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Background: Traditional initial management of proximal humerus fractures (PHF) involves arm immobilisation in a simple sling (SS) in an internally rotated position. We believe this risks fracture displacement and imbalance of soft tissues, encouraging malunion and stiffness. A neutral-rotation brace (NRB) maintains an arm position which may prevent this, leading to quicker and superior recovery. Methods: We randomised patients with two- to four-part PHF into 4 weeks of immobilisation with either a SS or NRB, independent of surgery. Range of motion (ROM), subjective shoulder value (SSV), DASH, Constant–Murley (CMS) and Oxford Shoulder (OSS) scores were assessed at 6-weeks, 3-months and 1-year post-injury. Results: The SS group included 11 patients vs 9 in the NRB group. At final follow-up, the SS and NRB groups had mean DASH scores of 42 vs 35, OSS 42 vs 46, CMS 71 vs 86, SSV 84% vs 92%, respectively. ROM was superior with the NRB (elevation 159°, ER 47° and IR score 8 vs 140°, 37° and 7 with SS). Conclusions: Despite being a small series, our results demonstrate a trend towards NRB providing better outcomes. This feasibility study supports the need for a larger multi-centre randomised controlled trial comparing these immobilisation methods for PHF. [ABSTRACT FROM AUTHOR]

ABSTRACT Background The blood loss associated with arthroscopic surgery has generally been considered to be minimal and not clinically relevant. However, there are currently no data available in the published literature to support this assumption. Methods The present prospective study used spectrophotometry of collected irrigation fluid to measure the blood loss associated with a variety of arthroscopic shoulder procedures conducted in 20 patients. Results Measured blood loss ranged from 1.22 mL to 36.45 mL. This confirmed that, even in lengthy arthroscopic procedures without a tourniquet, blood loss is minimal. Conclusions The results obtained in the present study confirm the presumed advantage of arthroscopic surgery in terms of blood loss, and also confirm that the full range of arthroscopic shoulder surgery can be safely performed, from a haemodynamic perspective, as day case procedures. [ABSTRACT FROM AUTHOR]

The article discusses the clinical assessment for the diagnosis of rotator cuff disease. It examines the diagnostic accuracy of clinical tests for rotator cuff pathology. It also explores the factors that could lead to an inaccurate or poor diagnosis of clinical tests which include the close relationships of structures in the shoulder, a lack of understanding of anatomical basis of the tests, and the lack of reproducibility.