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Periprosthetic shoulder infection (PSI), although less common than prosthetic hip and knee infections, continues to be a devastating complication of shoulder arthroplasty. Unlike its counterparts in the hip and knee, infection with nonsuppurative bacteria is more common than infection with more virulent bacteria in periprosthetic shoulder infection. The diagnosis of PSI can be challenging because the traditional clinical and laboratory findings are not always present. The authors present a narrative review of the current methods used in the diagnosis of PSI, as well as recently developed tests that may hold promise for the diagnosis of PSI. [ Orthopedics . 2020; 43(2):76–82.]

Transosseous repair of the rotator cuff has been shown to recreate the anatomic rotator cuff footprint in a secure and cost-efficient manner. However, the potential for sutures cutting through bone remains a concern with this strategy. Devices have been used successfully during open transosseous rotator cuff repair to augment the bone tunnels, potentially avoiding suture cut-out through the weak bone of the greater tuberosity. Recently, arthroscopic transosseous fixation of rotator cuff tears has become an alternative to arthroscopic suture anchor and open transosseous techniques. This method is expected to have the same potential pitfalls at the bone–suture interface as the open technique. The authors describe a technique for rotator cuff repair using a secure method of arthroscopic bone tunnel augmentation.

Rupture of the pectoralis major is an uncommon injury that can lead to pain, loss of strength, and cosmetic deformity. The purpose of this study was to analyze the outcome of pectoralis major repairs by a single surgeon. Twenty-four patients who underwent pectoralis major repair by the senior author (M.D.L.) between May 2005 and March 2011 were retrospectively identified. Patients were assessed at least 6 months postoperatively with the use of various questionnaires, including the Penn Shoulder Score, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, and Single Assessment Numeric Evaluation (SANE). All patients were men with an injury to the sternal head of the pectoralis. Most (16/24; 67%) patients sustained the injury while bench or incline bench pressing. Nineteen (79%) patients were successfully contacted for follow-up. Of these, an average preinjury bench press of 318 lb (range, 145–525 lb) was restored to an average of 264 lb (range, 100–500 lb) at follow-up. Average preoperative Penn Shoulder Score was 60 points (range, 33–77 points), improving to 94 points (range, 64–100 points) at last follow-up ( P =.011). Average postoperative ASES and SANE scores were 96 points (range, 60–100 points) and 93 points (range, 50–100 points), respectively. All but 1 patient were rated excellent (14/19; 74%) or good (4/19; 21%) by the Bak criteria. Operative treatment of pectoralis major rupture yields high patient satisfaction and allows predictable return of comfort, range of motion, cosmesis, and overall limb strength, with a slightly less predictable return of maximum bench press strength.

Proximal humerus fractures are the third most common fracture in elderly patients. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not amenable to open reduction and internal fixation. Reverse total shoulder arthroplasty is a newer option that appears to be less dependent on tuberosity healing than hemiarthroplasty. The authors hypothesized that reverse total shoulder arthroplasty provides improved functional outcomes compared with hemiarthroplasty for fractures in elderly patients. A retrospective review was performed of all patients treated with arthroplasty for acute proximal humerus fractures in an orthopedic practice using a Current Procedural Terminology code search, patient charts, and radiographs. Validated outcome scores were used to assess satisfaction, function, and general well-being. Twenty-three patients were treated for acute proximal humerus fractures (11 reverse total shoulder arthroplasties and 12 hemiarthroplasties). Three patients were lost to follow-up, and 6 patients were deceased. Mean follow-up was 3.6 years (range, 1.3–8 years). Reverse total shoulder arthroplasty outperformed hemiarthroplasty with regard to forward flexion, American Shoulder and Elbow Society score, University of Pennsylvania shoulder score, and Single Assessment Numerical Evaluation score. Reverse total shoulder arthroplasty is a reliable option for acute, proximal humerus fractures that are not amenable to closed treatment or reconstruction in elderly patients. Improved functional outcomes when compared with hemiarthroplasty must be balanced against the increased cost and limited life expectancy of patients with this injury.

Musculotendinous variations around the medial epicondyle can contribute to subluxation of the ulnar nerve at the elbow. This article reviews the presenting symptoms, operative findings, and results of surgery for subluxation of the ulnar nerve at the elbow. A retrospective evaluation was performed of 200 elbows managed operatively for medial elbow pathology over a 17-year period between 1990 and 2007. The patient charts were reviewed for chief complaint, radiographic studies, operative reports, and postoperative examination data. Seventeen patients (18 elbows) were treated for a subluxating ulnar nerve. Three patients were women and 14 were men, with a mean age of 27.6 years. Medial elbow pain was the chief complaint in all 17 patients. Seventeen elbows also demonstrated paresthesias in an ulnar nerve distribution. All patients were treated with anterior transposition of the ulnar nerve, and 11 patients (61%) were found to have a muscular anomaly. At a mean follow-up of 17 months, the mean visual analog scale for pain improved from 6.0 to 2.0. There was no functional impairment reported for any patient at final follow-up. Of the 200 elbows surgically treated for medial elbow pathology, 17 patients (8.5%) demonstrated a subluxating ulnar nerve. These patients tend to be young and present with a primary complaint of medial elbow pain. In addition, a subluxating ulnar nerve is often associated with muscular anomalies, which must be addressed concurrently.