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There is a paucity of literature demonstrating which factors are associated with signs of elbow instability on magnetic resonance imaging (MRI) following simple elbow dislocations (SED). This study aimed to evaluate demographic variables and MRI datasets to identify factors associated with elbow instability following SEDs. This retrospective multicenter MRI study included patients who had sustained SED and presented within 21 days of trauma. Measurements included ulnohumeral angle, drop sign, and radiocapitellar and ulnohumeral incongruity. The coronoid tip (Regan Morrey type I), lateral collateral ligament (LCL), common extensor origin (CEO), medial collateral ligament (MCL,) and common flexor origin (CFO) were assessed for injuries. Simple and multiple logistic regression analyses were performed to identify factors associated with signs of elbow instability (e.g., ulnohumeral incongruity > 1 mm) on MRI. A total of 147 patients (68 women, 79 men) with a mean age of 42.9 years (range, 17–85) were included. Of those, 62 patients (42.2%) demonstrated radiocapitellar (> 2 mm) and 36 patients (25.5%) demonstrated ulnohumeral incongruity (> 1 mm); 17 patients (11.6%) had a drop sign (≥ 4 mm). All patients with elbow instability on MRI had injury to the CEO and/or CFO. In multiple logistic regression, an ulnohumeral angle of ≤ 45° (p = 0.005; OR: 4.95), injury to the CEO (p

Background The re-tear rate after supraspinatus tendon (SSP) repair is high despite optimization of surgical techniques. The critical shoulder angle (CSA) > 35° has been identified as a risk for re-tear. Surgical reduction of the CSA performing additional lateral acromioplasty (ALAP) is intended to reduce the risk. Objective We aimed to evaluate the effect of ALAP on the re-tear rate in patients with a CSA > 35° after SSP repair. Patients and methods The study included 49 shoulders fulfilling predefined inclusion criteria. The patients were assigned to two groups; group I (25 SSP) was additionally treated with an ALAP. In group II (24 SSP) standard acromioplasty was performed during reconstruction. Magnetic resonance imaging and a clinical examination (Constant Score; CS) were performed 12 months after surgery. Results After 15 months group I showed a re-tear rate of 20%, a decreased CSA (mean 38.0° preoperatively vs. 34.5° postoperatively) and an increase in CS (mean 53.9 vs. 84.6). After 16 months group II showed a re-tear rate of 16.7%, no difference between pre- and postoperative CSA (37.8° vs. 37.6°), and an increase in CS (48.9 vs. 84.5). There was no difference between the groups in terms of re-tears and postoperative CS (p = 0.4557), but there was a significant difference in postoperative CSA (p 35° did not have a worse clinical outcome and no increased rate of re-tears compared with patients with a mechanically reduced CSA. Conclusion Additive lateral acromioplasty does not decrease the re-tear rate after arthroscopic SSP repair. However, ALAP significantly decreases the CSA to normal values.

Background The etiology of degenerative supraspinatus tendon (SSP) tear is still subject to discussion. Objectives Our objective was to correlate clinical, radiological, and intraoperative signs of mechanical outlet impingement in patients with degenerative SSP tears. Materials and methods This prospective study included 100 patients with degenerative SSP tears that required surgery. Preoperatively, clinical impingement signs and radiological parameters (critical shoulder angle [CSA], acromion type according to Bigliani, acromion index [AI]) were recorded. Intraoperatively, the extent of the rupture and grinding marks on the bottom of the acromion were assessed. Results Of the 100 patients, 59 had clinical impingement signs preoperatively; 90 patients had at least one positive radiological sign (CSA > 35°, AI > 0.67, acromion type II or III). In 23 patients a partial tear, in 55 patients a full thickness tear, and in 22 patients an additional infraspinatus tendon tear were found. In 10 cases no grinding marks at the bottom of the acromion during arthroscopy were found. In 75 cases moderate grinding marks and in 15 cases severe marks with bare bone at the bottom of the acromion were found. There was no statistically significant correlation between preoperative impingement signs and arthroscopic grinding marks (p = 0.83) or between clinical signs and radiological parameters (p = 0.44). There was no significant correlation between extent of the rupture, extent of grinding marks or radiological impingement parameters (p = 0.16; p = 0.26). Conclusion We could not verify a correlation between clinical and radiological impingement sign and arthroscopic impingement parameters. Based on our study, degenerative SSP tear cannot be characterized as the result of a mechanical outlet impingement.

Subacromial decompression is one of the most frequently performed procedures in the setting of arthroscopic shoulder surgery and typically includes acromioplasty. However, the indication for acromioplasty remains a subject of debate. Possible complications involve deltoid muscle insufficiency due to an excessive removal of the anterior acromion. This case report is intended to draw attention to this particular complication and its management.

Calcifying tendinitis is a very common pathology in the shoulder region, which may be acute or chronic. The rotator cuff, particularly the supraspinatus tendon, is most frequently affected. The tendons of the rotator cuff undergo a natural cycle of destruction and regeneration. The development of calcifying tendinitis is caused by defective tendon repair. Typical is a chronic course with acute pain exacerbation, which leads to medical presentation. Treatment options range from conservative therapy including rest, physical therapy, nonsteroidal anti-inflammatory drugs, and shock wave therapy, to surgical therapy with arthroscopic removal of the calcific focus. This article discusses the current stage-dependent therapeutic concepts and provides a treatment recommendation.

BackgroundThe aim of this study was to examine whether dynamic fluoroscopy is reliable for assessment of medial elbow stability in the presence of radial head resection and different stages of medial collateral ligament (MCL) dissection in a cadaveric elbow model.Materials and methodsSix intact elbow specimens were measured for joint angulation while applying valgus stress in four examination conditions (Examiner 1, Examiner 2, 1 Nm, 2 Nm) in four different elbow positions (fully pronated or supinated at 0° of elbow extension and 30° of elbow flexion). The elbow specimens were examined for valgus stress in three stages: (1) intact, (2) after radial head resection, and (3) after subsequent dissection of the complete MCL. Anteroposterior radiographs of the elbow were made at each stage to determine joint angulation. Intraclass correlation coefficients (ICCs) were calculated.ResultsIn intact elbows, mean joint angulation ranged from 2.2° ± 2.0 (1 Nm) to 5.2° ± 2.3 (Examiner 1). Radial head resection did not increase joint angulation during valgus stress, regardless of joint position and examination condition (Examiner 1: 5.5°; Examiner 2: 5.0°; 1 Nm: 2.6°, 2 Nm: 3.9°). Additional dissection of the MCL led to significantly higher joint angulation during measurements with the standardized torques (1 Nm: 12.4°; 2 Nm: 23.3°). Very good to excellent ICCs for joint angulation between Examiner 1 and Examiner 2 (0.861 to 0.959) were found.ConclusionDynamic fluoroscopy is a reliable diagnostic tool for determining medial elbow stability in the presence of radial head resection and different stages of MCL dissection.

Background The clinical and radiographic results of an all-polyethylene glenoid with variable backside curvature adapted to the individual anatomy were compared with a standard all-polyethylene glenoid. Methods This retrospective study included 87 patients with primary glenohumeral osteoarthritis and anatomic shoulder replacement with a short-stem prosthesis and cemented all-polyethylene glenoid. In all, 42 patients with a mean age of 67 ± 8 years were treated with an all-polyethylene glenoid without variable curvature (group 1) and 45 patients with a mean age of 68 ± 10 years were treated with an all-polyethylene glenoid with individualized curvature (group 2). Clinical outcome was determined by range of motion, Constant Score (CS) age- and sex-adjusted Constant Score (CS%), and Subjective Shoulder Value (SSV). Radiographs were analyzed for the occurrence of radiolucent lines according to the method of Mole. Results After a mean follow-up of 31 months (range, 24–50) a significant improvement was achieved in all clinical parameters in both groups (p p = 0.713). At the final follow-up, the radiolucent line scores were 1.2 ± 2.0 in group 1 and 0.9 ± 1.1 in group 2 (p = 0.410). In five patients (12%) from group 1 and four patients from group 2 (9%), the radiolucent line score increased over time. One patient in group 1 (2%) exhibited radiographic glenoid loosening. Conclusion The all-polyethylene glenoid with individualized curvature showed promising short-term clinical and radiographic results. Further studies with a longer follow-up are necessary to evaluate whether the new all-polyethylene glenoid is superior to the standard all-polyethylene glenoid.

In shoulder arthroplasty, there is a trend for shorter humeral implants to facilitate stem revision and preserve bone stock. This review evaluates the clinical and radiographic outcome of anatomical total shoulder replacement with uncemented humeral short stems. A systematic review was performed using PubMed and Cochrane databases. The search terms “short stem” (all) and “shoulder” (title/abstract) were used. The minimum follow-up was 20 months. The demographic data, clinical outcome (pain, range of motion, outcome scores), radiographic outcome (humeral bone adaptations, humeral loosening, glenoid loosening), risk for high radiographic bone adaptations, complications, and revision were determined. Ten studies comprising 653 shoulder arthroplasties were included in the analysis. At an average follow-up of 20–64 months, the clinical parameters of pain, range of motion, and outcome scores improved significantly in all studies. The most frequent radiographic finding was calcar resorption in 15–71% of patients. High filling ratio, lack of metaphyseal porous coating, and poor bone quality were associated with high bone adaptation. The radiographic changes did not influence the clinical outcome in any study. In 13 of 653 patients (2%), humeral stem loosening was observed leading to stem revision in nine patients, with one study reporting eight of 73 patients with humeral stem loosening. The average weighted complication rate was 6% and the average weighted revision rate was 4%. The short- to medium-term results of uncemented anatomical short-stem shoulder arthroplasty are encouraging and the clinical results are comparable to other 3rd- and 4th-generation shoulder arthroplasties. Further studies with longer follow-up are needed to evaluate and understand why the radiographic changes occur and to prove the theory of bone-sparing revision surgeries.

The current study investigated the clinical outcome of open elbow dislocations, focusing on the influence of associated soft tissue and bone injury.From October 2008 to August 2015, 230 patients with elbow dislocations were treated at the study center. Our retrospective study comprised 21 cases of open elbow dislocations. The mean age of patients was 49 years (20-83 years); there were six (29%) female and 15 (71%) male patients. The range of motion (ROM) of the injured and uninjured elbow was measured, and the Mayo Elbow Performance Score (MEPS), Mayo Wrist Score (MWS), and Disability of Arm, Shoulder and Hand (DASH) score were assessed. Complications and revision surgeries were recorded. The influence of the severity of soft tissue injury (I°/II° open vs. III° open) and type of dislocation (simple vs. complex) was evaluated.After a 57-month follow-up (range, 24-98 months), the mean DASH score was 20 ± 15, the MEPS was 82 ± 11, and the MWS was 74 ± 22. The ROM of the injured elbow was significantly decreased compared with the uninjured one (arc of ulnohumeral motion: 104° vs. 137°;Favorable clinical outcomes can be achieved after treatment of open elbow dislocations. These injuries are prone to neurovascular damage and complex dislocations are linked to high rates of complications and revision surgeries.Im Rahmen der vorliegenden Studie sollte der Einfluss des Weichteilschadens auf das klinische Ergebnis nach offener Ellenbogenluxation untersucht werden.Von Oktober 2008 bis August 2015 wurden insgesamt 230 Patienten mit Ellenbogenluxation behandelt. Diese retrospektive Studie umfasst 21 Fälle von offenen Ellenbogenluxationen. Das Durchschnittsalter der Patienten betrug 49 Jahre alt (20–83 Jahre), 6 Patienten waren weiblich (29%), 15 männlich (71%). Das Bewegungsausmaß des verletzten und unverletzten Ellenbogens wurde erhoben und das funktionelle Ergebnis u. a. mittels Mayo Elbow Performance Score (MEPS), Mayo Wrist Score (MWS) und dem Disability of Arm, Shoulder and Hand (DASH) Score erfasst. Zusätzlich wurden Komplikationen und Revisionsoperationen aufgezeichnet. Der Einfluss des Weichteilschadens (I°/II° offen vs. III° offen) und des Luxationstyps (einfach vs. komplex) auf das klinische Ergebnis wurde analysiert.Nach einem durchschnittlichen Nachuntersuchungszeitraum von 57 Monaten (24–98 Monate) betrug der DASH-Score 20 ± 15 Punkte, der MEPS 82 ± 11 Punkte und der MWS 75 ± 23 Punkte. Die Beweglichkeit am betroffenen Ellenbogengelenk war im Vergleich zur gesunden Gegenseite signifikant schlechter (Extension/Flexion: 104° vs. 137°;Offene Ellenbogenluxationen können mit einem zufriedenstellenden klinischen Ergebnis einhergehen. Insbesondere komplexe offene Ellenbogenluxationen sind jedoch sehr komplikationsbehaftet, wobei neurovaskuläre Komplikationen am häufigsten auftreten.

Avascular necrosis (AVN) of the humeral head is a severe complication after proximal humerus fracture dislocations, and leads to a poorer clinical outcome and subsequent revision surgeries. The aim of the current study was to analyze the influence of time to surgery on the AVN rate after locked plating of dislocation fractures of the proximal humerus. This retrospective study included 30 patients with a mean age of 63 ± 14 years with dislocation fractures of the proximal humerus type B3 or C3 according the AO/OTA classification. The rates of AVN of the humeral head were determined clinically and radiographically. In addition, the clinical outcome was determined using the Constant score (CS), the age- and sex-adjusted Constant score (CS%), Disabilities of the Arm, Shoulder, and Hand (DASH) score, the range of motion, and complication and revision rates. Patients were subdivided into groups of subjects operated on early (≤48 h after trauma) and those with late surgery (>48 h after trauma), and the relative risk (RR) for complications and revisions was determined for both groups. After a mean follow-up of 37 months (range: 12–66 month) the mean CS% was 60 ± 24 and the mean DASH score was 32 ± 24 points. Ten patients (33%) developed a symptomatic AVN, and ten patients underwent revision surgery. Early surgery was performed on 25 patients while five patients underwent late surgery. After late surgery, all five patients developed AVN, and patients had a fivefold increased RR for AVN (p = 0.002) and subsequent associated surgical revision (RR = 3.3, p = 0.031). In fracture dislocations of the proximal humerus, early surgery within 48 h of trauma significantly decreases the risk of AVN and subsequent surgery.