The Critical Shoulder Angle as a Highly Specific Predictor of a Full-Thickness Rotator Cuff Tear: A Case-Control Study.

Background: The critical shoulder angle (CSA) has become an important topic of study in patients with rotator cuff tears (RCTs). However, there are conflicting data on whether the CSA can differentiate between patients with normal shoulder pathology and full-thickness RCTs on shoulder radiographs.

Purpose/hypothesis: The purpose of this study was to define the relationship between full-thickness RCTs and the CSA.

Global Health Inequities in Orthopaedic Care: Perspectives Beyond the US.

Purpose Of Review: The burden of musculoskeletal disease is increasing globally and disproportionately affecting people in low and middle income countries (LMIC). We sought to review global access to orthopaedic care, burden of trauma, research infrastructure, impact of surgical mission trips, implant availability, and the effect of COVID-19 upon the delivery of orthopaedic care worldwide.

Recent Findings: The majority of people in LMIC do not have access to safe, quality surgical care, and there are few fellowship-trained orthopaedic traumatologists.

Bony encasement of the ulnar nerve secondary to heterotopic ossification of the elbow: an evaluation of long-term outcomes.

Background: Ulnar neuropathy at the elbow caused by heterotopic ossification (HO) is a rare condition. This retrospective study aims to report on 32 consecutive cases of ulnar nerve encasement caused by elbow HO and evaluate long-term outcomes of operative management and a standardized postoperative rehabilitation regimen.

Methods: A retrospective case series was conducted on 32 elbows (27 patients) that underwent operative management of bony ulnar nerve encasement.

External Rotation Strength After TSA in Osteoarthritic Shoulders with Eccentric Deformity Is Not Impacted by Posterior Rotator Cuff Deficiency.

Background: Patients with persistent glenohumeral osteoarthritis symptoms despite nonoperative management may pursue anatomic total shoulder arthroplasty (TSA). TSA revision rates are higher in patients with preoperative eccentric (asymmetric posterior erosion) compared with concentric (symmetric) glenoid deformity. If posterior rotator cuff deficiency demonstrated preoperatively in patients with eccentric deformity persists after TSA, it may manifest as relative weakness in external compared with internal rotation secondary to deficient activity of the shoulder external rotator muscles.

No Strength Differences Despite Greater Posterior Rotator Cuff Intramuscular Fat in Patients With Eccentric Glenohumeral Osteoarthritis.

Background: When nonoperative measures do not alleviate the symptoms of glenohumeral osteoarthritis (OA), patients with advanced OA primarily are treated with anatomic total shoulder arthroplasty (TSA). It is unknown why TSAs performed in patients with eccentric (asymmetric glenoid wear) compared with concentric (symmetric glenoid wear) deformities exhibit higher failure rates, despite surgical advances. Persistent disruption of the posterior-to-anterior rotator cuff (RC) force couple resulting from posterior RC intramuscular degeneration in patients with eccentric deformities could impair external rotation strength and may contribute to eventual TSA failure.

Primary versus revision total shoulder arthroplasty: comparing relative value and reimbursement trends.

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes.

Trends in leadership at shoulder and elbow fellowships: a cross-sectional demographic review.

Objective: To determine educational characteristics, trends, and demographics among shoulder and elbow fellowship leaders (FLs).

Background: Fellowship leaders in shoulder and elbow impart lasting impact on trainees and field development. Four previous studies have analyzed the characteristics and career path trends among orthopedic surgery subspecialty FLs (spine, adult reconstruction, trauma, and sports medicine).

Short-Term Outcomes After Total Shoulder Arthroplasty in Octogenarians: A Matched Analysis.

Introduction Studies have shown that the use of total shoulder arthroplasty is increasing every year in the United Stated at a rate higher than that of total hip or total knee arthroplasty. As the population of the United States continues to age, it is becoming more important for surgeons to understand the true impact of age on outcomes and complications following procedures such a total shoulder arthroplasty. The purpose of this study was to determine if octogenarians have poorer outcomes after total shoulder arthroplasty compared to a younger, matched control group.

Interprofessional Inconsistencies in the Diagnosis of Shoulder Instability: Survey Results of Physicians and Rehabilitation Providers.

Background: Clinicians of many specialties within sports medicine care for athletes with shoulder instability, but successful outcomes are inconsistent. Consistency across specialties in the diagnosis of shoulder instability is critical for care of the athlete, yet the extent of divergence in its diagnosis is unknown.

Hypothesis: Physicians differ from rehabilitation providers in which findings they deem clinically important to differentiate shoulder instability from impingement, and in how they diagnose athlete scenarios with atraumatic shoulder instability.

Imbalance in Axial-plane Rotator Cuff Fatty Infiltration in Posteriorly Worn Glenoids in Primary Glenohumeral Osteoarthritis: An MRI-based Study.

Background: Fatty infiltration of the rotator cuff evaluated with CT has been associated with asymmetric glenoid wear and humeral head subluxation in patients with glenohumeral arthritis. The relationship between rotator cuff pathologic findings and abnormal glenoid wear plays an important role in determining the optimal surgical management of advanced glenohumeral osteoarthritis. Compared with CT, MRI has increased sensitivity for identifying rotator cuff conditions; therefore, prior studies using CT may have underestimated the association between fatty infiltration of the rotator cuff and abnormal glenoid wear.

Clinical Y-view versus 3-dimensional assessments of intramuscular fat in patients with full-thickness rotator cuff tears.

Rationale And Objectives: Recent evidence suggests an inhomogeneous distribution of intramuscular rotator cuff fat infiltration (FI) in a small sample of individuals with rotator cuff tears, yet clinically just a few slices at the scapular Y-view are used to evaluate FI in patients with rotator cuff tears. The purpose of this study was to determine if assessment of FI using the scapular Y-view is representative of the entire muscle in patients with full-thickness rotator cuff tears, and whether this varies by tear size.

Materials And Methods: Patients (N = 25) diagnosed with full-thickness rotator cuff tear and confirmed with magnetic resonance imaging (MRI) were included.

Partial rupture of the distal biceps brachii tendon: a magnetic resonance imaging analysis.

Background: This study is the largest cohort of partial distal biceps brachii tendon ruptures in the literature that was analyzed according to rupture morphology of the long and short tendon heads.

Methods: Patients with partial distal biceps tendon ruptures were identified using an institutional enterprise data warehouse query at a single institution. A retrospective chart review was performed to record patient demographics, past medical history, and injury mechanism for each patient.

Differences in 30-day outcomes between inpatient and outpatient total elbow arthroplasty (TEA).

Background: As the health care system in the United States shifts toward value-based care, there has been increased interest in performing total joint arthroplasty in the outpatient setting to optimize costs, outcomes, and patient satisfaction. Several studies have demonstrated success in performing ambulatory total knee and hip arthroplasty. The purpose of this study was to compare short-term outcomes and complications after total elbow arthroplasty (TEA) across the inpatient and outpatient operative settings.

The Quality and Accuracy of Online Resources for Total and Reverse Shoulder Replacement.

Recent literature suggests that many online patient resources are poor in quality and lack important clinical information. The purpose of this study was to investigate the value of online resources available to patients considering shoulder arthroplasty. A total of 84 websites were discovered with the terms "total shoulder replacement" (TSR) and "reverse shoulder replacement" (RSR), they were reviewed and graded for quality and accuracy.

Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi-beach chair position.

Background: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion.

Development of 3D method to assess intramuscular spatial distribution of fat infiltration in patients with rotator cuff tear: reliability and concurrent validity.

Background: Intramuscular fat infiltration is a critical factor in surgical decision-making and is the most important factor used to prognosticate surgical repair outcomes in patients with rotator cuff tears. Quantitative 3D assessment of total rotator cuff fat infiltration in patients with rotator cuff tears has been realized. However, a reproducible method to evaluate 3D spatial distribution of rotator cuff intramuscular fat has not been established.

Optimizing methods to quantify intramuscular fat in rotator cuff tears with normalization.

Objective: To determine which normalization method may best account for confounding individual factors, such as age or BMI, when quantifying fat infiltration on MRI in patients with rotator cuff tears, the effects of normalization using three different muscles (teres major; triceps brachii; teres minor) were compared.

Methods: Thirty-seven consecutive patients diagnosed with rotator cuff pathology were included. MRI fat-water sequences were used to quantify rotator cuff intramuscular fat (%fat).

Cross-cultural adaptation and validation of the Romanian Oxford Shoulder Score.

Background: The use of validated patient reported outcome scores is critical to the reporting and monitoring of the effectiveness of clinical treatment. The aim of this study was to translate and culturally validate the English Oxford Shoulder Score (OSS) to Romanian.

Methods: Approximately, 125 patients with disorders of the rotator cuff and proximal humerus fractures completed the translated Oxford Shoulder Score (OSS_RO), the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and EuroQol 5-Dimension (EQ-5D-5L).

The relationship between the incidence of adhesive capsulitis and hemoglobin A.

Background: Previous studies have shown no correlation between adhesive capsulitis and hemoglobin A (HbA). However, HbA is only a measure of short-term blood sugar control. We created a previously nonvalidated variable, cumulative HbA, that uses HbA values over time to estimate the total disease burden a single individual experiences over a period.

Latarjet Fixation: A Cadaveric Biomechanical Study Evaluating Cortical and Cannulated Screw Fixation.

Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure.

Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure.

Neurocognitive Deficits and Cerebral Desaturation During Shoulder Arthroscopy With Patient in Beach-Chair Position: A Review of the Current Literature.

Arthroscopic shoulder surgery with the patient in the beach-chair position (BCP) has been associated with neurocognitive complications caused by cerebral ischemia. We reviewed the current literature for the incidence of postoperative neurocognitive deficits, number of reported neurocognitive complications, and incidence of intraoperative cerebral desaturation events in patients who underwent arthroscopic shoulder surgery in the BCP. Among 10 studies with a composite enrollment of 24,701 patients, there was only 1 case of a postoperative neurocognitive deficit (overall incidence, 0.

Isolated Avulsion of Extensor Carpi Radialis Longus and Brachioradialis Origins: A Case Report and Surgical Repair Technique.

The mobile wad of the elbow provides a tremendous mechanical advantage with respect to elbow flexion and wrist extension. Injury to these structures causes significant upper extremity dysfunction. In this article, we report the case of a 31-year-old right hand-dominant man who sustained an isolated avulsion of the extensor carpi radialis longus and brachioradialis origins from the lateral epicondyle and lateral supracondylar ridge.

Effect of head and neck positioning on cerebral perfusion during shoulder arthroscopy in beach chair position.

The aim of this prospective cohort study was to investigate the effect of head and neck positioning on cerebral perfusion during shoulder arthroscopy in the beach chair position. Regional cerebral tissue oxygen saturation (rSO2) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. The head of each subject was manipulated by the examiner and sequentially positioned for 45 seconds in terminal flexion, extension, bilateral rotation, and bilateral lateral bending.

Heterotopic ossification of the elbow treated with surgical resection: risk factors, bony ankylosis, and complications.

Background: Heterotopic ossification is the most common extrinsic cause of elbow contracture and may lead to clinically important stiffness, and rarely, complete bony ankylosis. Surgery sometimes is performed to treat this problem, and published reports differ regarding the factors that are associated with success or failure after this operation and whether the procedure is effective for patients with elbow ankylosis.

Questions/purposes: We wished (1) to identify potential patient characteristics and modifiable risk factors that are associated with improvements in ROM after surgery for heterotopic ossification of the elbow; (2) to compare ROM gains between patients with complete ankylosis and partially restricted ROM; and (3) to characterize the complications of elbows treated by surgical release and excision of heterotopic ossification followed by a standardized rehabilitation program.