Upper limb

Abstract: This prospective observational study was performed on young patients, less than 24 years old, with first-time, traumatic anterior shoulder dislocations. These patients were offered either arthroscopic or nonoperative treatment. Fifty-three patients chose nonoperative treatment. Sixty-three patients elected to have arthroscopic procedures. The average patient age was 19.6 years. There were 59 men and 4 women. All procedures were performed within 10 days of dislocation. All 63 patients had hemarthrosis. Sixty-one of 63 (97%) patients treated surgically had complete detachment of the capsuloligamentous complex from the glenoid rim and neck (Perthes-Bankart lesion), with no gross evidence of intracapsular injury. Of the other two patients, one had an avulsion of the inferior glenohumeral ligament from the neck of the humerus, and one had an interstitial capsular tear adjacent to the intact glenoid labrum. Fifty-seven patients had Hill-Sachs lesions; none were large. There were six superior labral anterior posterior lesions, two with detachment of the biceps tendon. There were no rotator cuff tears. Of the 53 nonoperatively treated patients, 48 (90%) have developed recurrent instability. In this population, the capsulolabral avulsion appeared to be the primary gross pathologic lesion after a first-time dislocation. These findings, associated with the 90% nonoperative recurrence rate, suggest a strong association between recurrent instability and the Perthes-Bankart lesion in this population.

Abstract: Symptomatic irrepairable rotator cuff tears usually entail complete loss of the substance of the supraspinatus and infraspinatus tendons. Loss of external rotation control and cranial migration of the humeral head on attempted flexion or abduction of the shoulder are the functional hallmarks. Transfer of the latissimus dorsi tendon from the humeral shaft to the superolateral humeral head provides a large, vascularized tendon that can be used to close a massive cuff defect and that exerts an external rotation and head-depressing moment that allow more effective action of the deltoid muscle. This procedure was carried out in 14 patients without any significant complications. Pain relief and functional results in those four cases with a minimum follow-up period of one year (average, 14 months) compared favorably with alternative treatment methods and warrant further anatomic, electromyographic, and clinical investigation.

Abstract: Background: The results of shoulder arthroplasty for osteoarthritis have been reported to be excellent or good for the majority of patients, but the value of using a glenoid component and the anatomic factors that affect outcome are still debated. The purpose of this study was to evaluate the influence of an operatively confirmed full-thickness tear of the rotator cuff, the severity of preoperative erosion of glenoid bone, preoperative radiographic evidence of subluxation of the humeral head, and the severity of preoperative loss of the passive range of motion on the outcome of total shoulder arthroplasty and hemiarthroplasty. Methods: In a multicenter clinical outcome study, we evaluated 128 shoulders in 118 patients with primary osteoarthritis who had been followed for a mean of forty-six months (range, twenty-four to eighty-seven months). Results: Patients with <10° of passive external rotation preoperatively had significantly less improvement in external rotation after hemiarthroplasty (p = 0.006). Thirteen (10%) of the 128 shoulders had a repairable full-thickness tear of the supraspinatus tendon, but these tears did not affect the overall American Shoulder and Elbow Surgeons score, the decrease in pain, or patient satisfaction. Severe or moderate eccentric glenoid erosion was seen in twenty-nine (23%) of the 128 shoulders, and total shoulder arthroplasty resulted in significantly better passive total elevation and active external rotation as well as a trend toward significantly better active forward flexion than did hemiarthroplasty in these shoulders. The humeral head was subluxated posteriorly in twenty-three shoulders (18%), and when they were compared with the other shoulders in the study, these shoulders were found to have lower final American Shoulder and Elbow Surgeons scores, more pain, and decreased active external rotation following either total shoulder arthroplasty or hemiarthroplasty. Conclusions: On the basis of our data, we recommend the use of a glenoid component in shoulders with glenoid erosion. Humeral head subluxation was associated with a less favorable result regardless of the type of shoulder arthroplasty and must be considered in preoperative planning and counseling. Severe loss of the passive range of motion preoperatively was associated with a decreased passive range of motion postoperatively. A repairable tear of the supraspinatus tendon is not a contraindication to the use of a glenoid component. Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.