The purpose of this prospective pilot study is to examine the feasibility of a physiotherapist led rapid access shoulder screening clinic (RASC). The goal of this study is to assess for improvements in patient access to care, patient reported outcome measures, patient reported experience measures, and cost outcomes using time driven activity based costing methods. Patient recruitment began in January 2021. Consultation requests from general practitioners and emergency rooms are analyzed and triaged through a central system. One half of patients awaiting consultation were triaged to the traditional route used at our center while the other half were triaged to be assessed at the RASC. Outcome measures consisting of the
Aim. Clavicular osteotomy was described as an adjunct to deltopectoral approach for improved exposure of the glenohumeral joint. This study aims to present contemporary outcomes and complications associated with the routine use of clavicular osteotomy by a single surgeon in a regional setting within New Zealand. Methods. A retrospective case series of patients who have undergone any shoulder arthroplasty for any indication between March 2017 to August 2022. This time period includes all patients who had clavicular osteotomy(OS) and patients over an equal time period prior to the routine use of osteotomy as a reference group (N-OS). Oxford Shoulder Score (OSS) and a
Background: Comparison of intra-articular corticoid injections and oral corticosteroids in the treatment of adhesive capsulitis of the shoulder. Methods: In a prospective randomized evaluation two different treatment regimen were compared. 40 patients with idiopathic adhesive capsulitis of the shoulder were treated either with an oral (20) corticoid treatment regimen for 4 weeks or intra-articular (20) injection series of corticosteroids (3 injections- 4, 8, 12 weeks).Patient groups were comparable in sex, age and affected side. Follow-up periods were after 4,8,12 weeks, 6 and 12 months. For the clinical evaluation the Constant and Murley Score, the
Implant removal is necessary in up to 25% of patients with plate osteosynthesis after proximal humeral fracture. Our new technique of arthroscopic implant removal offers all advantages of minimal invasive surgery. Additionally treatment of concomitant intraarticular lesions is possible. This study outlines the first results after arthroscopic implant removal in comparison with those of open implant removal. A prospective series of 40 consecutive treated patients had implant removal and arthrolysis after plate osteosynthesis of proximal humeral fracture. Implant removal was carried out due to limitation in range of movement, secondary implant dislocation and implant impingement. 30 patients (median age 63 (30–82) years) had arthroscopic, ten patients (median age 53 (34–76) years) had open implant removal. Median 10 months after implant removal subjective patient satisfaction, Constant Murley Score (CMS) and
Background. The purpose of this study was to determine if thresholds regarding the percentage of maximal improvement in the
Study design: Retrospective study of 34 patients with a massive rotator cuff tear, who were treated with an arthroscopic tuberoplasty, debridement of the degenerate cuff and biceps tenotomy. Objectives: To evaluate the clinical outcome of a reversed decompression at the medium term follow up. Summary of background data: Rotator cuff repair can become impossible for massive tears in the elderly. If conservative management fails, a reverse total shoulder arthroplasty (RSA) is commonly used. However, Fenlin described in 2002 a tuberoplasty for this pathology and reported good to excellent results. This procedure appears to be well tolerated as it is arthroscopic, not time consuming and not depending on intensive physiotherapy. In case of failure, a primary RSA is still possible. Methods: 36 patients treated with a tuberoplasty between February 2002 and September 2006 were identified. One patient deceased, one patient developed Alzheimer dementia, leaving 34 patients available for follow-up. They completed the SF-36 questionnaire and the
This study prospectively evaluated the functional outcome and strength of patients after rotator cuff surgery. Thirty-three patients were evaluated pre-operatively and post-operatively for one year. Each patient underwent clinical evaluation of shoulder range of motion and machine strength testing. Additionally they completed the SF-36, DASH, Western Ontario Rotator Cuff, and Washington
A reverse total shoulder arthroplasty (RSA) is frequently performed in the revision setting. The purpose of this study was to report the clinical outcomes and complication rates following revision RSA (RRSA) stratified according to the primary shoulder procedure undergoing revision, including failed hemiarthroplasty (HA), anatomic total shoulder arthroplasty (TSA), RSA, soft tissue repair (i.e., rotator cuff repair), and open reduction internal fixation (ORIF). A systematic review of the literature was performed using four databases (EMBASE, Medline, SportDISCUS, and Cochrane Controlled Trials Register) between January 1985 and September 2017. The primary outcomes of interest included active range-of-motion (ROM), pain, and functional outcome measures including the American Shoulder and Elbow Surgeons Score (ASES),
Background. Shoulder pain limits range of motion (ROM) and reduces performing activities of daily living (ADL). Objective assessment of shoulder function could be of interest for diagnosing shoulder pathology or functional assessment of the shoulder after therapy. The feasibility of 2 wearable inertial sensors for functional assessment to differentiate between healthy subjects and patients with unilateral shoulder pathology is investigated using parameters as asymmetry. Methods. 75 subjects were recruited into this study and were measured for at least 8 h a day with the human activity monitor (HAM) sensor. In addition, patients completed the Disability of the Arm, Should and Hand (DASH) score and the
Introduction: In clinical orthopaedics questionnaire based outcome scores such as the DASH shoulder score suffer from a ceiling effect, subjectivity and the dominance of pain perception over functional capacity. As a result it has becomes increasingly difficult to clinically validate medical innovations in therapy or implants and to account for rising patient demands. Thus, objective functional information needs to be added to routine clinical assessment. Motion analysis with opto-electronic systems, force plates or EMG is a powerful research tool but lab-based, too expensive and time consuming for routine clinical use. Inertia sensor based motion analysis (IMA) can produce objective motion parameters while being faster, cheaper and easier to operate. In this study a
Introduction. The impact of prior ipsilateral shoulder surgery on outcomes following total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) is unknown. The purpose of this study was to determine the impact of prior shoulder surgery on patients undergoing TSA and RSA compared to patients without prior shoulder surgery. The hypothesis was that patients undergoing arthroplasty after prior ipsilateral shoulder surgery would have inferior outcomes with higher complication rates compared to patients undergoing arthroplasty without having undergone prior surgery. Materials and Methods. Seven-hundred fifteen consecutive patients undergoing TSA or RSA between 1/2010 and 5/2014 with a minimum 2-year follow-up were prospectively analyzed. All patients were evaluated with the American Shoulder and Elbow Society (ASES),
Purpose: The aim of this study was to evaluate the arthroscopic findings and treatment of chronic shoulder pain after minimally displaced greater tuberosity (GT) fractures. Material and Methods: Arthroscopy was performed in 12 patients (8m, 4f; mean age of 36 years) with more than 6 months of shoulder pain after sustaining a minimally displaced GT fracture (inferior to 5 mms). 4 cases were associated with anterior shoulder dislocation. Results: Varied pathologic findings, some of them unsuspected, were observed in all cases, both at subacromial and glenohumeral level:. 5 cases of subacromial impingement secondary to protrusion of the proximal portion of the GT; 2 of them associated with Pasta lesion. 3 cases of unstable – non united bony fragments at subacromial level. 4 cases of isolated Pasta lesions, 2 pure tendinous and 2 “bony” with unstable osteocondral fragments. All lesions were arthroscopically treated: GT tuber-oplasty, repair of Pasta lesions, suture fixation of GT fragments. After minimum follow-up of one year, Constant and
Proximal humeral locked plates have been advocated as an improved option for treating displaced proximal humeral fractures. After a number of failures using other methods we moved to this option in 2003. We reviewed all patients treated with this method, since we started in 2004. 16 patients were available for follow up. Using the
Due to an arthroscopic’s surgery progress, almost all type of rotator cuff lesions including massive tears can be repaired. Correct preoperative surgical planning needs combination of dates coming from clinical history, diagnostic imaging and the demand of patient. Purpose: the goal of this study is to report on the arthroscopic repair of massive rotator cuff tear: surgical techniques used, outcome. Type of study: retrospective study in 2 Orthopedic Center in Rome (Italy). Methods: Between 2000 and 2007, 457 patients underwent arthroscopic repair of rotator cuff tear: 93 of these were complete massive cuff tear. The pre-op and postoperative outcomes were analyzed using the Costant Score (CS),
Background:. The use of reverse total shoulder arthroplasty (RTSA) has been increasing around the world. However, because of concerns over lack of internal rotation with the reverse prosthesis and the resultant difficulties with activities of daily living (ADLs), many have recommended against performing bilateral RTSA. Methods:. We performed a retrospective review of prospectively obtained clinical data on 15 consecutive patients (30 shoulders) that underwent staged bilateral primary RTSA for the diagnosis of cuff tear arthropathy (CTA) between 2004 and 2012. All operations were performed by a single surgeon. The mean follow-up was 29.6 months from the second RTSA (range 12–65 months). The mean age of the patients at the time of the first operation was 72.9 years (range 63–79 years), and the mean duration between arthroplasties was 21.6 months (range 8–50 months). Patients were evaluated preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and yearly with standardized clinical exams and outcome measures questionnaires including Constant, ASES, UCLA,
Purpose: The purpose of this study was to identify if preoperative pain scores predict postoperative pain and functional outcomes in patients following rotator cuff surgery and if a threshold where increased risk occurs could be established. Establishing a risk threshold may help identify patients who need increased follow-up or rehabilitation. Method: One hundred six subjects with rotator cuff pathology requiring operative intervention were prospectively followed. The pain subscale of the Shoulder Pain and Disability Index (SPADI) was used as an indicator of pre-operative pain. Postoperative function one year following surgery was determined using the
Purpose. Reverse shoulder prosthesis may lead to scapular notching, caused by attrition of the upper humeral component with scapular neck. We compared the clinical and radiographic results obtained with a SMR prosthesis, which allows a concentric or an eccentric glenosphere to be applied. Patients and methods. 67 patients, mean age 73 years, were treated with reverse prosthesis using concentric and eccentric glenosphere. In patients with concentric glenosphere, the glenosphere extended about 4 mm below the glenoid. The eccentric glenosphere protected the upper glenoid neck by its inferior prolongment. Patients were followed for a mean of 33 months. At final F-U the Constant Score (C.S.) and the score with the
Introduction Shoulder replacement is a classical indication in 3 and 4 part humeral head fractures, but the results reported in literature are not so good like arthritis. This is for some aspects as healing of tuberosity, rotatory cuff repair and difficult in positioning of prosthesis for lack of landmarks. The aim of this study is to assess the overall outcome of 30 patients treated with shoulder prosthesis for proximal humeral fractures. Methods Quality of life assessment, specific shoulder patients perspective and objective parameters were correlated with position of stem. Height and version of the stem, evaluated with CT scan as reported in Literature, were studied and correlated whether with the other side or with subjective and objective data. Subjective data included SF-36, DASH,
Purpose of the study: The purpose of this presentation was to focus on the situation where rotator cuff tears are associated with nerve injury and to clarify the clinical nosology of the shoulder triad (glenohumeral dislocation, acute cuff tear, and circumflex nerve injury) and of the «dead shoulder syndrome» (chronic massive cuff tear, acute glenohumeral dislocation, and circumflex nerve injury). Material and methods: This series included seven patients with the shoulder triad and five patients with dead shoulder syndrome who were treated in our department between 1996 and 2002. There were nine men and three women, aged 50–74 years (mean 58 years). Follow-up was two years or more. The Neer and Cofield classification was used to assess functional outcome and the
Purpose: Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>
25% of glenoid diameter) We hypothesized that restoring a near-normal glenoid structure would prevent further dislocations and that osseous union would be achieved. Method: All athletes with recurrent anterior shoulder instability and a large glenoid defect who underwent open anterior shoulder stabilization and glenoid reconstruction with iliac crest allograft were prospectively followed over a three year period. Pre-operatively, a detailed history and physical exam was obtained along with radiographs, a CT scan, and magnetic resonance imaging of the affected shoulder. All patients also complete the
