J. Michael Wiater

Shoulder outcome measures: a comparison of 6 functional tests.

Background Several shoulder function scores are used in research, with no universally adopted standard. This study compares 6 shoulder outcome scales. Hypothesis Correlations exist between shoulder outcome scales, allowing conversion between scales. Shoulder scales are correlated with age. Study Design Regression and correlation study. Methods Seventy subjects with shoulder pain completed 6 shoulder outcome scales. Pearson correlations were calculated between the total scores of the 6 instruments, between the components of the scales, and with age. Regression equations were calculated between scales. Results The range of r values for total scores was 0.495 [.lessequal] r [.lessequal] 0.770, P [.lessequal] .01. In general, a scales components were themselves highly correlated and added little new information to the scale (0.260 [.lessequal] r [.lessequal] 0.705, P [.lessequal] .05). Most of the scale scores were highly correlated with age (0.291 [.lessequal] r [.lessequal] 0.582, P [.lessequal] .05). Constants reported corrections for age reduced (from r = -0.582 to r = -0.250, P < .05) but did not eliminate age as a confounding variable. Conclusions Correlations exist between shoulder outcome scales, but existing shoulder scales are not equivalent in their assessments of function; they contain redundant information and, in some cases, may reflect a patients age better than his/her shoulder function. The utility of conversion equations is minimized as a result of low to moderate correlations between scales.

A radiographic analysis of the effects of prosthesis design on scapular notching following reverse total shoulder arthroplasty

BACKGROUNDnScapular notching is a well-recognized complication of reverse total shoulder arthroplasty (RTSA). This paper analyzes the effects of prosthesis design on scapular notching in RTSA.nnnMETHODSnFrom a database of all RTSA performed by the senior author, shoulders with minimum 12-month follow-up were included (65 shoulders). Notching in shoulders with a prosthesis neck-shaft angle of 155° and no center-of-rotation (COR) offset (group 1) was compared to notching in shoulders with a neck-shaft angle of 143° and 2.5-mm COR offset (group 2). P values less than .05 were considered significant.nnnRESULTSnThe notching grade was significantly higher in group 1 than in group 2, even after statistically adjusting for differences in length of follow-up (P = .0081). The incidence of notching in group 1 at 60.7% was significantly higher than the 16.2% incidence in group 2 (P = .0107).nnnCONCLUSIONnUsing prostheses with a smaller neck-shaft angle and increased COR offset can significantly reduce scapular notching in RTSA at 1 year, possibly improving prosthesis survival.

Surgical treatment of displaced proximal humerus fractures with a short intramedullary nail

BACKGROUNDnThe Polaris nail is an intramedullary device for treating displaced proximal humerus fractures with few published studies to support its use. Results of a consecutive series of patients treated with the Polaris nail are presented.nnnMETHODSnEighteen patients with a mean age of 71 years (range, 37-84) were treated for twelve 2- and six 3-part fractures. Radiographic results for all patients were evaluated. Thirteen patients with an average follow-up of 42 months (range, 24-84) were available for functional evaluation.nnnRESULTSnSeventeen of 18 patients healed. Postoperatively, the neck/shaft angle collapsed an average 11° (range, 5-30°) into varus. Nine of 18 patients had final neck/shaft angles <120° and were considered radiographic malunions. The mean Constant and American Shoulder and Elbow Surgeons (ASES) scores were 61 (range, 20-100) and 67 (range, 10-100), respectively. Forward elevation averaged 118°. Patients had an average 5/8 positive rotator cuff signs. Seven patients underwent reoperation for loss of fixation or prominent hardware, and 1 required revision to a hemiarthroplasty.nnnCONCLUSIONnThis study shows a higher than reported percentage of unsatisfactory results using the Polaris nail. The device violates the rotator cuff and is unable to resist the deforming forces that can lead to loss of fixation and varus collapse.

Rotator cuff rehabilitation: current theories and practice

Abstract A fully functioning, painless shoulder joint is essential to maintain a healthy, normal quality of life. Disease of the rotator cuff tendons (RCTs) is a common issue that affects the population, increasing with age, and can lead to significant disability and social and health costs. RCT injuries can affect younger, healthy patients and the elderly alike, and may be the result of trauma or occur as a result of chronic degeneration. They can be acutely painful, limited to certain activities or completely asymptomatic and incidental findings. A wide variety of treatment options exists ranging from conservative local and systemic pain modalities, to surgical fixation. Regardless of management ultimately chosen, physiotherapy of the RCT, rotator cuff muscles and surrounding shoulder girdle plays an essential role in proper treatment. Length of treatment, types of therapy and timing may vary if therapy is definitive care or part of a postoperative protocol. Allowing time for adequate RCT healing must always be considered when implementing ROM and strengthening after surgery. With current rehabilitation methods, patients with all spectrums of RCT pathology can improve their function, pain and quality of life. This manuscript reviews current theories and practice involving rehabilitation for RCT injuries.

Tranexamic acid in shoulder arthroplasty a systematic review and meta-analysis

Background: The role of tranexamic acid (TXA) in reducing blood loss following primary shoulder arthroplasty has been demonstrated in small retrospective and controlled clinical trials. This study comprehensively evaluates current literature on the efficacy of TXA to reduce perioperative blood loss and transfusion requirements following shoulder arthroplasty. Methods: PubMed, MEDLINE, CENTRAL, and Embase were searched from the database inception date through October 27, 2016, for all articles evaluating TXA in shoulder arthroplasty. Two reviewers independently screened articles for eligibility and extracted data for analysis. A methodological quality assessment was completed for all included studies, including assessment of the risk of bias and strength of evidence. The primary outcome was change in hemoglobin and the secondary outcomes were drain output, transfusion requirements, and complications. Pooled outcomes assessing changes in hemoglobin, drain output, and transfusion requirements were determined. Results: Five articles (n = 629 patients), including 3 Level-I and 2 Level-III studies, were included. Pooled analysis demonstrated a significant reduction in hemoglobin change (mean difference [MD], −0.64 g/dL; 95% confidence interval [CI], −0.84 to −0.44 g/dL; p < 0.00001) and drain output (MD, −116.80 mL; 95% CI, −139.20 to −94.40 mL; p < 0.00001) with TXA compared with controls. TXA was associated with a point estimate of the treatment effect suggesting lower transfusion requirements (55% lower risk); however, the wide CI rendered this effect statistically nonsignificant (risk ratio, 0.45; 95% CI, 0.18 to 1.09; p = 0.08). Findings were robust with sensitivity analysis of pooled outcomes from only Level-I studies. Conclusions: Moderate-strength evidence supports use of TXA for decreasing blood loss in primary shoulder arthroplasty. Further research is necessary to evaluate the efficacy of TXA in revision shoulder arthroplasty and to identify the optimal dosing and route of administration of TXA in shoulder arthroplasty. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

WITHDRAWN: Stemless humeral component in total shoulder arthroplasty: 2-year age-related clinical outcomes

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Reverse Shoulder Arthroplasty in the Setting of Proximal Humeral Bone Loss

Bone loss of the proximal humerus presents a unique and difficult problem. The loss of rotator cuff attachment sites causes dysfunction that can be successfully treated with reverse shoulder arthroplasty (RSA). However, significant bone loss can be detrimental to implant stability and function. Surgical options for shoulder reconstruction become increasingly more complex with increasing severity of proximal humeral bone deficiency.