The function of the upper extremity is highly dependent on correlated motion of the shoulder. The shoulder can be affected by several diseases. The most common are: rotator cuff tear (RCT), shoulder instability, shoulder osteoarthritis and fractures. Rotator cuff disease is a common disorder. It has a high prevalence rate, causing high direct and indirect costs. The appropriate treatment for RCT is debated. The American Academy Orthopaedic Surgeons guidelines state that surgical repair is an option for patients with chronic, symptomatic full-thickness RCT, but the quality of evidence is unconvincing. Thus, the AAOS recommendations are inconclusive. We are performing a randomized controlled trial to compare surgical and conservative treatment of RCT, in term of functional outcomes, rotator cuff integrity, muscle atrophy and fatty degeneration. Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. Shoulder instabilities have been classified according to the etiology, the direction of instability, or on combinations thereof. The Thomas and Matsen classification, which is currently the most commonly utilized classification, divides shoulder instability events into the traumatic, unidirectional, Bankart lesion, and surgery (TUBS) and the atraumatic, multidirectional, bilateral, rehabilitation, and capsular shift (AMBRI) categories. The acquired instability overstress surgery (AIOS) category was then added. Surgical procedures for shoulder instability includes arthroscopic capsuloplasty, remplissage, bone block procedure or Latarjet procedure. Reverse total shoulder arthroplasty (RTSA) represents a good solution for the management of patients with osteoarthritis or fracture of the proximal humerus, with associated severe osteoporosis and RC dysfunction

Osteoarthritis (OA) is a disease of the synovial joint with synovial inflammation, capsular contracture, articular cartilage degradation, subchondral sclerosis and osteophyte formation contributing to pain and disability. Transcriptomic datasets have identified genetic loci in hip and knee OA demonstrating joint specificity. A limited number of studies have directly investigated transcriptional changes in shoulder OA. Further, gene expression patterns of periarticular tissues in OA have not been thoroughly investigated. This prospective case control series details transcriptomic expression of shoulder OA by analysing periarticular tissues in patients undergoing shoulder replacement for OA as correlated with a validated patient reported outcome measure of shoulder function, an increasing (clinically worsening) QuickDASH score. We then compared transcriptomic expression profiles in capsular tissue biopsies from the OA group (N=6) as compared to patients undergoing shoulder stabilisation for recurrent instability (the control group, N=26). Results indicated that top ranked genes associated with increasing QuickDASH score across all tissues involved inflammation and response to stress, namely interleukins, chemokines, complement components, nuclear response factors and immediate early response genes. Some of these genes were upregulated, and some downregulated, suggestive of a state of flux between inflammatory and anti-inflammatory signalling pathways. We have also described gene expression pathways in shoulder OA not previously identified in hip and knee OA, as well as novel genes involved in shoulder OA.

Aims

We evaluated clinical and radiographic outcomes of total shoulder arthroplasty (TSA) using the second-generation Trabecular Metal (TM) Glenoid component. The first generation component was withdrawn in 2005 after a series of failures were reported. Between 2009 and 2012, 40 consecutive patients with unilateral TSA using the second-generation component were enrolled in this clinical study. The mean age of the patients was 63.8 years (40 to 75) and the mean follow-up was 38 months (24 to 42).

Introduction. Assessment of the humeral head translation with respect to the glenoid joint, termed humeral head migration (HHM), is crucial in total shoulder arthroplasty pre-operative planning. Its assessment informs current classification systems for shoulder osteoarthritis as well as the evaluation of surgical correction. In current clinical practice, HHM assessment relies on computed-tomography (CT) imaging. However, the associated supine position might undermine its functional relevance as it does not reflect the weight-bearing condition with active muscle engagement associated with the upright standing position of most daily activities. Therefore, we assessed to what extent HHM in a supine position is associated with HHM in a range of functional arm positions. Method. 26 shoulder osteoarthritis patients and 12 healthy volunteers were recruited. 3D shapes of the humerus and scapula were reconstructed from their respective CT scans using an image processing software. 3. , and their CT-scan-based HHMs were measured. Furthermore, all subjects underwent low-dose biplanar radiography . 4. in four quasi-static functional arm positions while standing: relaxed standing, followed by 45 degrees of shoulder extension, flexion, and abduction. Using a previously validated method implemented in the programming platforms. 5. , 3D shapes were registered to the pairs of biplanar images for each arm position and the corresponding functional HHM was measured. Bivariate correlations were assessed between the CT-based HHM and each functional arm position. Result. HHM in 45 degrees of flexion and extension both showed significant and strong correlations (r>0.66 and P<0.01) with HHM assessed in the supine position. However, such a high correlation was not found for relaxed standing and 45 abduction. Conclusion. Although HHM in a supine position correlates with HHM in 45-degree extension and flexion, it is poorly associated with the HHM in abduction and relaxed standing. These results may suggest the inclusion of more functionally-relevant patient positioning toward better-informed shoulder arthroplasty planning. Acknowledgement. Funding from PRosPERos-II Project

Purpose: The reverse total shoulder arthroplasty (RTSA) has shown improvement in both pain control and function in recent studies. The purpose of this study was to prospectively analyze functional outcomes and strength in patients following the use of the Delta III prosthesis in a single center. Method: Patients treated by one of two surgeons were prospectively evaluated following RTSA. An independent observer administered the Constant Score, SF-12, Shoulder Osteoarthritis (SOAQ), ASES, DASH questionnaires and patient satisfaction. Isometric strength testing was performed using the Powertrack II dynamometer. Follow-up for all patients was available up to 5 years following surgery. Results: The Delta III RTSA was performed on 51 study patients (67% female, mean age 74 (SD=10)). Improvements following surgery were noted in Quality of life (SF-12 Physical Summary= 30 to 38); shoulder disability (SOAQ= 144 to 79; ASES 7 to 15; DASH= 61 to 46; Constant 21 to 56), Symptoms (SOAQ symptoms 40 to 22), Physical impairments as determined by strength (External rotation = 3 to 5 Nm, Abduction 4 to 10 Nm); and ROM (Flexion= 51 to 115°, abduction 45 to 106°); p< 0.05. All patients had follow up between 2–5 years. Satisfaction was high (86% extremely, 3% not at all). Conclusion: Our data demonstrates significant improvements in quality of life, symptoms, patient satisfaction and disability with reduced and high at more than 2 years following RTSA. Novel to this study is improved objective evidence of strength in functional planes of motion. This is the first Canadian study to demonstrate such improvements in patients following RTSA

Aim: A prospective study to quantify the functional outcome of the Aequalis Shoulder Arthroplasty in our local population. Method: 110 Aequalis shoulder arthroplasties have been performed in 99 patients by a single surgeon in a district general hospital. Rheumatoid arthritis was the indication in 61 shoulders, Osteoarthritis in 26 and 23 for other indications. There were 78 females and 32 males. Patients were assessed using the Constant-Murley (CM) Score, the corrected Constant-Murley (CM) Score and the American Shoulder and Elbow Society (ASES) function score pre and post-operatively. Pain was measured on a reverse Visual Analogue Scale (VAS) and a range of movement was clinically assessed. All these parameters including standard radiographs were regularly assessed during the follow up period. Results: Mean length of follow up is 2.29 years (range 6 months to 8 years). 27/110 (24.55%) had a Glenoid replacement. There have been steady and significant improvements in all parameters over the follow up period. Improvements have been sustained and continue to increase the longer the prosthesis has been in situ. The pain score is measured on a reverse analogue score, which accounts for the increasing scores. There have been 2 cases complicated by deep infection requiring revision and 2 cases of peri-prosthetic fracture. Conclusion: The Aequalis shoulder prosthesis gives good, reliable results which are reproducable outside specialised centres

Purpose. There is minimal information on outcome of glenohumeral debridement for treatment of shoulder osteoarthritis (OA). The purpose of this study was to examine the outcome of this procedure with or without acromioplasty /resection of clavicle in subjective perception of disability and functional range of motion and strength at one year following surgery. Method. Prospectively collected data of patients with advanced OA of the glenohumeral joint who were not good candidates for shoulder arthroplasty due to young age, high activity level, or desire to avoid major surgery at the time of assessment were included. Arthroscopic debridement included removal of loose bodies, chondral flaps, and degenerative tissue. Resection of the lateral end of the clavicle or acromioplasty was performed as clinically indicated for management of osteoarthritis of the Acromioclavicular (AC) joint or subacromial impingement respectively. Disability at 12 months following surgery was measured by the American Shoulder and Elbow Surgeons (ASES) assessment form, Constant-Murley score (CMS), strength, and painfree range of motion in four directions. Results. Sixty-seven patients (mean age= 57, SD: 15 (range: 25–87), range: 35–86, 35 females, 32 males) were included in analysis. The average symptom duration was 5 years. Fifteen (22%) patients had left shoulder involvement with 37 (55%) having right shoulder problem and 15(22%) reporting bilateral complaints. The right shoulder was operated on in 41 (61%) patients. Fifty two (78%) patients had an associated subacromial decompression [49 (73%) had acromioplasty and 27 (40%) had resection of the lateral end of the clavicle with some procedures overlapping]. Paired student t-tests showed a statistically significant improvement in scores of ASES and CMS (p<0.001) and painfree range of motion (p=0.02) at 1 year follow-up. However, no change was observed in strength (p>0.05). Conclusion. Arthroscopic debridement with or without acromioplasty /resection of the lateral end of the clavicle improves disability and painfree range of motion in patients suffering from osteoarthritis of glenohumeral joint at one year following surgery

Background: The common surgical procedure in the treatment of bilateral shoulder osteoarthritis is surgical correction in two steps. There is little experience regarding the safety and the effectiveness of the simultaneous bilateral shoulder arthroplasty, as for other joints like knee and hip. In this study the results of the surgical procedure of both shoulders, in a single surgical stage, are presented and compared with an equal number of patients who underwent total shoulder arthroplasty in both their shoulders in two different stages. Materials and Method: We studied a series of 7 patients treated with bilateral shoulder arthroplasty in a single stage procedure for severe degenerative glenohumeral joint disease. The average age at the time of surgery was 72 years. These were 4 patients with primary osteoarthritis (8 total anatomical prostheses) and 3 patients with rotator cuff arthropathy (6 reverse prostheses). The second series include 7 consecutive patients who underwent the same shoulder arthroplasties in two different stages for the same diseases. The average age was 69 years and the time between the two operations was 6 to 12 months. The effectiveness of each one of the two procedures was evaluated on the basis of multiple objective characteristics like safety, total surgical duration, total blood loss, Constant Score, range of motion of the joints, post-surgical discomfort (pain, stiffness, motion, disability), post-surgical complications and ability of resumption of daily living activities. Results: The average follow up was 18 months. Patients that underwent bilateral shoulder arthroplasty in one stage had significantly shorter total time of in-hospital stay (mean stay 5 days in the first and 9.3 days in the second group), recovery (9 weeks vs. 20 weeks) and proportionately lower rate of post-operative blood loss in comparison with the patients that were treated with two different surgical procedures. The average need for blood transfusion was 2 blood units in the first group and 3.5 blood units in the second. The overall rate of complication was the same in two groups. The Constant Score improvement and the joint function, range of motion and pain improved more, but not in a statistically significant degree in the single-stage group. Conclusions: Bilateral shoulder arthroplasty in a single stage, in carefully chosen patients regarding their general condition, is a safe procedure, not associated with increase in complications, yielded better clinical results, reduced in-hospital stay and recovery period and decreased patient discomfort in comparison to the standard surgical procedure in two surgical stages and must be considered for selected cases

Introduction:. Total shoulder arthroplasty (TSA) is the current standard treatment for severe osteoarthritis of the glenohumeral joint [1]. Often, severe arthritis is associated with abnormal glenoid version or excessive posterior wear [2]. Reaming to correct more than 15° of retroversion back to neutral is not ideal as it may remove an excessive amount of the outer cortical support and medialize the glenoid component [3]. Two recent glenoid components with posterior augments—wedged and stepped—have been designed to address excessive posterior wear and to allow glenoid component neutralization. Hypothetically, these augmented glenoid designs lessen the complications associated with using a standard glenoid component in cases of shoulder osteoarthritis with excessive posterior wear. We set out to determine which implant type (standard, stepped, or wedged) corrects retroversion while removing the least amount of bone in glenoids with posterior erosion. Methods:. Serial shoulder CT scans were obtained from 121 patients before total shoulder arthroplasty. These were then classified using the Walch Classification. We produced 3D models of the scapula from CT scans for 10 subjects that were classified as B2 using the software MIMICS (Materialise, Belgium). Each of these 10 glenoid subjects were then virtually implanted with standard, stepped, and wedged glenoid components (Fig 1). The volume of surgical bone removed and maximum reaming depth were calculated for each design and for each subject. In addition, the area of the backside of the glenoid in contact with cancellous versus cortical bone was calculated for each glenoid design and for each subject (Fig 2). ANOVA testing was performed. Results:. Arthritic bone loss in shoulder specimens was always posteroinferior, and the worn portion or neoglenoid made up an average of 68 ± 11% in the shoulder specimens. Mean surgical bone volume removed (2857 ± 1618 mm. 3. ) was least for the wedged component when compared to stepped (4307 ± 1485 mm. 3. , p=.0003) and conventional (5385 ± 2348 mm. 3. , p=.0003) designs. Maximum bone depth removed for the wedge (4.5 ± 2.3 mm) was less than the stepped (7.6 ± 1.4 mm, p=.00003) and conventional (9.7 ± 2.7 mm, p=.00001). The mean percentage of the implant's back surface supported by cancellous bone was 17.0% for the conventional, 6.1% for the stepped (p=.009), and 3.1% for the wedged (p=.0001). Discussion:. Both wedged and stepped components were able to correct glenoid version to neutral and required less bone removal, required less reaming depth, and were supported by more cortical bone than the standard implant. The wedged component was significantly better in these three categories than the stepped implant. There may be a mismatch between the usual patterns of wear that occurs in B2 glenoids where neoglenoid comprises (68 ± 11%) vs. the stepped implant's 50%. A stepped implant that matches the usual B2 glenoid may correct version while removing less bone than the current design

Background. Degeneration of the shoulder joint is a frequent problem. There are two main types of shoulder degeneration: Osteoarthritis and cuff tear arthropathy (CTA) which is characterized by a large rotator cuff tear and progressive articular damage. It is largely unknown why only some patients with large rotator cuff tears develop CTA. In this project, we investigated CT data from ‘healthy’ persons and patients with CTA with the help of 3D imaging technology and statistical shape models (SSM). We tried to define a native scapular anatomy that predesignate patients to develop CTA. Methods. Statistical shape modeling and reconstruction:. A collection of 110 CT images from patients without glenohumeral arthropathy or large cuff tears was segmented and meshed uniformly to construct a SSM. Point-to-point correspondence between the shapes in the dataset was obtained using non-rigid template registration. Principal component analysis was used to obtain the mean shape and shape variation of the scapula model. Bias towards the template shape was minimized by repeating the non-rigid template registration with the resulting mean shape of the first iteration. Eighty-six CT images from patients with different severities of CTA were analyzed by an experienced shoulder surgeon and classified. CT images were segmented and inspected for signs of glenoid erosion. Remaining healthy parts of the eroded scapulae were partitioned and used as input of the iterative reconstruction algorithm. During an iteration of this algorithm, 30 shape components of the shape model are optimized and the reconstructed shape is aligned with the healthy parts. The algorithm stops when convergence is reached. Measurements. Automatic 3D measurements were performed for both the healthy and reconstructed shapes, including glenoid version, inclination, offset and critical shoulder angle. These measurements were manually performed on the mean shape of the shape model by a surgeon, after which the point-to-point correspondence was used to transfer the measurements to each shape. Results. The critical shoulder angle was found to be significantly larger for the CTA scapulae compared to the references (P<0.01). When analyzing the classified scapulae significant differences were found for the version angle in the scapulae of group 4a/4b and the critical shoulder angle of group 3 when compared to the references (P<0.05). Conclusion. Patients with CTA have a larger critical shoulder angle compared with reference patients. Some significant differences are found between the scapulae from patients in different stages of CTA and healthy references, however the differences are smaller than the accuracy of the SSM reconstruction. Therefore, we are unable to conclude that there is a predisposing anatomy in terms of glenoid version, inclination or offset for CTA

PURPOSE. To validate the efficacy and accuracy of a novel patient specific guide (PSG) and instrumentation system that enables minimally invasive (MI) short stemmed total shoulder arthroplasty (TSA). MATERIALS AND METHODS. Using Amirthanayagam et al.'s (2017) MI posterior approach reduces incision size and eliminates subscapular transection; however, it precludes glenohumeral dislocation and the use of traditional PSGs and instruments. Therefore, we developed a PSG that guides trans-glenohumeral drilling which simultaneously creates a humeral guide tunnel/working channel and glenoid guide hole by locking the bones together in a pre-operatively planned pose and drilling using a c-shaped drill guide (Figure 1). To implant an Affinis Short TSA system (Mathys GmbH), novel MI instruments were developed (Figure 2) for: humeral head resection, glenoid reaming, glenoid peg hole drilling, impaction of cruciform shaped humeral bone compactors, and impaction of a short humeral stem and ceramic head. The full MI procedure and instrument system was evaluated in six cadaveric shoulders with osteoarthritis. Accuracy was assessed throughout the procedure: 1) PSG physical registration accuracy, 2) guide hole accuracy, 3) implant placement accuracy. These conditions were assessed using an Optotrak Certus tracking camera (NDI, Waterloo, CA) with comparisons made to the pre-operative plan using a registration process (Besl and McKay, 1992). RESULTS. 3D translational accuracy of PSG physical registration was: humeral PSG- 2.2 ± 1.1 mm and scapula PSG- 2.5 ± 0.7 mm. The humeral and scapular guide holes had angular accuracies of 6.4 ± 3.2° and 8.1 ± 5.1°, respectively; while the guide hole positional accuracies on the articular surfaces (which will control bone preparation translational accuracy) were 2.9 ± 1.2 mm and 2.8 ± 1.3 mm. Final implantation accuracy in translation was 2.9 ± 3.0 mm and 5.7–6.8 ± 2.2–4.0° across the implants’ three rotations for the humerus and in translation was 2.8 ± 1.5 mm and 2.3–4.3 ± 2.2–4.4° across the implants’ three rotations for the scapula (Figure 3). DISCUSSION. The overall implantation accuracy was similar to results of previously reported open, unassisted TSA (3.4 mm & 7–12°, Hendel et al., 2012, Nguyen et al., 2009). Analysis of the positional PSG registration accuracy very closely mirrors the final implantation accuracy (humerus:2.2 mm vs 2.9 mm, and scapula:2.2 mm vs 2.8mm), thus, this is likely the primary predictor of implantation accuracy. Furthermore, the greatest component of PSG registration error was mediolateral translation (i.e. along the guiding axis) and thus should not affect guide hole drilling accuracy. The drilled guide hole positional and angular error was low for the humerus (2.9 mm and 6.4°) but somewhat higher in rotation (8.1°) for the glenoid which may indicate a slight shift in the PSG prior to guide hole drilling due to the weight of the arm applied when the PSGs are locked together. In conclusion, this work has detailed the step-by-step surgical errors associated with the developed system and demonstrated that it achieves similar accuracy to open, unassisted TSA, while avoiding complications related to muscular transection and dislocation. Therefore, we believe this technique is worthy of clinical investigation

Aims

To systematically review the predominant complication rates and changes to patient-reported outcome measures (PROMs) following osteochondral allograft (OCA) transplantation for shoulder instability.

Introduction. Shoulder arthroplasty is used to treat several common pathologies of the shoulder, including osteoarthritis, post-traumatic arthritis, and avascular necrosis. In replacement of the humeral head, modular components allow for anatomical variations, including retroversion angle and head-neck angle. Surgical options include an anatomic cut or a guide-assisted cut at a fixed retroversion and head-neck angle, which can vary the dimensions of the cut humeral head (height, anteroposterior (AP), and superoinferior (SI) diameters) and lead to negative long term clinical results. This study measures the effect of guide-assisted osteotomies on humeral head dimensions compared to anatomic dimensions. Methods. Computed tomography (CT) scans from 20 cadaveric shoulder specimens (10 male, 10 female; 10 left) were converted to three-dimensional models using medical imaging software. An anatomic humeral head cut plane was placed at the anatomic head – neck junction of all shoulders by a fellowship trained shoulder surgeon. Cut planes were generated for each of the standard implant head-neck angles (125°, 130°, 135°, and 140°) and retroversion angles (20°, 30°, and 40°) in commercial cutting guides. Each cut plane was positioned to favour the anterior humeral head-neck junction while preserving the posterior cuff insertion. The humeral head height and diameter were measured in both the AP plane and the SI plane for the anatomic and guide-assisted osteotomy planes. Differences were compared using separate two-way repeated measures ANOVA for each dependent variable and deviations were shown using box plot and whisker diagrams. Results. Guide-assisted cuts tend to be smaller than the anatomic humeral head dimensions. Retroversion angle showed a significant effect on head height, AP, and SI diameters (p=0.002). The effect of head-neck angle was only significant for SI diameter (p<0.001). The largest dimensional deviation was observed at 20 degrees of retroversion and resulted in a 2.5mm decrease in humeral head height, averaged over the range of head-neck values. Conclusion. Where patient's natural anatomy falls outside the range of commercial cutting guides, resection according to the template may result in a deviation from the natural dimensions of the humeral head, which impacts the sizing of the implant head component. This has implications for both manufacturers to create a template that has a larger range of retroversion angles, as well as surgeons' choices in intra-operative planning

Background. Massive rotator cuff tears and consequent cuff-deficient arthritis (CTA) of the shoulder can cause severe shoulder dysfunction in the elderly. Reverse total shoulder arthroplasty (RTSA) has been widely used for treatment of CTA in all over the world since its introduction in the 90's. In Japan, however, we have just started to clinically use RTSA from April 2014. In addition, we have only one choice of the implants (Aequalis Reverse, Tornier) currently, and only one size of the base-plate of the glenoid component (29 mm in diameter) is available so far. Japanese, especially elderly people, have generally smaller figure than Caucasians. We are not sure whether the base-plate would fit for the smaller Japanese. The purpose of this study was to measure the size of the glenoids in Japanese using CT images and to examine that they would fit the 29 mm base-plate. Methods. The shoulders without osteoarthritis of the glenohumeral joint were eligible for the study. The subjects consisted of 30 shoulders including 10 elderly males, 10 elderly females, and 10 younger males, and the mean ages were 73 (range, 63–81), 74 (range, 65–89), and 32 (range, 27–36) years old, respectively. Mean heights and weights were 164 cm (range, 156–179) and 59 kg (range, 49–72), 154 cm (range, 151–161) and 57 kg (range, 48–65), and 173 cm (range, 162–179) and 72 kg (range, 61–100), respectively. CT images with a 0.3 mm slice pitch were used for the analysis. The images were loaded into a DICOM viewer (OsiriX), and a slice for simulated implantation of the base-plate was created using the multi-planar reconstruction (Figure 1), which had 10° of inferior tilt to the glenoid face. The width of the glenoid in the antero-posterior direction was measured at 14 mm above the inferior edge of the glenoid. Results. Mean widths for the elderly males, elderly females, and younger males were 27.7 mm (range, 24.8–28.9), 25.3 mm (range, 24.4–25.9), and 27.8 mm (range, 25.9–29.8), respectively. Discussion. The present study revealed that most of the younger and elderly males would fit the 29 mm base-plate. However, the glenoid width of all elderly females in this study was much smaller than the base-plate diameter. The base-plate with smaller diameter is indispensable for Japanese, and the pre-operative planning may be important for secure surgeries

INTRODUCTION. The aim of this retrospective study is to evaluate clinically and radiographically the effectiveness of implanting an eccentric glenosphere and if a correct glenosphere positioning would avoid the occurrence of notching. METHODS. since 2006 40 patients with shoulder eccentric osteoarthritis were treated with reverse shoulder arthroplasty with a 36 mm eccentric glenosphere. We have selected 25 patients, with a minimum follow up of 24 months. The patients were clinically evaluated with the Constant score and SST and with X-ray, MRI and/or CT before and after surgery. At the follow up we evaluated the presence or absence of notch, and we measured the PSNA (prosthesis-scapular neck angle), the DBSNG (distance between the scapular neck angle and glenosphere), the PGRD distance (peg glenoid distance). Stastistical analysis was performed with a paired t test. RESULTS. In every patient the range of motion was improved. The AP X-ray did not show inferior scapular notching. The mean DBSNG, was found to be 4.3 mm. The mean PSNA was 92 ° and the mean PGRD was 21.2. The Constant score improved from 30 to 74 points and the SST from 1.7 to 8.4 points. DISCUSSION and CONCLUSION. The scapular notching is shown as the most frequent complication in reverse shoulder replacement. In our study the results indicate that proper positioning of the glenosphere with the inferior part of the metal back that overlaps the lower glenoid rim without overhang and the implantation of an eccentric glenosfere, lowers the center of rotation of 4 mm and avoid contact between the humeral component and the scapular neck during the adduction. Thus, all the patients increased the total joint range of motion

We reviewed 12 patients with primary glenoid dysplasia. Ten were assessed clinically and two from case notes and radiographs. We identified two groups according to the age at onset of symptoms. The first (seven patients) consisted of boys and younger men, all of whom developed symptoms before the age of 40 years. All four children were free from pain, whereas the three adults in this group had varying degrees of this. Four patients had symptoms of instability. The second group consisted of older men (five patients) all of whom had noted the onset of symptoms, in the form of pain and stiffness, after the age of 40 years. All five had radiological evidence of osteoarthritis. Although the four children in our study had minimal symptoms, all eight adults had ongoing shoulder pain and dysfunction, despite a specific rehabilitation programme. Four patients required surgery; one had posterior stabilisation for instability and three arthroplasties of the shoulder for osteoarthritis

Aims

Shoulder arthroplasty using short humeral components is becoming increasingly popular. Some such components have been associated with relatively high rates of adverse radiological findings. The aim of this retrospective review was to evaluate the radiological humeral bone changes and mechanical failure rates with implantation of a short cementless humeral component in anatomical (TSA) and reverse shoulder arthroplasty (RSA).

Objectives

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.

The December 2015 Shoulder & Elbow Roundup360 looks at: