Success treating AIS with bracing is related to time worn and scoliosis severity. Temperature monitoring can help patients comply with their orthotic prescription. Routinely collected temperature data from the start of first brace treatment was reviewed for 14 patients. All were female with an average age of 12.4 years (range 10.3–14.6) and average 49o Cobb angle (30–64).

Our current service recommendation is brace wear for 20 hours a day. Patients complied with this prescription 38.0% of the time, with four patients averaging this or more. Average brace wear was 16.3 hours per day (3.5–22.2).

There were 13 patients who had completed brace treatment. The majority had surgery (7/13; 54%) or were considering surgery (1/13; 8%). There were 5 who did not wish surgery at discharge (5/13; 38%); 1 achieved a 40o Cobb angle, with 4 larger (53o;53o;54o;68o). The Bracing in AIS Trial (BrAIST) study measured “success” as less than a 50o Cobb angle, so using this metric our cohort has had a single “success”.

Temperature monitors allowed an analysis of when patients were achieving their brace wear. When comparing daywear (8am-8pm) to nightwear (8pm-8am), patients wore their brace an average of 7.6 hours a day (2.5–11.2) and 8.7 hours a night (0.4–11.5).

We conclude the minority of our patients comply with our current 20 hour orthotic prescription. The “success” of brace treatment is lower than comparison studies despite higher average compliance but starting with a larger scoliosis. Brace wear is achieved during both the day and night.

Objective: The purpose of this study was to determine how changes in functional shoulder score (Constant Score) affected the values of the SF-36 score, to determine the amount of functional score change to be considered relevant.

Material and Method: 427 patients were included. All of them were assessed with a functional shoulder score (Constant Score) and fulfilled SF-36 score. Mean age was of 50,61(18–85), 200 of them were male and 227 female. 280 were considered to be active while 147 were retired as far as working status is concerned. There were 191 patients with university studies and 236 with primary studies. Primary diagnosis was cuff disorders in 265 patients, old-fracture in 43, degenerative in 72 and instability in 34. Correlations were performed with Spearman’s rho and regression models were evaluated

Results: There was a moderate but significant correlation between the total Constant Score and PF_NORM (0,511) and US standardized physical component (US STPH) (0,491) of the SF-36. For every point of increase in the Constant score the SF-36 increases 0,235 points. Looking into the different items of the Constant Score, Activities of daily living (ADL) and strength presented the stronger correlation with SF-36 (0,428, 0,411). In the regression model, every point of increase of pain, ADL, forward elevation, external rotation and internal rotation means an increase of 0,472, 0,39, 0,84, 0,82 and 0,86 of the US STPH of the SF-36.

Conclusions: Whenever the outcome of any shoulder treatment is analyzed it has to be taken into account that for every point of increase of the Total Constant Score just 0,235 points of the US SPTH of the SF-36 increase. Depending on the mean value of the US SPTH of the SF-36 of the population studied, the relevant increase of Constant Score can be calculated.

Mobility improvements seem to have more influence that pain changes as far as increasing the US SPTH of the SF-36 is concerned.

Introduction: Prostheses radiolucent lines are currently used to evaluate the components fixation. The objective of this study is to determine concordance and reproducibility of humeral stem radiolucent lines evaluation.

Material and method: Five observers evaluated 64 x-ray belonging to 32 pairs (1 antero-posterior view and 1 outlet view) obtained from 16 shoulder prostheses. 16 x-ray pairs were obtained immediately after surgery and 16 one year after surgery. Evaluation in four degrees of radiolucent width for each of the 7 zones that the humeral component was divided for. Evaluation of the component-cement interface and the cement-bone interface. Each observer made two evaluations of the 64 x-ray separated in 6 weeks. Statistics : index kappa with quadratic weighting.

Results: Intra-observer results: mean kappa index for component-cement interface: 0,3274. mean kappa index for cement-bone interface: 0,5269. Inter-observer results: mean kappa index for component-cement interface: 0,1242. mean kappa index for cement-bone interface: 0,2478. Evaluation of 2 pairs of x-ray of the each prostheses taken in a period of 1 year: component-cement interface: mean of 91,67% of plausible results, cement-bone interface: mean of 80,2% of plausible Results:

Conclusions:

- low kappa index of reproducibility (0,3274–0,5269) of humeral component radiolucent lines evaluation for component-cement interface as well as for cement-bone interface.

Objective: Analysis of the influence in shoulder function of restoring total humeral length (THL) in proximal humeral fractures (PHF) treated with hemiarthroplasty and comparing the data with a control group of proximal fractures treated with osteosynthesis.

Material and method: Prospective study involving 56 patients, twenty-nine 2 and 3 part PHF treated with osteosynthesis and twenty-seven 3 and 4 part fractures treated with hemiarthroplasty. Clinical assessment through Constant Score and radiological exam of the THL of both humerus as well as CT scans to analyze position of the tuberosities at 1-year follow-up.

Results: Osteosynthesis group: mean Constant Score of 77.37. In all cases greater tuberosity consolidated in good position. When differences in THL were higher than 2 cm Constant Score values significatively decreased to mean of 67, when ranging from 0 to 2 cm did not differ significatively from mean Constant Score.

Hemiarthroplasty group: mean Constant Score of 55.76. In 5 cases THL was increased (mean 0.87 cm) with a mean Constant Score of 63.5 and among them the greater tuberosity consolidated in place in 3 cases and posteriorly in 2. In 20 cases THL was decreased (mean 1.03 cm) with a mean Constant Score of 54.25 and among them if the difference was minor than 1 cm the greater tuberosity consolidated in place in 3 cases, consolidated posteriorly in 4 and absent in 1 case, and if the difference was greater than 1 cm, the greater tuberosity consolidated in place in 4 cases, consolidated posteriorly in 6 and absent in 2 cases . In 2 cases no differences in THL.

Conclusions: In PHF treated either with osteosynthesis or hemiarthroplasty, the greater tuberosity can be properly reattached if THL differences are less than 2 cm.

Constant Score correlates with greater tuberosity position at any difference of THL less than 2 cm.

Background: The Inferior Glenohumeral Ligament (IGHL) has a well known mechanical and propioceptive relevance in shoulder stability. The interrelation of the IGHL anatomical disposition and innervation has not actually been described. The studys purpose was to determine the IGHL innervation patterns and relate them to dislocation.

Material & methods: Forty-five embalmed and 16 fresh-frozen human cadaveric shoulders were studied. Massons Trichrome staining was used to detail the intra-ligamentous nerve fibre arrangements. Neural behaviour of the articular nerves was studied dynamically at the apprehension position and while anteroinferior dislocation of the shoulder joint was performed.

Results: The anatomy of the IGHL was clearly defined. However, in 7 out of 61 cases the anterior band was only a slight thickening of the ligament. It averaged 34 mm (range, 28 to 46 mm) in length. The posterior band was only seen in 40.98 % of the cases. The axillary nerve provided IGHL innervation in 95.08 % of the cases. We found two distinct innervation patterns originating in the axillary nerve. In Type 1 (29.5 % of the cases), one or two collaterals later diverged from the main trunk to enter the ligament. Type 2 (65.57%) showed innervation to the ligament provided by the posterior branch for three to four neural branches. In both cases, these branches enter the ligament near the glenoid rim and at 7 oclock position (right shoulder). The shortest distance to the glenohumeral capsule was noted at 5 oclock position. The radial nerve (Type 3 innervation pattern) provided IGHL innervation in 3.28 % (2 specimens). Microscopic analysis revealed wavy intraligamentous neural branches. The articular branches relaxed and separated from the capsule at external rotation and abduction and stayed intact after dislocation.

Conclusions: The current results showed the IGHL to have three different innervation patterns. The special neural anatomy of the IGHL suggested it was designed to avoiding denervation when dislocated. This might contribute to understand why the neural arch remains unaffected after most dislocations. To our knowledge this is the first work that clearly describes specimens in which the main innervation of the IGHL is provided by the radial nerve.

Knowledge of the neural anatomy of the shoulder will clearly help in avoiding its injury in surgical procedures.