Anatomic Total Shoulder Arthroplasty: Component Size Prediction with 3-Dimensional Pre-Operative Digital Planning.

Background: The rate, complexity, and cost of total shoulder arthroplasty (TSA) continues to grow. Technology has advanced pre-operative templating. Reducing cost of TSA has positive impact for the patient, manufacturer, and hospital.

Cow-hitch-suture cerclage for fixation of the greater tuberosity in fracture RTSA.

Background: The treatment of complex proximal humerus fractures in the elderly with reverse total shoulder arthroplasty is an established treatment option. Healing of the greater tuberosity (GT) is associated with better outcomes. It was the aim of this cadaver study to compare the stability of GT refixation obtained with the so-called "cow hitch" cerclage fixation with that of the recommended standard suture cerclage technique.

Comparison of Glenoid Version and Posterior Humeral Subluxation in Patients With and Without Posterior Shoulder Instability.

Purpose: To evaluate glenoid version and humeral subluxation on preoperative multiplanar imaging of patients who underwent surgery for posterior glenohumeral instability compared with a matched group of patients who had shoulder surgery for other pathology.

Methods: All patients over a 2-year period who underwent surgery for posterior instability had preoperative magnetic resonance (MR) imaging or MR arthrogram reviewed. Patients undergoing shoulder surgery for reasons other than instability were identified as a control group and matched by sex, laterality, and age.

The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study.

Objective: The aim was to assess diagnostic accuracy of 15 shoulder special tests for rotator cuff tears.

Design: From February 2011 to December 2012, 208 participants with shoulder pain were recruited in a cohort study.

Results: Among tests for supraspinatus tears, Jobe test had a sensitivity of 88% (95% confidence interval [CI], 80%-96%), specificity of 62% (95% CI, 53%-71%), and likelihood ratio of 2.

Accuracy of the Subchondral Smile and Surface Referencing Techniques in Reverse Shoulder Arthroplasty.

Inferior glenoid baseplate tilt relative to the coronal axis of the scapular body has been associated with improved results and fewer postoperative complications in reverse shoulder arthroplasty. However, the native glenoid surface is not always a reliable reference for the true scapular axis. Digital preoperative planning software and advanced imaging now allow surgeons to more precisely determine optimal glenoid placement.

Evaluation of satisfaction and durability after hemiarthroplasty and total shoulder arthroplasty in a cohort of patients aged 50 years or younger: an analysis of discordance of patient satisfaction and implant survival.

Background: Shoulder arthroplasty in individuals aged 50 years or younger reportedly leads to worse outcomes than in older patients. Current methods of determining survivorship may be inadequate and may not reflect actual patient definitions of satisfaction. The purpose of this study is to evaluate and contrast the survival of patient satisfaction and implant survival in the youngest reported patients undergoing either a primary hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) using a third-generation stemmed prosthesis.

Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction.

Proximal humerus fractures are common injuries that can require operative treatment. Different operative techniques are available, but the hallmark of fixation for 3- and 4-part fractures is a locking-plate-and-screw construct. Despite advances in this technology, obtaining anatomical reduction and fracture union can be difficult, and complications (eg, need for revision) are not uncommon.

Assessment of painful total shoulder arthroplasty using computed tomography arthrography.

Background: This study assessed the accuracy of computed tomography (CT) arthrography when evaluating glenoid component stability in the setting of postarthroplasty shoulder pain.

Methods: We retrospectively reviewed all patients presenting to the clinic during a 5.5-year period to identify those with a painful shoulder arthroplasty more than 1 year after the index procedure.

Failure after reverse total shoulder arthroplasty: what is the success of component revision?

Background: Complication rates remain high after reverse total shoulder arthroplasty (RTSA). Salvage options after implant failure have not been well defined. This study examines the role of reimplantation and revision RTSA after failed RTSA, reporting outcomes and complications of this salvage technique.

Latissimus Dorsi and Teres Major Transfer With Reverse Shoulder Arthroplasty Restores Active Motion and Reduces Pain for Posterosuperior Cuff Dysfunction.

Background: In patients with rotator cuff dysfunction, reverse shoulder arthroplasty can restore active forward flexion, but it does not provide a solution for the lack of active external rotation because of infraspinatus and the teres minor dysfunction. A modified L'Episcopo procedure can be performed in the same setting wherein the latissimus dorsi and teres major tendons are transferred to the lateral aspect of proximal humerus in an attempt to restore active external rotation.

Questions/purposes: (1) Do latissimus dorsi and teres major tendon transfers with reverse shoulder arthroplasty improve external rotation function in patients with posterosuperior rotator cuff dysfunction? (2) Do patients experience less pain and have improved outcome scores after surgery? (3) What are the complications associated with reverse shoulder arthroplasty with latissimus dorsi and teres major transfer?

Methods: Between 2007 and 2010, we treated all patients undergoing shoulder arthroplasty who had a profound external rotation lag sign and advanced fatty degeneration of the posterosuperior rotator cuff (infraspinatus plus teres minor) with this approach.

Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear?

Background: Recently, psychological status, patient-centered outcomes, and health-related quality of life (HRQoL) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized. The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated.

Questions/purposes: The primary objective of this study was to investigate changes in psychological status (depression, anxiety, insomnia) and HRQoL after rotator cuff repair.

Accuracy of long head of the biceps subluxation as a predictor for subscapularis tears.

Purpose: The aim of this study is to understand the relation between long head of the biceps tendon (LHBT) subluxation and full-thickness tears of the subscapularis.

Methods: Magnetic resonance imaging (MRI) scans of 94 patients undergoing shoulder arthroscopy were evaluated preoperatively for the presence or absence of LHBT subluxation. Intraoperative pathology of the biceps and subscapularis tendons was recorded.

Arthroscopic tissue culture for the evaluation of periprosthetic shoulder infection.

Background: Periprosthetic shoulder infections can be difficult to diagnose. The purpose of this study was to investigate the utility of arthroscopic tissue culture for the diagnosis of infection following shoulder arthroplasty. Our hypothesis was that culture of arthroscopic biopsy tissue is a more reliable method than fluoroscopically guided shoulder aspiration for diagnosing such infection.

Ultrasound of the pectoralis major muscle after reverse shoulder arthroplasty: a case report.

Only a few reports exist in the literature for sonographic assessment of the pectoralis major muscle. Presented is a case of pectoralis major muscle atrophy as a cause of persistent internal rotation weakness diagnosed via ultrasound in a patient with multiple previous surgeries and contraindication to magnetic resonance imaging because of a shoulder implant. This patient's physical examination suggested an abnormal contour of the pectoralis major muscle on contraction, so he was referred for diagnostic ultrasound.

Glenohumeral joint cartilage contact in the healthy adult during scapular plane elevation depression with external humeral rotation.

The shoulder (glenohumeral) joint has the greatest range of motion of all human joints; as a result, it is particularly vulnerable to dislocation and injury. The ability to non-invasively quantify in-vivo articular cartilage contact patterns of joints has been and remains a difficult biomechanics problem. As a result, little is known about normal in-vivo glenohumeral joint contact patterns or the consequences that surgery has on altering them.

Scapular Winging: A Great Masquerader of Shoulder Disorders: AAOS Exhibit Selection.

Background: The incidence of scapular winging is unclear, but it may be more common than previously thought. It can be difficult to diagnose because the presenting complaint and physical examination may direct the practitioner toward more common shoulder and neck conditions. Ongoing scapular dysfunction may result in inappropriate or failed surgery.

2014 Neer Award Paper: neuromonitoring the Latarjet procedure.

Background: We used intraoperative neuromonitoring to define the stages of the Latarjet procedure during which the nerves are at greatest risk.

Methods: Thirty-four patients with a mean age of 28.4 years were included.

Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger.

Background: This study examined outcomes and complications in young patients undergoing revision reverse total shoulder arthroplasty (RTSA) for failed prior total shoulder arthroplasty or hemiarthroplasty and compared them with those of an age-matched cohort undergoing primary RTSA.

Methods: RTSA as a revision for failed shoulder arthroplasty was performed on 36 patients younger than 65 years. Follow-up was available for 32 patients at an average of 55.

Complete Fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy.

Suprascapular neuropathy is generally considered to be a diagnosis of exclusion, although it has been described in association with several activities and conditions. To our knowledge, this is the first description of suprascapular neuropathy with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms. We present 4 cases of patients who presented with complete fatty infiltration of the supraspinatus (1 patient), infraspinatus (2 patients), and both (1 patient) resulting from suprascapular neuropathy.

Surgical treatment of isolated type II superior labrum anterior-posterior (SLAP) lesions: repair versus biceps tenodesis.

Background: It is still unclear which patients with isolated type II superior labrum anterior-posterior (SLAP) lesions benefit from either superior labral repair or biceps tenodesis. This study evaluates the indications and outcomes of patients with isolated type II SLAP lesions who have undergone either procedure.

Methods: A retrospective analysis was performed of patients who had surgery for an isolated type II SLAP lesion between 2008 and 2011.

Scapulothoracic fusion: outcomes and complications.

Background: Scapulothoracic fusion (STF) may be an option to alleviate pain and restore function. The purpose of this study is to report the clinical outcome of patients who underwent STF for the treatment of painful scapular winging.

Materials And Methods: From 1999 through 2008, 10 patients (12 shoulders) underwent an STF for painful winging of the scapula.

Treatment choice affects inpatient adverse events and mortality in older aged inpatients with an isolated fracture of the proximal humerus.

Background: This study tests the null hypothesis that, among patients aged 65 and older admitted to a United States hospital with an isolated fracture of the proximal humerus (no other injuries or fractures), there are no differences between operative (fixation or arthroplasty) and nonoperative treatments with respect to inpatient adverse events, inpatient mortality, and discharge to a long-term care facility rates accounting for comorbidities.

Methods: Using a large national database representing an estimated 132,005 patients aged 65 and older admitted to a US hospital with an isolated proximal humerus fracture between 2003 and 2007. Sixty-one percent did not have surgery, 22% were treated with open reduction and internal fixation (ORIF), and 17% were treated with arthroplasty.