Intraosseous Ganglion Protruding Into the Spinoglenoid Notch With Suprascapular Nerve Entrapment: A Case Report.

Suprascapular nerve entrapment caused by intraosseous cystic lesions is a rare condition. We present the case of a 49-year-old man with right shoulder numbness, slight infraspinatus (ISP) weakness, and shoulder pain. He underwent open surgery and arthroscopic evaluation.

Humeral Metadiaphyseal Fracture With Severe Osteoarthritis of the Shoulder and Simultaneous Contralateral Proximal Humeral Fracture Treated With Bilateral Reverse Shoulder Arthroplasty: A Rare Case Report.

Simultaneous bilateral proximal humerus fractures (PHFs) are infrequent. Particularly rare are cases of PHFs extending to the metadiaphysis accompanied by severe osteoarthritis (OA) of the shoulder. To our knowledge, there have been no reports of bilateral fractures that include metadiaphyseal fractures with severe OA on one side and a PHF on the contralateral side, treated with bilateral reverse shoulder arthroplasty (RSA).

Quantified Deltoid Muscle Stiffness Can Predict Improved Muscle Strength for Elevation Following Reverse Shoulder Arthroplasty.

: Although the indications for reverse shoulder arthroplasty (RSA) are expanding, an improvement in muscle strength in each patient following RSA remains unclear. The objective was to investigate whether or not improvement in muscle strength for shoulder elevation in patients who underwent RSA was influenced by pre- or postoperative deltoid muscle stiffness measured using shear wave elastography (SWE). : Sixty-five patients who underwent RSA over a 12-month follow-up period were included.

Evolution of Stemless Reverse Shoulder Arthroplasty: Current Indications, Outcomes, and Future Prospects.

Reverse total shoulder arthroplasty (rTSA) is increasingly being used as a reliable option for various shoulder disorders with deteriorated rotator cuff and glenohumeral joints. The stemless humerus component for shoulder arthroplasties is evolving with theoretical advantages, such as preservation of the humeral bone stock and decreased risk of periprosthetic fractures, as well as clinical research demonstrating less intraoperative blood loss, reduced surgical time, a lower rate of intraoperative fractures, and improved center of rotation restoration. In particular, for anatomical total shoulder arthroplasty (aTSA), the utilization of stemless humeral implants is gaining consensus in younger patients.

Periprosthetic Joint Infection Following Reverse Shoulder Arthroplasty Treated With Continuous Local Antibiotic Perfusion: A Case Report.

Prosthetic joint infection (PJI) is a crucial complication of reverse shoulder arthroplasty (RSA). Continuous local antibiotic perfusion (CLAP) with a high-concentration antimicrobial pharmacy administration method has recently received attention owing to its effectiveness in the treatment of bone and soft tissue infections. We herein report a case of PJI following RSA that was successfully treated with CLAP without removal of the entire implant.

A survey and biomechanical analysis of the feasibility of the thumb test for determining the cancellous bone quality for stemless shoulder prosthesis.

Background: The effect of the thumb test for assessing the cancellous bone quality at the resection plane of the proximal humerus on determining the application of a stemless shoulder prosthesis remains unclear. This study was conducted to survey the current utilization of the thumb test among surgeons and to investigate biomechanical features of the thumb test.

Method: A survey among shoulder surgeons who had experience with stemless prostheses was conducted to investigate the current utilization of preoperative assessments and intraoperative thumb test when applying stemless prosthesis.

Medial Condyle Fracture of the Distal Humerus in an Elderly Patient With Fishtail Deformity and Lateral Condyle Nonunion: A Case Report.

A medial condyle fracture of the humerus with preexisting fishtail deformity and lateral condyle nonunion is very rare, and there have been few reports describing favorable treatment options. We herein report the case of an 83-year-old woman who sustained a medial condyle fracture of her elbow with a comorbidity of long-lasting limited elbow motion with a history of elbow trauma in childhood. After conservative treatment with casting for four weeks, unstable medial condyle fracture in the presence of fishtail deformity and lateral condyle nonunion remained.

Simultaneous Reverse Shoulder Arthroplasty and Open Reduction With Internal Fixation for Bilateral Proximal Humerus Fractures in the Elderly: A Report of Two Cases.

Simultaneous bilateral proximal humerus fractures (PHFs) caused by a single trauma are considered rare. We herein report two patients with bilateral PHFs treated based on our treatment strategy: reverse shoulder arthroplasty (RSA) to obtain rigid stability for one shoulder and open reduction with internal fixation (ORIF) to regain the mobility of external and internal rotation for the other. By using Neer's four-segment fracture classification, patients underwent RSA for one shoulder with the more advanced fracture type and ORIF for the other.

The quantification of muscle activities during arm elevation following reverse shoulder arthroplasty or superior capsular reconstruction for irreparable rotator cuff tears using positron emission tomography.

Background: Reverse shoulder arthroplasty (RSA) and superior capsular reconstruction (SCR) are recognized as surgical options for an irreparable rotator cuff tear. However, the postoperative changes of the muscle activity patterns remain unclear. The purpose of this study was to investigate the quantified muscle activities on shoulder elevation in patients treated with RSA or SCR using fluorine-18-labelled fluorodeoxyglucose-positron emission tomography.

Surgical treatment for persistent second carpometacarpal joint pain.

The purposes of this study were to demonstrate the clinical characteristics of patients with persistent second carpometacarpal (CMC) joint pain without bony abnormalities known as the carpal boss, and to assess the clinical efficacy of surgical stabilization of the second CMC joint. Eleven patients had persistent wrist pain with characteristic symptoms, including tenderness over the second CMC joint, increased symptoms when the involved hand was placed on the ground or gripped strongly with the involved hand, a positive metacarpal stress test and temporary pain relief with the intra-articular injection of the lidocaine. The patients underwent arthrodesis of the second CMC joint.

Stiffness of the infraspinatus and the teres minor muscles during shoulder external rotation: An in-vitro and in-vivo shear wave elastography study.

Background: A better understanding of the morphological and functional differences in the anatomical sub-regions of the rotator cuff muscles is critical so that appropriate surgical and rehabilitation methodologies can be implemented in patients with shoulder-related injuries. The purpose of the current study was to develop a comprehensive imaging protocol using shear-wave elastography for the infraspinatus and teres minor muscles, and investigate differences in elastic properties of three distinct infraspinatus muscle sub-regions and of the teres minor muscle.

Methods: First, we developed a protocol for probe positioning for both muscles using three cadaveric shoulders.

Ultrasonographic Measurement of the Median Nerve Transverse Diameter at the Wrist for Diagnosing Carpal Tunnel Syndrome.

Ultrasonographically measuring the median nerve cross-sectional area (MN-CSA) is a useful and complementary method for diagnosing carpal tunnel syndrome (CTS). This study investigated the usefulness of the median nerve transverse diameter (MN-TD) as a simpler and easier technique than MN-CSA for diagnosing CTS severity. We examined 145 hands from 101 patients with CTS and 114 age- and gender-matched control hands.

Clinical Features of Ulnar Tunnel Syndrome and the Diagnostic Value of Nerve Conduction Measurements.

Objectives: The purposes of this study were to assess the clinical features of ulnar tunnel syndrome (UTS) and to investigate the diagnostic value of nerve conduction measurements for UTS.

Methods: Eighteen patients with UTS were reviewed retrospectively. Fifteen patients had intrinsic muscle atrophy and motor weakness, and 15 had numbness with hypesthesia.

Three-dimensional quantitative measurements of atrophy and fat infiltration in sub-regions of the supraspinatus muscle show heterogeneous distributions: a cadaveric study.

Introduction: Rotator cuff tears are common in the older population. Atrophy and fat infiltration develop un-evenly in torn supraspinatus (SSP) muscles leading to pre- and post-surgical complications. The purpose of the current study was twofold: first, to implement a volumetric and quantitative magnetic resonance imaging (MRI) approach to quantify the degree of muscle atrophy and fat infiltration within the SSP muscle and its four sub-regions (AS, PS, AD, and PD); second to compare 3-D MRI outcomes to the standard 2-D assessment and investigate their relationship with tear size.

Does glenoid remodeling occur with an erosion-type bone loss after arthroscopic Bankart repair?

Introduction: Fragment-type glenoid bone loss is known to remodel after arthroscopic Bankart repair. To our knowledge, no studies have been reported about the morphologic changes of the erosion-type bone loss.

Aim: To determine the morphologic changes of erosion-type glenoid bone loss after arthroscopic Bankart repair.

Downsizing effect of a modular radial head prosthesis on the lateral collateral ligament of the elbow: A cadaveric study.

Background: It remains unclear how the head and stem diameters for the radial head prosthesis could affect mechanical properties of the lateral collateral ligament measured by strain changes during elbow and forearm motions.

Methods: Eight cadaveric specimens were secured to the device, which allows elbow flexion-extension and forearm pro-supination. Using six different implant combinations comprising 2 sizes for the head (long- and short-axis of the native head) and 3 sizes for the stem (press-fit, -1 mm, and -2 mm downsizing), prostheses were attached via the posterior approach.

Mechanism and patterns of bone loss in patients with anterior shoulder dislocation.

Background: Bony defects are common injuries associated with anterior shoulder dislocation. It is generally thought that these bony defects are created at the time of dislocation. However, there have been no biomechanical reports demonstrating the exact time point when these lesions occur.

Immobilization in External Rotation Reduces the Risk of Recurrence After Primary Anterior Shoulder Dislocation: A Meta-analysis.

Background: The best method for nonsurgical treatment after primary dislocation of the shoulder is not clear. The efficacy of immobilization with the arm in external rotation (ER) compared with internal rotation (IR) remains controversial.

Purpose: To determine the efficacy of ER immobilization versus IR immobilization on recurrence rate after primary dislocation of the shoulder from the evidence of randomized controlled trials.

Ligament Reconstruction for Recurrent Anterior Dislocation of the Radial Head.

Isolated recurrent dislocation of the radial head (RH) is very rare, and there have been few reports describing the surgical treatment of this injury. We herein report the case of a 13-year-old girl who underwent ligament reconstruction surgery for isolated recurrent RH dislocation. Her symptoms included pain and apprehension at the elbow with the forearm in supination.

Peripheral-Track and Central-Track Hill-Sachs Lesions: A New Concept of Assessing an On-Track Lesion.

Background: It has been demonstrated biomechanically that 25% is a critical size defect of the glenoid. However, a recent clinical study reported that a bone loss between 13.5% and 20% (subcritical bone loss) led to impairment of quality of life but not a recurrence of instability.

Effect of subcritical glenoid bone loss on activities of daily living in patients with anterior shoulder instability.

Background: It has been biomechanically demonstrated that 20% to 25% is a critical glenoid bone loss. Recently, there are several reports describing that a bone loss less than 20% to 25% needed to be treated because patients may have decreased quality of life without recurrent instability events. The purpose of this study was to clarify the presence of subcritical bone loss that would affect postoperative instability or quality of life.

Comparison of best-fit circle versus contralateral comparison methods to quantify glenoid bone defect.

Background: Several measurement techniques have been reported to quantify glenoid bone defect in patients with anterior shoulder instability. Among them, the method that uses a best-fit circle and another that uses the contralateral glenoid as a control are most commonly used. However, to our knowledge, no study has been reported that compared the reliability of these methods.

Curved-guide system is useful in achieving optimized trajectory for the most inferior suture anchor during arthroscopic Bankart repair.

Background: A curved-drill guide system was recently introduced to achieve a better trajectory for a low anteroinferior anchor during arthroscopic Bankart repair. However, the clinical performance of such a device remains unclear. The purpose of this study was to evaluate the trajectory and position of the low anteroinferior suture anchor with use of the curved-guide system in clinical cases.

Shoulder arthroplasty in patients with immunosuppression following solid organ transplantation.

Background: The purpose was to determine the risk and outcomes of primary shoulder arthroplasties in patients with immunosuppression who had undergone solid organ transplantation.

Methods: Using a single institution's total joint registry, we reviewed 30 primary shoulder arthroplasties in 25 post-transplantation patients, including 12 total shoulder arthroplasties, 10 hemiarthroplasties, and 8 reverse shoulder arthroplasties, between 1985 and 2012. Therapy and patient variables were recorded, including immunosuppressive therapy protocols, the date of preceding solid organ transplantation, and specific medications taken in the perioperative period.