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Symptomatic spinoglenoid ganglion cyst is a rare cause of shoulder pain and disability. Surgical treatment, which may be considered after failed nonoperative treatment, includes open or arthroscopic cyst debridement. Arthroscopic treatment is less invasive and has the advantage of addressing intraarticular pathologies; however, exposure of the cyst may be deemed difficult. Furthermore, the suprascapular nerve is susceptible to iatrogenic injury owing to its close proximity to the posterior glenoid rim. The purpose of this article is to present our technique for arthroscopic spinoglenoid cyst decompression after preoperative ultrasound-guided methylene blue injection., NA

Background: the Covid-19 pandemic drastically affected the health care delivery worldwide. Elective surgical interventions were cancelled or postponed to avoid disease transmission and excessive consumption of critical hospital resources. The main objective for composing this survey was to document the preventive attitude and its variations against the Covid-19 pandemic in a specific group: shoulder and elbow surgeons. The secondary objective was to evaluate their perception of emergency and to envisage the “new normal” with the altered order of priority in the upcoming post-coronavirus era. Methods: an anonymous survey composed of 25 questions was sent to all the members of the Turkish Society of Shoulder and Elbow Surgery in April 22-29, 2020, while governmental preventive measures were maximal. A secure web-based application (SurveyMonkey Inc., San Mateo, CA, USA) was used for the composition of the survey and the analysis of the responses. Results: eighty-eight responses were collected from 129 members of the Turkish Society of Shoulder and Elbow Surgery (68%), with a mean 13.9 years of practice in shoulder and elbow surgery. A more than 75% decrease in surgical and outpatient clinical activity was documented. Half of respondents used telemedicine, and the rate of obtaining informed consent remained low. The preventive attitude showed significant variation. Discussion: the perception of emergency and the protective measures showed a wide discrepancy among our respondents. Almost 80% of our respondents indicated the necessity of task forces for composing protocols to maintain subspecialty practice under adequate protective measures, and the subspecialty societies as the most eligible institutions to compose these criteria., NA

Rationale: facioscapulohumeral muscular dystrophy (FSHD) is the third most common muscular dystrophy, which is associated with facial, shoulder girdle, and paraspinal muscle atrophy. Most of the patients develop hypokyphosis and hyperlordosis in the course of the disease, to preserve standing posture. Corrective fusion is contraindicated in these patients as the surgery results with loss of compensatory hyperlordosis and leads to loss of trunk balance while standing. Although spinal fusion in neuromuscular scoliosis is a known treatment option, there are no studies in the literature on the spinal fusion of this specific patient group. Patient concerns: in this case report we have presented a 66-year-old woman, who was admitted with back and abdominal pain, inability to sit straight, abdominal discomfort, and numbness in the lower extremities after prolonged sitting. Diagnoses: the patient developed severe hyperlordosis causing intra-abdominal disorders, radicular symptoms, and sitting discomfort due to FSHD. Interventions: the patient underwent T2-S1 fusion and successful fusion was achieved. Outcomes:Individualized Neuromuscular Quality of Life Questionnaire (INQoL) was used to assess preoperative and 3 years postoperative functional outcomes. All domains and total score improved at the end of the follow-up period and successful fusion was verified radiologically. Lessons: this case suggests that spinal fusion may provide functional improvement in carefully selected patient groups. Patient stratification considering spinal disability is required for further studies in this specific indication., NA

Context: ideal rehabilitation method following arthroscopic capsulolabral repair surgery for anterior shoulder instability has not been proven yet. Although rapid or slow protocols were compared previously, home- or hospital-based protocols were not questioned before. Objective: the aim of this prospective unrandomized controlled clinical trial is to compare the clinical outcomes of home-based and hospital-based rehabilitation programs following arthroscopic Bankart repair. Design: non-randomized controlled trial. Setting: orthopedics and physical therapy units of a single institution. Patients: fifty-four patients (49 males and 5 females) with an average age of 30.5 (9.1) years, who underwent arthroscopic capsulolabral repair and met the inclusion criteria, with at least 1-year follow-up were allocated into 2 groups: home-based (n = 33) and hospital-based (n = 21) groups. Interventions: both groups received identical rehabilitation programs. Patients in the home-based group were called for follow-up every 3 weeks. Patients in the hospital-based group admitted for therapy every other day for a total of 6 to 8 weeks. Both groups were followed identically after the eighth week and the rehabilitation program continued for 6 months. Main Outcome Measures: Clinical outcomes were assessed using Disabilities of Arm Shoulder Hand, Constant, and Rowe scores. Mann-Whitney U test was used to compare the results in both groups. Wilcoxon test was used for determining the progress in each group. Results: groups were age and gender matched (P =.61, P =.69). Average number of treatment sessions was 13.8 (7.3) for patients in the hospital-based group. Preoperative Disabilities of Arm Shoulder Hand (27.46 [11.81] vs 32.53 [16.42], P =.22), Constant (58.23 [14.23] vs 54.17 [10.46], P =.13), and Rowe (51.72 [15.36] vs 43.81 [19.16], P =.12) scores were similar between groups. Postoperative scores at sixth month were significantly improved in each group (P =.001, P =.001, and P =.001). No significant difference was observed between 2 groups regarding clinical scores in any time point. Conclusions: we have, therefore, concluded that a controlled home-based exercise program is as effective as hospital-based rehabilitation following arthroscopic capsulolabral repair for anterior shoulder instability., NA

Objective: rotator interval lesion (RIL) is a distinct rotator cuff (RC) injury patern consisting of subscapularis and supraspinatus tear with biceps problem. This pathology is an underdiagnosed RC entitiy and not studied in-depth. Aim of this study is to report the functional and radiological results of RIL surgeries performed. Methods: surgeries performed in a single center, in a 7-year-period were retrospectively reviewed. Sixteen cases (n=16) who underwent ar throscopic RC repair including subscapularis with biceps tenodesis or tenotomy were called for an up-to-date assessment. Fourteen shoulders of 13 patients (3 females, 10 males) were included. Constant, disabilities of the arm shoulder and hand (DASH), standardized shoulder assessment form (ASES) scores, and RC thickness measurements with magnetic resonance imaging (MR1) were recorded. Preoperative and postoperative results were compared. Results: average age of the patients were 60.6 (47-74), and follow-up period was 3.2 +/- 1.9 years. Average preoperative Constant, DASH and AS ES scores were 44.43 +/- 15.4, 22.11 +/- 17.21 and 51.37 +/- 27.6, respectively. Postoperative values improved to 90.45 +/- 6.44, 6 +/- 13.68 and 95.82 +/- 7.82, respectively (p, NA

Delamination of rotator cuff tears presents a challenge for surgeons. Recognizing and repairing such a complex tear pattern often require innovative approaches to achieve an anatomic restoration of footprint. In this Technical Note, we described our preferred method that anatomically repairs both layers of delaminated rotator cuff tear separately in a knotless transosseous equivalent technique. Two sutures are placed to the articular layer in a cinch stitch configuration. Then, closed-loop end sutures are passed through both layers while keeping the closed-loop end at the working portal. The free ends of cinch stitches are loaded to anchors with a preloaded fiber tape loop, which is placed to the medial row while approximating the articular layer onto its footprint. Fiber tapes are then shuttled through both layers of tendon with the help of a previously placed closed-loop suture. Finally, the lateral row anchors are placed while fiber tapes are tensioned in a cross-bridge configuration. We believe that this technique may facilitate uneventful healing of delaminated rotator cuffs by providing the biomechanical properties of transosseous equivalent repair., NA

Objective: The aim of this study was to assess the effects of coracoid bone block (modified Latarjet) procedure on clinical and functional results in cases with glenoid bone defect accompanied with anterior shoulder instability.Methods: The study included 35 patients (average age: 35 years; range: 20 to 58 years) with glenoid bone defect and recurrent dislocations treated with the modified Latarjet procedure. There were 12 sports injuries, 5 post-epileptic cases and 18 recurrent anterior shoulder dislocation following non-sports-related injuries. Recurrence was reported in 7 patients formerly treated with the Bankart procedure. Average number of preoperative dislocations was 10.8±6.5 and average time range between the first dislocation and surgery was 14.9±13.2 months. All patients underwent preoperative diagnostic arthroscopy. Postoperative isometric exercises in braces were assigned for the first 6 weeks, followed by active strengthening exercises. Pre- and postoperative functional results were evaluated using the ASES (American Shoulder and Elbow Surgeons) and Rowe scores and pain using the VAS (Visual Analog Scale).Results: Osseous union of coracoid graft was achieved in all patients. Average follow-up was 24±12.2 (range: 12 to 74) months. No degenerative arthritis or continuing instability was detected in any of the patients. Average forward flexion was 165°±20° and external rotation 59°±13°. Mean preoperative ASES and Rowe scores of 49.6±10.6 and 47.9±21.5 increased postoperatively to 91.3±11 and 89.1±9.2, respectively. Mean VAS scores decreased significantly from 6.2±2.4 to 1.8±0.6 postoperatively (p, Amaç: Bu çalışmanın amacı anterior omuz instabilitesine eşlik eden glenoid kemik defektli olgularda korakoid kemik blok (modifiye Latarjet) prosedürünün klinik ve fonksiyonel sonuçlara etkilerinin değerlendirilmesi idi.Çalışma planı: Tekrarlayan çıkık nedeniyle başvuran ve modifiye Latarjet prosedürü ile tedavi edilen, glenoid kemik defektli 35 hasta (ortalama yaş: 35, dağılım: 20-58) çalışmaya alındı. On iki hastada spor travması, 5’inde epilepsi nöbetleri sonrası, 18’inde ise spor dışı travma sonrası tekrarlayan anterior omuz çıkığı hikayesi mevcuttu. Daha önce Bankart onarımı uygulanan 7 hastada nüks vardı. Hastaların ameliyat öncesi ortalama çıkık sayısı 10.8±6.5, ilk çıkıktan ameliyata kadar geçen ortalama süre ise 14.9±13.2 ay olarak kaydedildi. Girişim öncesinde tüm hastalara tanısal artroskopi yapıldı. Hastalara ameliyat sonrası ilk 6 hafta askı içinde izometrik egzersizler, sonrasında aktif güçlendirme egzersizleri uygulandı. Ameliyat öncesi ve sonrası fonksiyonel sonuçlar ASES (American Shoulder and Elbow Surgeons) ve Rowe skorları ile, ağrı ise VAS (Visual Analog Scale) ile değerlendirildi.Bulgular: Ortalama 24±12.2 (dağılım: 12-74) ay takip edilen hastaların tümünde greft kaynaması sağlandı. Hiçbir hastada dejeneratif artrit bulgusu ve devam eden instabilite saptanmadı. Ortalama öne fleksiyon 165°±20°, dış rotasyon 59°±13° olarak ölçüldü. Ameliyat öncesi ASES ve Rowe skorları, sırasıyla, ortalama 49.6±10.6 ve 47.9±21.5 iken bu değerlerin son kontrollerinde 91.3±11 ve 89.1±9.2’ye yükseldiği görüldü. Hastaların ortalama VAS skorları ise 6.2±2.4’ten iken ameliyat sonrasında 1.8±0.6 değerlerine geriledi (p