Shoulder & Elbow

Type II superior labral (SLAP) tears commonly occur in athletes in the abducted and externally rotated position in the late cocking phase of throwing. This study investigates arthroscopic repairs of SLAP lesions using a knotless polymeric (KINSA) anchor.

Superficial tissues were dissected from 10 cadaveric shoulders. The glenohumeral capsule was preserved. Type II SLAP tears were created through arthroscopic portals and repaired with two anchors anterior and posterior to the biceps tendon. Glenohumeral joints were then fixed in 60° gleno-humeral abduction in the scapular plane with 1 Nm torque in external rotation to recreate the late cocking phase of the throwing cycle. Specimens were mounted onto an Instron machine and the biceps tendon was loaded until failure.

The mean ultimate peak load was 239 N (SD 101 N). The primary mode of failure was in the tendon substance and 19 out of 20 anchors remained intact in bone.

To our knowledge this is the first study to investigate arthroscopic SLAP repairs in an intact joint in this susceptible position. We conclude that the KINSA anchor can withstand high tensile loads and may be used to treat SLAP tears in high-demand overhead throwing athletes.

Glenoid component fixation remains an issue in the long-term survival of total shoulder arthroplasty. As a consequence revision of the glenoid component is becoming increasingly more common and reconstructive techniques to preserve and restore bone stock are becoming more important.

In this article we describe the combined technique of impaction grafting and glenoid component exchange together with a classification of the glenoid defect with a report on four sequential cases in patients with rheumatoid arthritis with an average age of 56 years. The minimum follow-up was 34 months (range 34 months to 62 months).

Patients reported excellent pain relief and some improvement in motion and function. The complication rate remains low. Radiological assessment using tomograms showed good incorporation of the bone graft and minimal signs of glenoid loosening.

The results of this study confirm that at least in the short term impaction grafting techniques used to reconstitute the glenoid in revision surgery can be successful.

To determine whether a correlation exists between the clinical symptoms and signs of impingement, and the severity of the lesions seen at bursoscopy.

Fifty-five patients who underwent arthroscopic subacromial decompression were analyzed. Pre-operatively patients completed an assessment form consisting of visual analogue pain score, and shoulder satisfaction. The degree of clinical impingement was also recorded. At arthroscopy impingement was classified according to the Copeland-Levy classification. Post-operatively the shoulder assessment was repeated. Statistical analysis was carried to determine if the degree of impingement at arthroscopy correlated with pre-operative pain, satisfaction and clinical signs of impingement.

Pre-operative pain level, shoulder satisfaction and degree of clinical impingement did not correlate significantly with severity of the lesions of the acromion and cuff. (average correlation coefficient r² 0.018.) There was no correlation between the improvement in the shoulders post-operatively and the severity of lesions (r² 0.008).

There was no correlation between pain, clinical signs or outcomes of subacromial decompression and the severity of impingement lesions seen at arthroscopy.

Osteoarthritis of the elbow is a difficult problem to treat. The results of total joint arthroplasty have historically been poor.

Seventy-nine patients who underwent ulnohumeral arthroplasty between 1994 and 2002 were included in the study. Fifty-nine elbows in 58 patients were available for clinical assessment. There were 14 females and 44 males with an average age of 63 years (32 to 80) and a mean follow-up of 7.8 years (5 to 12). There were 39 (67%) patients with primary osteoarthritis, 18 (31%) with post-traumatic and 1 patient with post-septic arthritis of the elbow.

Using the visual analogue scale (VAS) (0 to 10), the pain score was seen to improve from 8 (6 to 10) to 3.8 (0 to 9). Twenty six patients (44%) were on minimal or no analgesia. The arc regarding flexion/extension was found to increase by 18°. Twenty-four percent of patients suffered an adverse incident. Radiologically 28 (6%) patients had recurrent bone formation in the olecranon fossa. This however did not correspond to the clinical outcome. Patients with loose bodies seemed to do better in the post-operative phase.

Ulnohumeral arthroplasty has a role in the management of the arthritic elbow as it provides pain relief in the post-operative period. However the improvement in the range of movement is limited particularly with regard to the arc of extension. This improvement in pain appears to diminish with time.

This was a retrospective study presenting our results and survivorship of the Acclaim total elbow when used as a revision implant.

Between May 2001 and July 2005, 29 revision elbow replacements were carried out on 28 patients in our institution. Five were redo revisions and one received the fourth sequential implant. A variety of implants were removed for aseptic loosening (17), periprosthetic fracture (7), dislocation (3) and infection (2). Two patients had died and one was unavailable for follow-up.

At a mean follow-up of 50 months (12 to 80 months) pain, functional assessment scores and radiographs were assessed and a Kaplan-Meier survival curve created. Symptoms were reliably relieved with 72% reporting no pain. Mean flexion was 128° with loss of full extension of 34°. Complications were noted in six cases of which three patients underwent further surgery. None of the 29 revisions has been re-revised till date.

The medium term results for this implant suggest it is an effective revision prosthesis.

Tennis elbow is a chronic condition that can be challenging to treat. Physiotherapy is often a treatment of choice, but previous reviews have failed to draw any conclusions as to which is the most effective therapeutic modality in the management of this condition.

The best available evidence is for active exercise approaches, possibly supplemented by manual therapy and taping treatments. There is insufficient evidence to recommend the use of passive modalities such as electrotherapy or acupuncture at present. Physiotherapy is a cost effective form of treatment.

Arthroscopic shoulder stabilization for anterior instability should enable athletes to return to their full pre-injury level of sport.

We reviewed case notes and sent postal questionnaires to establish the recurrent instability rate and also the rate of return to sport in athletes after surgery.

In 120 procedures, surgery achieved successful stabilization in 88%, but only 51% returned to full sporting activity. Patients aged 30 years or under were twice as likely to return to their pre-injury level of sport than those aged over 30 years. Half of those patients who did not return to sport had no subjective symptoms of instability but were inhibited by fear of further injury alone. Successful stabilization of the shoulder did not always translate into the desired outcome.

In order to increase the number of athletes returning to sport following primary arthroscopic stabilization of the shoulder, those patients with no restrictive symptoms should be encouraged to return to full activity. We plan to tailor rehabilitation to the specific needs of individual patients and now feel better able to inform athletes deciding on surgery.

The aim of this study was to evaluate, prospectively, outcomes following arthroscopic capsular release on patients with a clinical diagnosis of frozen shoulder, comparing immediate mobilization (IM) vs immediate mobilization plus external rotation splintage at night for 10 nights (IM+EXT).

Patients with a clinical diagnosis of non-traumatic frozen shoulder seen in a single unit from May 2005 to December 2006 were considered for inclusion. Patients were assessed using the Constant score, Oxford shoulder questionnaire, and a visual analogue scale for pain (VAS pain). Patients were randomized to have immediate mobilization (IM) or immediate mobilization plus external rotation splintage at night for 10 nights (IM+EXT).

Thirty patients were included and both groups showed significant improvement in all scores. Mean length of follow-up was 17 months. There was early (4 weeks post-operatively) significant improvement in shoulder function in both groups. The rehabilitation regime used did not affect the overall outcome.

Arthroscopic capsular release produces early symptom improvement in primary frozen shoulder. The use of an external rotation splint at night does not appear to improve outcome over simple early mobilization.