes to the healing insertion site. To test this hypothesis, the supraspinatus tendon of rats was surgically detached and then repaired immediately or after a delay of 2, 4, or 16 weeks. The repair tension was measured using a tensiometer and the mechanical properties, collagen organization, and protein expression of the healing insertion site were evaluated 4 and/or 16 weeks following repair. We found that the repair tension increased with time following detachment, and was related to a decrease in the failure properties and viscoelastic peak stress and an increase in cross-sectional area and stiffness of the insertion site. Therefore, repair tension should be minimized in the clinical setting. Future studies will include additional animal model studies involving the relationship between tension and muscle properties and a clinical study investigating the role of repair tension on repair failure.

Animals↗
PubMedDate not supplied

A new prosthetic design for proximal humeral fractures: reconstructing the glenohumeral unit.

A new shoulder prosthesis design for proximal humeral fractures has been developed. The rim of the articular component of this prosthesis has several holes to which the bone-tendon junction of the rotator cuff is fixed, to allow an anatomic reconstruction of the glenohumeral unit. The strength of the tuberosity fixation to this prosthesis is investigated in a cadaveric study. Artificial 4-part fractures were created in 18 human, fresh-frozen, paired shoulder joints with intact rotator cuffs. Two methods of tuberosity fixation were used in a matched-pair fashion. In group I the tuberosities were sutured to the rim of the prosthetic head, and in group II the tuberosities were circumferentially tension band-wired. Strength testing was performed on a material-testing machine, and displacement was recorded with an opto-electronic device. Both fixation methods proved to be equally reliable in the forces exerted during activities of daily living without significant displacement of the fracture fragments.

Aged↗
PubMedDate not supplied

Physeal changes and range-of-motion differences in the dominant shoulders of skeletally immature baseball players.

The purpose of this study was to document range-of-motion differences and radiographic changes in the dominant shoulder of skeletally immature throwers and to determine how pain associated with throwing may relate to these changes. Seventy-nine male youth baseball players (aged 8-15 years) completed a questionnaire, a shoulder examination, and a series of radiographs to determine physeal changes and humeral retroversion. Radiographs were reviewed and interpreted by a blinded musculoskeletal radiologist. Measurement of proximal humeral physeal width revealed a significant increase on the dominant side for the entire group, in subjects with a history of symptoms during the current season, and in subjects who had never had symptoms. Visual radiographic changes were commonly found in subjects with a history of pain (16/26 [62%]) as well as in those subjects without symptoms (29/53 [55%]). Subjects had increased external rotation of the dominant arm as compared with the nondominant arm, and this pattern increased in magnitude as the throwers aged. Range-of-motion and radiographic asymmetry of the shoulders is common, is often asymptomatic, and may represent adaptive changes in this population.

Adolescent↗
PubMedDate not supplied

Positional-dependent changes in glenohumeral joint contact pressure and force: possible biomechanical etiology of posterior glenoid wear.

The purpose of this study was to simulate the forces in the individual periscapular muscles and investigate the possible biomechanical etiology of posterior erosion of the glenoid. Twelve fresh-frozen human cadaveric shoulders were used with a custom shoulder jig that uses independently controlled pneumatic cylinders to apply forces across the tendon of each muscle. The simulated muscle forces included the rotator cuff, the deltoid, the latissimus dorsi, and the pectoralis major. The shoulders were tested in 12 overhead activity positions. A 6-degree-of-freedom load cell was used to measure the glenohumeral joint forces, and the glenohumeral contact pressures and areas were measured by use of Fuji pressure-sensitive film. There were no significant differences in glenohumeral joint forces between 60 degrees and 90 degrees of vertical abduction or between 60 degrees and 90 degrees of external rotation. At 70 degrees of horizontal adduction from the scapular plane, there was a significant decrease in superior force, a significant increase in posteriorly directed force, and a significant decrease in compression when compared with 30 degrees and 50 degrees of horizontal adduction ( P < .05). Similar statistical trends were seen for 60 degrees of vertical adduction. For the glenohumeral contact area and pressure, a significant decrease in contact area was seen between 30 degrees of horizontal adduction and 70 degrees of horizontal adduction for both 60 degrees and 90 degrees of vertical adduction ( P < .05). A significant increase in contact pressure was seen at 70 degrees of horizontal adduction compared with 50 degrees and 30 degrees ( P < .05). The contribution of the humerothoracic muscles is significant and should be considered for proper restoration of glenohumeral joint biomechanics. Furthermore, asymmetric loading with excessive or repetitive overhead activities may eventually lead to posterior glenoid erosion.

Biomechanical Phenomena↗
PubMedDate not supplied

Posterior capsulolabral reconstruction in posterior shoulder instability: deltoid saving.

To determine the efficacy of an open posterior capsulolabral reconstruction (PCLR) with a posterior deltoid-saving approach, 30 PCLRs in 29 patients with unidirectional posterior instability were reviewed retrospectively. The mean follow-up period was 30 months (range, 25-59 months). Posterior capsular redundancy was observed in all cases, but a posteroinferior labral tear was found in only 5. Posterior capsular thinning developed in 6 patients. According to the Rowe scale, 24 shoulders were rated as excellent, 1 as good, 2 as fair, and 3 as poor. The modified American Shoulder and Elbow Surgeons score at last follow-up was 91. During follow-up, recurrence of instability was observed in 4 cases, including 3 cases of voluntary instability. The overall recurrence rate was 13.3%, but the success rate was 92.6% when cases of voluntary instability were excluded. Whereas the midterm clinical results of PCLRs were satisfactory, the risk of recurrence was very high in patients with voluntary posterior instability, even though some subjective improvement could be obtained through a PCLR.

Adolescent↗
PubMedDate not supplied

The correlation of the Buford complex and SLAP lesions.

The Buford complex has previously been thought to be a normal anatomic variant with minimal clinical significance. The purpose of this study was to determine a potential correlation of an arthroscopic finding of a Buford complex and superior labrum anterior-posterior (SLAP) lesions in patients. Two hundred fifty consecutive shoulder arthroscopies performed at one institution were reviewed retrospectively. Operative reports and arthroscopic pictures were carefully inspected, with particular attention paid to descriptions of labral variations and pathology. Two hundred thirty-five reports met criteria for study inclusion. Of the 235 cases, 6 had a Buford complex (2.5%), displaying a cordlike middle glenohumeral ligament and absent anterior-superior labral tissue. Of these 6 patients, 5 had a corresponding SLAP lesion (83.3%). Of the remaining 229 patients 40 had SLAP lesions (17.5%). The significant difference between these groups (P < .003) indicates that there is a correlation of patients with Buford complexes and SLAP lesions.

Adult↗
PubMedDate not supplied

Incidence and risk factors for blood transfusion in shoulder arthroplasty.

Although there have been numerous reports concerning the incidence and risk factors for transfusion with knee and hip arthroplasty, there is no information available for shoulder arthroplasty. Therefore, the purpose of this study was to determine the incidence of transfusion in a consecutive group of patients undergoing shoulder arthroplasty and examine risk factors for a transfusion. Between January 1, 1998, and December 31, 2002, the senior author performed 407 consecutive primary shoulder arthroplasties. Risk factors analyzed included preoperative hemoglobin level, age, sex, diagnosis, and hemiarthroplasty versus total shoulder arthroplasty. The indications for transfusion and associated complications were also reviewed. The overall transfusion rate was 8.1% (33/407). The incidence of transfusion was significantly greater among women (13.6% [29/213]) in comparison to men (2.1% [4/194]) (P = .0002). The risk for transfusion was significantly greater for patients undergoing shoulder arthroplasty for sequelae of trauma (15.8% [9/57]) (P = .0048) and rheumatoid arthritis (13.8% [8/58]) (P = .0153) compared with osteoarthritis (4.6% [10/218]). Preoperative hemoglobin level was found to be a significant risk factor for the need for transfusion (P < .0001). The rate of transfusion for hemiarthroplasty (8.3% [9/108]) and that for total shoulder arthroplasty (8.0% [24/299]) were not significantly different (P = .9203). The data from this study suggest that the rate of transfusion for shoulder arthroplasty varies markedly by sex and diagnosis. This information may be used to more accurately predict the need for transfusion and tailor preoperative blood ordering accordingly.

Aged↗
PubMedDate not supplied

Ambulatory open Bankart repair under a single general anesthesia: a prospective study of the immediate outcome.

The interscalenic block technique is widely used for ambulatory shoulder surgery despite a substantial number of failures and adverse effects. We prospectively evaluated satisfaction in 40 consecutive patients who underwent open Bankart repair under a single general anesthesic performed in an ambulatory care unit. The mean age of the patients was 23 years. There were 29 men and 11 women. Patients were evaluated postoperatively with a visual analog scale of pain (in the recovery room, at the time of discharge, and the day after and 1 week after surgery) via a home assessment questionnaire that included the following: effectiveness of oral pain medication, ability to perform activities of daily life, and overall satisfaction. One patient failed to be discharged because of a feeling of faintness not related to pain. None of the 39 patients would have preferred an overnight hospital stay. This study confirms that the open Bankart procedure is feasible as a same-day technique and indicates that a single anesthesic with proper management of analgesia is a reliable technique for major shoulder surgery in an ambulatory care unit.

Adolescent↗
PubMedDate not supplied

Surgical treatment of os acromiale with and without associated rotator cuff tears.

Nineteen consecutive patients treated surgically for meso-os acromiale and subacromial pathology were reviewed retrospectively, with a mean length of follow-up of 40 months (range, 24-94 months). Of the patients, 11 (58%) were treated with acromioplasty in the presence of a stable os acromiale; 8 patients (42%) underwent open reduction-internal fixation for an unstable and painful os fragment. Of the 19 patients, 8 (42%) with an os acromiale had an associated full-thickness rotator cuff tear. Overall, only 10 of 19 patients (53%) achieved a satisfactory result. All 8 patients (100%) treated with open reduction-internal fixation achieved union of the os fragment, although only 3 (37.5%) achieved a satisfactory result. Of the 11 patients who underwent acromioplasty, only 7 (64%) achieved a satisfactory result. The outcome of surgical management of symptomatic meso-os acromiale with concomitant rotator cuff pathology was satisfactory in 4 of 8 patients in our study group. The rate of satisfactory results was similar in patients with (50%) and without (55%) associated rotator cuff tears. When we analyzed our results to exclude workers' compensation patients, 80% achieved satisfactory results (compared with only 22% in our workers' compensation group).

Acromion↗
PubMed2006

Shoulder arthroplasty in cases with avascular necrosis of the humeral head.

Avascular necrosis (AVN) is a relatively uncommon cause of glenohumeral arthritis. Previous retrospective reviews of shoulder arthroplasty for AVN have shown very good results in small numbers of patients. This study prospectively evaluated a consecutive series of 21 shoulders in 19 patients treated with the same modular prosthesis at a single institution. Of the shoulders, 8 developed AVN after a proximal humeral fracture, 1 was associated with a massive rotator cuff tear, 10 developed after corticosteroid therapy, and 2 were idiopathic. The patients, 14 women and 5 men, with a mean age of 54 years, were followed up for a mean of 4.7 years (range, 2 to 8 years). Hemiarthroplasty was performed in 15 shoulders, whereas 6 required total shoulder arthroplasty. Assessment included visual analog scales, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons Shoulder Score Index (SSI). Physical examination was performed, and radiographs were obtained. The visual analog scale scores for pain and function improved significantly after surgery (P < .01). The mean SSI score rose from 36 to 81 (where 0 indicates the worst outcome and 100 indicates the best outcome). The mean number of positive responses on the Simple Shoulder Test increased from 3 to 10. Mean active elevation increased from 88 degrees to 123 degrees . External rotation improved from 7 degrees to 34 degrees , and internal rotation improved from L4 to T12. No difference in outcome was noted based on age or sex. Patients with steroid-related or idiopathic AVN had greater pain and functional impairment preoperatively (mean SSI score, 26) than those with prior fracture or rotator cuff tear (mean SSI score, 49) (P < .01). Postoperatively, however, these groups fared equally well (mean SSI score, 78 vs 82). Shoulder arthroplasty for AVN produces good pain relief and function, although a concurrent series with osteoarthritis yielded better results. Forward elevation did not approach normal as had been previously reported.

Adult↗