Comparison of three modalities of teleophthalmology delivery in regional Western Australia during the COVID-19 lock-down.

Clinical Relevance: In conjunction with local optometry services, telehealth may be used in to provide specialist care for patients living in rural areas underserved by ophthalmology.

Background: To combat travel restrictions for specialist outreach to regional areas during the 2020 COVID-19 lockdown, Lions Outback Vision introduced three different modalities of teleophthalmology consultations; home-based telephone, hospital-based video, and optometry-based video. This study evaluated the utility of these in providing specialist care to rural patients during the pandemic.

Optometry-facilitated teleophthalmology: an audit of the first year in Western Australia.

Background: Lions Outback Vision has run a state-wide teleophthalmology service since 2011. In September 2015 the Australian federal government introduced a Medicare reimbursement for optometry-facilitated teleophthalmology consultations under specific circumstances. This audit demonstrates the first 12 months experience with this scheme.

Understanding Indigenous patient attendance: A qualitative study.

Objective: To better understand Indigenous patient non-attendance at medical specialty appointments by learning from the patients attending their scheduled outreach ophthalmology clinic appointment.

Design, Setting And Participants: A qualitative study using face-to-face, semi-structured interviews with 69 Indigenous Australian ophthalmology patients and 8 clinic workers at one urban and one rural Aboriginal Medical Service (AMS) over the period from April 2015 to November 2015.

Main Outcome Measures: Explored motivations and enablers for attending patients to guide best practice for specialist outreach clinics.

Increasing the impact of teleophthalmology in Australia: Analysis of structural and economic drivers in a state service.

Problem: Despite its potential to improve service provision for country patients, teleophthalmology is currently underused in Australia. There is an associated lack of cost-effectiveness data for teleophthamology.

Design: Retrospective and prospective hospital-based clinical audits of 5456 patients; descriptive survey of available telehealth equipment in 129 regional facilities; cost calculations for teleophthalmology, patient transfers and outreach services.

Surface replacement arthroplasty for glenohumeral arthropathy in patients aged younger than fifty years: results after a minimum ten-year follow-up.

Background: The role of cementless surface replacement arthroplasty (CSRA) in young individuals is currently unclear. The aim of this study was to evaluate CSRA long-term results for glenohumeral arthritis in young patients.

Methods: Between 1990 and 2003, 54 CSRAs were performed on 49 patients (25 men, 24 women) aged younger than 50 years.

Medium to long-term outcome of thoracoscapular arthrodesis with screw fixation for facioscapulohumeral muscular dystrophy.

Background: Shoulder girdle muscle weakness is the most constant feature of facioscapulohumeral muscular dystrophy and leads to scapular winging. Mechanical fixation of the scapula to the thoracic wall provides a stable fulcrum on which the deltoid muscle can exert its action on the humerus. The aim of this study was to evaluate the medium to long-term outcome of thoracoscapular arthrodesis with screw fixation (the modified Howard-Copeland technique).

"Put your 'extended' finger on the bleeder": the use of direct pressure from the shaver blade to achieve hemostasis.

Maintaining good hemostasis is vital to ensure clear vision during arthroscopic surgery. This is most commonly achieved with electrocautery or radiofrequency devices. Another technique involves temporarily increasing the arthroscopic fluid inflow pressure to tamponade the bleeding.

Scapular fixation in muscular dystrophy.

Background: Winging of the scapula is caused by weakness of the thoracoscapular muscles, which allows the scapula to lift off the chest wall during shoulder movements. In facioscapulohumeral muscular dystrophy (and occasionally in other muscular dystrophies) there is selective weakness of the thoracoscapular muscles which may spare other shoulder muscles such as the deltoid muscle. This imbalance results in significant winging and loss of shoulder function.

The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears.

The management of massive rotator cuff tears in medically unfit, elderly patients is difficult. We prospectively assessed 17 patients with radiologically confirmed, nontraumatic, massive rotator cuff tears who were treated with an anterior deltoid rehabilitation program. All patients were medically unfit, with an average age of 80 years (range, 70-96 years).

Arthroscopic capsular release for posttraumatic shoulder stiffness.

Severe pain and shoulder stiffness after soft tissue trauma or fracture is a major cause of dysfunction. Some patients may have residual, resistant, significant shoulder stiffness that causes long-term functional impairment. This study reports the results of arthroscopic capsular release in 21 patients who presented with posttraumatic stiff shoulders resistant to nonoperative therapy.

Wear in the prosthetic shoulder: association with design parameters.

Total replacement of the glenohumeral joint provides an effective means for treating a variety of pathologies of the shoulder. However, several studies indicate that the procedure has not yet been entirely optimized. Loosening of the glenoid component remains the most likely cause of implant failure, and generally this is believed to stem from either mechanical failure of the fixation in response to high tensile stresses, or through osteolysis of the surrounding bone stock in response to particulate wear debris.

Radiofrequency capsular shrinkage for voluntary shoulder instability.

We report a prospective study of 13 consecutive shoulders treated exclusively with radiofrequency capsular shrinkage for voluntary instability. Before surgery, voluntary instability had ceased in all patients with physiotherapy, but involuntary shoulder instability continued. The mean follow-up was 45 months (range, 32-57 months).

Histologic evaluation of the glenohumeral joint capsule after radiofrequency capsular shrinkage for atraumatic instability.

We evaluated histologically 10 biopsy specimens taken preoperatively from the anterior-inferior glenohumeral ligament from patients with atraumatic instability who had undergone radiofrequency capsular shrinkage, 10 taken immediately postoperatively, and 13 taken before revision. The synovial and subsynovial layers returned to normal histology in biopsy specimens taken from 6 months onwards. Collagen bundles in the fibrous layer continued to have a reparative histology during the period of the study (up to 37 months).

Subacromial plica as a cause of impingement in the shoulder.

The subacromial bursa is the largest bursa in the body. In 1934, Codman described the presence of subacromial plicae, similar to the suprapatellar plicae found in the knee. It is recognized that plicae in the knee can cause anterior knee pain with impingement against the patella in young persons.

Arthroscopic management of the painful snapping scapula.

Purpose: The aim of this study was to evaluate the results of the arthroscopic management of the snapping scapula syndrome.

Type Of Study: Case series.

Methods: Thirteen patients underwent surgery for painful scapular snapping that had not responded to adequate conservative treatment.

Stress fracture of the clavicle in a patient with no obvious risk factors.

A 28-year-old woman presented with right shoulder pain and, after a delay, a diagnosis of clavicular stress fracture was made. The patient gave no history of repetitive abnormal loading of the upper limbs which could have assisted the diagnosis. The authors wish to raise awareness of this rare diagnosis such that it can be considered in the differential for shoulder pain of unclear origin.

Geometrical analysis of Copeland surface replacement shoulder arthroplasty in relation to normal anatomy.

This study examines the effect of humeral head surface replacement on the geometry of the arthritic glenohumeral joint and correlates changes to clinical outcome. Thirty-nine patients undergoing resurfacing arthroplasty were prospectively followed up clinically and radiologically for a mean of 38 months (range, 24 to 72 months). Measurements were taken from coronal radiographs by use of a validated technique.

"Wet diapers--dry patients": an effective dressing for patients undergoing arthroscopic shoulder surgery.

Shoulder arthroscopy is very commonly associated with postoperative leakage of irrigation fluid. This causes apprehension to patients and their relatives and leads to frequent change of dressings. We describe a simple and effective diaper dressing for patients undergoing arthroscopic shoulder surgery.

Cementless surface replacement arthroplasty (Copeland CSRA) for osteoarthritis of the shoulder.

Clinical experience with the Copeland cementless surface replacement arthroplasty (CSRA) of the shoulder now spans 17 years. Between 1986 and 1997, 79 CSRAs (42 total shoulder replacements and 37 hemiarthroplasties) were performed for primary osteoarthritis of the shoulder. Total shoulder replacement was done in 12 men and 30 women with a mean age of 71.

Copeland surface replacement arthroplasty of the shoulder in rheumatoid arthritis.

Background: Shoulder arthroplasty with a stemmed prosthesis is a recognized treatment for rheumatoid arthritis of the shoulder. The humeral component of the Copeland cementless surface replacement arthroplasty consists of a cup for surface replacement with a short central peg for primary fixation to the bone. We hypothesized that surface replacement may offer some advantages over stemmed prostheses.

Mechanical properties of regenerated coracoacromial ligament after subacromial decompression.

Recent publications suggest that the coracoacromial ligament regenerates after it has been partially excised during subacromial decompression or acromioplasty. This observation may aid the understanding of the successes and failures of this very commonly performed surgical procedure. This study determines the mechanical properties of the apparently regenerated ligament.