Shoulder Motion Analysis During Codman Pendulum Exercises.

Purpose: To quantify shoulder motion during Codman pendulum exercises.

Methods: Shoulder kinematics were analyzed in 17 healthy volunteers using a validated biomechanical model coupling patient-specific imaging and motion capture. Participants were instructed to perform medio-lateral, antero-posterior and circular pendulum exercises.

Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: a 2-year MRI follow-up.

Background: partial-thickness rotator cuff tears frequently enlarge due to increased local strain and often progress to full-thickness tears. Studies suggest the addition of new tendinous tissue to injured cuff tendons would significantly decrease peak strain, possibly protecting against tear progression. The aim of this study was to assess the ability of a highly-porous collagen implant to induce new tissue formation and limit tear progression when placed on the bursal surface of partial-thickness cuff tears.

Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial.

Background: Lasting disability and further falls are common and costly problems in older people following fall-related lower limb and pelvic fractures. Exercise interventions can improve mobility after fracture and reduce falls in older people, however the optimal approach to rehabilitation after fall-related lower limb and pelvic fracture is unclear. This randomised controlled trial aims to evaluate the effects of an exercise and fall prevention self-management intervention on mobility-related disability and falls in older people following fall-related lower limb or pelvic fracture.

Preliminary investigation of a biological augmentation of rotator cuff repairs using a collagen implant: a 2-year MRI follow-up.

Background: the inability to restore the normal tendon footprint and limit strains on the repair site are thought to contribute to re-tearing following rotator cuff repair. The purpose of this study was to use a collagen implant to augment rotator cuff repairs through the restoration of the native tendon footprint and the induction of new tissue to decrease overall tendon strain.

Methods: repairs of full-thickness rotator cuff lesions in 9 adult patients were augmented with a novel collagen implant placed over the bursal surface of the repair.

Altered stress induced by partial transection of the infraspinatus tendon leads to perlecan (HSPG2) accumulation in an ovine model of tendinopathy.

Perlecan is a widely distributed, heparan sulphate proteoglycan with roles in the sequestration of FGFs, PDGF, VEGF through which it promotes cell proliferation and matrix production. Perlecan also stabilises extracellular matrices through interaction with a diverse range of matrix components. This study examined the distribution of perlecan in an ovine partial transection tendinopathy model.

Surgical management of traumatic anterior glenohumeral instability: an international perspective.

The treatment of traumatic anterior glenohumeral instability has evolved considerably in recent years. The results of arthroscopic repair have considerably improved, and, for many surgeons, arthroscopic techniques have supplanted traditional open techniques. Although a scoring system and other assessment tools can be useful, the choice of a surgical treatment for glenohumeral stabilization requires a careful assimilation of the patient's expectations and the surgeon's experience as well as an understanding of the relevant individual pathoanatomy.

Complex shoulder disorders: evaluation and treatment.

Evaluation of patients with shoulder disorders often presents challenges. Among the most troublesome are revision surgery in patients with massive rotator cuff tear, atraumatic shoulder instability, revision arthroscopic stabilization surgery, adhesive capsulitis, and bicipital and subscapularis injuries. Determining functional status is critical before considering surgical options in the patient with massive rotator cuff tear.

Photoelastic comparison of strains in the underlying glenoid with metal-backed and all-polyethylene implants.

An alteration in the stress and strain environment following arthroplasty is believed to lead to bone remodeling, which can trigger implant loosening and subsequent failure. Bone remodeling, while well-studied in hip arthroplasty, has received less attention in total shoulder replacement. This study examines differences in strain states between intact glenoids and following replacement with an uncemented metal backed keeled component and a cemented all polyethylene pegged component with the same articular geometry, using the photoelastic method.

Proteoglycan 4 downregulation in a sheep meniscectomy model of early osteoarthritis.

Osteoarthritis is a disease of multifactorial aetiology characterised by progressive breakdown of articular cartilage. In the early stages of the disease, changes become apparent in the superficial zone of articular cartilage, including fibrillation and fissuring. Normally, a monolayer of lubricating molecules is adsorbed on the surface of cartilage and contributes to the minimal friction and wear properties of synovial joints.

Regional assessment of articular cartilage gene expression and small proteoglycan metabolism in an animal model of osteoarthritis.

Osteoarthritis (OA), the commonest form of arthritis and a major cause of morbidity, is characterized by progressive degeneration of the articular cartilage. Along with increased production and activation of degradative enzymes, altered synthesis of cartilage matrix molecules and growth factors by resident chondrocytes is believed to play a central role in this pathological process. We used an ovine meniscectomy model of OA to evaluate changes in chondrocyte expression of types I, II and III collagen; aggrecan; the small leucine-rich proteoglycans (SLRPs) biglycan, decorin, lumican and fibromodulin; transforming growth factor-beta; and connective tissue growth factor.

Should acute anterior dislocations of the shoulder be immobilized in external rotation? A cadaveric study.

The high recurrence rate associated with anterior shoulder dislocations may reflect inadequate healing of a Bankart lesion when the arm is immobilized in internal rotation. The effect of external rotation (ER) of the humerus on the glenoid-labrum contact of Bankart lesions was examined in 10 human cadaveric shoulders. The contact force between the glenoid labrum and the glenoid was measured in 60 degrees of internal rotation, neutral rotation, and 45 degrees of ER in 10 human cadaveric shoulders.

What is the role of joint replacement surgery?

Now into the fourth decade of widespread clinical acceptance and use, joint replacement surgery has had a major impact on the preservation of physical independence and general health in the ageing population. However, today's data are tomorrow's history. Rather than tell clinicians and patients what they might expect today from yesterday's procedure, this chapter surveys the role of joint replacement in the treatment of degenerative disease, assesses the associated fiscal burden on society and notes the significant gaps in our current knowledge.

Internal fixation of symptomatic os acromiale: a series of twenty-six cases.

Twenty-six patients who presented to our shoulder service with a symptomatic meso-os acromiale were reviewed. All had been initially treated for impingement symptoms. Nonoperative treatment had failed in all patients.

Regional antibiotic prophylaxis in elbow surgery.

In this study we describe a technique for the delivery of regional antibiotic prophylaxis in patients undergoing elbow surgery and compare tissue antibiotic concentrations achieved by this technique with those achieved by standard systemic intravenous prophylaxis. We collected bone and fat samples from patients undergoing elective elbow surgery who had received regional antibiotic prophylaxis and measured the tissue antibiotic concentration. For comparison, we measured the antibiotic concentration in bone and fat samples taken from patients undergoing elective shoulder surgery who had received systemic prophylaxis.

Biomechanical analysis of five fixation techniques used in glenohumeral arthrodesis.

Background: The purpose of the present study is to compare five fixation techniques in shoulder fusion. The most common complications resulting from shoulder fusion, non-union and unacceptable arm position, might reflect a failure to achieve rigid fixation during the surgical procedure.

Methods: Twenty-five shoulder fusions were carried out on human cadaveric specimens using the following techniques: screw fixation, external fixation, external fixation supplemented with screw fixation, single plate fixation and double plate fixation.

Role of community diagnostic ultrasound examination in the diagnosis of full-thickness rotator cuff tears.

Background: Diagnostic ultrasound examination has become the most commonly used investigation in Australia for diagnosing rotator cuff tears. The authors felt that the results of such investigations were often inaccurate in their clinical practices.

Methods: The diagnostic ultrasound findings in 336 cases were compared to arthrography, and in 225 cases findings at surgery.

Structural factors affecting the outcome of rotator cuff repair.

A retrospective review of 667 rotator cuff tears analyzed structural factors that might influence outcome. Tear size was not found to be an indicator of likely patient satisfaction, and concomitant rupture of the biceps tendon did not prejudice the outcome. In this first reported study of the influences of delamination disease and the surgical manner in which it is treated, it was found that at least when treated by interlaminar curettage before repair, cuff delamination did not appear to prejudice patient satisfaction.

Outcome of rotator cuff repair.

From 710 consecutive open rotator cuff repairs by a single surgeon, the results of 667 were available for detailed analysis. Patient-assessed outcomes and the ability to perform specific activities of daily living, employment, and recreation were correlated with independent nonstructural variables including age, sex, workers' compensation status, and revision surgery status. The study shows that patient self-assessment of satisfaction is very high, with 87.