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Carolin Rickert,1,* Ulrike Fels,1,* Georg Gosheger,1 Tobias Kalisch,1 Dennis Liem,2 Sebastian Klingebiel,1 Kristian Nikolaus Schneider,1 Dominik Schorn1 1Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany; 2Sporthopaedicum Berlin, Berlin, Germany*These authors contributed equally to this workCorrespondence: Carolin RickertDepartment of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer Campus 1, Gebäude A1, Münster, 48149, GermanyEmail carolin.rickert@ukmuenster.deObjective: Although many findings on occupational musculoskeletal complaints are available from American and European dentists, the corresponding data from Germany are still scarce. Therefore, the aim of this study was to provide additional information on the prevalence of and risk factors for musculoskeletal disorders of the upper extremity, particularly the shoulder in this specific population.Methods: A written survey was carried out among 600 dentists in the state of North Rhine-Westphalia, Germany. Questionnaire items included physical and psychosocial workload, general health, and the occurrence of musculoskeletal symptoms during the previous 12 months that led to sick leave and medical care according to a modified version of the Nordic Musculoskeletal Questionnaire (NMQ). Regression analysis was used to evaluate relevant risk factors for severe musculoskeletal disorders.Results: A total of 229 dentists were participated in the study (response rate 38%). Overall, 92.6% of the participants had already suffered from musculoskeletal symptoms in at least one body region. Symptoms were mostly reported in the neck (65.1%) and in the shoulder (58.1%). Limitations in daily activities were experienced by 15.9% due to neck pain and by 15.4% due to shoulder pain. Medical care was sought by 23.7% because of neck pain and by 21.1% due to shoulder pain. Risk factors for symptoms in the upper extremity regions were gender (female), increased physical load, and numerous comorbidities.Conclusion: There is a high prevalence of musculoskeletal disorders among dentists. Suitable interventions are therefore needed to prevent musculoskeletal diseases and pain among dental professionals, with particular attention to female dentists.Keywords: musculoskeletal disease, prevalence, dentists, risk factors, occupational exposure

Background: Reverse shoulder arthroplasty is an established procedure for patients with rotator cuff tear arthropathy. However, the repair of the subscapularis tendon remains a controversial and frequently discussed topic. This prospective randomized study was conducted to evaluate the clinical benefit of the subscapularis repair after reverse shoulder arthroplasty., Methods: Fifty patients (36 female and 14 male) were randomized and assigned to either the "repaired" (rep) or the "not repaired" (nrep) cohort. Intraoperatively, the subscapularis tendon was reattached in the rep cohort with 4 tendon-to-tendon sutures, whereas no repair was performed in the nrep cohort. The Constant-Murley Score (CS) and the range of motion were evaluated preoperatively as well as 12 and 36 months postoperatively. The Subjective Shoulder Value and the Lift-off test were performed 36 months postoperatively. The postoperative subscapularis integrity was assessed sonographically., Results: Twelve months postoperatively the rep cohort presented better results in the CS (rep: 71 vs. nrep: 66, P = .037). The normalized CS was 80% in the rep cohort and 75% in the nrep cohort (P = .114). At our last follow-up after 36 months, we did not find significant differences between the rep cohort and the nrep cohort in the CS (rep: 76 vs. nrep: 75, P = .285) and normalized CS (rep: 91% vs. nrep: 91%, P = .388). Concerning internal rotation (in points), the rep cohort achieved better results than the nrep cohort (rep: 7.3 vs. nrep: 6.6, P = .040). Flexion (rep: 145° vs. nrep: 151°, P = .826), abduction (rep: 135° vs. nrep: 137°, P = .816), external rotation (rep: 34° vs. nrep: 37°, P = .817), and the Subjective Shoulder Value (rep: 81% vs. nrep: 77%, P = .398) presented no significant differences between the cohorts. The ultrasound examination after 36 months displayed an intact tendon in 70%., Conclusions: Although the subscapularis repair affects the postoperative internal rotation positively, there were no differences in midterm follow-up concerning the overall results after reverse total shoulder arthroplasty. Further, the external rotation is not affected by the repair of the subscapularis tendon., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Introduction: Indications for reverse shoulder arthroplasties (rTSA) have increased since their development by Paul Grammont in 1985. Prosthesis design was enhanced over time, but the management of the tendon of the M. subscapularis (SSC-tendon) in primary rTSA is still a controversial subject with regard to perform a refixation or not., Methods: 50 patients were randomized in a refixation group (A) and a non-refixation-group (B) of the SSC-tendon in a double-blinded fashion. SSC-function was assessed at baseline before surgery, such as 3 and 12 months after surgery. Constant-Murley-Shoulder Score (CS), American Shoulder and Elbow Surgeons Score (ASES), strength, range of motion (ROM), and pain on numeric rating scale (NRS) were measured in all examinations. An ultrasound examination of the shoulder was performed for evaluation of subscapularis tendon integrity at 3 and 12 month follow-up visits. Pain was evaluated on NRS via phone 5 days after surgery. Surgery was performed by a single experienced senior surgeon in all patients., Results: Patients with a refixation of the SSC-tendon and primary rTSA had improved internal rotation [40° (20°-60°) vs. 32° (20°-45°); p = 0.03] at 12 months of follow-up. Additionally, the A-group had increased CS [74 (13-90) vs. 69.5 (40-79); p = 0.029] 1 year after surgery. Results were strengthened by subgroup analysis of successful refixation in ultrasound examination vs. no refixation. No differences were seen in ASES and NRS 1 year after rTSA., Conclusion: SSC-tendon repair in rTSA improves CS and internal rotation 12 months after surgery., (© 2021. The Author(s).)

Background: Total humeral replacement is an option to reconstruct massive bone defects after resection of locally advanced bone tumors of the humerus. However, implant survivorship, potential risk factors for implant revision surgery, and functional results of total humeral replacement are poorly elucidated because of the rarity of the procedure., Questions/purposes: We asked: (1) What is the revision-free implant and overall limb survivorship after total humerus replacement? (2) What factors are associated with implant revision surgery? (3) What is the functional outcome of the procedure as determined by the Musculoskeletal Tumor Society (MSTS) score and the American Shoulder and Elbow Surgeons (ASES) score?, Methods: Between August 1999 and December 2018, 666 patients underwent megaprosthetic reconstruction after resection of a primary malignant or locally aggressive/rarely metastasizing tumor of the long bones at our department. In all, 23% (154) of these patients had a primary tumor located in the humerus. During the study, we performed total humeral replacement in all patients with a locally advanced sarcoma, in patients with pathological fractures, in patients with skip metastases, or in patients with previous intralesional contaminating surgery, who would have no sufficient bone stock for a stable implant fixation for a single joint megaprosthetic replacement of the proximal or distal humerus. We performed no biological reconstructions or reconstructions with allograft-prosthetic composites. As a result, 5% (33 of 666) of patients underwent total humerus replacement. Six percent (2 of 33) of patients were excluded because they received a custom-made, three-dimensionally (3-D) printed hemiprosthesis, leaving 5% (31) of the initial 666 patients for inclusion in our retrospective analysis. Of these, 6% (2 of 31) had surgery more than 5 years ago, but they had not been seen in the last 5 years. Median (interquartile range) age at the time of surgery was 15 years (14 to 25 years), and indications for total humeral replacement were primary malignant bone tumors (n = 30) and a recurring, rarely metastasizing bone tumor (n = 1). All megaprosthetic reconstructions were performed with a single modular system. The implanted prostheses were silver-coated beginning in 2006, and beginning in 2010, a reverse proximal humerus component was used when appropriate. We analyzed endoprosthetic complications descriptively and assessed the functional outcome of all surviving patients who did not undergo secondary amputation using the 1993 MSTS score and the ASES score. The median (IQR) follow-up in all survivors was 75 months (50 to 122 months), with a minimum follow-up period of 25 months. We evaluated the following factors for possible association with implant revision surgery: age, BMI, reconstruction length, duration of surgery, extraarticular resection, pathological fracture, previous intralesional surgery, (neo-)adjuvant radio- and chemotherapy, and metastatic disease., Results: The revision-free implant survivorship at 1 year was 77% (95% confidence interval 58% to 89%) and 74% (95% CI 55% to 86%) at 5 years. The overall limb survivorship was 93% (95% CI 75% to 98%) after 1 and after 5 years. We found revision-free survivorship to be lower in patients with extraarticular shoulder resection compared with intraarticular resections (50% [95% CI 21% to 74%] versus 89% [95% CI 64% to 97%]) after 5 years (subhazard ratios for extraarticular resections 4.4 [95% CI 1.2 to 16.5]; p = 0.03). With the number of patients available for our analysis, we could not detect a difference in revision-free survivorship at 5 years between patients who underwent postoperative radiotherapy (40% [95% CI 5% to 75%]) and patients who did not (81% [95% CI 60% to 92%]; p = 0.09). The median (IQR) MSTS score in 9 of 13 surviving patients after a median follow-up of 75 months (51 to 148 months) was 87% (67% to 92%), and the median ASES score was 83 (63 to 89) of 100 points, with higher scores representing better function., Conclusion: Total humeral replacement after resection of locally advanced bone tumors appears to be associated with a good functional outcome in patients who do not die of their tumors, which in our study was approximately one- third of those who were treated with a resection and total humerus prosthesis. However, the probability of early prosthetic revision surgery is high, especially in patients undergoing extraarticular resections, who should be counseled accordingly. Still, our results suggest that if the prosthesis survives the first year, further risk for revision appears to be low. Future studies should reexamine the effect of postoperative radiotherapy on implant survival in a larger cohort and evaluate whether the use of soft tissue coverage with plastic reconstructive surgery might decrease the risk of early revisions, especially in patients undergoing extraarticular resections., Level of Evidence: Level III, therapeutic study., Competing Interests: All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2021 by the Association of Bone and Joint Surgeons.)

Background: The postoperative integrity of the subscapularis tendon after primary anatomical shoulder arthroplasty has a significant effect on postoperative results. A transosseus Single Row Refixation technique (SRR) has shown up to 30% of partial tears in literature, a modified Double Row Refixation technique (DRR) has biomechanically shown a significantly reduced tear rate, but is yet to be proven in a clinical setting. Thus, we compared the SRR to the DRR technique using clinical outcome parameters and ultrasound examination., Materials and Methods: 36 patients (40 shoulders; 20f, 16 m; øage: 66 years) were included in our retrospective cohort study. 20 shoulders were treated with the SRR technique (12f, 8 m; FU ø40.9 months) and 20 with the DRR technique (11f, 9 m; FU ø31.6 months). The SRR was performed with three to five transosseus mattress sutures. DRR consisted of two medial placed transosseus sutures and four laterally placed single tendon-to-tendon sutures. The postoperative subscapularis integrity was evaluated by ultrasound examination, the clinical outcome was assessed with the Constant-Murley Score (CS) and the American Shoulder and Elbow Surgeons Score (ASES)., Results: The subscapularis tendon was intact in 14 patients (70%) after SRR, whereas 18 patients (90%) treated with the DRR demonstrated a sonographically intact postoperative subscapularis tendon. The CS was 61.4 points in the SRR cohort and 67.3 points in the DRR cohort (p = 0.314). No significant differences were found in both cohorts preoperative (øSRR: 21.3 points; øDRR: 16.2 points, p = 0.720) and postoperative absolute ASES Scores (øSRR: 70.2 points; øDRR: 73.0 points, p = 0.792). However, the DRR cohort showed a statistical tendency to a higher postoperative ASES increase than the SRR cohort (øSRR-ASES increase: 48.9 points; øDRR-ASES increase: 56.8 points, p = 0.067)., Conclusion: The results of this study show that application of the DRR technique can significantly reduce the total rate of postoperative subscapularis tears what effects a clinical tendency towards higher ASES improvements and a better range of motion compared to the SRR technique.

The tenosynovial giant cell tumor is a rare disease of the joint mucosa, tendon sheaths and bursa. We report on the rare constellation of an intraosseous manifestation of the proximal tibia of a lower leg stump after Burgess amputation as a result of a locally uncontrollable tenosynovial giant cell tumor of the upper ankle. The curettage of the local findings and operative stabilization through an intramedullary composite osteosynthesis led to an early rehabilitation of the exoprosthesis care with regaining patient autonomy.