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Background: The anatomic interplay and overlap between the cervical spine and the shoulder constitutes a challenge for shoulder and spine surgeons, as symptoms of spine and shoulder pathologies are often similar and may lead to entity misdiagnosis. Methods: PubMed, Cochrane, and Google Scholar (page 1-20) searches were updated to October 2023 in search of the qualified papers. Boolean Operators were used with a combination of the keywords “spine” OR “neck” And “Shoulder”. Furthermore, reference lists from papers were also searched to find literature. Results: It is of pivotal importance to conduct comprehensive preoperative clinical investigation to appropriately evaluate and assess the source of the pathology and the leading causes behind it. Certain markers can help guide surgeons towards etiologies, and these include areas of pain and physical exam findings with the arm squeeze test having the highest sensitivity and specificity for diagnosing cervical radiculopathy. As for the shoulder, despite its low sensitivity, the Yergason test had the highest specificity for diagnosing subacromial impingement. Local anesthetic injection can help as well in the diagnostic approach. Moreover, the interplay between these anatomic locations is not solely related to preoperative diagnosis. Studies have shown that previous surgery for cervical spine pathology may negatively affect the outcomes of shoulder procedures like arthroplasties. Conclusion: Shoulder and spine surgeons should be wary and vigilant of accurately diagnosing the etiology of the presenting symptoms to ensure proper management and optimize prognosis.

Background: Humeral fractures (HF) are common orthopedic pathologies. Reviewing the content and quality of influential literature over time is important to advance scientific research regarding a specific topic. This study aims to explore and appraise the fifty most cited HF studies that had been published in orthopedic literature. Methods: The Web of Science database was used to conduct a systematic search for articles pertaining to HF. Articles were sorted out in descending order of citations and were included based on their relevance to HF. Data and metrics of the included studies were recorded. The methodological quality of the studies was assessed using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies criteria. Statistical analysis was conducted to explore any significant relationships between the date of publication and other relevant variables. Results: Included articles (N = 50) were published between 1959 and 2015, with a total of 14,864 accumulated citations. Europe and North America contributed to all but one of the included studies. The Journal of Bone and Joint Surgery contributed to the highest number of included articles with 27 articles (54%). The proximal humerus was the most commonly explored HF location in our study (72%). The average MCMS and Methodological Index for Non-randomized Studies scores were reported to be 64.6 and 10.4, respectively, and the majority of articles (52%) were considered level four case series. Year of publication was found to have a positive correlation with increasing level of evidence(r = −0.301, P = .044), citation density (r = 0.734, P < .001), and MCMS score (r = 0.41, P = .01). Conclusion: The level of evidence, MCMS scores, and citation density of influential HF literature has been increasing with time, reflecting the increasing effort and work being put in that field. While the findings seem encouraging, additional high-quality research is needed to help achieve better treatment strategies and outcomes.

Background: ChatGPT is an artificial intelligence (AI) language processing model that uses deep learning to generate human-like responses to natural language inputs. Its potential use in health care has raised questions and several studies have assessed its effectiveness in writing articles, clinical reasoning, and solving complex questions. This study aims to investigate ChatGPT's capabilities and implications in diagnosing and managing patients with new shoulder and elbow complaints in a private clinical setting to provide insights into its potential use as a diagnostic tool for patients and a first consultation resource for primary physicians. Methods: In a private clinical setting, patients were assessed by ChatGPT after being seen by a shoulder and elbow specialist for shoulder and elbow symptoms. To be assessed by the AI model, a research fellow filled out a standardized form (including age, gender, major comorbidities, symptoms and the localization, natural history, and duration, any associated symptoms or movement deficit, aggravating/relieving factors, and x-ray/imaging report if present). This form was submitted through the ChatGPT portal and the AI model was asked for a diagnosis and best management modality. Results: A total of 29 patients with 15 males and 14 females, were included in this study. The AI model was able to correctly choose the diagnosis and management in 93% (27/29) and 83% (24/29) of the patients, respectively. Furthermore, of the remaining 24 patients that were managed correctly, ChatGPT did not specify the appropriate management in 6 patients and chose only one management in 5 patients, where both were applicable and dependent on the patient’s choice. Therefore, 55% of ChatGPT’s management was poor. Conclusion: ChatGPT made a worthy opponent; however, it will not be able to replace in its current form a shoulder and elbow specialist in diagnosing and treating patients for many reasons such as misdiagnosis, poor management, lack of empathy and interactions with patients, its dependence on magnetic resonance imaging reports, and its lack of new knowledge.

Background: Adhesive capsulitis is a debilitating shoulder condition with unknown etiology and complex diagnosis. Treatment options include conservative and operative measures. Exploring the therapeutic trials targeting adhesive capsulitis can help shed light on effective treatment modalities, and pinpoint inadequacies and areas of improvement. Methods: On June 15, 2022, interventional therapeutic clinical trials related to adhesive capsulitis on Clinicaltrials.gov were screened. Trial characteristics including phase, duration, enrollment, study design, type of intervention, outcomes, and location were collected. Publications linked to trials in our study were reviewed for outcome reporting. Results: A total of 70 trials were included in our study. The majority of the trials had no FDA-defined phase (70%). Only 9 publications were associated with the trials, constituting a low publication rate of 13%. Majority of trials had an enrollment size between 11 and 50 participants (54%), and more than 90% were initiated after the start of 2010. Asia/Australia witnessed the highest number of trials with 31 trials. Physical therapy was the most commonly involved intervention type (50%) and disability/function was the most commonly explored primary outcome (71%). Majority of trials included a single institution (83%), were randomized (91%), and adopted an interventional model with parallel assignment (87%). Fourteen trials (20%) adopted an open labeled approach. Conclusion: The majority of trials that were undertaken remain with unpublished results. Trial results need to be published to help physicians navigate treatments and establish therapeutic protocols. Involving multiple institutions and reinforcing blinding can help decrease bias and increase the validity and reliability of trial results.

Background: Total shoulder arthroplasty has been effective in treating primary glenohumeral arthritis surgically. However, the subscapularis (SSC) tendon must be released as part of the surgery's conventional approach, which could lead to postoperative problems and later tendon failure. Using a procedure that spares the tendon, Lafosse et al reported improved postoperative SSC performance. This meta-analysis will compare this approach to the standard one. Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched till October 2022. The clinical outcomes consisted of the postoperative pain, adverse events, and range of motion. Results: Only 3 studies were included in this meta-analysis. The subscapularis sparing approach tended to have better postoperative internal rotation (P = .06) and shoulder elevation (P = .1); however, the results were marginally statistically insignificant. Conclusion: This is the first meta-analysis to compare the subscapularis sparing to the standard approach in total shoulder arthroplasty. Showing better postoperative range of motion (elevation and internal rotation), the SSC approach might be considered as a good substitute to the standard one. However, it is limited by the potentially limited exposure making it harder to use in muscular and obese patients. More randomized clinical trials are needed to reach more significant results and establish clearer indications of this approach.

Background Acromioclavicular (AC) joint trauma is a frequent sports injury. Modified Weaver Dunn (MWD) is a commonly used technique to address this injury. However, tendinous grafts (Autogenous Palmaris Longus or Semitendinosus tendons) are increasingly being used due to the biologic weakness of MWD. Methods Three search was done until January 2024 with data extraction consisting of adverse events (infections and failures), Constant-Murley score, American Shoulder and Elbow Surgeons score, and postoperative coracoclavicular distance. Results Four studies were included in this metaanalysis. Tendinous graft was shown to have statistically better ASES and Constant-Murley scores. Furthermore, there were no difference in adverse events, and postoperative coracoclavicular distance. Conclusion The tendinous graft showed no differences in adverse events, and postoperative coracoclavicular distance when compared to modified Weaver Dunn. However, it showed higher postoperative ASES and Constant-Murley score without analysis of the minimal clinical important difference making the difference solely statistical. Level of evidence 3.

Patients who undergo shoulder surgery are frequently affected by osteoporosis and osteopenia, and the prevalence of this association is expected to increase due to the growing number of elderly individuals undergoing these procedures. It may be advisable to conduct a preoperative DXA scan for orthopedic surgical candidates at high risk, to detect those who could benefit from early intervention and avoid any related adverse events. Some of these complications include periprosthetic fractures, infection, subsequent fragility fractures, and have an all-cause revision arthroplasty at 2 years post-op. Some studies analyzed the beneficence of antiresorptive medications pre-operatively but the latter did not show favorable outcomes. Surgical management may include cementing components of the prosthesis as well as modifying the diameter of the shoulder stem. Nevertheless, more studies are needed to evaluate the efficacy of any intervention, whether medical or surgical, to avoid any shoulder arthroplasty related-complication that may be precipitated by the reduced bone mineral density.