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The evaluation and diagnosis of shoulder pain is a common challenge encountered by primary care providers. The differential for shoulder pain is broad and the presentation may be varied. The patient’s history and physical examination alone are often enough to reach a diagnosis; however, plain films and advanced imaging studies are frequently helpful for further confirmation and to guide decision-making. In this section, we will review several common causes of shoulder pain related to soft tissue pathology: adhesive capsulitis, biceps tendinopathy, acromioclavicular joint pain, and rotator cuff pathology.

Background Meniscal tears often accompany knee osteoarthritis, a disabling condition affecting 14 million individuals in the United States. While several randomized controlled trials have compared physical therapy to surgery for individuals with knee pain, meniscal tear, and osteoarthritic changes (determined via radiographs or magnetic resonance imaging), no trial has evaluated the efficacy of physical therapy alone in these subjects. Methods The Treatment of Meniscal Tear in Osteoarthritis (TeMPO) Trial is a four-arm multi-center randomized controlled clinical trial designed to establish the comparative efficacy of two in-clinic physical therapy interventions (one focused on strengthening and one containing placebo) and two protocolized home exercise programs. Discussion The goal of this paper is to present the rationale behind TeMPO and describe the study design and implementation strategies, focusing on methodologic and clinical challenges. Trial registration The TeMPO Trial was first registered at clinicaltrials.gov with registration No. NCT03059004. on February 14, 2017. Electronic supplementary material The online version of this article (10.1186/s12891-018-2327-9) contains supplementary material, which is available to authorized users.

Background: Although lateral retinacular release (LR) surgery has historically been one of the most commonly used arthroscopic procedures for the treatment of patellar instability and anterior knee pain, it may be associated with complications and poor functional outcome measures.Purpose: To examine the clinical efficacy of open lateral retinacular closure (LRC), a novel but technically simple procedure in the treatment of disabling anterolateral knee pain, tenderness, and positive medial patellar apprehension testing in patients who have undergone prior arthroscopic LR surgery.Study Design: Case series; Level of evidence, 4.Methods: The records of 22 patients who had previously undergone an arthroscopic LR and underwent a diagnostic arthroscopy and LRC were reviewed. Physical examination findings and symptoms after prior LR surgery, duration between LR and LRC surgeries, and arthroscopic findings immediately before LRC were analyzed. Preoperative and postoperative Lysholm knee scores and activity levels were compared, and subjective satisfaction ratings assessed.Results: Average follow-up after LRC was 3.2 years. Mean preoperative Lysholm knee score was 46.5 (range, 25-90), which improved postoperatively to a mean score of 86 (range, 48-100). Fourteen percent of patients subjectively rated their preoperative function as fair and 86% as poor. Postoperatively, 82% rated themselves as good or excellent and 18% as fair, with all patients improving from the LRC procedure. All patients stated that they would have the procedure again for the same problem.Conclusion: Open LRC provides significant pain relief and improvement in functional knee outcome scores in patients with persistent pain and tenderness at the site of a previous lateral release and a positive medial patellar apprehension test. Lateral release procedures should be considered with caution. For patients with anterolateral knee pain and symptoms of medial patellar instability after lateral release, LRC may provide symptomatic relief and functional improvement.

Localized articular cartilage lesions of the humeral head can be a source of persistent pain and functional decline in patients who have failed conservative treatment measures. Many are younger, active patients who pose a challenging management decision for surgeons. The goals of treatment should focus on maintaining humeral bone stock, restoring the contour of the articular surface, minimizing soft-tissue disruption, and relieving symptoms. There has been a trend toward humeral resurfacing arthroplasty and away from stemmed components over the past few decades for younger patients potentially requiring future revision surgery. More recently, the HemiCAP resurfacing system (Arthrosurface, Franklin, MA) has been used for localized defects in patients with Hill-Sachs and reverse Hill-Sachs lesions, avascular necrosis, focal chondral defects, and humeral head osteoarthritis. Early, short-term outcome results of the HemiCAP system are encouraging. In this article, we describe our technique for management of localized articular cartilage defects of the humeral head using the HemiCAP resurfacing system.

Normal hip range of motion (ROM) is essential in running and transfer of energy from lower to upper extremities during overhead throwing. Dysfunctional hip ROM may alter lower extremity kinematics and predispose athletes to hip and groin injuries. The purpose of this study is characterize hip internal/external ROM (Arc) and its effect on the risk of hip, hamstring, and groin injuries in professional baseball players. Bilateral hip internal and external ROM was measured on all baseball players (N=201) in one professional organization (major and minor league) during spring training. Players were organized according to their respective positions. All injuries were documented prospectively for an entire MLB season (2010 to 2011). Data was analyzed according to position and injuries during the season. Total number of players (N=201) with an average age of 24±3.6 (range=17-37). Both pitchers (N=93) and catchers (N=22) had significantly decreased mean hip internal rotation and overall hip arc of motion compared to the positional players (N=86). Players with hip, groin, and hamstring injury also had decreased hip rotation arc when compared to the normal group. Overall, there is a correlation between decreased hip internal rotation and total arc of motion with hip, hamstring, and groin injuries.

We have revisited the original description of the Finkelstein test and review the reasons for its subsequent erroneous description. We have also outlined a staged description of this test, which we have found to be reliable and minimally painful for the diagnosis of de Quervain's tendonitis within our clinical practice.

Proximal lacerations of the extensor tendon apparatus can pose a surgical challenge, especially when located at the musculotendinous junction or in patients presenting late. We describe a technique to augment the suture repair of these injuries utilizing local harvested strips of dorsal forearm fascia.

To establish normative values for the magnitude of anterior tibial translation (ATT) in the Lachman and pivot shift tests in the intact and anterior cruciate ligament (ACL)-deficient states, and to explore whether a correlation in ATT magnitude exists between the Lachman and pivot shift tests. Twenty-six fresh frozen cadaveric hip-to-toe specimens were used. Mechanized testing was performed to simulate both a Lachman and pivot shift test with the ACL intact. Tests were repeated after sectioning the ACL. ATT was recorded using a computer navigation system. Difference in ATT after sectioning was calculated for each specimen. For the Lachman, mean lateral compartment ATT in the intact knee was 5.3 mm (SD = 2.8 mm). After sectioning the ACL, translation increased to 11.4 mm (SD = 3.9 mm; P

Both open and arthroscopic anterior shoulder stabilization procedures are commonly performed to address shoulder instability and have been shown to be successful in restoring shoulder stability and patient function. However, a critical review of the risk factors for recurrent instability following anterior stabilization is required to determine which patients may benefit from open stabilization, as recurrence rates following arthroscopic stabilization have historically been higher than with open stabilization. Multiple prospective studies have implicated younger patient age, capsular stretching, ligamentous laxity, contact athletics, and glenoid or humeral bone loss as risk factors for arthroscopic anterior shoulder stabilization failure [1–7].