Normal Shoulder Research Articles

Does objective shoulder impairment explain patient-reported functional outcome? A study of proximal humerus fractures

Following a healed proximal humerus fracture, patient-reported outcome is predicted by objective physical examination findings. Range of motion and strength thresholds can correctly identify subjects with normal functioning shoulders. Subjects were age ≥55 years with a healed proximal humerus fracture. Impairment was measured with a focused physical examination of the shoulder; patient-reported outcome was assessed using 4 outcome questionnaires. Linear regression was used to determine how well variations in shoulder impairment explain differences in patient-reported outcomes. ROC curves were constructed to determine the physical examination thresholds that would correctly identify normally functioning shoulders. Thirty-one subjects with a mean age of 70 ± 8 years participated. The mean patient-reported outcome scores were: DASH 21 ± 19, ASES 82 ± 17, SST 8 ± 3, and Oxford 20 ± 8. The linear regression analysis suggests that shoulder impairment explains 38% of the Oxford, 50% of the DASH, 58% of the SST, and 70% of the ASES variance. Abduction strength was a significant predictor for all functional outcomes. Based on ROC analysis, forward flexion had the best discriminatory ability for identifying normally functioning shoulders (area under curve, 0.93). A threshold of 120° forward flexion correctly classified 90% of the shoulders. Range of motion and strength thresholds can identify subjects with normal shoulder function. A discordance between shoulder impairment and patient-reported outcome has been demonstrated and further work to identify patient, injury, or treatment factors to minimize this discrepancy is still needed.

Rotator cable at MR imaging: considerations on morphological aspects and biomechanical role

The rotator cable (RC) is a thickening of the coracohumeral ligament. It extends from the coracohumeral ligament to the inferior border of the infraspinatus tendon, with fibres running perpendicularly to the rotator cuff fibres. According to some authors, the RC tends to thicken with age, thus allowing some individuals with a cuff lesion to preserve normal shoulder function. We evaluated the RC with magnetic resonance (MR) imaging and investigated its possible role in the biomechanics of the shoulder affected by cuff lesions. Between November 2007 and May 2008, we performed shoulder MR examinations for shoulder pain or disability on 94 patients (46 males, 48 females; age range 16-79 years; mean age 54.09 ± 15.09 years) for a total of 104 shoulders (62 right, 42 left). RC was more easily detectable in oblique coronal scans where it appeared as a crescent-shaped, regularly marginated structure adjacent to the articular surface of the supraspinatus tendon and medial to the insertion point of this tendon on the greater tuberosity. Its thickness was 2.8 ± 0.3 mm. The structure was identified in 62% of cases (mean patient age 55.3 ± 14.9 years). No statistically significant difference in age was found between patients with and without evidence of RC (Student's t test=0.05; p=0.82). Among patients with partial- or full-thickness supraspinatus tendon lesions at MR imaging, no statistically significant difference was found between the presence or absence of RC and disability on Jobe's test (χ(2)=1.17; p>0.05). RC can be observed at MR imaging in >60% cases. In our sample it did not seem to influence shoulder function in patients with cuff lesions.

A Spectral Analysis of Rotator Cuff Musculature Electromyographic Activity: Surface and Indwelling

Electromyography (EMG) of the shoulder girdle is commonly performed; however, EMG spectral properties of shoulder muscles have not been clearly defined. The purpose of this study was to determine the maximum power frequency, Nyquist rate, and minimum sampling rate for indwelling and surface EMG of the normal shoulder girdle musculature. EMG signals were recorded using indwelling electrodes for the rotator cuff muscles and surface electrodes for ten additional shoulder muscles in ten healthy volunteers. A fast Fourier transform was performed on the raw EMG signal collected during maximal isometric contractions to derive the power spectral density. The 95% power frequency was calculated during the ramp and plateau subphase of each contraction. Data were analyzed with analysis of variance (ANOVA) and paired t tests. Indwelling EMG signals had more than twice the frequency content of surface EMG signals (p < .001). Mean 95% power frequencies ranged from 495 to 560Hz for indwelling electrodes and from 152 to 260Hz for surface electrodes. Significant differences in the mean 95% power frequencies existed among muscles monitored with surface electrodes (p = .002), but not among muscles monitored with indwelling electrodes (p = .961). No significant differences in the 95% power frequencies existed among contraction subphases for any of the muscle-electrode combinations. Maximum Nyquist rate was 893Hz for surface electrodes and 1,764Hz for indwelling electrodes. Our results suggest that when recording EMG of shoulder muscles, the minimum sampling frequency is 1,340Hz for surface electrodes and 2,650Hz for indwelling electrodes. The minimum sampling recommendations are higher than the 1,000Hz reported in many studies involving EMG of the shoulder.

Analyzing glenohumeral torque–rotation response in vivo

Background Because the human shoulder has many degrees of freedom that allow redundant means of producing the same net humerothoracic motion, there are many impediments to objective, repeatable assessment of shoulder function in vivo. Devices designed to date have suffered from poor reliability. In this study we introduce a new device and methods to evaluate human shoulder kinematics and evaluate its reproducibility from subject to subject and from day to day. Methods This was a controlled laboratory study. Using electromagnetic motion sensors to record the position and orientation of the thorax, scapula, and humerus, we quantified the kinematic response of twenty four normal shoulders in response to known internal–external torque application. A four-parameter logistic function was selected to characterize the strident features of the torque–rotation relationship. Findings Our analysis in conjunction with the measurement technique described herein, allowed the passive glenohumeral internal–external range of motion to be differentiated from other motion components and was determined to within 9.6% of full scale over three repeated trials. Range of motion was the most reliable biomechanical outcome, more so than computed indices of glenohumeral flexibility and hysteresis. The exact profile of the torque–rotation response, and therefore the repeatability of the calculated outcomes, was unique from shoulder to shoulder. Interpretation The development of the capacity for precise, non-invasive measurement of shoulder biomechanics over time is a requisite step towards optimizing treatment of shoulder injury and disease. Our current methods are superior to previous attempts at trying to non-invasively evaluate the biomechanics of the glenohumeral joint .

Pain Relief, Motion, and Function after Rotator Cuff Repair or Reconstruction May Not Persist after 16 Years

Short- to medium-term rotator cuff repair reportedly relieves pain in 82% to 97% of patients and provides normal or almost normal shoulder function in 82% to 92%. However, it is unknown whether pain relief and function persist long term. We asked whether, after rotator cuff repair or reconstruction, pain relief, ROM, shoulder strength, and function remained over the long term. We retrospectively reviewed 75 patients who underwent rotator cuff repair between 1980 and 1989. There were 55 men and 20 women. Their mean age at surgery was 52 years. The minimum followup was 16 years (mean, 20 years; range 16-25 years). Twenty-eight of the 75 patients (37%) had persistent relief of pain lasting for 20 years. In the remaining 47 patients, alleviation of pain lasted, on average, 14 years (range, 0-24 years). Mean flexion and abduction strength increased postoperatively but during long-term followup decreased to less than preoperative levels. External rotation also decreased. At the last followup, the Constant-Murley score averaged 66 (range, 10-98) in men and 60 (range, 29-89) in women. In the Simple Shoulder Test questionnaire, the mean number of yes answers was eight of 12. Of the 75 patients, 32 (43%) reported impairment in activities of daily living owing to an index shoulder complaint. Severe degenerative changes of the glenohumeral joint were evident in 14 patients (19%). The early high functional scores after primary rotator cuff repair or reconstruction of the types we performed in the 1980s did not persist. The function achieved postoperatively was lost, as ROM and strength decreased to less than preoperative values. However, alleviation of pain was long-standing in most patients. Based on our data, we should warn patients to expect less than permanent relief with those repairs. We cannot say whether the same will apply to currently performed types of repairs. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Evaluation of glenoid bone defects in anterior shoulder instability: determination of the center of the glenoid inferior portion

Objective To explore the feasibility and application of determining the center of the inferior portion of the glenoid on a standard anteroposterior view of the normal glenoid. Methods Seventy shoulders of 35 mature adults were measured in this study. A 64-slice CT 3D reconstruction was performed for each glenoid. A standard anteroposterior view and the scale of glenoid were made at a 3D workstation by one radiologist, and then transferred to software AutoCAD as 2D images. The 2D images were analyzed with AutoCAD respectively by 3 radiologists. The line was drawn between the most anterior and the most inferior points of the glenoid bony rim. On the same image, another line was drawn between the most posterior and the most inferior points of the glenoid bony rim. Two perpendicular bisectors of the 2 lines were drawn. The cross point of the 2 perpendicular bisectors was regarded as the circle center of the inferior part of the glenoid. The distances from the circle center to the anteroinferior and the posteroinferoir rims of the glenoid and the most posterior point were measured. Measurements were expressed as the mean ± standard deviation. Several related samples Friedman rank sum test was used to compare the measurements (the distance from the circle center to the most posterior point) by the 3 radiologists. Paired t tests were used to compare the differences between the left and right glenoids. Results The mean distance from the circle center to the most posterior point was ( 14. 1 ± 1.6) mm, the anteroinferior rim was ( 14. 0 ± 1.7) mm, and the posteroinferoir rim was ( 14. 1 ±1.6) mm. No significant differences were found ( P>0. 05) between measurements by the 3 radiologists. No significant differences were found ( P>0. 05) between the measurements of the both-side glenoids. Conclusions The method of determining the center of the inferior portion of the glenoid based on the most anterior,posterior and inferior points of the glenoid on a standard 3D anteroinferior view of the normal glenoid is easy,practical and highly repeatable. The radius of the left glenoid is comparable to the radius of the right side in normal shoulders. This method can be used to quantify a glenoid bone defect precisely. Key words: Shoulder joint; Joint instability; Imaging, three-dimensional; Glenoid; Bone defects

Shoulder Injury - Football

HISTORY: A 14-year-old freshman high school football player sustained a left shoulder injury after landing directly on his left shoulder while attempting to catch a pass. The receivers and quarterbacks had been practicing receiving routes without pads. The patient dove in order to catch an overthrown pass. He landed on the lateral aspect of his left shoulder. The patient heard a pop when he landed and experienced immediate pain in his shoulder, which he rated as a nine out of ten. There was no swelling, numbness, tingling, or radiating pain. Ice was applied to the shoulder immediately. The patient was seen 2 days later in the sports medicine clinic. PHYSICAL EXAMINATION: Examination in clinic revealed tenderness of the entire left shoulder with significant pain to palpation of the posterior aspect of his acromion and his coracoid process. No obvious deformities noted on inspection. Limited range of motion of the shoulder due to pain. Positive arm cross over test. DIFFERENTIAL DIAGNOSIS: Shoulder subluxation AC joint sprain Occult fracture Salter-harris fracture of Coracoid Shoulder contusion TEST AND RESULTS: AP internal/external rotation and axillary radiographs of the left shoulder -Slight widening of the coracoid synchondrosis on the left, previous left shoulder x-rays demonstrated a normal shoulder with closed coracoid apophysis. -Alignment of the acromialclavicular joint is normal -The humeral head is congruent with the glenoid MRI left shoulder: -Nondisplaced acute fracture through the base of the coracoid process with diffuse surrounding bone marrow edema -No evidence of rotator cuff, biceps tendon, or glenoid labrum tear. FINAL WORKING DIAGNOSIS: Non-displaced fracture through the base of the left caracoid process TREATMENT AND OUTCOMES: Vicodin for pain control initially and transitioned to motrin Immobilized in a sling for two weeks then permitted to wear sling as needed Physical activity limited to non contact activities with no risk of fall Physicial therapy of the shoulder initiated 3 weeks status post injury

A Biomechanical Analysis of the Native Coracoclavicular Ligaments and Their Influence on a New Reconstruction Using a Coracoid Tunnel and Free Tendon Graft

To understand and characterize the kinematic properties of the 2 coracoclavicular ligaments and to evaluate the biomechanical performance of a new 3-tunnel reconstruction of the coracoclavicular ligaments by use of a free tendon graft. Ten fresh-frozen cadaveric shoulders were tested. The kinematics and in situ forces of the coracoclavicular ligaments were tested with a robotic testing system. Kinematics of the shoulder in the intact state, in the sectioned state, and finally, after a coracoclavicular reconstruction and a coracoclavicular sling reconstruction were evaluated. The conoid had higher in situ forces during anterior and superior loading of the clavicle when compared with the trapezoid ligament, whereas the trapezoid ligament had higher in situ forces during posterior loading. Sectioning the trapezoid ligament significantly increased translation of the clavicle in the posterior direction, whereas sectioning the conoid ligament significantly increased superior translation. When we compared the 2 reconstruction techniques, the coracoid tunnel reconstruction was superior in controlling anterior translation whereas the coracoclavicular sling reconstruction was inferior because of anterior displacement of the graft. There was no significant difference in posterior or superior translation between either reconstruction technique. The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics because of their anatomic attachments. By more faithfully restoring these insertion sites on the clavicle and controlling motion of the graft on the coracoid, the 3-tunnel reconstruction technique more closely restores native shoulder kinematics than the coracoclavicular sling technique. Understanding the unique roles of the conoid and trapezoid bundles of the coracoclavicular ligament may improve surgical techniques in the management of acromioclavicular joint injuries. The reconstructive technique presented more faithfully restores normal kinematics and forces across the acromioclavicular joint than the coracoclavicular sling technique.

Meniscectomy of the sternoclavicular joint: A report of two cases

The sternoclavicular joint (SCJ) is the only true articulation between the axial and appendicular skeleton. It is a saddle-type, diarthrodial joint where less than half of the clavicle articulates with the sternum26; sprains, fractures, or dislocations, especially from indirect forces, are often attributed to this relatively bony incongruity.20 Its location close to the center of the body and its strong ligamentous restraints, however, limit the frequency of injury to this joint.9,25 Biomechanically, the SCJ is characterized by approximately 30° to 35° of forward elevation and 35° of flexion/extension during normal shoulder range of motion (ROM), with 4° of sternoclavicular motion for every 10° of shoulder elevation.

Contact between the coracoacromial arch and the rotator cuff tendons in nonpathologic situations: A cadaveric study

A recent ultrasound study has shown that impingement phenomenon was observed in healthy shoulders. We hypothesized that nonpathologic contact beneath the coracoacromial arch occurs in normal shoulders. Seven fresh-frozen cadaveric shoulders were studied. Each specimen was attached to a custom-designed shoulder-positioning device. A 22-N force was applied to the humeral head to keep it centered in the glenoid fossa. Contact pressure beneath the coracoacromial arch was measured by a flexible force sensor during flexion, abduction, internal and external rotation, extension, and horizontal abduction motions. Bending deformation of the coracoacromial ligament was measured by a linear variable differential transducer sensor. Data were recorded with the arm from 0 degrees to maximum range of motion with 10 degrees increments. Contact pressure with the coracoacromial ligament and acromion was not zero in the neutral position and increased during particular motions, such as flexion, abduction, horizontal abduction, and extension, whereas it was almost constant during internal and external rotation. Bending deformation of the coracoacromial ligament during flexion, abduction, and horizontal abduction motions was also shown to be greater than that during internal and external rotation. It is possible that repetitive contact of the coracoacromial ligament may cause degenerative changes, and a ridge of proliferative acromial spurs may be the result of nonpathologic contact. Contact phenomenon of the coracoacromial arch was observed during all motions. Nonpathologic contact beneath the coracoacromial arch may be present in normal shoulders.

Shoulder mobility after spinal accessory nerve–sparing modified radical neck dissection in oral cancer patients

Radical neck dissection (RND), a standard surgical procedure for lymph node metastasis of head and neck cancer for decades, causes various dysfunctions, such as pain or limited abduction of the shoulder. Various RND modifications have been made to reduce these postoperative dysfunctions, but the effect of preservation of the spinal accessory nerve is still controversial. The aim of this study was to explain our surgical method of sparing the accessory nerve during neck dissection and to clarify the effect of preserving the nerve on reduction in shoulder dysfunction. One hundred five neck dissections were performed in 90 patients with oral cancer: 4 RNDs and 101 modified radical neck dissections (mRNDs). The spinal accessory nerve was preserved in 96 neck dissections. Dysfunction of the trapezius muscle was evaluated by the limitation of shoulder lateral abduction at 3 months after the operation. All 9 patients with resection of the spinal accessory nerve showed severe shoulder dysfunction, whereas 90 out of 96 with preservation of the nerve maintained normal shoulder function. Spinal accessory nerve-sparing neck dissection can reduce postoperative shoulder dysfunction if careful operating procedures are used.

EVALUATION OF ANATOMICAL INTEGRITY USING ULTRASOUND EXAMINATION, AND FUNCTIONAL INTEGRITY USING THE CONSTANT & MURLEY SCORE, OF THE ROTATOR CUFF FOLLOWING ARTHROSCOPIC REPAIR

Objective: To evaluate the functional and anatomical results from surgical treatment via arthroscopy in cases of complete rupture of the rotator cuff, using ultrasound images and the Constant and Murley functional index to investigate the correlation between them. Methods: 100 patients (110 shoulders) were evaluated. The mean follow-up was 48.8 ± 33.28 months (12 to 141 months). The mean age was 60.25 ± 10.09 (36 to 81 years). Rupture of the supraspinal tendon alone occurred in 85 cases (77%), and in association with the infraspinatus in 20 cases (18%) and subscapularis in four shoulders (4%). An association of supraspinatus, infraspinatus and subscapularis lesions was found in one shoulder (1%). The lesions were classified according to DeOrio and Cofield scores as small/medium in 85 shoulders (77%) and large/extensive in 25 (23%). The clinical results were assessed in accordance with the Constant and Murley criteria. The ultrasound results relate to reports issued by different radiologists. Statistical analysis was carried out using the chi-square test, Fisher's exact test, Student's t test, Pearson's correlation, Kruskal-Wallis correlation and logistic regression (significance: p < 0.05). Results: The mean Constant evaluation was 85.3 ± 10.06 in the normal shoulders and 83.96 ± 8.67 in the operated shoulders (p = 0.224). Excellent and good results were found in 74 shoulders (67%), satisfactory and moderate results in 32 (29%) and poor results in four (4%). The ultrasound evaluation showed 38 shoulders with re-rupture (35%) and absence of rupture in 71 (65%). Among the 74 shoulders (67%) with excellent/good results, 22 (30%) presented re-rupture in the ultrasound report (p = 0.294). Among the four shoulders (4%) with poor results, two (50%) presented reports of intact tendons (p = 0.294). Conclusion: There was no statistically valid correlation between the ultrasound diagnosis and the clinical evaluation of results among the patients who underwent arthroscopic repair to treat full tear lesions of the rotator cuff. The clinical results from the complete rotator cuff repairs via arthroscopy presented a high level of functional recovery (Constant 83.96), compared with the contralateral shoulder. The postoperative ultrasound reports presented a high percentage of re-rupture (35%). Postoperative strength was greater among the patients aged under 60 years (p = 0.002) and in cases of lesions less than or equal to 3 cm (p = 0.003).

Traumatic Sternoclavicular Joint Injuries

Fractures and dislocations of the sternoclavicular joint (SCJ) are unusual but potentially devastating injuries in adolescents and young adults. Indeed, earlier reports have suggested that SCJ injuries represent less than 5% of all traumatic shoulder girdle injuries. Although historically many of these injuries were observed or treated nonoperatively, more recent information on the pathoanatomy, natural history, and potential outcomes of SCJ injuries treated operatively has improved our ability to restore more normal shoulder girdle anatomy and mechanics in an effort to improve functional outcomes. The purpose of this discussion is to review the pertinent clinical anatomy, clinical and radiographic evaluation, and treatment options for adolescents and young adults with SCJ fracture-dislocations, with particular emphasis on surgical indications and techniques.

Elastofibroma dorsi: management, outcome and review of the literature

Elastofibroma dorsi is an uncommon, benign, slow-growing soft-tissue tumour of uncertain aetiology. It classically presents as an ill-defined mass at the inferior pole of the scapula with symptoms which include swelling, discomfort, snapping, stiffness and occasionally pain. We report the symptoms, function and outcome after treatment of 21 elastofibromas in 15 patients. All were diagnosed by MRI and early in the series four also underwent CT-guided biopsy to confirm the diagnosis. In all, 18 tumours were excised and three were observed. After excision, the mean visual analogue score for pain decreased from 4.6 (0 to 10) pre-operatively to 2.4 (0 to 8) post-operatively (p = 0.04). The mean shoulder function, at a mean follow-up of 4.2 years (3 months to 16 years), was 78.1% (30 to 100) using the Stanmore percentage of normal shoulder assessment scoring system. The mean range of forward flexion improved from 135 degrees (70 degrees to 180 degrees ) to 166 degrees (100 degrees to 180 degrees ) after excision (p = 0.005). In four patients a post-operative haematoma formed; one required evacuation. Three patients developed a post-operative seroma requiring needle aspiration and one developed a superficial infection which was treated with antibiotics. Our findings support previous reports suggesting that a pre-operative tissue diagnosis is not necessary in most cases since the lesion can be confidently diagnosed by MRI, when interpreted in the light of appropriate clinical findings. Surgical excision in symptomatic patients, is helpful. It has been suggested that elastofibroma is caused by a local tissue reaction and is not a true neoplastic process. A strong association has been noted between elastofibroma and repetitive use of the shoulder, which is supported by our findings.

Avaliação da integridade anatômica por exame de ultrassom e funcional pelo índice de Constant &amp; Murley do manguito rotador após reparo artroscópico

OBJETIVO: Avaliar os resultados funcionais e anatômicos do tratamento cirúrgico via artroscópica nas roturas completas do manguito rotador usando imagens de ultrassom e o índice funcional de Constant e Murley, investigando a correlação entre eles. MÉTODOS: Avaliados 100 pacientes (110 ombros). Seguimento médio de 48,8 ± 33,28 (12 a 141) meses. Média de idade de 60,25 ± 10,09 (36 a 81) anos. Rotura isolada do tendão supra-espinal esteve presente em 85 casos (77%); em associação com o infraespinal, em 20 (18%), e associado ao subescapular, em quatro ombros (4%). A associação de lesões supra-espinal, infraespinal e subescapular foi encontrada em um ombro (1%). De acordo com DeOrio e Cofield, as lesões foram classificadas em pequenas/médias em 85 ombros (77%) e, grandes/extensas em 25 (23%). Avaliação clínica de resultados realizada de acordo com critérios de Constant e Murley. Resultados do ultrassom (US) se referem aos laudos emitidos por diferentes radiologistas. Análise estatística de acordo com os métodos Qui-quadrado, teste exato de Fisher, teste t de Student, correlação de Pearson, Kruscall-Wallis e regressão logística (significância p < 0,05). RESULTADOS: Média da avaliação de Constant de 85,3 ± 10,06 nos ombros normais e 83,96 ± 8,67 nos operados (p = 0,224). Excelentes e bons resultados observados em 74 ombros (67%), satisfatórios e regulares em 32 (29%) e maus em quatro (4%). Avaliação por ultrassonografia evidenciou 38 ombros com re-rotura (35%) e integridade em 71 (65%). Nos 74 (67%) ombros com excelentes/bons resultados, 22 (30%) apresentaram laudo ultrassonográfico de re-rotura (p = 0,294). Nos quatro (4%) ombros com maus resultados, dois (50%) apresentaram laudos de tendões íntegros (p = 0,294). CONCLUSÃO: Não há correlação estatisticamente válida entre o diagnóstico ultrassonográfico e o método clínico de avaliação de resultados de pacientes submetidos ao reparo artroscópico de roturas completas do manguito rotador. Os resultados clínicos nos reparos das roturas completas do manguito rotador por via artroscópica apresentam alto nível de recuperação funcional (Constant 83,96) quando comparado com o ombro contralateral. Os laudos de ultrassom pós-operatórios apresentam alta porcentagem de re-rotura (35%). A força pós-operatória é maior nos pacientes com menos de 60 anos de idade (p = 0,002) e em casos de lesões menores ou iguais a 3cm (p = 0,003).

Simulation for Teaching Normal Delivery and Shoulder Dystocia to Midwives in Training

Simulation for Teaching Normal Delivery and Shoulder Dystocia to Midwives in Training

Abnormal Translation in SLAP Lesions on Magnetic Resonance Imaging Abducted Externally Rotated View

The purpose of this study was to measure in vivo axial-plane translation of the glenohumeral joint by use of magnetic resonance imaging in patients with and without SLAP lesions between the conventional adducted neutral rotation (AD) view and an abducted externally rotated (ABER) view. Seven patients with an intraoperative SLAP lesion that was unstable and required repair were selected into the SLAP group. Although they did not have normal shoulders, 15 patients were selected into the control or comparison group, most of whom had rotator cuff pathology. The glenohumeral contact point (CP) and humeral head center (HHC) were calculated and compared with the glenoid surface as a relative anterior or posterior translation. The relative posterior translation between the ABER and AD views for each patient was calculated as Delta CP and Delta HHC. These values were compared between the SLAP and control groups. There was a significant difference in Delta CP between the SLAP and control groups (3.62 v 0.79 mm of relative posterior translation, P = .005). There was not a similar significant difference found in Delta HHC between the SLAP and control groups (3.19 mm v 1.48 mm of relative posterior translation, P = .14). There was a significant difference between the mean translations of the SLAP-ABER group and the SLAP-AD group for both CP (-3.65 mm v -0.04 mm, P = .008) and HHC (-2.22 mm v +0.97 mm, P = .03). The difference between the control-ABER group and the control-AD group was not as pronounced. The magnetic resonance imaging ABER view in patients with unstable SLAP lesions requiring repair showed in vivo glenohumeral posterior translation relative to the adducted neutral rotation view of greater than 3 mm. This finding furthers the understanding of the pathokinematics in SLAP lesions.

Arthroscopic repair of rotator cuff tear with anchor and transosseous suture

Objective To discuss the surgical methods and techniques of rotator cuff tear repair with anchor and transosseous suture and evaluate the clinical outcomes. Methods From February 2007 to February 2009, 32 cases of various types of rotator cuff tear were treated arthroscopically. The rotator cuff was repaired with suture anchor and transosseous suture. Twenty-five cases had full thickness tear, 5 had partial bursa-side tear,and 2 had partial articular-side tear. Sixteen lesions were on the dominant side. Preoperatively X-rays of the shoulder at the anteroposterior and supraspinatus outlet projection were obtained in all cases. Eleven patients had undergone MRI examinations and 21 cases had MRA. All the patients underwent acromioplasty. Eighteen cases were treated by single roll suture anchor and 1 or 2 transosseous tunnel suture, while 14 cases were treated by double roll suture anchor and 1 or 2 transosseous tunnel suture. UCLA scoring system was adopted to evaluate shoulder function before the operation and at the final postoperative follow up. Results All 32 cases were followed up for 3 to 23 months, with a mean interval of 13.4 months. The average UCLA score was 13.3 preoperatively and 33. 1 postoperatively. Twenty-three cases were rated as good and 9 cases as fair. Pain disappeared in 21 cases, while occasional and mild pain and discomfort still existed in 5 cases. In 6 cases pain was triggered by massive movement or special maneuvers. Normal shoulder movement was achieved in 24 cases. Active forward flexion and abduction reached > 150° in 26 cases and 90° to 120° in 6 cases. Muscle power of forward flexion and abduction was M5 in 25 cases and M4 in 7 cases. All the patients were satisfied with the surgical outcomes. Conclusion Arthroscopic repair using anchor and transosseous suture is a good method for repairing rotator cuff tear. This technique leads to secure fixation and hence ensures rotator cuff to bone healing. It is especially suitable for patients with osteoporosis or for revision cases. Key words: Shoulder joint; Reconstructive surgical procedures; Arthroscopes

Shoulder dislocation in a very-low-birth-weight infant: case report and review of the literature

Shoulder dislocation in a preterm infant is very rare. We report a case of a preterm infant, with gestational age of 25 2/7 weeks and birth weight of 910 g, with anterior shoulder dislocation after breech delivery. The infant was successfully treated with closed reduction. In general, long-term outcome of shoulder dislocation in these infants is good. However, prompt recognition and treatment of the dislocated shoulder are essential to maintain normal shoulder girdle function and to prevent functional disability.

Adequate Mobilization of the Inferior Glenohumeral Ligament-labrum Complex During Arthroscopic Bankart Repair: the “Suction-reduction” Sign

Arthroscopic repair of Bankart lesions is a safe and effective surgical procedure that is commonly performed. Crucial to the success of the repair is anatomic restoration of the inferior glenohumeral ligament-labrum complex. Without anatomic restoration of this complex the risk of recurrent shoulder instability may be increased. Current techniques for assessing adequate mobilization of the inferior glenohumeral ligament-labrum complex include the use of graspers that may apply varying amounts of force to position the tissue. The use of graspers may increase trauma to the capsulolabral complex. This article describes a simple, atraumatic technique that helps determine adequate capsulolabral complex mobilization during arthroscopic repair of Bankart lesions. This technique does not require any additional expensive equipment beyond a normal shoulder arthroscopy setup. Furthermore, this technique provides another way to verify proper anatomic positioning when placing suture anchors. This technique has been used successfully in more than 30 patients undergoing arthroscopic repair of Bankart lesions.