Appropriateness of prior authorization requirements for total shoulder arthroplasty: a systematic review.

Background: Total shoulder arthroplasty has become increasingly utilized for managing glenohumeral osteoarthritis (GHOA), with procedure rates expected to rise. Consequently, there has been a surge in prior authorization (PA) requests for total shoulder arthroplasty, imposing a substantial administrative burden and highlighting the need for physician advocates to challenge the current PA system. A notable PA requirement is preoperative physical therapy (PT), a treatment modality for GHOA that has not been extensively studied and is not endorsed by the American Academy of Orthopeadic Surgery as necessary for the treatment for GHOA.

Evaluation of Diaphragmatic Function after Interscalene Block with Liposomal Bupivacaine: A Randomized Controlled Trial.

Background: Interscalene blocks provide analgesia for shoulder surgery but also cause phrenic nerve paralysis. Liposomal bupivacaine is approved for use in interscalene blocks with the potential to provide longer pain control. However, the impact of liposomal bupivacaine on the phrenic nerve has not been evaluated.

Perioperative Management in Reverse Total Shoulder Arthroplasty.

Purpose Of Review: A successful reverse total shoulder arthroplasty requires careful preoperative planning and perioperative management. Preoperative comorbidity risks, perioperative pain management, and postoperative rehabilitation are all critical components of this arthroplasty. The current review examines available literature to guide the perioperative care of the reverse total shoulder arthroplasty patient.

Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making.

Background: The optimal surgical approach for recurrent anterior shoulder instability remains controversial, particularly in the face of glenoid and/or humeral bone loss. The purpose of this study was to use a contingent-behavior questionnaire (CBQ) to determine which factors drive surgeons to perform bony procedures over soft tissue procedures to address recurrent anterior shoulder instability.

Methods: A CBQ survey presented each respondent with 32 clinical vignettes of recurrent shoulder instability that contained 8 patient factors.

Hemiarthroplasty and Total Shoulder Arthroplasty Conversion to Reverse Total Shoulder Arthroplasty.

Purpose Of Review: The incidence of shoulder arthroplasty is increasing dramatically for primary arthroplasty but also for revision arthroplasty. Revision to reverse total shoulder arthroplasty is increasingly the salvage operation for failed primary arthroplasty. The purpose of this review is to explore the indications for and results of revision reverse total shoulder arthroplasty.

Outpatient and Semi-Outpatient Total Shoulder Replacement: Patient Selection and Program Management.

Shoulder arthroplasty has traditionally been viewed as an inpatient procedure because of the inherent medical comorbidities associated with an aging population and the need for postoperative pain control. Recent studies have shown that in appropriately selected patients, shoulder arthroplasty procedures can be safely done as outpatient procedures and can deliver economic value in today's cost-conscious health care environment. Several factors help ensure a successful surgical outcome, including cooperation from the ambulatory anesthesia service, proper patient selection, and perioperative pain control.

Retrospective review of open and arthroscopic repair of anterosuperior rotator cuff tears with subscapularis involvement: a single surgeon's experience.

Background: There have been conflicting results when comparing outcomes of open vs. arthroscopic anterosuperior rotator cuff repairs with subscapularis involvement. The purpose of this study was to evaluate midterm outcome differences and complications following open vs.

Neck-shoulder crossover: how often do neck and shoulder pathology masquerade as each other?

Cases of consecutive new patients seen at orthopedic spine and shoulder clinics were reviewed. Four percent of spine patients had significant shoulder pathology, and 3.6% of shoulder patients had significant spine pathology.

Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy.

"Impingement syndrome" is a common diagnostic label for patients presenting with shoulder pain. Historically, it was believed to be due to compression of the rotator cuff tendons beneath the acromion. It has become evident that "impingement syndrome" is not likely an isolated condition that can be easily diagnosed with clinical tests or most successfully treated surgically.

Intermediate outcomes following percutaneous fixation of proximal humeral fractures.

Background: Mini-open reduction and percutaneous fixation of proximal humeral fractures historically results in good outcomes and a low prevalence of osteonecrosis reported with short-term follow-up. The purpose of this study was to determine the midterm results of our multicenter case series of proximal humeral fractures treated with percutaneous fixation.

Methods: Between 1999 and 2006, thirty-nine patients were treated with percutaneous reduction and fixation for proximal humeral fractures at three tertiary shoulder referral centers.

National trends in rotator cuff repair.

Background: Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair.

Methods: The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States.

Subacromial impingement syndrome.

Subacromial impingement syndrome (SIS) represents a spectrum of pathology ranging from subacromial bursitis to rotator cuff tendinopathy and full-thickness rotator cuff tears. The relationship between subacromial impingement and rotator cuff disease in the etiology of rotator cuff injury is a matter of debate. Both extrinsic compression and intrinsic degeneration may play a role.

A history of reverse total shoulder arthroplasty.

Background: Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arthroplasty designs.

Where to tenodese the biceps: proximal or distal?

Background: The best location for biceps tenodesis is controversial as surgeons have begun to question whether tenodesis location affects the incidence of residual bicipital postoperative pain. An open distal tenodesis technique has been previously proposed to eliminate remaining symptoms at the bicipital groove.

Questions/purposes: We asked the following questions: (1) Does a higher tenodesis in the biceps groove result in postoperative pain? And (2) can the tenodesis location be successfully moved more distally ("suprapectoral tenodesis") by an arthroscopic technique?

Methods: We retrospectively reviewed 17 patients undergoing arthroscopic biceps tenodesis and evaluated their tenodesis location, either within the upper half of the groove (five) or in the lower half of the groove or shaft (12).

Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?

Hypothesis: Conservative rehabilitation after arthroscopic rotator cuff repair does not result in long-term stiffness and improves rates of tendon healing.

Materials And Methods: We retrospectively evaluated 43 patients with full-thickness rotator cuff tears who underwent a standardized, conservative protocol of full-time sling immobilization without formal therapy for 6 weeks after arthroscopic repair. At 6 to 8 weeks of follow-up, we categorized patients as "stiff" if they demonstrated forward elevation of less than 100° and external rotation of less than 30° passively; all others were designated "nonstiff.

Do porous tantalum implants help preserve bone?: evaluation of tibial bone density surrounding tantalum tibial implants in TKA.

Background: TKA with conventional metal-backed tibial implants subjects the tibial metaphysis to stress shielding, with resultant loss of bone density.

Questions/purposes: We hypothesized tibial bone mineral density in patients with porous tantalum (trabecular metal) tibial baseplates would (1) more closely parallel tibial bone mineral density in the nonoperative control limb and (2) be better maintained than in conventional historical controls.

Patients And Methods: We prospectively followed 41 patients (35 men, six women) 60 years of age or younger undergoing TKA with uncemented trabecular metal tibial components.