Shoulder and Elbow

Latest journal articles about shoulder and elbow from Journal of Shoulder and Elbow Surgery, The Bone & Joint Journal, Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, Acta Orthopaedica, Orthopedic Clinics of North, America, Journal of Orthopaedic Surgery and Research, Orthopedics

Related Articles Patient expectations before arthroscopic shoulder surgery: correlation with patients' reasons for seeking treatment. J Shoulder Elbow Surg. 2013 Jul 11; Authors: Warth RJ, Briggs KK, Dornan GJ, Horan MP, Millett PJ Abstract BACKGROUND: Elevated expectations before orthopaedic procedures appear to correlate with inferior preoperative subjective measures. The purpose of this study was to evaluate preoperative patient expectations before arthroscopic shoulder surgery and to correlate them with preoperative subjective measures and patients' reasons for seeking treatment. METHODS: We prospectively collected and retrospectively analyzed data from patients before elective arthroscopic shoulder surgery for a wide range of pathologic processes. Preoperative subjective data included QuickDASH scores, pain and functional components of the American Shoulder and Elbow Surgeons (ASES) score, and mental and physical components of the SF-12 score. Expectations data were collected and grouped on the basis of the reasons for seeking of medical treatment and ranked according to their relative importance.

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Related Articles Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results. J Shoulder Elbow Surg. 2013 Jul 10; Authors: Bak K, Fogh K Abstract BACKGROUND: Chronic symptomatic anterior sternoclavicular (SC) instability is a rare condition with sparse treatment options. Owing to the rarity of the condition and the potential risk of fatal complications, only a few reports on treatment of this condition have been published. We evaluated a prospective series of patients with chronic anterior SC instability who underwent minimally open reconstruction with an autologous tendon graft. METHODS: From 2002 to 2010, 32 consecutive patients underwent minimally open SC ligament reconstruction using a tendon autograft. A palmaris longus was used in 7 patients and a gracilis tendon autograft was used in 25. All patients with at least 2 years of follow-up were reviewed. Five were lost to follow-up. The remaining 27 patients (84.4%) were a median age of 35 years (range, 11-61 years) at surgery. Patients were evaluated with the Western Ontario Shoulder Instability (WOSI) score preoperatively and at follow-up at a median 54 months (range, 24-120 months) postoperatively.

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Related Articles Revision arthroplasty with a hip-inspired computer-assisted design/computer-assisted manufacturing implant for glenoid-deficient shoulders. J Shoulder Elbow Surg. 2013 Jul 10; Authors: Uri O, Beckles V, Falworth M, Higgs D, Lambert S Abstract BACKGROUND: Revision arthroplasty for failed post-traumatic humeral head replacement associated with rotator cuff and glenoid deficiency is challenging. Current surgical solutions are fraught with complications, and no best-practice strategy has been established. We hypothesized that the computer-assisted design/computer-assisted manufacturing (CAD/CAM) shoulder (Stanmore Implants, Elstree, UK), a total shoulder design resembling a total hip prosthesis, can offer a reliable alternative in this surgically challenging subset of patients with rotator cuff deficiency and advanced glenoid bone loss. METHODS: Twenty-one patients with failed post-traumatic humeral head replacement associated with rotator cuff and glenoid deficiency underwent revision with CAD/CAM shoulders between 2005 and 2010. Clinical data were collected prospectively and analyzed at a mean follow-up of 3 years.

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Related Articles Decision-making in the treatment of diaphyseal clavicle fractures: is there agreement among surgeons? Results of a survey on surgeons' treatment preferences. J Shoulder Elbow Surg. 2013 Jul 6; Authors: Heuer HJ, Boykin RE, Petit CJ, Hardt J, Millett PJ Abstract BACKGROUND AND HYPOTHESIS: Nonoperative treatment is standard for most diaphyseal clavicle fractures, but recent studies have demonstrated improved outcomes with operative treatment of displaced fractures. The objectives of this diagnostic study were to assess agreement of orthopaedic surgeons regarding their treatment preferences for diaphyseal clavicle fractures and to compare them with recent recommendations. Interobserver and intraobserver agreement in treatment decisions were hypothesized to be only slight. METHODS: Anonymized case vignettes of 50 acute diaphyseal clavicle fractures including medical history, physical examination findings, and radiographs were independently reviewed by 32 orthopaedic surgeons from the United States. Four treatment options were offered and decisions were compared with current treatment recommendations. Interobserver agreement was calculated using Fleiss' kappa coefficient. Average intraobserver agreement for surgeons who completed a retest review (minimum interval of 8 weeks) was calculated. RESULTS: Thirty-two surgeons completed the first round of reviewing and 27 completed the retest (mean interval, 22 weeks). Interobserver

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Related Articles Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors. Clin Orthop Relat Res. 2013 Jul 9; Authors: Kuroda S, Ishige N, Mikasa M Abstract BACKGROUND: Although arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair. DESCRIPTION OF TECHNIQUE: After acromioplasty and adequate footprint decortication, three K-wires with perforated tips are inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint using a customized aiming guide. After pulling the rotator cuff stump laterally with a grasper, three K-wires are threaded through the rotator cuff and skin. Thereafter, five Number 2 polyester sutures are passed through three bone tunnels using the perforated tips of the K-wires. The surgery is completed by inserting two pairs of mattress sutures and three bridging sutures.

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Related Articles Durability of partial humeral head resurfacing. J Shoulder Elbow Surg. 2013 Jul 5; Authors: Delaney RA, Freehill MT, Higgins LD, Warner JJ Abstract BACKGROUND: Partial humeral head resurfacing arthroplasty uses a stemless device, which conserves bone and restores normal anatomy. We hypothesized that this does not offer a reasonable alternative to full resurfacing or total shoulder arthroplasty. METHODS: We performed a retrospective study of 39 shoulders with focal chondral defects of the humeral head treated with partial resurfacing arthroplasty. A minimum of 2 years' follow-up was reported, unless failure and operative intervention superseded this duration. The mean follow-up period was 51.3 months. The mean age was 45.6 years (range, 27-76 years). Preoperative and postoperative evaluation included history, physical examination, radiographs, and clinical scoring with the American Shoulder and Elbow Surgeons Shoulder Score Index and Subjective Shoulder Value. RESULTS: Of the 39 shoulders, 25 (64.1%) showed functional improvement and decreased pain. Significant mean improvements were observed in forward flexion (121° to 152°, P = .002), external rotation (37° to 58°, P = .0003), mean Subjective Shoulder Value (31% to 74%, P < .0001), and ASES score (29 to 70, P < .0001). However, at a mean of 26.6 months' follow-up, the failure group included 6 patients (15.3%) who underwent revision and another 4 (10.2%) who

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Related Articles Analysis of arm elevation muscle activity through different movement planes and speeds during in-water and dry-land exercise. J Shoulder Elbow Surg. 2013 Jul 5; Authors: Castillo-Lozano R, Cuesta-Vargas A, Gabel CP Abstract OBJECTIVE: The objectives of this cross-sectional, analytical inference analysis were to compare shoulder muscle activation at arm elevations of 0° to 90° through different movement planes and speeds during in-water and dry-land exercise and to extrapolate this information to a clinical rehabilitation model. METHODS: Six muscles of right-handed adult subjects (n = 16; males/females: 50%; age: 26.1 ± 4.5 years) were examined with surface electromyography during arm elevation in water and on dry land. Participants randomly performed 3 elevation movements (flexion, abduction, and scaption) through 0° to 90°. Three movement speeds were used for each movement as determined by a metronome (30°/sec, 45°/sec, and 90°/sec). Dry-land maximal voluntary contraction tests were used to determine movement normalization.

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Related Articles Can surgeons predict what makes a good hemiarthroplasty for fracture? J Shoulder Elbow Surg. 2013 Jul 5; Authors: Boileau P, Winter M, Cikes A, Han Y, Carles M, Walch G, Schwartz DG Abstract BACKGROUND: The purposes of this study were (1) to identify the risk factors for tuberosity complications and poor functional outcomes and (2) to compare a standard humeral stem with a fracture-specific humeral stem in hemiarthroplasty for the treatment of 3- and 4-part proximal humeral fractures. METHODS: We retrospectively reviewed the cases of 60 consecutively operated patients (61 shoulders) using radiographs and computed tomography scans. There were 56 displaced four-part and 5 three-part fractures. The technique was standardized for prosthesis positioning in height and retroversion and for tuberosity fixation. A conventional standard stem was implanted in the first 31 shoulders (group A), and a specific fracture stem was implanted in the next 30 shoulders (group B). The sample size needed for comparison was predetermined with an a priori power analysis. The mean follow-up period was 64 months (range, 24 to 150 months).

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Related Articles Radial head fractures: indications and outcomes for radial head arthroplasty. Orthop Clin North Am. 2013 Jul;44(3):425-31 Authors: Fowler JR, Goitz RJ Abstract Radial head fractures without associated bony or ligamentous injury can be safely treated with internal fixation, if possible, or arthroplasty if nonreconstructable. However, nonreconstructable radial head fractures in association with elbow dislocation and/or ligamentous injury in the elbow or forearm represent a specific subset of injuries that requires restoration of the radiocapitellar articulation for optimal function. The purpose of this article was to summarize the indications for radial head arthroplasty and discuss the reported outcomes. PMID: 23827844 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23827844?dopt=Abstract

Related Articles Posterior elbow wounds: soft tissue coverage options and techniques. Orthop Clin North Am. 2013 Jul;44(3):409-17 Authors: Patel KM, Higgins JP Abstract Many options exist for reconstruction of the posterior elbow/olecranon area following wound formation. Careful early wound management is crucial to ensure successful outcomes following reconstruction. Local and regional options are preferred methods for soft tissue coverage in this region. Common flap options include the reversed lateral arm flap, the radial forearm flap, posterior interosseous artery flap, brachioradialis muscle flap, flexor carpi ulnaris flap, and the latissimus flap. The advantages and disadvantages of these flap options are discussed in this review. PMID: 23827842 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23827842?dopt=Abstract