Impact of interscalene versus superior trunk blocks as sole anesthetics on respiratory outcomes for shoulder arthroscopy: a randomized controlled trial.

Background: Traumatic anterior labral injuries (Bankart lesions) lead to anterior shoulder instability. Arthroscopic anterior labral repair (also known as Bankart repair) provides a soft tissue reconstruction to reduce the risk of dislocation. However, the described techniques vary significantly. We present our technique for enhancing the quality and volume of tissue incorporated in the repair and utilizing interval closure to further reduce recurrent instability rates. Indications: Non-throwing athletes or high-demand patients with recurrent instability after a traumatic event with <20% glenoid bone loss. This can include young patients (<25 years) who are first-time dislocation patients participating in high-risk sports. Technique: Shoulder arthroscopy is performed in the lateral position with a standard posterior portal and 2 anterior portals. While viewing from the posterior portal and working from the anterosuperior portal, the labral and capsular tissues are completely elevated from the anterior and inferior glenoid. The native labral footprint on the glenoid is prepared for repair using a hooded bur. Sutures are passed through the capsulolabral tissue with a self-retrieving device. The first suture is passed into the inferior labral tissue from the anteroinferior portal. In contrast, subsequent suture passages along the anterior glenoid are performed from the posterior portal, all while viewing from the anterosuperior portal. The tissue is then sequentially advanced into the knotless anchors along the anterior face of the glenoid, creating a robust soft tissue restraint to glenohumeral instability. An arthroscopic rotator interval closure is then performed for further stability. Results: A review of this procedure in 38 active patients with at least 2 years of follow-up demonstrated an improved outcome score, with a 10.5% rate of redislocation. Two shoulders underwent revision surgery for recurrent instability. Discussion/Conclusion: Arthroscopic anterior labral repair with capsulorrhaphy and interval closure effectively reduces recurrent anterior shoulder instability. This video demonstrates techniques for enhancing the quality and quantity of soft tissue incorporated into the repair. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) have included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Rotator cuff tears are a common disease and various radiological measurement methods are still being investigated to make the diagnosis. The aim of this study was to investigate whether the coracoclavicular distance is associated with rotator cuff tears. Shoulder magnetic resonance imaging (MRI) examinations of 101 patients who underwent shoulder arthroscopy due to rotator cuff tears and 158 patients with normal MRI findings were evaluated retrospectively. Coracohumeral distance, acromiohumeral distance and supraspinatus volume were measured. When the acromiohumeral distance, coracoclavicular distance and supraspinatus volume were compared between the groups, each measurement was found to be statistically significantly lower in the tear group (Group 2) (p<0.001). In the analysis of ROC for the detection of full-thickness supraspinatus tear, the following findings were observed: if the coracoclavicular distance measured less than 12.4mm, a sensitivity of 89% and specificity of 73% were determined. Similarly, if the acromiohumeral distance measured less than 7.5mm, a sensitivity of 73% and specificity of 84% were determined. In full-thickness supraspinatus tears, if the supraspinatus volume measured below 51 cm3, a sensitivity of 89% and specificity of 72% were determined. Our study, conducted on a limited population, demonstrated that coracoclavicular distance is a significant metric for detecting supraspinatus tears. We believe that we have identified a new parameter that may be useful in the diagnosis of rotator cuff tears.

Implant-free loop tenodesis significantly improves functional outcome in the treatment of long head of biceps brachii tendon lesions: 2-year results of a prospective case series.

Interscalene nerve blocks (ISB) are commonly used for perioperative pain control after shoulder arthroscopy. Bupivacaine has historically been the primary anesthetic used in ISBs. In 2018, the U.S. Food and Drug Administration approved liposomal bupivacaine for ISBs. This study aims to identify the effect of ISBs using bupivacaine alone (B) versus liposomal bupivacaine + bupivacaine (LBB) on postoperative pain control after arthroscopic rotator cuff repair (RCR). A single-center, prospective, double-blinded, randomized, control trial following Consolidated Standards of Reporting guidelines was conducted from January 2020 to April 2024; 128 opiate naive patients undergoing arthroscopic RCR were randomized 1:1 into the B-only group (25 cc of 0.5% bupivacaine) versus the LBB group (133 mg [10 mL] of liposomal bupivacaine + 15 cc 0.5% bupivacaine). Demographics, comorbidities, additional procedures performed, daily morphine milligram equivalents (MME) consumed, and daily visual analog scale (VAS) pain scores for 14 days were collected. No differences were noted between age, sex, comorbidities, or American Society of Anesthesiologists physical classification system scores. On postoperative day 2, the LBB group consumed markedly lower MMEs (0.0 [0.0 to 7.5] versus 0.0 [0.0 to 15.0]; [P = 0.04]) and demonstrated a notable improvement in VAS scores on postoperative day 2 (4.8 ± 3.0 versus 6.0 ± 2.8; [P = 0.03]). No notable difference was seen in other daily MMEs consumed, daily VAS scores, or total 14-day MMEs. Total median MME consumed in both groups was low (MME 35.6 [7.5 to 88.1] or 5 [1 to 12] oxycodone pills). Although the use of LBB in ISBs led to markedly lower VAS scores and less narcotic consumption on postoperative day (POD2), these findings can be regarded as not clinically notable. The difference was the equivalent of one oxycodone tablet, and VAS did not meet minimal clinically important difference. No other differences were found in MME consumed or VAS scores during the first 2 weeks postoperatively following RCR. Overall narcotic consumption was low in both groups. I.

Objectives: Arthroscopic shoulder surgery, especially in rotator cuff procedures, often faces challenges due to compromised visibility, exacerbated by the absence of a tourniquet and the risk of bleeding in the sub-acromial space. Present strategies, including cautery, present potential complications. This study explores the potential improvement in intraoperative visualization and reduction in operative time through injections of 1:200,000 epinephrine to the portal site during arthroscopically performed rotator cuff repair. Materials and Methods: A prospective blinded comparative study included patients with partial-thickness supraspinatus tears (Ellman Grade 2 or Neer Stage 3). Participants were divided into an intervention group (receiving an epinephrine injection) and a control group (receiving no injection). The primary outcome was assessed using a Likert scale and Johnson’s visibility classification. Secondary outcomes included arthroscopic pump pressure adjustments, blood pressure changes, and operative time. The Statistical Package for the Social Sciences was used to conduct statistical analysis. Results: Out of 110 enrolled patients, the intervention group ( n = 55) showed significantly better intraoperative visibility compared to the control group ( n = 55) ( P &lt; 0.05). Likert scale scores and Johnson’s visibility classification demonstrated improved outcomes in the injection group ( P = 0.002). Temporary increases in arthroscopic pump pressure and blood pressure adjustments were less frequent in the intervention group. Operative time showed no significance ( P = 0.338). No complications related to the epinephrine injection were recorded. Conclusion: The study concludes that portal-site injections of diluted epinephrine offer a secure and effective method to improve intraoperative visibility during arthroscopic rotator cuff repair. This intervention may contribute to enhanced surgical precision without prolonging operative time, providing a valuable strategy for shoulder arthroscopy.

In shoulder arthroscopy, visual clarity is essential for safe and efficient procedures, yet intraoperative bleeding often compromises the surgical field. Several randomized studies have demonstrated that adding epinephrine to irrigation fluid significantly reduces bleeding and enhances visual clarity. This meta-analysis synthesizes findings from multiple studies to critically evaluate the overall efficacy and safety of epinephrine in improving intraoperative visualization during arthroscopic shoulder surgery. A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, and Google Scholar for studies published up to September 8, 2025. Eligible studies included randomized controlled trials and comparative observational studies evaluating the effect of epinephrine added to irrigation fluid during shoulder arthroscopy in adults. Primary outcomes included surgeon-rated visual clarity (scored on a 1-to-10 scale) and the incidence of increased pump pressure. Secondary outcomes included operative time, irrigation fluid volume used, and mean arterial pressure. Six studies met the inclusion criteria, including 422 adult patients undergoing arthroscopic shoulder surgery. Epinephrine use was associated with significantly improved surgeon-reported visual clarity, with a mean difference of 2.32 (95% CI 0.32-4.32; p = 0.02) compared to controls. The epinephrine group also had a significantly lower likelihood of requiring increased pump pressure (risk ratio = 0.39; 95% CI 0.27-0.57; p < 0.001). While trends toward reduced operative time (MD = - 4.38min; 95% CI: - 10.41 to 1.64; p = 0.15) and lower irrigation fluid volume (MD = - 0.83 L; 95% CI: - 2.04 to 0.37; p = 0.18) were observed, these differences were not statistically significant. No significant differences in mean arterial pressure were found between groups (p > 0.05). In the studies reviewed, epinephrine in irrigation fluid during arthroscopic shoulder surgery significantly increases visual clarity. Based on surgical and patient-specific factors, this should be taken into consideration for arthroscopic shoulder procedures.

Diagnosing shoulder pathologies is rather challenging. The reason is not only the anatomical structure and biomechanics of the joint, but also the concomitant conditions, specifically of cervical spine, which can significantly contribute to the pathophysiology. The aim of this study was to evaluate the diagnostic accuracy of clinical examination and magnetic resonance imaging in relation to the actual intraoperative finding in patients with selected shoulder pathologies. The data of patients in whom shoulder arthroscopy was performed at the Department of Trauma Surgery, University Hospital Ostrava in the 2018-2019 period were extracted retrospectively from the hospital information system. Our attention was focused on 4 diagnoses, namely rotator cuff tear (RCT), anterior shoulder instability due to lesion of the anterior capsular-labral complex (STA), shoulder impingement syndrome (impingement) and SLAP lesion - superior labral anterior posterior tear (SLAP). The study included 71 patients, of whom 46 were men (65%) and 25 women (35%). The difference in the median age of men and women was not significant (p = 0.740). High specificity (clinical examination 91.8%, MRI 91.8%) and low sensitivity (clinical examination 58.0%, MRI 61.0%) were evident in all diagnoses. In shoulder instability (STA) the sensitivity was significantly higher than in the other diagnoses. The accuracy of both methods was also high (clinical examination 79.9%, MRI 81.0%). These matters have already been described in literature. Nonetheless, most of the studies compared the MRI and arthroscopy findings. Our study reflects the actual diagnostic procedure, i.e. the examination of the patient, referral for MRI for suspected pathology and subsequent surgery to confirm or rule out the diagnosis. Magnetic resonance imaging can detect also other pathological findings that are not apparent during shoulder arthroscopy. High specificity of clinical examination as well as MRI was confirmed by this study. The sensitivity of both examination methods was significantly lower, except for the diagnosis of anterior shoulder instability (STA), where it was satisfactorily high for both methods. In the case of a positive clinical finding, in rotator cuff tear (RCT) diagnosis the MRI scan provides higher accuracy and eliminates false positives, which was, however, not confirmed in the other diagnoses. In the case of a negative clinical finding, the MRI helps refine the diagnoses. This does not apply to the STA diagnosis, where we may assume that a negative finding of clinical examination will most likely mean a negative intraoperative finding and this negative predictive value will not be increased by the MRI.

Return to Fishing and Hunting Recreation After Shoulder Arthroscopy and Arthroplasty, A PacWest Shoulder Study Group Survey

IntroductionA significant proportion of circulating opioids can be attributed to overprescribing of these medications for post-operative pain control. The present study aimed to determine the success of pain management after surgery, to gain insight into how satisfaction levels vary between those patients receiving opioid pain relief and those treated with non-opioid methods only following common orthopedic procedures.MethodsA prospective cohort study was conducted at a university hospital using a phone survey and a retrospective review of electronic medical records from 2017 to 2019. Opioid prescriptions, usage, and patient-reported pain outcomes were recorded to compare opioid and non-opioid users after knee arthroscopy, shoulder arthroscopy, and carpal tunnel release.ResultsThere were 159 patients who underwent common orthopedic procedures and met inclusion criteria. Among the 66 patients who underwent knee arthroscopy, 62/64 respondents (96.8%) were “very satisfied” or “satisfied” with pain control whether they used opioids (97.8%) or not (94%) with non-opioid users more frequently reporting very well controlled pain and greater satisfaction (p = 0.002 and p = 0.005, respectively). In the 32 patients who underwent carpal tunnel release, in both the opioid (18.7%) and non-opioid (81.2%) groups all patients were “very satisfied” or “satisfied” with pain control. Of the 61 shoulder arthroscopy patients, 96.1% using opioids were “very satisfied” or “satisfied” with pain control compared to 100% in the non-opioid group. No statistically significant differences in reported pain control and satisfaction were observed for carpal tunnel release or shoulder arthroscopy.DiscussionPatients who did not use opioids after knee arthroscopy reported significantly better perceived pain control and satisfaction than those who did. For shoulder arthroscopy and carpal tunnel release, patient satisfaction was high in both groups without significant differences. Providers should be aware of the utility in pursuing non-opioid versus opioid analgesia after certain common orthopedic procedures.

Purpose:To analyze if earlier orthopaedic evaluation (within 100 days of injury) is associated with a greater full duty return to work for shoulder arthroscopy patients with active workers' compensation (WC) claims.Methods:This was a retrospective chart review of all patients with an active WC claim treated with arthroscopic shoulder surgery at a community hospital between 2011 and 2018 and for 2 years postoperatively. The WC patients were divided into two groups: early orthopaedic evaluation (evaluated within 100 days of injury) and delayed orthopaedic evaluation (evaluated greater than 100 days after injury). Outcomes evaluated were rate and time until full duty return to work.Results:Final inclusion yielded 59 patients (36 early orthopaedic evaluation and 23 late orthopaedic evaluation). There was a higher rate of return to full duty in early versus late orthopaedic evaluation, 26 of 36 (72%) versus eight of 23 (35%), respectively (P = 0.005). A strong correlation was identified between time until orthopaedic evaluation and time to return to full duty after injury (r = 0.519, P = 0.002). Late orthopaedic evaluation was associated with a 4.89 times increased odds of not returning to full duty (odds ratio = 4.89, 95% confidence interval = [1.6 to 14.9]).Conclusion:Earlier Orthopaedic Surgeon evaluation of WC patients with shoulder injuries was associated with a higher return to full duty after shoulder arthroscopic surgery.

Preoperative Mental Health Diagnosis Associated With Increased Risk of 90-Day Readmission After Shoulder Arthroscopy.

Supraclavicular regional anesthesia is a safer alternative in the immediate postoperative period after shoulder arthroscopy: A systematic review & meta-analysis.

Early Surgical Stabilization Is a Positive Predictor Whereas Dominant Extremity Involvement and Off-Track Lesions Are Negative Predictors in Arthroscopic Repair of Bony Bankart Lesions With Glenoid Bone Loss <25.

BackgroundThe superior trunk block (STB) has been proposed as an alternative to interscalene block for reducing the risk of hemidiaphragmatic paralysis (HDP) while maintaining adequate analgesia. However, the optimal local anesthetic dosage for STB has not been established. This study aimed to evaluate whether a low dose of ropivacaine could effectively provide surgical anesthesia, reduce the incidence of complete and partial HDP, and improve anesthetic safety and patient comfort during shoulder arthroscopy.MethodsEighty-eight patients scheduled for shoulder arthroscopy were enrolled and randomly allocated in a 1:1 ratio to either a low-dose group (LD group; 10 mL of 0.25% ropivacaine) or a conventional-dose group (CD group; 15 mL of 0.5% ropivacaine). The primary outcome was the incidence of HDP assessed at 3 h post-block. Secondary outcomes included rates of successful surgical anesthesia, pain scores, opioid consumption, duration and onset time of the block, handgrip strength, and patient satisfaction.ResultsThe incidence of complete and partial HDP at 3 h post-STB was significantly lower in the LD group than in the CD group (31.8% vs. 84.1%, p < 0.001), with an absolute risk reduction of 52.3% (95% CI: 34.8% to 69.8%). All patients in both groups successfully underwent surgery without conversion to general anesthesia with tracheal intubation or requiring supplemental intraoperative analgesia. The overall patient satisfaction score was significantly higher in the LD group compared to the CD group (p = 0.003). However, patients in the LD group reported higher pain scores at 12 h post-block (p = 0.044), exhibited a shorter duration of sensory block (p = 0.001) compared to the CD group.ConclusionsThese findings indicate that a low-dose ropivacaine regimen (10 mL of 0.25%) for STB significantly reduces the incidence of HDP while still providing sufficient surgical anesthesia. However, this approach may be associated with reduced efficacy in postoperative analgesia.Trial registrationThis trial was registered at the Chinese Clinical Trial Registry (No. ChiCTR2000036608).

Background: Shoulder joint is the most freely moveable, but a relatively unstable joint in the body. The most commonly used currently prevalent diagnostic tools for shoulder joint disorders are clinical examination, Magnetic Resonant Imaging (MRI) and the gold standard arthroscopy. All have their inherent advantages and disadvantages and none is an all-inclusive tool. Furthermore, the current literature lacks studies comparing all the three diagnostic tools together or has just included one or two of the wide array of shoulder joint disorders. Therefore, this study was undertaken to identify correlation between all three diagnostic methods in arriving at a diagnosis in various shoulder disorders taking arthroscopy as a gold standard. Methods: The study was a prospective descriptive study carried out at a tertiary care hospital over period of 2 years. 33 symptomatic shoulder patients underwent standardized history, physical examination and MRI prior to diagnostic/therapeutic arthroscopy procedure. Shoulder arthroscopy considered as the gold standard, was used as a benchmark for comparing and confirming the results of clinical and radiological findings using the standard statistical data analysis. Results: Amongst clinical and radiological (MRI) findings; clinical examination was found to be superior to MRI in diagnosing adhesive capsulitis and bicipital tendinitis; MRI was found to be superior to clinical examination for diagnosing rotator cuff tears and Gleno-Humeral (GH) arthritis; both were equivocal in diagnosing Sub-Acromial Impingement Syndrome (SAIS), GH instability and Superior Labrum Anterior Posterior (SLAP) lesions. Conclusions: No modality in isolation is accurate and a combination of various available diagnostic tools gives the best precision in diagnosing shoulder joint disorders.

ObjectivesMulti-material decomposition (MMD), a key application of dual-energy computed tomography (DECT), has shown potential in musculoskeletal research. This study aimed to compare the diagnostic performance of DECT-based MMD with standard CT and MRI in detecting rotator cuff disease.Materials and methodsThis retrospective study evaluated patients diagnosed with rotator cuff disease who underwent third-generation dual-source DECT and 3.0-T MRI within a 2-week interval between December 2023 and November 2024. Shoulder arthroscopy served as the reference standard. Six readers independently assessed rotator cuff tears and determined the degree of supraspinatus tendon diseases using standard CT, DECT-based MMD and MRI. Area under the curve (AUC), sensitivity, specificity, positive/negative predictive values and accuracy were calculated for the diagnosis of rotator cuff disease. Friedman test was used to analyze the radiologists’ diagnostic confidence across the three image types.ResultsIn total of 103 patients (mean age: 50.0 ± 15.6 years) underwent shoulder arthroscopy. MMD demonstrated a higher average AUC for diagnosing rotator cuff tears (88% vs. 65%, p < 0.001) and supraspinatus tendon disease (86% vs. 63%, p < 0.001) compared to standard CT. Its diagnostic performance for supraspinatus tendon disease (91% vs. 90%, p = 0.35) and full-thickness tears (95% vs. 93%, p = 0.11) was comparable to that of MRI.ConclusionDECT-based MMD demonstrated superior diagnostic performance and reliability for detecting rotator cuff diseases compared to standard CT, with accuracy comparable to that of MRI in detecting supraspinatus tendon tears. DECT-based MMD offers a promising approach for the opportunistic detection of rotator cuff diseases.Critical relevance statementDual energy CT-based multi-material decomposition demonstrated accuracy comparable to that of MRI in detecting supraspinatus tendon tears, and may provide an alternative for patients with contraindications to MRI, facilitating early detection of injuries and accurate diagnosis of rotator cuff diseases.Key PointsDual energy (DE) CT multi-material decomposition (MMD) improves diagnostic performance for rotator cuff tears and supraspinatus tendon injuries.Radiologists with varying experience levels benefited from MMD, with experienced readers achieving MRI-level diagnostic performance.DECT MMD offers a promising alternative for patients with contraindications for MRI.Graphical

IntroductionDespite growing interest in non-pharmacological analgesia, clinical evidence supporting transauricular vagus nerve stimulation (taVNS) for postoperative pain management following arthroscopic shoulder surgery remains limited. This study aimed to evaluate the efficacy and safety of taVNS in postoperative analgesia after shoulder arthroscopy.MethodsSeventy patients scheduled for arthroscopic shoulder surgery were randomly assigned to two groups on the basis fo computer-generated concealed allocation sequences. The intervention group received taVNS once on the day of surgery and once daily for the following two consecutive days, with each session lasting 2 h. The control group received sham stimulation following an identical schedule. The primary outcome was total sufentanil consumption within 24 h postoperatively.ResultsPostoperative sufentanil consumption at 24 and 48 h, resting Numeric Rating Scale (NRS) scores at 4, 6, 12, 24, and 48 h, and the requirement for rescue analgesia were all significantly lower in the taVNS group compared with the sham stimulation group (all P < 0.05). In addition, quality of recovery-15 (QoR-15) scores at 24, 48, and 72 h post surgery were significantly higher in the taVNS group (all P < 0.05). No significant intergroup differences were observed in hemodynamic parameters (all P > 0.05). The incidences of nausea, vomiting, constipation, and gastrointestinal dysmotility were lower in the taVNS group, while other adverse events did not differ significantly between groups.ConclusionsTaVNS demonstrates both safety and efficacy in the management of postoperative pain following shoulder arthroscopy. Its application is associated with a reduction in analgesic requirements and contributes to an improved quality of recovery during the early postoperative period.Trial RegistrationClinicalTrials.gov identifier no. ChiCTR2400094087.

Shoulder injuries resulting from acute trauma are frequent. Minimally invasive (MIS) procedures such as arthroscopy are increasingly being used instead of traditional open approaches for several surgical purposes. When it comes to arthroscopy evaluations and treatments, the shoulder ranks second most often. Various shoulder pathologies, including rotator cuff pathology, subacromial impingement, acromioclavicular joint abnormalities, and more, may now be evaluated and treated with the use of shoulder arthroscopy. Shoulder arthroscopy has several benefits over open surgery, such as less comorbidity, faster recovery, and social and economic benefits. Shoulder arthroscopic treatments are more likely to be successful when meticulous care is taken with the patient's positioning, portal placement, fluid management, and other aspects.

PurposeRebound pain (RP) often occurs after the resolution of peripheral nerve blocks. Studies suggest that perineural esketamine prolongs block duration and reduces RP incidence. This study aimed to determine whether intravenous esketamine reduces RP incidence following single-shot interscalene brachial plexus block (ISBPB) in shoulder arthroscopic surgery.Patients and methodsIn this randomized controlled trial, 200 patients scheduled for shoulder arthroscopy received ultrasound-guided single-shot ISBPB preoperatively and were randomized to receive either intravenous esketamine (0.5 mg/kg bolus + 0.25 mg/kg/h infusion) or placebo. Primary outcomes included RP incidence, onset time, duration, and pain scores. Secondary outcomes included block duration, postoperative pain scores, and hemodynamic parameters (heart rate [HR], mean arterial pressure [MAP]).ResultsThe incidence rates of rebound pain (RP) were comparable between groups, with no significant differences in RP duration or pain scores (P>0.05). However, the Numeric Rating Scale at rest (NRS-R) scores at 8h, 12h, and 24h postoperatively were significantly higher in the C-group compared to the E-group (P<0.05). Hemodynamic stability was superior in the E-group during immediately post-administration (T4) to skin incision (T8), with higher MAP at T6–T10 (P<0.05). Sensory/motor block onset and duration showed no intergroup differences (P>0.05). Adverse events (dizziness, nausea) were comparable, with one transient hallucination in the E-group.ConclusionPatients undergoing arthroscopic rotator cuff repair under combined single-shot interscalene brachial plexus block and general anesthesia exhibit a rebound pain incidence of approximately 25%. Intravenous administration of esketamine (0.5 mg/kg bolus followed by continuous infusion at 0.25 mg/kg/h) during the operation failed to significantly reduce the incidence of rebound pain post-block (P>0.05). However, it demonstrated significant reductions in pain scores at 8h, 12h, and 24h postoperatively (P<0.05), with enhanced hemodynamic stability observed from anesthetic induction to pre-incision periods. No severe adverse events were reported.