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Shoulder pain is a very common complaint, and affects as many as 20% of all people at some point during their lives. Despite the availability of more advanced imaging modalities, X-ray remains the first imaging test to be performed in the investigation of any shoulder pain. However, with their increasing availability, ultrasound and magnetic resonance imaging have in recent years become first-line techniques for the diagnostic imaging of the shoulder. Moreover, ultrasound of the shoulder is increasingly performed in lieu of radiography. Nevertheless, many patients who visit a shoulder specialist for their pain are referred by a family physician or community orthopedist without an X-ray having ever been performed. Shoulder pain can be caused by many conditions, including rotator cuff tears, calcification within the tendons of the rotator cuff, stiff shoulder, subacromial impingement, space-occupying lesions, degenerative changes, and rheumatoid arthritis. This paper reviews various types of shoulder injury and the radiographic symptomatology of each, with the goal of encouraging the use of radiography by demonstrating the importance of this basic tool in the diagnostic process for these injuries. [ABSTRACT FROM AUTHOR]

Purpose: Age has been suggested as a negative prognostic factor for hip arthroscopy. The purpose of this study was to compare patient characteristics and outcomes after hip arthroscopy in patients aged 50 years or older with a matched control group of patients aged 30 years or younger at a minimum postoperative follow-up of 2 years., Methods: Between September 2008 and March 2010, data were prospectively collected on all patients aged 50 years or older undergoing primary hip arthroscopy. Fifty-two patients met our inclusion and matching criteria, of whom all 52 (100%) were available for follow-up at a minimum of 2 years. This cohort was compared with a matched-pair control group of patients aged 30 years or younger who underwent similar procedures., Results: The mean age of the study group was 54.8 years (range, 50 to 69 years), and that of the control group was 20.3 years (range, 13 to 30 years). The groups were matched at a 1:1 ratio, including 18 male patients (34.6%) and 34 female patients (65.4%) in each group, with a mean follow-up period of 32 months (range, 24 to 54 months). In the younger control group, the score improvement from preoperatively to 2 years' follow-up was 62.9 to 84.2 for the modified Harris Hip Score, 60.5 to 84.2 for the Non-Arthritic Hip Score, 63.1 to 86.5 for the Hip Outcome Score-Activities of Daily Living, and 42.2 to 72.7 for the Hip Outcome Score-Sport-Specific Subscale. In the older study group, the score improvement from preoperatively to 2 years' follow-up was 61.2 to 82.2 for the modified Harris Hip Score, 59.9 to 80.4 for the Non-Arthritic Hip Score, 63.9 to 83 for the Hip Outcome Score-Activities of Daily Living, and 41.2 to 64.6 for the Hip Outcome Score-Sport-Specific Subscale. All improvements in both groups were statistically significant at the 2-year postoperative follow-up (P < .001). There was no significant difference for all patient-reported outcome (PRO) scores at final follow-up between both groups. When we compared the change in PRO scores (Δ) from preoperatively to 2 years postoperatively, there was no significant difference between both groups. The overall survivorship rate was 98.1% for the younger control group and 82.7% for the older study group., Conclusions: Survivors aged 50 years or older show similar improvement to patients aged 30 years or younger in PRO and patient satisfaction scores. The 2-year survivorship rate was 98.1% for the younger control group and 82.7% for the older study group. Therefore we believe that hip arthroscopy should be considered a valid treatment option when treating hip pain in patients aged 50 years or older with a Tönnis arthritic grade of 0 or 1. Older patients should be counseled on the possibility of later conversion to total hip arthroplasty. Future work may include development of a decision-making tool to assess for prognosis to better delineate the indications for hip arthroscopy in the older population., Level of Evidence: Level III, therapeutic case-control study., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

It is unclear if open surgical dislocation or arthroscopy of the hip is superior for the treatment of femoroacetabular impingement (FAI). We prospectively compared the clinical results of these 2 surgical methods performed by a single surgeon. Five patients met the inclusion criteria for the open surgical dislocation group and 18 for the arthroscopic group. Patient-reported scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) and Hip Outcome Score-Activities of Daily Living (HOS-ADL) were used preoperatively, and at 3 months, 6 months, and 1 year postoperatively to compare the 2 groups. Average follow-up was 14.7 months (range, 12 to 25 months); both groups showed significant improvement in their postoperative scores compared with preoperative scores (P < .01). The arthroscopic group had better, earlier improvement at 3- and 6-month follow-up, with NAHS significantly better at 3 months (P < .0002). However, improvements were comparable between the 2 groups at 1 year. Open surgical dislocation and arthroscopy are viable options for the treatment of FAI. The arthroscopic group demonstrated a trend toward faster recovery and quicker return to sports, but larger and longer-term studies are needed.

Purpose: The purpose of this study was to prospectively compare outcomes of patients receiving surgical hip dislocation and those undergoing arthroscopic treatment for femoroacetabular impingement (FAI), using a matched-pair analysis., Methods: Between January 2008 and August 2011, patients aged 30 years or younger with a diagnosis of FAI treated with surgical dislocation or arthroscopy were included. Patients were excluded with Tönnis grade 2 or greater, dysplasia, Legg-Calve-Perthes disease, and previous hip surgery. Patients treated with surgical dislocation were pair-matched to patients treated arthroscopically in a 1:2 ratio. Patient-reported outcomes were prospectively obtained in all patients preoperatively and postoperatively at 3 months, at 1 year, at 2 years, and at latest follow-up. Alpha angles were measured preoperatively and postoperatively for both groups. Revision surgery and complications were recorded for each group., Results: Ten patients were included in the surgical dislocation group, and 20 pair-matched patients were included in the arthroscopic group. We obtained 100% follow-up at a mean of 24.8 months in the open group and 25.5 months in the arthroscopic group. Preoperative scores were similar between the 2 groups; significant improvements were made postoperatively for both groups. When we compared the 2 groups, the change in Hip Outcome Score-Sport-Specific Subscale (42.8 v 23.5, P = .047) and 2-year Non-Arthritic Hip Score (94.2 v 85.7, P = .01) were significantly higher in the arthroscopic group. Both groups showed a significant decrease in the alpha angle postoperatively (P = .775)., Conclusions: Favorable results were shown with both approaches, with significant improvement in all patient-reported outcome measures and high patient satisfaction ratings. However, arthroscopic treatment of FAI showed greater improvement in the Hip Outcome Score-Sport-Specific Subscale and a higher absolute Non-Arthritic Hip Score at an average 2-year follow-up., Level of Evidence: Level II, prospective matched-pair comparative study., (Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to examine the relationship between nontraumatic ligamentum teres (LT) tears and acetabular radiographic architecture., Methods: The inclusion criteria for this study were all patients who had anteroposterior pelvis radiographic views and had undergone arthroscopic examination of the LT. The exclusion criteria were Tonnis arthritic grade 3 and traumatic high-energy mechanisms of injury. Radiographic data were measured preoperatively on an anteroposterior pelvis view, including acetabular inclination (AI), lateral center edge (CE) angle, magnitude of cross-over sign, and ischial spine prominence. A Lateral Coverage Index (LCI) was defined as the center edge angle minus acetabular inclination. Hips were divided into 3 groups according to the LCI: (1) high: 34° and above; (2) medium: 19° to 33°; and (3) low: below 19°., Results: Of the 463 hips (430 patients) included in the study, 226 (49%) had a partial- or full-thickness LT tear. Patients with tears were significantly older than patients without tears (P < .0001), with average ages of 38 and 33 years, respectively. Radiographically, patients with tears had less acetabular retroversion, as reflected by lower ischial spine prominence values and lesser cross-over signs (P = .01 and .0005, respectively). Using the LCI, 115 hips (25%) were classified as high, 236 (50%) as medium, and 114 (25%) as low. Hips with low LCI were 1.74 times more likely to have LT tears than high LCI hips., Conclusions: This study found that the presence of LT tears was associated with acetabular bony morphology and age. LT tears were less frequent with high LCI and acetabular retroversion and less frequent in patients younger than 30 years. Further study is needed to establish whether there is a causal relationship between acetabular undercoverage and LT tears and whether LT tears may be a sign of microinstability of the hip., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the correlation between computed tomography (CT) and magnetic resonance imaging (MRI) measurements of femoral anteversion, as well as the relation of anteversion with physical examination and radiographic findings., Methods: Preoperative CT and MRI measurements of anteversion along with clinical examination were performed on 129 consecutive hips before hip arthroscopy for nonarthritic hip injuries. All anteversion measurements were performed by 2 musculoskeletal radiologists. The radiographic findings and physical examination findings were analyzed for statistically significant correlations. For statistical analysis purposes, the patients were divided into 3 groups according to the mean CT anteversion measurement: group I (low), less than 10°; group II (medium), 10° to 22°; and group III (high), greater than 22°., Results: High interobserver correlation was found for femoral anteversion measurement by CT and MRI (r = 0.95 and r = 0.86, respectively; P < .0001 for both). CT and MRI measurements showed high correlation with each other (r = 0.80, P < .0001). However, in 96% of the cases, the CT measurement was larger, with a mean difference of 8.9° (range, -37° to 1.5°). A significant correlation coefficient was found between internal rotation and anteversion angles as measured by CT (r = 0.36, P < .0001). However, no correlation was found with other hip movement measurements. Abnormal femoral acetabular bony architecture of the hip was found in 64% of the patients; isolated cam impingement was more prevalent in group I, whereas isolated pincer impingement was more prevalent in group III (P = .01)., Conclusions: Although high correlation was found between anteversion angle measurements by CT and MRI, significant discrepancies in the absolute anteversion number between the 2 techniques suggest that they may not be interchangeable. Furthermore, CT was found to have higher interobserver reliability than MRI. There was a significant correlation between CT and examination of internal rotation of the hip. Clinically, the findings of the study show that the diagnosis of excessive femoral anteversion or retroversion should have different thresholds according to MRI and CT measurements; moreover, the diagnosis should not rely exclusively on either examination or radiologic criteria., Level of Evidence: Level III, retrospective comparative study., (Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: Over the last decade, the surgical treatment of femoroacetabular impingement (FAI) has evolved as surgical techniques through arthroscopy, open surgical dislocation, and combined approaches have been developed. The purpose of this systematic review was to evaluate and compare the clinical results of available surgical approaches for FAI., Methods: A review of the literature was performed through the PubMed database and related articles' reference lists. Inclusion criteria were (1) all patients treated for FAI, (2) Level I, II, III, or IV study design, and (3) written in the English language. Case reports and studies involving patients with acetabular dysplasia were excluded., Results: Overall, 1,299 articles fit our keyword search criteria. Of these, 26 articles reported clinical outcomes, using 3 surgical modalities: open surgical dislocation, arthroscopic, and combined approaches. In compiling the data in these articles, we analyzed the outcomes of a total 1,462 hips in 1,409 patients. The most published surgical method was arthroscopy, which included 62% of the patients. Labral repair was performed more frequently in open surgical dislocation (45%) and combined approach (41%) procedures than in arthroscopies (23%). Mean improvement in the modified Harris hip score after surgery was 26.4 for arthroscopy, 20.5 for open surgical dislocation, and 12.3 for the combined approach. A higher rate of return to sport was reported for arthroscopy in professional athletes than for open surgical dislocation. Overall complication rates were 1.7% for the arthroscopic group, 9.2% for the open surgical dislocation group, and 16% in the combined approach group., Conclusions: All 3 surgical approaches led to consistent improvements in patient outcomes. Because a wide variety of subjective hip questionnaires were used, direct comparisons could not be made in many cases, and none of the approaches could be clearly shown to be superior to the others. However, it seems that, overall, the arthroscopic method had the lowest complication and fastest rehabilitation rate., (Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Tears in the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis, have recently emerged as an important cause of recalcitrant greater trochanter pain syndrome. Advances in endoscopic surgery of the hip have created opportunities to better evaluate and treat pathology in the peritrochanteric compartment. We reviewed the literature on trochanteric pain syndrome and gluteus medius tendon injuries. Existing techniques for endoscopic and open gluteus tendon repair and potential challenges in restoration of abductor function were analyzed. Partial-thickness undersurface tears of the gluteus medius were identified as a common pathologic entity. Although these tears are otherwise analogous to partial-thickness tears of the rotator cuff, the lack of arthroscopic access to the deep side of the gluteus medius tendon represents a unique technical challenge. To address the difficulty in visualizing and thus repairing undersurface tears of the gluteus medius, a novel endoscopic trans-tendinous repair technique was developed. The purposes of this article are to review the anatomy, pathology, and existing repair techniques of gluteus medius tendon tears and to describe the rationale and surgical steps for endoscopic trans-tendinous repair., (Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)