American Shoulder Elbow Surgeons Score Research Articles

Outcomes after revision surgery for glenoid baseplate failure in reverse shoulder arthroplasty

Background The purpose of this study was to report clinical outcomes in patients who underwent revision surgery for glenoid baseplate failure after index reverse shoulder arthroplasty (RSA). Methods A retrospective review was performed to identify patients from 2010 to 2020 at a single institution who sustained glenoid baseplate failure after RSA and underwent revision surgery. Exclusion criteria included periprosthetic joint infection or lack of minimum 1 year clinical and radiographic follow-up. Included patients were contacted for clinical outcomes (American Shoulder Elbow Surgeons (ASES), Visual Analog Scale (VAS) pain, Single Assessment Numeric Evaluation (SANE) and Patient Satisfaction scores). Results A total of 24 patients were identified, and 22 out of 24 (92%) patients were available for clinical follow-up at a mean period of 3.4 years after final revision surgery. The mean age was 70 years, and 15 out of 22 (68%) patients were female. A total of 17 patients were revised to RSA, and five patients were revised to hemiarthroplasty. For the 22 included patients, the mean follow-up ASES score was 64.6, VAS pain was 2.4 and SANE was 58%, which were all significantly improved versus pre-revision. In total, 64% of patients were satisfied or completely satisfied. Discussion Revision surgery after glenoid baseplate failure in RSA yields unpredictable clinical outcomes. Revision to RSA or hemiarthroplasty both resulted in modest functional results with persistent mild pain.

Poster 159: At-home physical therapy with a remote monitoring digital health platform leads to similar patient reported outcomes compared to traditional in-office physical therapy following shoulder surgery

Objectives: Physical therapy (PT) following shoulder surgery has traditionally occurred via in-office supervised visits. Recently digital health tools with remote patient monitoring (RPM) have emerged as an option to enhance the ability to both monitor and encourage engagement of home PT. The appeal of such tools has been accelerated by the impact of COVID-19 on the healthcare system. The primary purpose of this study was to compare patient-reported outcomes (PROs) following shoulder surgery of patients who completed at-home PT with a digital rehab application to patients who completed in-office supervised PT. The secondary purpose was to assess engagement among patients who used digital PT. Methods: A retrospective matched comparative evaluation was performed of patients who underwent arthroscopic shoulder surgery or shoulder arthroplasty at a single institution between April 2020 and May 2021. Patients who underwent home-based physical therapy with a digital remote monitoring platform (PT Genie; Orland, FL) were identified and age and procedure matched (arthroscopy or arthroplasty) to a cohort of patients that underwent in-office physical therapy. The digital platform provided remote monitoring capabilities with measurement of range of motion. PROs measured preoperatively and at 1 year postoperative included visual analog scale pain score (VAS), American Shoulder Elbow Surgeons Score (ASES), and Single Assessment Numeric Evaluation (SANE). Engagement measured as the number of sessions recorded was analyzed in the digital PT based on 6 age groups (≤40, 41-50, 51-60, 61-70, 71-80, and 81+). Statistical analysis using the student t-test to compare means was performed using SPSS version 17 (SPSS Inc., Chicago). Results: A total of 862 patients were identified, including 396 arthroscopic surgeries (198 in each PT group) and 466 in the arthroplasty group (233 patients in each PT group). The groups were similar at baseline other than a higher preoperative ASES score in the digital PT arthroplasty group (Table 1). There was no significant difference in any PROs between the two groups at 1-year follow-up. The highest engagement in the digital PT group was observed in the arthroplasty group and over the age of 50 (Figure 1). Conclusions: There appears to be no difference in PROs following shoulder surgery whether physical therapy is performed in-office or at home via a digital platform. Interestingly, engagement with digital PT was highest in older patients, suggesting that the technology is not a large barrier. Although further study is needed to confirm these findings, benefits of digital PT with remote monitoring may include: 1) Decreased cost for the healthcare system, 2) Decreased travel time for the patient, and 3) Scheduling efficiency and improved access to the PT for the patient.

Anterior deltoid muscle reflection using a deltopectoral approach is safe and does not influence outcome of reverse shoulder arthroplasty.

The deltopectoral approach is well accepted for shoulder arthroplasty procedures. The extended deltopectoral approach with detachment of the anterior deltoid from the clavicle allows increased joint exposure and can protect the anterior deltoid from traction injury. The efficacy of this extended approach has been demonstrated in anatomical total shoulder replacement surgery. However, this has not been shown in reverse shoulder arthroplasty (RSA). The primary aim of this study was to evaluate the safety of the extended deltopectoral approach in RSA. The secondary aim was to evaluate the performance of the deltoid reflection approach in terms of complications, surgical, functional and radiological outcomes up to 24 months post-surgery. A prospective non-randomized comparative study was performed between January 2012 and October 2020 including 77 patients in the deltoid reflection group and 73 patients in the comparative group. Decision for inclusion was based on patient and surgeon factors. Complications were recorded. Patients were followed up for at least 24 months to evaluate their shoulder function and ultrasound evaluation. Functional outcome measures included the Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder Elbow Surgeons score (ASES), pain intensity (VAS 0-100), range of motion (forward flexion (FF), abduction (AD), and external rotation (ER)). A regression analysis was performed to evaluate any factors of influence on the VAS. There were no significant differences in the rate of complications between the two groups (14.5% in the deltoid reflection group and 13.8% in the comparative group, p=0.915). Ultrasound evaluation was available in 64 (83.1%) patients, and no proximal detachment was observed. In addition, there were no significant differences in functional outcome measures both preoperatively and at 24 months post-surgery between the groups on Mean VAS pain, OSS, DASH, ASES, FF, ABD, and ER. Adjustment for possible confounders in a regression model indicated that only prior surgery significantly influenced the VAS pain (p=0.031, 95%CI 0.574 - 11.67) after surgery. Deltoid reflection (p=0.068), age (p=0.466), sex (p=0.936), glenoid graft (p=0.091), prosthesis manufacturer (p=0.382) and preop VAS score (p=0.362) were not of influence. Results of this study show an extended deltopectoral approach for RSA is safe. Selected reflection of the anterior deltoid muscle improved exposure and prevents anterior deltoid muscle injury followed by re-attachment. Patients had similar functional scores preop and at 24 months compared to a comparative group. Furthermore, ultrasound evaluation showed intact re-attachments.

Exactech Equinoxe anatomic versus reverse total shoulder arthroplasty for primary osteoarthritis: case controlled comparisons using the machine learning–derived Shoulder Arthroplasty Smart score

<h2>Abstract</h2><h3>Background</h3> The role of reverse total shoulder arthroplasty (rTSA) for glenohumeral osteoarthritis (GHOA) with an intact rotator cuff remains unclear with prior investigations demonstrating similar patient reported outcome measures (PROMs) to anatomic total shoulder arthroplasty (aTSA). However, legacy PROMs are subject to skewed distributions with many patients achieving the maximum possible score (ceiling scores). We evaluated a cohort of primary rTSAs performed for GHOA with an intact rotator cuff compared to a case matched cohort of aTSAs utilizing the Shoulder Arthroplasty Smart score (SAS), a machine learning derived PROM which eliminates the ceiling effect. <h3>Methods</h3> A retrospective review of an international shoulder arthroplasty database was performed between 2001 and 2020. Patients undergoing rTSA for rotator cuff intact GHOA (n = 367) were matched 1:1 with aTSA controls (n = 367) with a minimum of 2-year follow-up. Assessed variables included patient demographics, range of motion, American Shoulder Elbow Surgeons score (ASES), Constant, Simple Shoulder Test (SST), and the SAS score. <h3>Results</h3> Preoperatively, the SAS (49.0 vs. 45.2; <i>P</i> < .001), SST (4.7 vs. 4.1; <i>P</i> = .002), and Constant score (42.5 ± 15.3 vs. 38.1 ± 14.2; <i>P</i> < .001) were greater in aTSA versus rTSA. Similarly, the SAS score (82.3 vs. 77.6; <i>P</i> < .001) and SST score (10.8 vs. 10.3; <i>P</i> = .003) remained greater in aTSA postoperatively. In contrast, no differences in the ASES (<i>P</i> = .103) or Constant scores (<i>P</i> = .108) were found between aTSA and rTSA patients postoperatively. Improvement preoperatively to postoperatively did not differ between aTSA and rTSA patients when assessed using the SAS (<i>P</i> = .257), ASES (<i>P</i> = .888), or SST scores (<i>P</i> = .510). However, a higher rate of improvement in the Constant score (31.8 vs. 35.0; <i>P</i> = .022) was observed in the rTSA compared to aTSA. A higher rate of complications (5.4% vs. 1.6%; <i>P</i> = .008). and revision surgery (4.1% vs. 0.5%; <i>P</i> = .002) were observed in aTSA compared to rTSA. <h3>Conclusions</h3> Patients undergoing shoulder arthroplasty for rotator cuff intact GHOA experienced higher rates of complications and revisions in aTSA compared to rTSA, but similar levels of clinical improvement between implants when evaluated using a validated outcome score without a ceiling effect. Unlike the ASES and SST scores which are limited by ceiling effects, a higher mean postoperative SAS score after aTSA was observed but preoperative to postoperative SAS differences were similar to after rTSA.

Poor Psychological Readiness Inhibits Return to Play Following Operative Management of Superior-Labrum Anterior-Posterior Tears

The purposes of this study were to determine why athletes did not return to play (RTP) following operative management of superior-labrum anterior-posterior (SLAP) tears, compare these athletes to those who did RTP, and evaluate the SLAP-Return to Sport after Injury (SLAP-RSI) score to assess the psychological readiness of athletes to RTP after operative management of SLAP tears. A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 24-month follow-up was performed. Outcome data, including visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, patient satisfaction, and whether they would undergo the same surgery again was collected. Additionally, the rate and timing of return to work (RTW), the rate and timing of RTP, SLAP-RSI score, and VAS during sport were evaluated, with subgroup analysis among overhead and contact athletes. The SLAP-RSI is a modification of the Shoulder Instability-Return to Sport after Injury (SI-RSI) score, with a score >56 considered to be a passing score for being psychologically ready to RTP. The study included 209 athletes who underwent operative management of SLAP tears. A significantly higher percentage of patients who were able to return to play passed the SLAP-RSI benchmark of 56 compared to those who were unable to return (82.3% vs 10.1%; P < .001), and the mean overall SLAP-RSI scores were also significantly higher among those capable of returning to play (76.8 vs 50.0; P < .0001). Additionally, there was a significant difference between the two groups in every component of the SLAP-RSI score (P < .05 for all). Fear of reinjury and the feeling of instability were the most common reasons for not returning to play among contact athletes. Residual pain was the most common complaint among overhead athletes. A binary regression model predicting return to sports was performed, which demonstrated ASES score (odds ratio [OR]: 1.04, 95%; (confidence interval [CI]: 1.01-1.07; P= .009), RTW within 1 month after surgery (OR: 3.52, 95%; CI: 1.01-12.3; P= .048), and SLAP-RSI score (OR: 1.03, 95%; CI: 1.01-1.05; P= .001) were all associated with greater likelihood of return to sports at final follow-up. Following the operative management of SLAP tears, patients who are unable to RTP exhibit poor psychological readiness to return, which may be due to residual pain in overhead athletes or fear of reinjury in contact athletes. Lastly, the SLAP-RSI tool in combination with ASES proved to be useful in identifying patients' psychological and physical readiness to RTP. Level IV, prognostic case series.

Substantial clinical benefit values demonstrate a high degree of variability when stratified by time and geographic region.

A Substantial Clinical Benefit (SCB) value is the amount of change in a patient-reported outcome measure required for a patient to feel they significantly improved from an intervention. Previously published SCB values are often cited by researchers when publishing outcomes data. Where these SCB values are set can have a large impact on the conclusions drawn from a study citing them. As such, the goal of this study was to determine the generalizability of SCB values for a procedure when stratified by time from surgery and geographic region. A nationwide outcomes database was utilized to obtain preoperative, one-year, and two-year postoperative outcome measurements for patients who underwent anatomic total shoulder arthroplasty (TSA) or reverse TSA. The data were divided into three geographic regions: the South, the Midwest, and the West. An East region was not included due to its limited number of patients. SCB values were calculated for four outcomes measures: Single Assessment Numeric Evaluation score, American Shoulder Elbow Surgeons score, Visual Analog Scale, and Western Ontario Osteoarthritis of the Shoulder score. SCB values were calculated for each region, for each procedure, and at both one and two years postoperatively. To determine the variability of potential SCBs within each region, simulated datasets were created to determine a distribution of possible calculated SCBs. A total of 380 anatomic TSA patients and 543 reverse TSA patients were included for analysis. There was a high degree of variability of SCB values when stratified by procedure, time, and region. While some simulated datasets did produce homogenous SCB distributions among regions, some outcome measures demonstrated a large heterogeneity in distribution among regions, with concomitant large distributions of values within individual regions. There is notable heterogeneity of SCB values when stratified by region or time. The current method of citing previously published SCB values for determining the efficacy of an intervention may be inappropriate. It is likely that this variability holds true in other areas of orthopedics.

Short-term clinical effectiveness of 5% lidocaine patch after arthroscopic rotator cuff repair: study protocol for a randomized, double-blinded, placebo-controlled clinical trial

BackgroundArthroscopic rotator cuff repair (ARCR) often causes unbearable postoperative pain, even more severe than before surgery. Opioids are the drugs of choice for temporary postoperative analgesia. However, this conventional approach also has some side effects and potential for drug abuse. The aims of this study are expected to verify the effect of 5% lidocaine patch (LP5) on the intensity of early postoperative pain, functional recovery and quality of life in patients undergoing ARCR.MethodsIn this randomized, double-blind, and placebo-controlled clinical trial, a total of 102 postoperative patients undergoing ARCR will be randomly assigned to either the LP5 group, receiving topical lidocaine analgesia, or the placebo control group. The primary outcome measure will be the change in the American Shoulder Elbow Surgeons score from pre-operation to 90 days post-operation. Secondary outcomes will include pain scores, range of motion, opioid use, safety indicators, blinding assessment and several shoulder function score questionnaires. The effect of the allocated treatment will be assessed at preoperative baseline and at 7-, 14-, 30- and 90-day postoperatively.DiscussionIn this study, the efficacy and safety of the 5% lidocaine patch will be evaluated in terms of short-term clinical symptoms in patients undergoing ARCR. The results of this study will help determine whether LP5 is effective in early functional recovery in ARCR and whether it relieves pain and reduces opioid consumption.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org.cn) ChiCTR2200060108. Registered on 19 May 2022.

Arthroscopic-Assisted Double-Bundle Coracoclavicular Ligament Reconstruction Using Cortical Fixation Buttons With Suture Tape Provides Superior Vertical Stability Than the Single-Bundle Reconstruction for Acute Acromioclavicular Joint Dislocation

This study aimed to compare clinical and radiologic outcomes between single- and double-bundle arthroscopic-assisted coracoclavicular (CC) ligament reconstruction using cortical fixation buttons with suture tapes for acute acromioclavicular (AC) joint dislocation. Patients who underwent arthroscopic-assisted CC ligament reconstruction using cortical fixation buttons with suture tapes for acute AC joint dislocation from July 2014 to March 2019 were identified. This study included patients treated for acute AC joint dislocation within 2 weeks after an injury, with a Rockwood classification of III or V and at least 2 years of follow-up. Patients were divided into 2 groups based on the reconstruction technique: group I (single-bundle technique) and group II (double-bundle technique). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Constant score, and visual analog scale for pain score between the 2 groups. On the plain radiograph, the CC interval ratio (CCIR) was measured to evaluate maintenance of CC interval fixation. Postoperative complications, including reduction failure, were also documented. Fifty-eight patients (26 in group I, 32 in group II) were enrolled. There were no significant differences in CCIR between the 2 groups preoperatively and 3 months postoperatively. However, the CCIR of group I was significantly greater than that of group II 6 months postoperatively (group I: 160.5% ± 48.5%, group II: 125.4% ± 38.9% at 6 months postoperatively, P= .01; group I: 164.0% ± 57.3%, group II: 123.2% ± 35.9% at the last visit, P= .01). Despite radiologic differences, the clinical outcomes demonstrated no significant differences between 2 the groups (ASES score: 93.5 ± 5.2 in group I, 94.4 ± 4.5 in group II, P= .54; Constant score: 92.9 ± 5.3 in group I, 94.8 ± 4.3 in group II, P= .16). Reduction failure occurred in 4 patients (15.3%) in group I and in 1 patient (3.2%) in group II (P= .16). Arthroscopic-assisted double-bundle CC ligament reconstruction using cortical fixation buttons with suture tapes provided superior vertical stability than the single-bundle technique. Level III, retrospective comparative study.

Choosing patient-reported outcome measures for shoulder pathology.

This study was designed to identify the most frequent shoulder patient-reported outcome measures (PROMs) reported in high-quality literature.A systematic review was performed to identify shoulder PROMs, and their diffusion within the scientific literature was tested with a subsequent dedicated search in MEDLINE.506 studies were included in the final data analysis, for a total number of 36,553 patients.The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the American Shoulder, Elbow Surgeons Score (ASES) and the Shoulder Pain and Disability Index (SPADI) were the most frequently reported PROMs in the analysed publications, with disease-specific PROMs being used with increasing frequency.A core set of outcome measures for future studies on patients with shoulder pathologies, based on the international acceptance and diffusion of each PROM, is needed.A combination of the DASH score for shoulder outcome assessment with more specific PROMs, such as the ASES for rotator cuff pathology and osteoarthritis and the SPADI for shoulder stiffness and shoulder pain of unspecified origin, is proposed as a recommended set of PROMs. Cite this article: EFORT Open Rev 2021;6:779-787. DOI: 10.1302/2058-5241.6.200109

Ibuprofen Use Did Not Affect Outcome Metrics After Arthroscopic Rotator Cuff Repair,

PurposeTo determine whether patients who are prescribed ibuprofen after arthroscopic rotator cuff repair have significantly different patient-reported outcomes for pain, function, and overall health at baseline and 1 and 2 years after operation relative to patients only prescribed opioids.MethodsPatients who underwent a rotator cuff repair by a total of 3 surgeons and participated in the outcomes registry from 2012 to 2016 were screened for inclusion in this study. Inclusion criteria were primary arthroscopic rotator cuff repair, at least 2 years from the date of surgery and over the age of 18. Exclusion criteria were revision and open rotator cuff repair. All patients followed the standard postoperative rehabilitation protocol for rotator cuff repair. Patients were divided into 2 cohorts. Group I included patients who received ibuprofen/nonsteroidal anti-inflammatory agents (NSAID) after surgery (n = 281), and Group II consisted of patients who did not receive ibuprofen/NSAID after surgery (n = 182). Patient-reported outcome measures for Visual Analogue Scale, American Shoulder Elbow Surgeons score, Single Assessment Numeric Evaluation score, Simple Shoulder Test and The Veterans Rand 12-Item Health Survey were collected preoperatively and at 3 and 6 months, 1 year, and 2 years after surgery. Statistical analysis was performed to compare patient-reported outcome measures between Group I and II.ResultsThis study consisted of 463 patients who underwent arthroscopic rotator cuff repair, and patients were divided into 2 cohorts. There were 281 patients who did not receive ibuprofen/NSAID after operation in Group I and 182 patients who did receive ibuprofen in Group II. There were no statistically significant differences between the 2 groups in age at treatment, mean body mass index, gender, ethnicity, diabetes, and number of rotator cuff tendons involved; however, there was a statistically significant difference in receiving worker’s compensation (P = .005), and this was subsequently adjusted for in our analysis. There were no significant differences in patient-reported outcomes for all metrics between the group prescribed ibuprofen and the group that was not prescribed ibuprofen at 1 and 2 years after surgery or in change from baseline.ConclusionPatients receiving ibuprofen did as well as patients who did not receive ibuprofen after arthroscopic rotator cuff repair on patient-reported outcome measures assessing shoulder pain, function, and overall health.Level of EvidenceLevel III, retrospective comparative study.

Results of repeat manipulation under ultrasound-guided cervical nerve root block with corticosteroid and local anaesthetic injection for recurrence of frozen shoulder

BackgroundThis study aimed to evaluate the clinical results of a repeat manipulation under ultrasound-guided cervical nerve root block (MUC) with corticosteroid and local anaesthetic injection for recurrence of idiopathic frozen shoulder after MUC.MethodsA consecutive series of 42 shoulders in 39 patients with idiopathic frozen shoulder underwent MUC. All patients were assessed according to the American Shoulder Elbow Surgeon (ASES) score and shoulder range of motion (ROM) both before MUC and at 1 year thereafter. If patients continued to have pain and limited ROM at 3 months after the procedure, they were offered a repeat MUC. Such patients were also assessed before the procedure and at 3 months and 1 year thereafter.ResultsThe initial MUC was successful in 31 shoulders (single group). Repeat MUC was required in 11 shoulders (repeat group). Patients in the single group showed significant improvement in ROM and ASES score at 1 year after the procedure (p < 0.001); similarly, patients in the repeat group had significant improvement in ROM and ASES score at 3 months and 1 year after the procedure (p < 0.001). Patients in the repeat group had had significantly more severely limited ROM (p < 0.01) and decreased ASES score (p < 0.001) before the procedure compared with those in the single group.ConclusionsA repeat MUC with corticosteroid and local anaesthetic injection is a valuable option before proceeding to surgery for recurrence of idiopathic frozen shoulder. When there is severely limited ROM and decreased ASES score before the MUC, a repeat MUC may be necessary, which would require the patient’s informed consent.Trial registrationRetrospectively registered

Nonlinear Models And Computer Adaptive Testing Can Decrease Orthopedic Patient Survey Burden

The National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) assess patient symptom level in fewer questions than legacy patient reported outcomes (PRO). While there are benefits to CATs, clinicians commonly desire legacy PROs where they have an existing knowledge base. The American Shoulder & Elbow Surgeons score (ASES) is commonly used to assess shoulder function; it is unknown if PROMIS measures can predict ASES scores. PURPOSE: Design a nonlinear model using PROMIS CATs to predict ASES scores. METHODS: Military Health System beneficiaries who underwent a shoulder surgery and consented to allow their clinical data be used for research (n=897) completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at varying time points, providing 1,471 complete observations. PROMIS Physical Function and Pain Interference surveys were modeled as these are the theoretical constructs the ASES evaluates. For the prediction models, PROMIS CAT scores were re-weighted based on the standard error of the score, reflecting the confidence in the score, via inverse-variance reweighting. A beta distribution Generalized Additive Mixed Model (GAMM) accounted for multiple observations while incorporating nonlinear interactions into the model. The model’s predictive quality was assessed via four-fold cross-validations evaluating the following metrics between predicted vs true data: 1) Pearson correlation coefficients, 2) linear regression R2 values, and 3) root mean square error (RMSE). RESULTS: The GAMM predictive model (Figure 1) had the following characteristics: Pearson coefficient = 0.74-0.76, R2 = 0.55-0.58, and RMSE = 13.4-14.2. CONCLUSIONS: PROMIS CATs, in conjunction with nonlinear predictive modeling, can reliably predict legacy PRO scores. PROMIS CATs reduce patient question burden and can provide clinicians the information they are accustomed to receiving from legacy PROs.

Proximal Approach of Ultrasound-guided Suprascapular Nerve Block: Comparison with Subacromial Steroid Injection.

BackgroundThis study was undertaken to evaluate early clinical outcomes of ultrasound-guided suprascapular nerve block (SSNB) using a proximal approach, as compared with subacromial steroid injection (SA).MethodsThis retrospective study included a consecutive series of 40 patients of SSNB and 20 patients receiving SA, from August 2017 to August 2018. The visual analogue scale (VAS), American Shoulder Elbow Surgeon’s score (ASES), University of California, Los Angeles score (UCLA), the 36 health survey questionnaire mental component summary (SF36-MCS), physical component summary (PCS), and range of motion (forward elevation, external rotation, and internal rotation) were assessed for clinical evaluations.ResultsCompared with the baseline, VAS, and ranges of motion in the SSNB group significantly improved at the 4-week follow-up (VAS scores improved from 6.7 ± 1.6 to 4.3 ± 2.4, p<0.001; all ranges of motion p<0.05), while other variables showed no statistically significant differences. All clinical variables were significantly improved in the SA group (p<0.05). However, all clinical scores at the 4-week follow-up showed no significant difference between groups.ConclusionsUltrasound-guided SSNB using proximal approach provides significant pain relief at 4-weeks after treatment, with statistically significant difference when compared with SA, suggesting that SSNB using proximal approach is a potentially useful option in managing shoulder pain. However, in the current study, it was less effective in improving shoulder function and health-related quality of life, compared with SA.

Decreased complication profile and improved clinical outcomes of primary reverse total shoulder arthroplasty after 2010: A systematic review.

The purpose of this review was to update the complication profile of reverse total shoulder arthroplasty (rTSA) post-2010, given greater procedural familiarity, improved learning curves, enhanced implant designs, and increased attention to the nuances of patient selection. Three electronic databases were searched and screened in duplicate from 1 January 2010 to 16 December 2018 based on predetermined criteria. Twenty-two studies examining 1455 patients (26% male; mean age: 73.4 ± 3.6; mean follow-up: 23.4 ± 14.3 months) were reviewed. Post-operative motion ranged a mean 122.4° ± 11.5° flexion, 109° ± 19.4° abduction, and 33° ± 11.2°/41° ± 5° external/internal rotation. Post-operative mean Constant score was 58.9 ± 10.1, American Shoulder Elbow Surgeon score was 73.4 ± 6.1, Simple Shoulder Test score was 63.5 ± 6.5, and a Visual Analog Scale pain score was 1.6 ± 0.9. The overall complication rate was 18.2% and major complication rate was 15.4%. Compared to pre-2010, the overall complication rate of 18.2% is lower than previous rates of 19%-68%, with the rate of "major" complications dropping three-fold from 15.4% to 4.6%. The data suggest that rTSA is a safe and efficacious alternative to aTSA and HA, and the "stale" nature of previous complication profiles are points fundamental to perioperative discussions surrounding rTSA.

The clinical effects of reverse shoulder arthroplasty for the patients with the cuff tear arthritis

Objective: To analyze the clinical effects of reverse shoulder arthroplasty (RSA) for the patients with the cuff tear arthritis(CTA). Methods: A retrospective analysis of 12 patients who had underwent primary RSA for treatment of CTA from January 2012 to June 2017 in Department of Orthopedic, Beijing Chaoyang Hospital, Capital Medical University. There were 8 males and 4 females, aged 69.4 years (range: 64-73 years). The operation was performed in a conventional manner, the subscapularis and biceps tendon were repaired separately.The preoperative and postoperative American shoulder elbow surgeons score and university of California at LosAngeles score of patients were recorded. The complications and the images of radiological examinations were collected. Data were analyzed by paired-samples t-test. Results: At mean follow-up of (34.7±18.1) months (range:3-66 months), the preoperative ASEA score improved from 58.2±8.2 to 92.9±2.9 (t=14.32, P=0.00) and UCLA score improved from 13.2±1.5 to 30.8±1.7(t=23.14, P=0.00). No complications like loosening of prosthesis, superficial wound infection and shoulder dislocation were noted. Conclusion: Reverse shoulder arthroplasty have satisfactory effect for the patients with the cuff tear arthritis.

Clinical Outcomes and Recurrence Rates After Arthroscopic Stabilization Procedures in Young Patients With a Glenoid Bone Erosion: A Comparative Study Between Glenoid Erosion More and Less Than 20%

To evaluate the clinical outcomes and recurrence rates of arthroscopic stabilization procedures in young patients who had recurrent anterior shoulder instability with a glenoid bone erosion more than 20%, and to compare with those in patients with a glenoid bone erosion less than 20%. A total of 161 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability with anterior glenoid bone erosions and at least 2years of follow-up were included. Patients were divided into 2 groups based on the glenoid defect size (group I [32 patients]: erosion >20%, group II [129 patients]: erosion <20%). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Rowe score, and sports/recreation activity level between the 2 groups. Postoperative complications including instability recurrence were documented. The mean glenoid defect size was 22.1 ± 2.1% in group I, and 12.2 ± 3.7% in group II. In group I, clinical outcomes were significantly improved after operation (ASES score: 57.9 ± 14.3 at initial, 88.9 ± 6.2 at the last visit, P= .001; Rowe score: 42.1 ± 15.6 at initial, 87.4 ± 7.6 at the last visit, P= .001). These results were inferior to the clinical outcomes of patients in group II (ASES score: 91.5 ± 12.7, P < .001; Rowe score: 89.3 ± 12.4, P=.01). Postoperative recurrences occurred in 5 patients (15.6%) in group I, whereas patients in group II showed 5.4% of recurrence rate (P= .05). Competent recoveries to sports/recreation activity were achieved in 84.4% of patients in group I. Arthroscopic stabilization procedures for recurrent anterior shoulder instability in young patients with glenoid bone erosions more than 20% showed satisfactory clinical outcomes and recurrence rate, although these results were inferior to those of patients with glenoid erosions less than 20%. Arthroscopic stabilization procedures can be applied as the primary treatment of recurrent anterior shoulder instability with a large glenoid bone erosion for functional restoration and return to previous sports activity level. Level III, retrospective comparative study.

Clinical treatment of suprascapular nerve compression syndromes via posterior portal by arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve

Objective To investigate the clinical outcomes of arthroscopic decompression of spinoglenoid notch cysts and release of suprascapular nerve in treating suprascapular nerve compression syndromes via posterior portal. Methods Eleven patients from January 2010 to January 2017 with spinoglenoid notch cysts complicated suprascapular nerve compression syndromes were included. There were 7 males and 4 females with the average age of 41.5±5.3 years old (range 29-56 years) with 3 patients left side involved and 8 right side. All patients were diagnosed with MRI and EMG. The surgical procedure began with posterior capsule arthroscopic releasement from the labrum, then found the spinoglenoid notch cyst. Split of the cyst was made for internal drainage, then found the suprascapular nerve and vessel bundle for clearing the bursal tissue with probe, decompressed the suprascapular nerve finally. Mecobalamin was taken (0.5 mg, tid) until 3 months postoperatively. The patients were evaluated by functional scores from American Shoulder Elbow Surgeons (ASES) and Constant-Murley preoperatively and postoperatively. Statistical analysis was conducted by student t-test. Results All patients were followed up at 7-15 months (with an average of 10 months). The mean preoperative ASES score increased from 46.5±3.7 to 93.8±2.2 at the time of final follow-up with the significant difference (t=3.359, P<0.05). Preoperative ASES score were good in 5 cases, fair in 4 cases and poor in 2 cases. The postoperative score were excellent in all patients. The Constant-Murley score was 47.3±4.2 preoperatively and 94.0±1.8 postoperatively with significant difference (t=4.776, P<0.05). Preoperative score were good in 6 cases and fair in 5 cases. The postoperative score were excellent in all patients. These patients had no recurrence of cyst after surgery and returned to work. Conclusion Arthroscopic decompression of spinlglenoid notch cyst and suprascapular nerve release via posterior portal can successfully treat suprascapular nerve compression syndrome resulting in spinoglenoid notch cyst. Key words: Shoulder; Arthroscopy; Cysts; Nerve compression syndromes

Clinical and MRI results of arthroscopic repair for massive rotator cuff tear

Objective To investigate the clinical and MRI outcomes of the arthroscopic rotator cuff repair for massive rotator cuff tear at minimum 2 years after surgery. Methods From October, 2010 to March, 2013, data of 79 shoulders in 77 patients with massive rotator cuff tear who were treated with arthroscopic rotator cuff repair were retrospectively analyzed. There were 42 male (44 shoulders) and 35 female (35 shoulders). The average age before surgery was 57.4 years (43.1-80.4 years). There were 64 right shoulders and 15 left shoulders. The dominate side were involved in 70 cases. A trauma history was documented in 52 shoulders. The symptoms persisted less than 3 months in 42 shoulders, between 3 and 6 months in 11 shoulders, between 6 and 12 months in 11 shoulders and more than 1 year in 15 shoulders. No revision case was included. The clinical results (range of motion, forward elevation strength, external rotation strength and American Shoulder & Elbow Surgeons (ASES) score and MRI results were collected. Results All 77 cases were followed up more than 2 years. The forward elevation (156.9°±20.0° to 103.2°±54.5°), external rotation (40.6°±15.5° to 32.0°±21.4°), internal rotation (L1 to L2), forward elevation strength (9.7±4.7 lb to 4.6±4.9 lb), external rotation strength (11.1±5.1 lb to 8.3±5.4 lb) and ASES score (82.7±14.6 to 45.2±17.4) were all improved significantly at the latest follow-up. During the surgery, complete repair were achieved in 68 shoulders. The forward elevation (146.4°±31.4° to 110.0°±56.7°), external rotation (45.0°±14.8° to 34.1°±20.8°) and ASES score (78.6±14.9 to 54.5±13.9) were all improved significantly at the latest follow-up in patients with partial repair during the surgery. But the forward elevation strength (10.5±4.9 lb to 6.2±3.2 lb) and external rotation strength (11.5±5.1 lb to 8.3±3.8 lb) were significantly better improved in patients who had complete repair. In 68 shoulders with complete repair during the surgery, 20 shoulders were found to have rotator cuff re-tear. The re-tear rate was 29.4%. But none of the patient with postoperative re-tear received revision surgery. The forward elevation (152.0±23.3 to 103.5±60.5), forward elevation strength (8.5±4.7 lb to 5.0±4.7 lb) and ASES score (76.9±16.5 to 40.8±18.6) were all improved significantly at the latest follow-up in patients with postoperative re-tear of the rotator cuff tendon. But the forward elevation (161.4°±13.4° to 152.0°±23.3°), forward elevation strength (11.3±4.7 lb to 8.5±4.7 lb), external rotation strength (12.4±4.8 lb to 9.6±5.3 lb) and ASES score (86.0±13.0 to 76.9±16.5) were significantly better in patients with complete healed rotator cuff tendon comparing with the re-tear group. Conclusion The rotator cuff repair can significantly improve the shoulder function of massive rotator cuff tear even when the rotator cuff tendon can only be partially repaired or re-tear after the surgery. The shoulder function is significantly better in patients with complete healed rotator cuff tendon comparing with the partial repair group and the re-tear group. Key words: Shoulder joint; Arthroscopy; Soft tissue injuries

A comparison study of phlios plate and multiloc nail in treatment of proximal humerus fractures

Objective To evaluate the clinical and radiological results of Phlios plate and Multiloc nail in treatment of proximal humerus fractures. Methods From February 2013 to December 2015, data of 37 cases of proximal humerus fractures who were treated by reduction and fixation using Phlios plate or Multiloc nail were retrospectively analyzed. In group one (Phlios plate), there were 10 males and 8 females, with an average age of 56.3±5.8 years, including 7 cases of Neer 2-part surgical neck fracture, 6 cases of Neer 3-part fracture, 4 cases of Neer 4-part fracture, and 1 case of fracture-dislocation. In group two (Multiloc nail), there were 8 males and 11 females, with an average age of 57.2±7.4 years, including 8 cases of Neer 2-part surgical neck fracture, 9 cases of Neer 3-part fracture, 1 case of Neer 4-part fracture, and 1 case of fracture-dislocation. Operation time, range of motion of shoulder joint, visual analogue scale (VAS) pain score, American Shoulder & Elbow Surgeon (ASES) score and Constant-Murley score were collected. Results All 37 patients were followed up for an average period of 15.5 months (range, 12-36 months). The average bone healing time were 2.5±0.5 months (range, 2-3 months) and 2.2±0.5 months (range, 1.5-3 months) in the plate and nail group respectively. At the latest follow-up, average VAS score was 0.4±0.6 (range, 0-2), the ASES score averaged 85.4±6.8 points (range, 73-96), Constant-Murley score averaged 83.4±7.3 points (range, 71-94), and external rotation averaged 30.8°±10.0° (range, 10°-50°) in plate group, while average VAS score was 0.2±0.4 (range, 0-1), ASES score averaged 89.7±5.6 points (range, 80-98), Constant-Murley score averaged 88.5±6.8 points (range, 76-98), and external rotation averaged 40.3°±7.9° (range, 20°-50°) in the intramedullary nailing group. One case had partial necrosis of humeral head in the plate group, while 1 case suffered absorption of the greater tuberosity in the nail group, with the complication rate of 5.6% (1/18) and 5.3% (1/19) respectively, without significant difference. The internal and external rotation degrees, ASES and Constant-Murley scores were better in nail group than those in plate group for 2-part fractures, while the forward elevation and abduction degrees were similar. Conclusion Similar results were achieved for the treatment of proximal humeral fractures by Phlios plate and Multiloc nail. The Multiloc nailing group had achieved superior outcomes in Neer-2-part proximal humeral fractures. Key words: Shoulder fractures; Internal fixators; Fracture fixation, intramedullary

The Mini-Open Modified Bristow-Latarjet Procedure for Anterior Shoulder Instability: A 15-Year Study on the Results of 90 Cases

The described procedure is a reproducible and effective technique used to restore joint stability in patients who have incurred anterior recurrent shoulder dislocation. This study presents the middle time results of Modified Bristow–Latarjet consisting of the association of 2 procedures, the congruent glenoid reconstruction with two headless screws fixtion of the standing coracoid and the rotator interval approach ensuring the intactness of subscapularis muscle in the treatment of traumatic anterior shoulder instability. Ninety patients were enrolled in this retrospective case-series study with 2 to 15 years’ follow-up. Preoperatively and postoperatively all patients underwent a computed tomography scan to assess the percentage of glenoid bone loss and the glenoid cavity reconstruction respectively. The rate of recurrent of shoulder instability, Glenohumeral osteoarthritis,bone-healing, bone position and loss of external motion was evaluated. Rowe, ASES (American-Shoulder-Elbow-Surgeons), Constant-Murley, and DASH scores, were used to assess the shoulder function. The mean length of follow-up was 5.6 years (range, 2-15 years). None patients had shoulder redislocation and none reported shoulder indisability. All patients get bone-union in 6 months. The arthropathy of the shoulder, 82(92%)were classified as normal, 6(6%) as mild, 2(2%)as moderate, and none as severe according to Samilson-Prieto classification. The mean loss of external rotation was 11.6°(95%CI, 9.9-13.2) with the arm at the side of the body, and the mean deficit was 12.4°(95%CI, 10.8-14.0) with the arm on abduction 90°. The Rowe, ASES, Constant-Murley and DASH scores showed significant improvements(p<0.001): The Rowe score increased from 45.6 to 92.6, the ASES score increased from 62.0 to 93.9, the Constant-Murley score increase from 58.2 to 90.8,and the DASH score deceased from 15.9 to 5.0. The described procedure is a reproducible and effective technique used to restore joint stability in patients who have incurred anterior recurrent shoulder dislocation.