Introduction and Aims: To establish how effective conservative treatment is for rotator
Total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) are excellent surgical options for individuals with shoulder arthritis, providing good to excellent results in the vast majority of patients. Complications are rare, but can be devastating for both the patient and surgeon. An uncommon, but extremely problematic complication following shoulder arthroplasty is shoulder stiffness. While substantial literature discussing post-arthroplasty stiffness is available for other joints such as the hip, knee, and elbow, there is a paucity of research available discussing this complication in the shoulder. As noted in multiple reviews, diminished range of motion following TSA or RSA may be due to a number of factors, including pre-operative diagnosis of proximal humerus fracture, inadequate post-operative rehabilitation, implant-related factors such as malpositioning and/or inappropriate-sized implants, and heterotopic ossification. Often, pathology leading to post-arthroplasty stiffness involves scarring of the long head of the biceps tendon, rotator
Two surgeons performed arthroscopic subacromial decompression (ASD) on 302 shoulders between January 1995 and January 1999. The mean age of patients was 49.6 years (28 to 81). The mean follow-up period was 36 months (4 to 62). Evaluated using the modified UCLA scoring system, 91% of patients had a good to excellent result at short-term follow-up. However, patients reviewed for two years or longer showed a 98% successful outcome. The commonest delay in improvement was stiffness, with six patients requiring surgical intervention. Early mobilisation with posterior capsular stretching is recommended. Careful clinical assessment of patients with chronic rotator
From January 1995 to January 1999, the author performed arthroscopic subacromial decompression (ASD) on 220 patients. The mean age of patients was 47.4 years (28 to 72). The follow-up period ranged from 4 to 60 months. The modified UCLA scoring system was used to evaluate patients at four months and again at 24 to 60 months. At short-term follow-up, 91% of patients achieved good to excellent results. However, patients reviewed for two years or longer showed a 98% successful outcome. Stiffness was commonly the last thing to improve, and three patients required surgical intervention. Early mobilisation with posterior capsular stretching is recommended. Careful clinical assessment of patients with chronic rotator
Aim. To review the natural history of upper limb osteochondromas and assess their functional effect. Materials. We performed a retrospective casenote review of a consecutive patient cohort presenting between 1997–2012 with upper limb osteochondromas. Indications for surgical intervention were noted and considered to be cosmetic, functional (including pain relief) and ‘prophylactic’ in terms of deformity prevention. All patients were invited to complete questionnaires for the PODCI, DASH, OSS and MHS scores. Results. We identified 102 patients (62 male: 40 female; mean age = 13.3 years; range 3–31 years). 84 patients had multiple exostoses whilst 18 had a solitary lesion. 52 patients had shoulder girdle involvement (scapula, clavicle and proximal humerus), 51 forearm (Masada I (n=31) Masada II (n=9) Masada III (n=11)), and 38 hand involvement. 46/102 patients had concurrent lower limb lesions. 56 operative procedures were performed primarily for functional benefit. Shoulder girdle procedures (n=21) improved pressure related pain, scapular pseudowinging/dyskinesia and
Our retrospective study of 189 patients aimed to establish the efficacy of conservative treatment for rotator
Painful conditions of the acromioclavicular (AC) joint are common in South Africa, particularly among sportsmen. These conditions are often treated by open excision of the distal end of the clavicle, but an arthroscopic procedure offers many advantages. From February 1994 to February 2000, we performed 138 procedures. The mean age of patients ({71% men and 29% women) was 29 years (19 to 53). In cases of rotator
Summary. Data of 663 patients with three different pathologies were examined. We found that using patients with significant symptoms and functional difficulty in the opposite shoulder will not bias the results of observational studies if outcomes are based on routine disability measures such as ASES or Constant-Murley scores. Introduction. Recently, using patients with bilateral limb problems as independent cases has raised concerns in orthopaedic research due to violating the assumption of independence. If observations are too similar in characteristics, they become highly correlated which leads to lowering the variance and biasing the results. Type of pathology (impingement, cuff tear, osteoarthritis) and aging are expected to affect the incidence of bilateral shoulder complaints and should be considered when examining potential bias in this area. In addition, the impact of dominant side pathology has not been investigated primarily in patients with shoulder problems. The objectives of this study were: 1) to examine the incidence of bilateral shoulder complaints and pathology on the dominant side in patients with impingement syndrome, rotator cuff tear and osteoarthritis of the glenohumeral joint, 2) to explore the role of sex and age in developing bilateral shoulder complaints, and 3) to examine the impact of bilaterality and hand dominance on pre and one year post-operative disability. Patients and Methods. This study involved review of data of patients with a diagnosis of impingement syndrome, rotator cuff tears and osteoarthritis (OA) of the gleno-humeral joint who had undergone surgery and had returned for their one year follow-up. Two outcome measures were used; the American Shoulder & Elbow Surgeons (ASES) and the Constant Murley score (CMS). Results. Data of 663 patients (317 females; 269 impingement syndrome, 290 rotator cuff tear, 104 osteoarthritis) were included in the analysis. There was a difference in the incidence of bilateral symptoms in patients with different pathologies: osteoarthritis 46%, impingement 26%, and rotator cuff tears 23% (p<0.0001). The incidence of dominant side involvement was 70%, 68% and 50% in patients with rotator
Aim: Despite many studies the implications of perfusion and blood flow abnormalities in the rotator cuff (RC) in vivo are not clearly understood. Laser Doppler Flowmetry (LDF) is an established technique for the measurement of perfusion in tissue, which has been applied in animal and human studies. This study aims to evaluate Laser Doppler Flowmetry (LDF) as a technique for the assessment of blood flow in the normal and diseased RC. Methods: With Ethics committee approval and informed consent patients undergoing arthroscopy for
Introduction: Laser Doppler Flowmetry (LDF) is an established technique for the measurement of perfusion in tissues, which has been applied in animal and human studies. Despite many studies the implications of perfusion and blood flow abnormalities in the rotator cuff (RC) in vivo are not clearly understood. This study aims to assess the blood flow in the normal and diseased RC using Laser Doppler Flowmetry (LDF) technique. Methods: With Ethics approval and informed consent patients undergoing arthroscopy for
Indocyanine green (ICG) fluorescence angiography is an emerging technique that can provide detailed anatomical information during surgery. The purpose of this study is to determine whether ICG fluorescence angiography can be used to evaluate the blood flow of the rotator cuff tendon in the clinical setting. Twenty-six patients were evaluated from October 2016 to December 2017. The participants were categorized into three groups based on their diagnoses: the rotator cuff tear group; normal rotator cuff group; and adhesive capsulitis group. After establishing a posterior standard viewing portal, intravenous administration of ICG at 0.2 mg/kg body weight was performed, and fluorescence images were recorded. The time from injection of the drug to the beginning of enhancement of the observed area was measured. The hypovascular area in the rotator cuff was evaluated, and the ratio of the hypovascular area to the anterolateral area of the rotator cuff tendon was calculated (hypovascular area ratio).Objectives
Methods