This study aimed to evaluate recovery of complex upper-limb movements from a kinematic and biomechanical perspective in patients undergoing Reverse Total Shoulder Arthroplasty (RSA), comparing movement quality during athletic gestures with healthy controls. Two groups were analyzed: patients with RSA and healthy individuals without shoulder pathology. Participants performed basic shoulder tasks (flexion-extension and abduction-adduction) and three athletic gestures of increasing complexity: boccia throw, golf swing, and padel víbora stroke. Kinematic data (joint angles, angular velocities, and accelerations) were collected using a wearable inertial motion analysis system (Movit System G1). Controls demonstrated a greater range of motion (maximum joint angle: 184.0° vs. 144.03°), though differences were not statistically significant. Angular velocities and accelerations were largely comparable between groups, indicating that patients with RSA adopt conservative yet functional movement strategies. No significant differences were observed during the boccia throw or golf swing. The víbora stroke showed the highest variability but remained within functional limits in both groups. This pilot feasibility study suggests that patients with RSA can perform complex upper-limb and sport-specific movements with biomechanical patterns comparable to healthy individuals. Although limited by small sample size, large effect sizes indicate clinically relevant differences, supporting the need for larger, confirmatory studies.

Midshaft clavicle fractures affect young, active patients with high functional demands. Open reduction and internal fixation (ORIF) achieve reliable union, but it is unclear whether outcomes meet patient-defined standards. This study aimed to (1) establish Patient Acceptable Symptom State (PASS) thresholds for the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Visual Analog Scale (VAS) one year after fixation, (2) determine the proportion of patients meeting these thresholds, and (3) assess each metric's ability to discriminate satisfaction. We retrospectively analyzed prospectively collected data from 166 patients who underwent ORIF between 2017 and 2021 with ≥1-year follow-up. Patients completed ASES, SANE, VAS, and a validated satisfaction anchor. PASS thresholds were derived via ROC analysis and the Youden index. Discrimination was assessed using area under the curve (AUC). At one year, 87.3% reported satisfaction. PASS thresholds were ASES ≥100, SANE ≥90, and VAS ≤0. Despite high average scores (ASES 96.2; SANE 85.1; VAS 0.7), only 63.9%, 56.7%, and 59.4% met PASS, respectively. ASES (AUC 0.678) and VAS (0.679) showed modest discrimination, while SANE performed poorly (0.569). Most patients are satisfied after ORIF, but many fail to meet PROM-based PASS, highlighting the need to align surgical success with patient-defined benchmarks.

Elbow arthroscopy is a treatment option for advanced symptomatic arthropathy with few outcomes reported in the literature. This study determines the safety and short to long-term outcome of therapeutic elbow arthroscopy in haemophilic arthropathy of the elbow. Patients undergoing arthroscopy between 2005 and 2023 were included. Patients were treated by a multidisciplinary team comprising orthopaedic surgeon, haematologists, physiotherapists and allied professionals. All patients were assessed pre-operatively, intra-operatively and post-operatively with pain, range of motion (ROM), Haemophilia Joint Health Score (HJHS) and EQ5D. Fifteen elbows in 13 patients were managed with arthroscopy for symptomatic haemophilic arthropathy. Mean age was 44.1 ± 13.1 years. The median follow-up was seven years. Intra-operatively, flexion-extension and prono-supination improved by 35° and 26°, respectively. This gradually deteriorated with time, returning to pre-operative levels at approximately 2-5 years. HJHS improved by 2.5 points at six months, 1.67 at 12 months and returned to pre-operative levels at 2-5 years. EQ-VAS score deteriorated by 10.5 points at six months but improved by 19.1 at 12 months, by 10.1 at 2 years and by 14.4 at five years. There were no perioperative complications, the commonest complication was recurrence of stiffness, and two required arthroplasty in long term. Therapeutic arthroscopy is safe in advanced haemophilic elbow arthropathy. It shows potential benefit for function and quality of life in the short to medium term. Though there is a 33% risk of further surgery within 10 years, it should be considered an important adjunct to the multidisciplinary musculoskeletal care pathway in haemophilic elbow arthropathy, especially amongst a young patient cohort.

Limited passive shoulder external rotation (ER) range of motion (ROM) is one of the critical clinical criteria in the diagnosis of frozen shoulder. External rotation ROM is equally commonly assessed in sitting with the arm by the side or in supine at 90° shoulder abduction, but it is unclear if ER ROM varies with body posture or shoulder abduction angle. Using a repeated measures design the aim was to examine if there are differences in passive shoulder ER ROM when measured in different body postures and different shoulder abduction angles. Eleven healthy adults aged between 18 and 60 years were recruited. Passive shoulder ER ROM was measured bilaterally in five different positions: sitting with the arm by the side, and supine with the arm by the side and at 30°, 60° and 90° shoulder abduction. There were significant increases in passive shoulder ER ROM with increasing shoulder abduction angle. No significance difference in ER ROM was found between body posture when measured with the arm by the side. Clinicians need to be cognisant of the shoulder abduction angle at which passive ER ROM tests are performed to ensure valid interpretation regarding diagnosis and treatment effectiveness.

To determine epidemiological trends, demographic variation, and indications for shoulder arthroscopy in the United States (US). We queried the TriNetX database to identify patients undergoing shoulder arthroscopy in the US. The sample was stratified by indication, location, age, sex, race, BMI, and two-year intervals. Comparisons were performed using incidence rates and incidence rate ratios. 95% confidence intervals were calculated assuming a Poisson distribution. P-values<0.05 were considered significant. We identified 191,549 patients who underwent shoulder arthroscopy from 2014-2024. Approximately 55% of patients were male. Most were white (73%), and the Northeast (39%) and South (34%) had the greatest representation among geographic regions. Overall incidence rate was 238.59 procedures per 100,000 patients (95% CI: 237.52-239.66). Patients aged 50-54 years had the greatest incidence rate (589.72 per 100,000). Incidence rates increased significantly with BMI (P < 0.000001) except for BMI>40.0. Rotator cuff repair was the most common indication (65.1%) followed by DCR (26.1%) and biceps tenodesis (22.3%). Patients undergoing shoulder arthroscopy in the US are primarily older, white, male adults. Rotator cuff repair remains the most common indication. Persistent disparities in utilization exist among racial groups, sexes, and locations. Those with greater BMIs are generally more likely to undergo shoulder arthroscopy.

The arthroscopic Latarjet procedure is an established treatment for recurrent anterior shoulder instability with significant glenoid bone loss. This systematic review compared outcomes of screw versus suture-button fixation and identified contexts where each technique may be advantageous. Following PRISMA 2020 guidelines, PubMed and Google Scholar were searched on 23 July 2024 for English-language studies of arthroscopic Latarjet procedures using screw or suture-button fixation. Eligible studies included full-text human data with clear follow-up and outcome reporting. Extracted data included demographics, surgical details, functional scores, union rates, complications, and reoperations. Risk of bias was assessed using established tools for non-randomized studies. Pooled statistical comparisons for complication, reoperation, and non-union rates were performed using chi-square tests. Twenty studies met the inclusion criteria: 11 using suture-button fixation (804 patients) and nine using screws (753 patients). Both techniques achieved high graft union rates (>90%) and improved functional outcomes. Suture-button fixation showed lower complication (13.3% vs. 22.1%, p < 0.001) and reoperation rates (0.8% vs. 8.2%, p < 0.00001), with a non-significant trend toward higher non-union (9.6% vs. 3.6%, p = 0.08). Both fixation methods restore shoulder stability effectively. Fixation choice should be individualized to patient anatomy, functional demands, and surgeon experience. Further prospective comparative studies are warranted.

As total shoulder arthroplasty (TSA) becomes more common, current risk prediction tools often fail to reflect the physiological complexity of elderly surgical patients. Although tools such as the modified Frailty Index (mFI-5), Risk Analysis Index (RAI), and Geriatric Nutritional Risk Index (GNRI) show moderate prognostic utility, no validated composite score integrates multiple frailty domains to optimize perioperative risk stratification. This study developed and validated a novel frailty-based score-the Combined ASA-RAI-Preoperative Acute Severe Condition (CARP) score-and evaluated its predictive accuracy against existing indices in patients undergoing TSA for primary osteoarthritis. Using CPT code 23472, we identified TSA cases from 2015-2021 in the ACS-NSQIP database. Inclusion required complete frailty, comorbidity, and 30-day outcome data. The CARP score incorporated ASA class, RAI, and acute physiologic stress variables. Outcomes included 30-day major complications, readmission, reoperation, extended length of stay (eLOS), and non-home discharge. We assessed predictive performance using multivariable logistic regression, AUC, and internal bootstrap validation. Among 14,150 patients (mean age 68.9), major complications occurred in 0.78%, readmissions in 2.2%, and non-home discharges in 6.2%. CARP score demonstrated superior predictive accuracy for major complications (AUC 0.720), readmission (0.666), and eLOS (0.675), outperforming ASA, RAI, GNRI, and mFI-5. All CARP components were independently associated with adverse outcomes. Bootstrap validation confirmed model robustness. CARP scores outperform traditional indices in predicting adverse 30-day outcomes after TSA. Its multidomain design enables better risk stratification, with potential to enhance surgical planning, resource use, and patient counseling. External validation is recommended.

This study aimed to synthesize the applications, performance, and methodological conduct of artificial intelligence (AI) prediction models for total shoulder arthroplasty (TSA) outcomes. PUBMED, MEDLINE, EMBASE, and CENTRAL were searched on November 2, 2025 for all articles that utilized AI to develop prognostic or diagnostic prediction models utilizing TSA populations. Methodological quality was assessed using the TRIPOD statement and PROBAST tool. Twenty-four studies comprising outcomes of 497,365 patients (35.6% female; 69.6 ± 0.9 years) were included. Of these patients, 31.0% underwent rTSA, 29.1% aTSA, and 2.8% hemiarthroplasty. The remaining patients received a mix of aTSA and rTSA, but the exact proportions were not reported in their respective studies. Nine studies applied AI to clinical outcomes (AUC 0.85, 0.65-0.96), seven to adverse events (AUC 0.73, 0.52-0.92), and six to resource utilization (AUC 0.78, 0.59-0.91). All twelve studies comparing AI to traditional regression reported that AI models demonstrated superior performance. The need and caution for external validation was reported in 15 studies (62.5%). The mean TRIPOD adherence was 11.6 items (range 9-15); 19 studies (82.3%) met >50% of criteria, and 6 (26.1%) met >66%. PROBAST rated 16 studies (66.7%) at high risk of bias. AI prediction models in TSA show poor methodology, especially in calibration, sample size, missing data, and validation, warranting cautious interpretation and clearer direction for future research.Level of evidence: IV, systematic review of level I-IV studies.

In patients with symptomatic rotator cuff tears, arthroscopic rotator cuff repair (ARCR) is typically recommended when conservative management fails to provide symptom relief. Chronic post-surgical pain (CPSP) following ARCR is not uncommon and significantly reduces function and quality of life. This study aimed to develop a clinical prediction model for CPSP after ARCR. This prospective analysis included 103 participants who underwent ARCR between August 2022 and November 2024. Potential predictor outcome variables were recorded preoperatively, and postoperative pain was assessed at 6 weeks, 3 months, and 6 months. The primary outcome was CPSP at rest and on shoulder movements, which was measured at the 6-month follow-up. Prediction models were developed using binomial logistic regression analysis and bootstrapping techniques for internal validation. Key independent predictors included scores on measures of Pain Catastrophizing Scale, Depression, Anxiety, Stress Scale 21, and Central Sensitization Inventory, as well as the pressure pain threshold over the middle deltoid muscle on the affected side. Prediction models have been developed to forecast the occurrence of CPSP of the shoulder at 6 months post-ARCR. This represents a foundational step towards providing tailored risk evaluation, which can guide decisions regarding surgical management and therapeutic interventions for patients undergoing ARCR.

To assess the influence of neck-shaft angle (NSA) (145° vs. 155°) on abduction and adduction using three-dimensional (3D) simulations, to find the best configuration and preserve sufficient abduction, while improving adduction, and therefore reducing impingement risk. One hundred and four shoulders that underwent reverse shoulder arthroplasty (RSA) were imported into the image processing software TruMatch® to create virtual shoulder models. Semi-constrained and long-stemmed implant design for RSA was used and four configurations were simulated: (i) 155°NSA and 42 mm glenosphere (ii) 145°NSA and 42 mm glenosphere, (iii)155°NSA, 38 mm glenosphere, and bony increased offset-RSA (BIO-RSA) and (iv) 145°NSA, 38 mm glenosphere, and BIO-RSA. Whether or without BIO-RSA, configurations with 145° NSA (compared to the 155°) had significantly smaller abduction, and distalisation shoulder angle. Configurations with 145° NSA also had significantly greater adduction, lateralisation shoulder angle, flexion, extension, internal (IR) and external (ER) rotations. Regarding changes in muscle length between native anatomy and simulated RSA, whether with or without BIO-RSA, both NSA configurations would lengthen the deltoid, but shorten the subscapularis, infraspinatus and teres minor. Whether with or without BIO-RSA, decreasing the NSA could increase adduction and therefore reduce risks of scapular notching, but decrease abduction. Furthermore, decreasing the NSA could increase IR, ER, flexion and extension.Level of Evidence: Comparative simulation study: Level IV.