Judicious use of corticosteroid injections prior to shoulder arthroplasty does not compromise outcomes at a minimum of 2 years following surgery.

Background: The use of total shoulder arthroplasty is continuing to rise with its expanding indications. For patients with chronic conditions, such as glenohumeral arthritis and rotator cuff arthropathy, nonoperative treatment is typically done prior to arthroplasty and often includes corticosteroid injections (CSIs). Recent studies in the shoulder arthroplasty literature as well as applied from the hip and knee literature have focused on the risk of periprosthetic infection.

Corticosteroid injection prior to surgery had no effect on 2-year outcomes following arthroscopic rotator cuff repair.

Background: Corticosteroid injections (CSIs) can be an effective nonsurgical treatment for patients with rotator cuff tears. Recent large database studies have raised concern that CSI may result in a higher reoperation rate, increased infection risk, and worse outcome after arthroscopic rotator cuff repair (ARCR). The purpose of this study was to evaluate the reoperation rate, incidence of postoperative infection, and two-year outcomes of patients undergoing ARCR with and without the use of preoperative CSI.

Assessment of glenoid baseplate initial micromotion and fixation strength in reverse total shoulder arthroplasty designs using a direct shear force methodology.

Background: In a reverse total shoulder arthroplasty, the altered glenohumeral joint center of rotation subjects the glenoid baseplate to increased shear forces and potential loosening.

Methods: This study examined glenoid baseplate micromotion and initial fixation strength with the application of direct shear force in a Sawbone model. The reverse total shoulder arthroplasty systems examined were the DJO Reverse® Shoulder Prosthesis, the Exactech Equinoxe® Reverse System, and the Tornier Aequalis Reverse Shoulder Prosthesis.

Preoperative screening in patients having elective shoulder surgery reveals a high rate of fall risk.

Introduction: Fall risk is an acknowledged but relatively understudied concern for older patients undergoing shoulder surgery. The cause is multifactorial, and it includes advanced age, impaired upper extremity function, use of shoulder abduction braces, and postoperative use of opioid medications. No previous study has examined preoperative fall risk in patients undergoing elective shoulder surgery.

Regenesorb and polylactic acid hydroxyapatite anchors are associated with similar osseous integration and rotator cuff healing at 2 years.

Background: Commercially available suture anchors for rotator cuff repairs can differ significantly in architecture and material. Clinical data on their osseous integration and its effect on patient-reported outcomes is scarce. Preclinical investigations indicated a higher rate of osseous integration for the open-architecture design of the Healicoil Regenesorb anchor than the closed-threaded design of the Twinfix (Smith & Nephew).

Does Functional Bracing of the Unstable Shoulder Improve Return to Play in Scholastic Athletes? Returning the Unstable Shoulder to Play.

Background: Functional bracing is often used as an adjunct to nonoperative treatment of anterior shoulder instability, but no study has evaluated the effectiveness of in-season bracing. The purpose of this study was to examine successful return to play in a nonoperative cohort of adolescent athletes with in-season shoulder instability and compare those athletes treated with bracing to those who were not.

Hypothesis: The use of functional bracing will improve success rates in a cohort of athletes treated nonoperatively for in-season shoulder instability.

The Nonoperative Instability Severity Index Score (NISIS): A Simple Tool to Guide Operative Versus Nonoperative Treatment of the Unstable Shoulder.

Background: The management of the adolescent athlete after initial shoulder instability remains controversial.

Hypothesis: Individual risk factors in athletes with shoulder instability who are managed nonoperatively can be integrated into a scoring system that can predict successful return to sport.

Study Design: Retrospective cohort study.

The influence of radiographic markers of biomechanical variables on outcomes in reverse shoulder arthroplasty.

Background: Controversy exists in reverse total shoulder arthroplasty in regard to variability in the center of rotation (COR), which modifies the superior-inferior position of the humerus to affect the acromiohumeral interval (AHI), and its effect on the deltoid lever arm (DLA), acromial index (AI), and critical shoulder angle (CSA). The purpose of this study was to investigate the variation in biomechanics and the association with patient-reported outcomes (PROs) and range of motion (ROM) measurements.

Methods: Radiographs, ROM, and 2-year PRO scores were retrospectively reviewed for 108 patients.

Subscapularis Repair Is Unnecessary After Lateralized Reverse Shoulder Arthroplasty.

Background: Controversy exists as to whether the subscapularis should be repaired after reverse shoulder arthroplasty. The purpose of the present study was to evaluate the utility of repairing the subscapularis after reverse shoulder arthroplasty with regard to complications, objective findings, and patient-reported outcome measures.

Methods: We retrospectively reviewed the records for 99 patients who had undergone a lateralized reverse shoulder arthroplasty with (n = 58) or without (n = 41) subscapularis repair.

Validity and Responsiveness of the Single Alpha-numeric Evaluation for Shoulder Patients.

Background: There is an ever-increasing demand for widespread implementation of patient-reported outcomes. However, adoption is slow owing to limitations in clinical infrastructure and resources within busy orthopaedic practices. Prior studies showed the single alpha-numeric evaluation (SANE) score to correlate at a single point in time with the American Shoulder and Elbow Surgeons (ASES) score.

Outcomes of Anatomic Total Shoulder Arthroplasty with B2 Glenoids: A Systematic Review.

Background: Total shoulder arthroplasty remains an effective procedure for shoulder pain relief. Despite the negative effect of abnormal glenoid morphology and specifically retroverted and posteriorly subluxated glenoids, there is no consensus for management of B2 glenoids in total shoulder arthroplasty. The purpose of this study was to compare the outcomes and complication rates for B2 glenoid techniques so as to provide a baseline understanding of the current state of treatment of this pathology.

Outcomes of Trabecular Metal-backed glenoid components in anatomic total shoulder arthroplasty.

Background: As glenoid failure is one of the primary causes of failure of anatomic total shoulder arthroplasty (TSA), Trabecular Metal-backed glenoid components have become popular. This study reports implant survival and clinical outcomes of patients who received a Trabecular Metal-backed glenoid component during primary anatomic TSA.

Methods: Patients who underwent TSA with a Trabecular Metal-backed glenoid component by a single surgeon were identified and reviewed for clinical, radiographic, and patient-reported outcome measures with a minimum of 2 years' follow-up.

Clinical outcomes of suprascapular nerve decompression: a systematic review.

Background: Suprascapular neuropathy is an uncommon clinical diagnosis. Although there have been a number of case series reporting on this pathologic process, to date there has been no systematic review of these studies. This study aimed to synthesize the literature on suprascapular neuropathy with regard to clinical outcomes.

The incidence and effect of fatty atrophy, positive tangent sign, and rotator cuff tears on outcomes after total shoulder arthroplasty.

Background: Treatment choices for total shoulder arthroplasty (TSA) in the absence of full-thickness rotator cuff tears (RCTs) are not clearly defined in current literature. This study investigated the prevalence and effect of preoperative partial-thickness RCTs and muscular degenerative changes on postoperative outcomes after TSA.

Methods: Medical records and magnetic resonance imaging studies were reviewed for patients who underwent TSA for primary glenohumeral osteoarthritis with minimum 2-year follow-up to determine preoperative tear classification, Goutallier grade, and supraspinatus tangent sign.

Arthroscopic Repair of Posterior Bony Bankart Lesion and Subscapularis Remplissage.

Posterior shoulder instability with glenoid bone loss has only a fraction of the prevalence of anterior instability. Unlike the latter, there is a paucity of literature regarding the treatment of posterior bony Bankart lesions and even less with concomitant reverse Hill-Sachs lesions. This combination of pathology leads to a difficult situation regarding treatment options.

Liposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: a prospective randomized controlled trial.

Background: Pain management strategies following shoulder arthroplasty vary significantly. Liposomal bupivacaine (LB) is an extended-release delivery of a phospholipid bilayer encapsulating bupivacaine that can result in drug delivery up to 72 hours. Prior studies in lower extremity surgery demonstrated efficacy of LB in comparison to a single-shot peripheral nerve block; however, no study has investigated LB in a total shoulder arthroplasty population.

Outcomes of total shoulder arthroplasty in patients younger than 65 years: a systematic review.

Background: Despite concerns about the longevity of total shoulder arthroplasty (TSA) in young patients, it remains an attractive option because of the absence of superior options.

Methods: A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. English-language studies were identified with search terms "total shoulder arthroplasty" (title/abstract) or "shoulder replacement" (title/abstract) and "young" (title/abstract) or "under 65 years of age" (title/abstract).

Nonoperative management versus reverse shoulder arthroplasty for treatment of 3- and 4-part proximal humeral fractures in older adults.

Background: The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcomes between RSA and nonoperative treatment groups.

Management of deep infection after reverse total shoulder arthroplasty: a case series.

Background: Reverse total shoulder arthroplasty (RSA) is being increasingly used in the treatment of disabling shoulder conditions. This study reports the management of deep infections after RSA.

Materials And Methods: Eight of 138 patients were treated for deep infection after the index procedure.

Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis.

Background: Despite improved results with reverse shoulder arthroplasty (RSA), questions still remain regarding certain technical aspects of the operation. One particular area of question is the effect of subscapularis repair on complication rates, dislocation, pain, and overall range of motion. Some authors suggest that when a deltopectoral approach is used, not repairing the subscapularis leads to a higher complication rate, especially for dislocation.

SLAP tear associated with a minimally displaced proximal humerus fracture.

Nondisplaced proximal humerus fracture may be associated with soft tissue injury. This case report examines 2 cases of superior labral anterior-posterior (SLAP) tears in association with nondisplaced fractures of the proximal humerus. In the first case, the patient fell from a jet ski, causing a traction injury to his arm.