pme_1236 1449 Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a... more pme_1236 1449 Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a universal problem affecting a large number of patients. Corticosteroid injections are frequently used to treat pain in the shoulder by shoulder specialists, general orthopedic surgeons, and other doctors, including rheumatologists. In spite of this widespread use of this intervention, surprisingly little research and publications appear. It is therefore most appropriate that the article Effects of Corticosteroid Injection in Rotator Cuff Tears is published in this journal [1]. The authors treated irreparable rotator cuff tears with triamcinolone acetate injections in irreparable rotator cuff tears and reported their results in the study presented here. Good relief was obtained both with single and repeated injections, and the study emphasizes the value of affording pain relief to these patients. Corticosteroid injections are widely used in the shoulder for problems in the subacromial sp...
Injections around the shoulder joint are necessary for diagnostic and therapeutic reasons in the ... more Injections around the shoulder joint are necessary for diagnostic and therapeutic reasons in the course of evaluating shoulder pain.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 28, 2017
To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral art... more To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up. We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded. The indications for AGR were severe primary shoulder osteoarthritis without significant bone loss in younger, higher-demand patients. Outcome measures included revision, pain and American Shoulder and Elbow Surgeons (ASES) scores, and range of motion. Exact logistic regression was used to assess preoperative risk factors for revision. Forty-three shoulders with an average of 60 months' clinical follow-up underwent AGR. The rate of revision to prosthetic arthroplasty was 23% (95% confidence interval [CI], 12%-39%) after a mean of 45 months. The visual analog scale pain score (0-10) improved from a median of 7 ...
Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and... more Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and most current techniques do not reliably achieve this goal. The BiPOD repair is an arthroscopically assisted procedure performed with image intensifier guidance that reconstructs the coracoclavicular ligaments as well as the acromioclavicular ligaments to achieve bidirectional stability. Repair is achieved with a combination of 2-mm FiberTape (Arthrex, Naples, Florida) and 20-mm Poly-Tape (Neoligaments, Leeds, England) to achieve rigid repair, prevent bone abrasion, and promote tissue ingrowth. This study is a prospective review of the first 6 patients treated for high-grade acute acromioclavicular injury with the BiPOD technique. The study included 6 men who were 21 to 36 years old (mean, 27 years). At 6-month follow-up, complications were recorded and radiographic analysis was used to determine the coracoclavicular distance for vertical reduction and the amount of acromioclavicular tra...
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Background The optimal management of anterior shoulder instability in athletes continues to be a ... more Background The optimal management of anterior shoulder instability in athletes continues to be a challenge. The present study aimed to evaluate the functional outcomes of athletes with anterior shoulder instability following modified Latarjet reconstruction through assessing the timing of return to sport and complications. Methods Retrospective assessment was performed of athletes ( n = 56) who presented with recurrent anterior shoulder instability and were treated with modified congruent arc Latarjet reconstruction over a 1-year period. Rugby union was the predominant sport performed. Pre-operative instability severity index scores were assessed. Postoperative complications were recorded as was the time taken for the athlete to return to sport. Results Arthroscopic evaluation revealed that 86% of patients had associated bony lesions affecting the glenohumeral joint. The overall complication rate relating to the Latarjet reconstruction was 7%. No episodes of recurrent shoulder insta...
Introduction: We have devised a new technique of lesser tuberosity osteotomy with double row fixa... more Introduction: We have devised a new technique of lesser tuberosity osteotomy with double row fixation of the subscapularis using suture anchors. Aim: To evaluate the biomechanical properties of this novel technique against two established methods of subscapularis repair including tendon to tendon and transosseous repairs. Method: Matched pairs of human cadaveric shoulders were allocated into 3 groups. Group 1 consisted of the double row technique with incision of the subscapularis along the bicipital groove with a lesser tuberosity osteotomy. A double loaded suture anchor was placed along the medial border of the osteotomy site and sutures were passed through subscapularis medial to the bone island in a horizontal mattress manner. A second anchor was inserted along the lateral border of the osteotomy site and the two sutures were tied onto the subscapularis holding sutures. In group 2, the subscapularis was divided 1cm medial to the bicipital groove and repaired with tendon to tendon suturing. In group 3, the subscapularis was repaired to the cut humeral neck through transosseous tunnels. The cyclic elongation, load to failure, displacement and mode of failure were analysed. Results: All specimens in Group 1 and 40% of Group 2 and 3 passed the cyclic loading test. The ultimate tensile strength in Group 1 was found to be 2.8 times that of Group 2 and 2.4 times that of Group 3 (p Conclusion: This novel technique is simple to perform and biomechanically stronger than established methods of repair. A stronger fixation may allow early mobilization without the risk of tendon rupture and is much less likely to loosen with gap formation and subsequent fibrous tissue interposition. Additional advantages include bone to bone healing without violation of the subscapularis tendon.
Background Shoulder injuries are common in rugby, with the most severe match injury being shoulde... more Background Shoulder injuries are common in rugby, with the most severe match injury being shoulder dislocation and instability. A limitation of epidemiological studies is that the injury information is based on player interviews after the injury or reports from the medical staff. The objective of this study is to describe the specific injury mechanisms for shoulder dislocation using video recordings in a consecutive series of 4 elite male rugby players who sustained an episode of shoulder dislocation during an official match. Methods Videotapes were reviewed to identify the mechanism of the injury. The incidents, including the play leading up to each incident, were analysed. A shoulder dislocation mechanism score was developed to describe the injury mechanism and the events leading up to the injury. Results For all the athletes, player-to-player contact was responsible for the shoulder dislocation. Three of the four injuries resulted from trauma with the elbow in an extended position forcing the shoulder to exceed the limits of the normal range of motion, causing anterior shoulder dislocation. One injury resulted from trauma with the elbow in a flexed position and the direction of the injuring force along the longitudinal axis of the humerus causing posterior shoulder dislocation. Conclusions This study provides preliminary evidence that thorough video analysis can provide detailed information about the mechanisms of shoulder dislocation in elite rugby players. Knowledge of the common mechanisms of injuries in these athletes may potentially lead to improved sports technique to attempt to reduce the occurrence of shoulder dislocations. Further studies with a larger number of patients are required to better clarify the exact mechanism of shoulder dislocation in rugby players, and how these results may be applied in training and matches to prevent shoulder dislocation in elite rugby players.
Anterior shoulder instability is a complex problem and necessitates accurate pre- and intraoperat... more Anterior shoulder instability is a complex problem and necessitates accurate pre- and intraoperative assessment of soft-tissue and bony pathology. Soft tissue pathology plays a major role in anterior instability without bone loss, and includes glenoid lesions (glenoid labral tears/avulsions), capsular lesions (plastic deformation and tears), and humeral side lesions (humeral avulsion of glenohumeral ligament lesion referred to as “HAGL” lesions). Glenoid labral tears and capsular lesions are adequately addressed with the “labroplasty” procedure. This involves a sequential capsulolabral shift using correctly oriented suture-anchors, to effectively reduce the capsular volume. In addition, technical maneuvers like the “double-grasper shift” and “Noose maneuver” are crucial to recreate a labral bumper effect at the glenoid edge. HAGL lesions may be difficult to detect, and use of the axillary-pouch portal (Bhatia portal) facilitates identification of the tear. A new mini-open subscapula...
The purpose of this study was to compare the stability and force of ultimate failure of the acrom... more The purpose of this study was to compare the stability and force of ultimate failure of the acromioclavicular joint (ACJ) after direct arthroscopic distal clavicle excision (DCE) through superior portals and indirect arthroscopic DCE through inferior portals in paired cadaveric shoulders. Ten paired saline-embalmed cadaveric shoulders were operated alternatively using the indirect and direct technique. Biomechanical testing was performed in the horizontal plane, testing displacement at 15N and 30N and finally failure strength was measured testing the constructs until failure occurred. There was a significant difference in failure strength with the direct DCE being stronger: 766.6 N (SD 233.5) against 5403 N (SD 239.1) for the indirect DCE, p = 0.01334). There was no statistical difference for the displacement measured at 15N and 30N. A direct DCE will result in a postoperative ACJ with greater ultimate failure strength compared to indirect DCE because the inferior ACJ capsule can be...
Benjamin WT Gooding ∗ , Timothy R. Cresswell ∗ , Roger Sloan ∗ , Don F. du Toit & Joe de Bee... more Benjamin WT Gooding ∗ , Timothy R. Cresswell ∗ , Roger Sloan ∗ , Don F. du Toit & Joe de Beer ... ∗ Department of Trauma and Orthopaedics, Derby Hospitals NHS Foundation Trust, Derby, UK Department of Anatomy and Histology, University of Stellenbosch, ...
Background and Objectives: This study reports our early experience with continuous cervical parav... more Background and Objectives: This study reports our early experience with continuous cervical paravertebral block (CCPVB) using a stimulating catheter for the management of acute pain after shoulder surgery. Methods: This prospective observational study presents 256 CCPVB for pain relief after 14 different shoulder operations. Surgery was performed under general anesthesia and blocks were placed prior to induction of general anesthesia (n ϭ 81 [32%]), after induction of general anesthesia (n ϭ 116 [45%]), or postoperatively in the recovery room (n ϭ 59 [23%]). A bolus dose of 30 mL of 0.5% ropivacaine was followed by an infusion of 0.1 mL/kg/h of 0.2% ropivacaine. Patient-or nurse-initiated bolus doses of 10 mL of the same drug were used for breakthrough pain and rescue analgesics were available. Postoperative pain, patient satisfaction, and motor function in different parts of the upper limb were evaluated immediately after surgery (time 0), and then 6, 12, 24, 48, 60 hours, and 14 days postoperatively. Results: An average of 2 (range 1-7) attempts were needed to advance the catheter while still stimulating the nerve. Average postoperative pain ranged from 0.27 Ϯ 1.04 cm to 0.78 Ϯ 1.56 cm (mean Ϯ SD) on a visual analog scale (VAS) (0-10 cm) for the first 48 hours and 3.8 Ϯ 2.1 cm and 3.5 Ϯ 2.4 cm at 60 hours and 14 days, respectively. Patient satisfaction on a VAS of 0 to 5 was 4.19 Ϯ 1.1, 4.28 Ϯ 1.01, and 4.69 Ϯ 1.05 at times 0, 6 hours, and 14 days, respectively. Motor function returned to normal in the fingers within 24 hours and in the shoulder within 60 hours. Complications included Horner's syndrome (40%), dyspnea (8%), superficial skin infection (5%), posterior neck pain (22%), subclavian artery puncture (1%), contralateral epidural spread (4%), and 8% of the patients complained of an unpleasant "dead feeling" of the arm. Ninety-one percent of patients would request CCPVB again for future shoulder surgery. There was no evidence of nerve damage.
Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a universal pro... more Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a universal problem affecting a large number of patients. Corticosteroid injections are frequently used to treat pain in the shoulder by shoulder specialists, general orthopedic surgeons, and other doctors, including rheumatologists. In spite of this widespread use of this intervention, surprisingly little research and publications appear. It is therefore most appropriate that the article Effects of Corticosteroid Injection in Rotator Cuff Tears is published in this journal [1]. The authors treated irreparable rotator cuff tears with triamcinolone acetate injections in irreparable rotator cuff tears and reported their results in the study presented here. Good relief was obtained both with single and repeated injections, and the study emphasizes the value of affording pain relief to these patients.
Recurrent anterior shoulder instability is commonly associated with glenoid bone defects. When th... more Recurrent anterior shoulder instability is commonly associated with glenoid bone defects. When the defect is significant, bony reconstruction is typically necessary. The congruent arc modification of the Latarjet procedure uses the concavity of the undersurface of the coracoid to optimally reconstruct the glenoid. Outcomes are maximized and complications minimized.
Calcifying tendinitis of the rotator cuff is a common disorder and the underlying cause is still ... more Calcifying tendinitis of the rotator cuff is a common disorder and the underlying cause is still not fully understood. About 90% of patients can be treated non-operatively but some are resistant to conservative treatment and surgery is indicated. Non-operative treatments include non-steroidal anti-inflammatory drugs, subacromial injection of steroid, physiotherapy, extracorporeal shockwave therapy and needle aspiration irrigation. When conservative treatment fails, arthroscopic excision of calcium, sometimes combined with an acromioplasty and/or rotator cuff repair, reliably produces excellent results with high patient satisfaction. In this article, an up-to-date review of the published papers evaluating each treatment modality is presented.
The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedu... more The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedure to debride and resurface the arthritic glenoid, in a middle-aged population, using an acellular human dermal scaffold. Between 2003 and 2005, thirty-two consecutive patients underwent an arthroscopic debridement and biological glenoid resurfacing for glenohumeral arthritis. The diagnoses included primary osteoarthrosis (28 patients), arthritis after arthroscopic reconstruction for anterior instability (1 patient) and inflammatory arthritis (3 patients). All shoulders were assessed clinically using the Constant and Murley score, and results graded according to Neer's criteria. Statistical analysis was performed to determine significant parameters and associations. A significant improvement (P < 0.0001) in each parameter of the subjective evaluation component (severity of pain, limitation in daily living and recreational activities) of the Constant score was observed. The Constant and Murley score increased significantly (P < 0.0001) from a median of 40 points (range 26-63) pre-operatively to 64.5 (range 19-84) at the final assessment. Overall, the procedure was considered as "successful outcome" in 23 patients (72%) and as a "failure" in 9 patients (28%). According to Neer's criteria, the result was categorized as excellent in 9 (28%), satisfactory in 14 (44%) and unsatisfactory in 9 (28%). Within the unsatisfactory group, there were five conversions to prosthetic arthroplasty. A standard magnetic resonance imaging was performed on 22 patients in the successful outcome group; glenoid cartilage was identified in 12 (thick in 5, intermediate in 1, thin in 6) and could not be identified in 10 patients (complete/incomplete loss in 5, technical difficulties in 5). Overall, five complications included transient axillary nerve paresis, foreign-body reaction to biological material, inter-layer dissociation, mild chronic non-specific synovitis and post-traumatic contusion. Dominance of affected extremity and generalized disease (diabetes, rheumatoid arthritis, generalized osteoarthritis) was associated with an unsatisfactory outcome (P < 0.05). Arthroscopic debridement and biological resurfacing of the glenoid is a minimally invasive therapeutic option for pain relief, functional improvement and patient satisfaction, in glenohumeral osteoarthritis, in the intermediate-term.
Partial-thickness bursal-surface tears of supraspinatus tendon may be missed on preoperative inve... more Partial-thickness bursal-surface tears of supraspinatus tendon may be missed on preoperative investigations and can be overlooked at surgery if not specifically sought. The authors describe an arthroscopic sign to detect these tears, when they involve more than half the tendon fibres, from the articular-side of the joint. The "paraglider-wing" sign, visualized during diagnostic glenohumeral arthroscopy, is demonstrated as an upward bulge of the capsulo-tendinous layer through the bursal-surface tear, under pressure of the inflow fluid. A positive sign indicates (1) presence of a partial-thickness bursal-side tear of the supraspinatus tendon, (2) significant depth (stage II or III) of the tear, and (3) the medial extent of the tear along the length of the tendon. A meticulous subacromial bursoscopy and excision of the bursa is then performed to visualize the tear from the subacromial space. Repair of the tear is performed with a double-row suture anchor fixation technique; the medial row of sutures is passed through the intact region of the tendon using the "paraglider-wing" sign as a guide.
We report on a displaced surgical scapular neck fracture with an ipsilateral undisplaced distal c... more We report on a displaced surgical scapular neck fracture with an ipsilateral undisplaced distal clavicle fracture of the dominant shoulder in a professional athlete. Although directives for determining the treatment of choice, whether conservative or operative, can be found in the literature, confusion still exists.1,6,14-16 Our management adds a treatment alternative, which has not yet been reported to our knowledge.
pme_1236 1449 Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a... more pme_1236 1449 Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a universal problem affecting a large number of patients. Corticosteroid injections are frequently used to treat pain in the shoulder by shoulder specialists, general orthopedic surgeons, and other doctors, including rheumatologists. In spite of this widespread use of this intervention, surprisingly little research and publications appear. It is therefore most appropriate that the article Effects of Corticosteroid Injection in Rotator Cuff Tears is published in this journal [1]. The authors treated irreparable rotator cuff tears with triamcinolone acetate injections in irreparable rotator cuff tears and reported their results in the study presented here. Good relief was obtained both with single and repeated injections, and the study emphasizes the value of affording pain relief to these patients. Corticosteroid injections are widely used in the shoulder for problems in the subacromial sp...
Injections around the shoulder joint are necessary for diagnostic and therapeutic reasons in the ... more Injections around the shoulder joint are necessary for diagnostic and therapeutic reasons in the course of evaluating shoulder pain.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 28, 2017
To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral art... more To investigate the outcomes of arthroscopic glenoid resurfacing (AGR) for severe glenohumeral arthritis at short- to medium-term follow-up. We performed a multicenter retrospective review of consecutive patients undergoing AGR (2005-2013) with a minimum of 2 years' follow-up or until revision. Patients lost to follow-up and those included in a prior study were excluded. The indications for AGR were severe primary shoulder osteoarthritis without significant bone loss in younger, higher-demand patients. Outcome measures included revision, pain and American Shoulder and Elbow Surgeons (ASES) scores, and range of motion. Exact logistic regression was used to assess preoperative risk factors for revision. Forty-three shoulders with an average of 60 months' clinical follow-up underwent AGR. The rate of revision to prosthetic arthroplasty was 23% (95% confidence interval [CI], 12%-39%) after a mean of 45 months. The visual analog scale pain score (0-10) improved from a median of 7 ...
Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and... more Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and most current techniques do not reliably achieve this goal. The BiPOD repair is an arthroscopically assisted procedure performed with image intensifier guidance that reconstructs the coracoclavicular ligaments as well as the acromioclavicular ligaments to achieve bidirectional stability. Repair is achieved with a combination of 2-mm FiberTape (Arthrex, Naples, Florida) and 20-mm Poly-Tape (Neoligaments, Leeds, England) to achieve rigid repair, prevent bone abrasion, and promote tissue ingrowth. This study is a prospective review of the first 6 patients treated for high-grade acute acromioclavicular injury with the BiPOD technique. The study included 6 men who were 21 to 36 years old (mean, 27 years). At 6-month follow-up, complications were recorded and radiographic analysis was used to determine the coracoclavicular distance for vertical reduction and the amount of acromioclavicular tra...
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Background The optimal management of anterior shoulder instability in athletes continues to be a ... more Background The optimal management of anterior shoulder instability in athletes continues to be a challenge. The present study aimed to evaluate the functional outcomes of athletes with anterior shoulder instability following modified Latarjet reconstruction through assessing the timing of return to sport and complications. Methods Retrospective assessment was performed of athletes ( n = 56) who presented with recurrent anterior shoulder instability and were treated with modified congruent arc Latarjet reconstruction over a 1-year period. Rugby union was the predominant sport performed. Pre-operative instability severity index scores were assessed. Postoperative complications were recorded as was the time taken for the athlete to return to sport. Results Arthroscopic evaluation revealed that 86% of patients had associated bony lesions affecting the glenohumeral joint. The overall complication rate relating to the Latarjet reconstruction was 7%. No episodes of recurrent shoulder insta...
Introduction: We have devised a new technique of lesser tuberosity osteotomy with double row fixa... more Introduction: We have devised a new technique of lesser tuberosity osteotomy with double row fixation of the subscapularis using suture anchors. Aim: To evaluate the biomechanical properties of this novel technique against two established methods of subscapularis repair including tendon to tendon and transosseous repairs. Method: Matched pairs of human cadaveric shoulders were allocated into 3 groups. Group 1 consisted of the double row technique with incision of the subscapularis along the bicipital groove with a lesser tuberosity osteotomy. A double loaded suture anchor was placed along the medial border of the osteotomy site and sutures were passed through subscapularis medial to the bone island in a horizontal mattress manner. A second anchor was inserted along the lateral border of the osteotomy site and the two sutures were tied onto the subscapularis holding sutures. In group 2, the subscapularis was divided 1cm medial to the bicipital groove and repaired with tendon to tendon suturing. In group 3, the subscapularis was repaired to the cut humeral neck through transosseous tunnels. The cyclic elongation, load to failure, displacement and mode of failure were analysed. Results: All specimens in Group 1 and 40% of Group 2 and 3 passed the cyclic loading test. The ultimate tensile strength in Group 1 was found to be 2.8 times that of Group 2 and 2.4 times that of Group 3 (p Conclusion: This novel technique is simple to perform and biomechanically stronger than established methods of repair. A stronger fixation may allow early mobilization without the risk of tendon rupture and is much less likely to loosen with gap formation and subsequent fibrous tissue interposition. Additional advantages include bone to bone healing without violation of the subscapularis tendon.
Background Shoulder injuries are common in rugby, with the most severe match injury being shoulde... more Background Shoulder injuries are common in rugby, with the most severe match injury being shoulder dislocation and instability. A limitation of epidemiological studies is that the injury information is based on player interviews after the injury or reports from the medical staff. The objective of this study is to describe the specific injury mechanisms for shoulder dislocation using video recordings in a consecutive series of 4 elite male rugby players who sustained an episode of shoulder dislocation during an official match. Methods Videotapes were reviewed to identify the mechanism of the injury. The incidents, including the play leading up to each incident, were analysed. A shoulder dislocation mechanism score was developed to describe the injury mechanism and the events leading up to the injury. Results For all the athletes, player-to-player contact was responsible for the shoulder dislocation. Three of the four injuries resulted from trauma with the elbow in an extended position forcing the shoulder to exceed the limits of the normal range of motion, causing anterior shoulder dislocation. One injury resulted from trauma with the elbow in a flexed position and the direction of the injuring force along the longitudinal axis of the humerus causing posterior shoulder dislocation. Conclusions This study provides preliminary evidence that thorough video analysis can provide detailed information about the mechanisms of shoulder dislocation in elite rugby players. Knowledge of the common mechanisms of injuries in these athletes may potentially lead to improved sports technique to attempt to reduce the occurrence of shoulder dislocations. Further studies with a larger number of patients are required to better clarify the exact mechanism of shoulder dislocation in rugby players, and how these results may be applied in training and matches to prevent shoulder dislocation in elite rugby players.
Anterior shoulder instability is a complex problem and necessitates accurate pre- and intraoperat... more Anterior shoulder instability is a complex problem and necessitates accurate pre- and intraoperative assessment of soft-tissue and bony pathology. Soft tissue pathology plays a major role in anterior instability without bone loss, and includes glenoid lesions (glenoid labral tears/avulsions), capsular lesions (plastic deformation and tears), and humeral side lesions (humeral avulsion of glenohumeral ligament lesion referred to as “HAGL” lesions). Glenoid labral tears and capsular lesions are adequately addressed with the “labroplasty” procedure. This involves a sequential capsulolabral shift using correctly oriented suture-anchors, to effectively reduce the capsular volume. In addition, technical maneuvers like the “double-grasper shift” and “Noose maneuver” are crucial to recreate a labral bumper effect at the glenoid edge. HAGL lesions may be difficult to detect, and use of the axillary-pouch portal (Bhatia portal) facilitates identification of the tear. A new mini-open subscapula...
The purpose of this study was to compare the stability and force of ultimate failure of the acrom... more The purpose of this study was to compare the stability and force of ultimate failure of the acromioclavicular joint (ACJ) after direct arthroscopic distal clavicle excision (DCE) through superior portals and indirect arthroscopic DCE through inferior portals in paired cadaveric shoulders. Ten paired saline-embalmed cadaveric shoulders were operated alternatively using the indirect and direct technique. Biomechanical testing was performed in the horizontal plane, testing displacement at 15N and 30N and finally failure strength was measured testing the constructs until failure occurred. There was a significant difference in failure strength with the direct DCE being stronger: 766.6 N (SD 233.5) against 5403 N (SD 239.1) for the indirect DCE, p = 0.01334). There was no statistical difference for the displacement measured at 15N and 30N. A direct DCE will result in a postoperative ACJ with greater ultimate failure strength compared to indirect DCE because the inferior ACJ capsule can be...
Benjamin WT Gooding ∗ , Timothy R. Cresswell ∗ , Roger Sloan ∗ , Don F. du Toit & Joe de Bee... more Benjamin WT Gooding ∗ , Timothy R. Cresswell ∗ , Roger Sloan ∗ , Don F. du Toit & Joe de Beer ... ∗ Department of Trauma and Orthopaedics, Derby Hospitals NHS Foundation Trust, Derby, UK Department of Anatomy and Histology, University of Stellenbosch, ...
Background and Objectives: This study reports our early experience with continuous cervical parav... more Background and Objectives: This study reports our early experience with continuous cervical paravertebral block (CCPVB) using a stimulating catheter for the management of acute pain after shoulder surgery. Methods: This prospective observational study presents 256 CCPVB for pain relief after 14 different shoulder operations. Surgery was performed under general anesthesia and blocks were placed prior to induction of general anesthesia (n ϭ 81 [32%]), after induction of general anesthesia (n ϭ 116 [45%]), or postoperatively in the recovery room (n ϭ 59 [23%]). A bolus dose of 30 mL of 0.5% ropivacaine was followed by an infusion of 0.1 mL/kg/h of 0.2% ropivacaine. Patient-or nurse-initiated bolus doses of 10 mL of the same drug were used for breakthrough pain and rescue analgesics were available. Postoperative pain, patient satisfaction, and motor function in different parts of the upper limb were evaluated immediately after surgery (time 0), and then 6, 12, 24, 48, 60 hours, and 14 days postoperatively. Results: An average of 2 (range 1-7) attempts were needed to advance the catheter while still stimulating the nerve. Average postoperative pain ranged from 0.27 Ϯ 1.04 cm to 0.78 Ϯ 1.56 cm (mean Ϯ SD) on a visual analog scale (VAS) (0-10 cm) for the first 48 hours and 3.8 Ϯ 2.1 cm and 3.5 Ϯ 2.4 cm at 60 hours and 14 days, respectively. Patient satisfaction on a VAS of 0 to 5 was 4.19 Ϯ 1.1, 4.28 Ϯ 1.01, and 4.69 Ϯ 1.05 at times 0, 6 hours, and 14 days, respectively. Motor function returned to normal in the fingers within 24 hours and in the shoulder within 60 hours. Complications included Horner's syndrome (40%), dyspnea (8%), superficial skin infection (5%), posterior neck pain (22%), subclavian artery puncture (1%), contralateral epidural spread (4%), and 8% of the patients complained of an unpleasant "dead feeling" of the arm. Ninety-one percent of patients would request CCPVB again for future shoulder surgery. There was no evidence of nerve damage.
Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a universal pro... more Shoulder pain, and more specifically pain due to rotator cuff tendon problems, is a universal problem affecting a large number of patients. Corticosteroid injections are frequently used to treat pain in the shoulder by shoulder specialists, general orthopedic surgeons, and other doctors, including rheumatologists. In spite of this widespread use of this intervention, surprisingly little research and publications appear. It is therefore most appropriate that the article Effects of Corticosteroid Injection in Rotator Cuff Tears is published in this journal [1]. The authors treated irreparable rotator cuff tears with triamcinolone acetate injections in irreparable rotator cuff tears and reported their results in the study presented here. Good relief was obtained both with single and repeated injections, and the study emphasizes the value of affording pain relief to these patients.
Recurrent anterior shoulder instability is commonly associated with glenoid bone defects. When th... more Recurrent anterior shoulder instability is commonly associated with glenoid bone defects. When the defect is significant, bony reconstruction is typically necessary. The congruent arc modification of the Latarjet procedure uses the concavity of the undersurface of the coracoid to optimally reconstruct the glenoid. Outcomes are maximized and complications minimized.
Calcifying tendinitis of the rotator cuff is a common disorder and the underlying cause is still ... more Calcifying tendinitis of the rotator cuff is a common disorder and the underlying cause is still not fully understood. About 90% of patients can be treated non-operatively but some are resistant to conservative treatment and surgery is indicated. Non-operative treatments include non-steroidal anti-inflammatory drugs, subacromial injection of steroid, physiotherapy, extracorporeal shockwave therapy and needle aspiration irrigation. When conservative treatment fails, arthroscopic excision of calcium, sometimes combined with an acromioplasty and/or rotator cuff repair, reliably produces excellent results with high patient satisfaction. In this article, an up-to-date review of the published papers evaluating each treatment modality is presented.
The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedu... more The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedure to debride and resurface the arthritic glenoid, in a middle-aged population, using an acellular human dermal scaffold. Between 2003 and 2005, thirty-two consecutive patients underwent an arthroscopic debridement and biological glenoid resurfacing for glenohumeral arthritis. The diagnoses included primary osteoarthrosis (28 patients), arthritis after arthroscopic reconstruction for anterior instability (1 patient) and inflammatory arthritis (3 patients). All shoulders were assessed clinically using the Constant and Murley score, and results graded according to Neer's criteria. Statistical analysis was performed to determine significant parameters and associations. A significant improvement (P < 0.0001) in each parameter of the subjective evaluation component (severity of pain, limitation in daily living and recreational activities) of the Constant score was observed. The Constant and Murley score increased significantly (P < 0.0001) from a median of 40 points (range 26-63) pre-operatively to 64.5 (range 19-84) at the final assessment. Overall, the procedure was considered as "successful outcome" in 23 patients (72%) and as a "failure" in 9 patients (28%). According to Neer's criteria, the result was categorized as excellent in 9 (28%), satisfactory in 14 (44%) and unsatisfactory in 9 (28%). Within the unsatisfactory group, there were five conversions to prosthetic arthroplasty. A standard magnetic resonance imaging was performed on 22 patients in the successful outcome group; glenoid cartilage was identified in 12 (thick in 5, intermediate in 1, thin in 6) and could not be identified in 10 patients (complete/incomplete loss in 5, technical difficulties in 5). Overall, five complications included transient axillary nerve paresis, foreign-body reaction to biological material, inter-layer dissociation, mild chronic non-specific synovitis and post-traumatic contusion. Dominance of affected extremity and generalized disease (diabetes, rheumatoid arthritis, generalized osteoarthritis) was associated with an unsatisfactory outcome (P < 0.05). Arthroscopic debridement and biological resurfacing of the glenoid is a minimally invasive therapeutic option for pain relief, functional improvement and patient satisfaction, in glenohumeral osteoarthritis, in the intermediate-term.
Partial-thickness bursal-surface tears of supraspinatus tendon may be missed on preoperative inve... more Partial-thickness bursal-surface tears of supraspinatus tendon may be missed on preoperative investigations and can be overlooked at surgery if not specifically sought. The authors describe an arthroscopic sign to detect these tears, when they involve more than half the tendon fibres, from the articular-side of the joint. The "paraglider-wing" sign, visualized during diagnostic glenohumeral arthroscopy, is demonstrated as an upward bulge of the capsulo-tendinous layer through the bursal-surface tear, under pressure of the inflow fluid. A positive sign indicates (1) presence of a partial-thickness bursal-side tear of the supraspinatus tendon, (2) significant depth (stage II or III) of the tear, and (3) the medial extent of the tear along the length of the tendon. A meticulous subacromial bursoscopy and excision of the bursa is then performed to visualize the tear from the subacromial space. Repair of the tear is performed with a double-row suture anchor fixation technique; the medial row of sutures is passed through the intact region of the tendon using the "paraglider-wing" sign as a guide.
We report on a displaced surgical scapular neck fracture with an ipsilateral undisplaced distal c... more We report on a displaced surgical scapular neck fracture with an ipsilateral undisplaced distal clavicle fracture of the dominant shoulder in a professional athlete. Although directives for determining the treatment of choice, whether conservative or operative, can be found in the literature, confusion still exists.1,6,14-16 Our management adds a treatment alternative, which has not yet been reported to our knowledge.
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Papers by Joe De Beer