Search

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Background: Prior authorization review (PAR), in the United States, is a process that was initially intended to focus on hospital admissions and costly high-acuity care. Over time, payors have broadened the scope of PAR to include imaging studies, prescriptions, and routine treatment. The potential detrimental effect of PAR on health care has recently been brought into the limelight, but its impact on orthopedic subspecialty care remains unclear. This study investigated the denial rate, the duration of care delay, and the administrative burden of PAR on orthopedic subspecialty care., Methods: A prospective, multicenter study was performed analyzing the PAR process. Orthopedic shoulder and/or sports subspecialty practices from 6 states monitored payor-mandated PAR during the course of providing routine patient care. The insurance carrier (traditional Medicare, managed Medicare, Medicaid, commercial, worker's compensation, or government payor [ie, Tricare, Veterans Affairs]), location of service, rate of approval or denial, time to approval or denial, and administrative time required to complete process were all recorded and evaluated., Results: Of 1065 total PAR requests, we found a 1.5% (16/1065) overall denial rate for advanced imaging or surgery when recommended by an orthopedic subspecialist. Commercial and Medicaid insurance resulted in a small but statistically significantly higher rate of denial compared to traditional Medicare, managed Medicare, worker's compensation, or governmental insurance (P < .001). The average administrative time spent on a single PAR was 19.5 minutes, and patients waited an average of 2.2 days to receive initial approval. Managed Medicare, commercial insurance, worker's compensation, and Medicaid required approximately 3-4 times more administrative time to process a PAR than to traditional Medicare or other governmental insurance (P < .001). After controlling for the payor, we identified a significant difference in approval or denial based on geographic location (P < .001). An appeal resulted in a relatively low rate of subsequent denial (20%). However, approximately a third of all appeals remained in limbo for 30 days or more after the initial request., Conclusions: This is the largest prospective analysis to date of the impact of PAR on orthopedic subspecialty care in the United States. Nearly all PAR requests are eventually approved when recommended by orthopedic subspecialists, despite requiring significant resource use and delaying care. Current PAR practices constitute an unnecessary process that increases administrative burden and negatively impacts access to orthopedic subspecialty care. As health care shifts to value-based care, PAR should be called into question, as it does not seem to add value but potentially negatively impacts cost and timeliness of care., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

To examine how the chemotactic agent stromal cell-derived factor-1alpha (SDF-1α) modulates the unique cellular milieu within rotator cuff muscle following tendon injury, we developed an injectable, heparin-based microparticle platform to locally present SDF-1α within the supraspinatus muscle following severe rotator cuff injury. SDF-1α loaded, degradable, N-desulfated heparin-based microparticles were fabricated, injected into a rat model of severe rotator cuff injury, and were retained for up to 7 days at the site. The resultant inflammatory cell and mesenchymal stem cell populations were analyzed compared to uninjured contralateral controls and, after 7 days, the fold-change in anti-inflammatory, M2-like macrophages (CD11b+CD68+CD163+, 4.3X fold-change) and mesenchymal stem cells (CD29+CD44+CD90+, 3.0X, respectively) was significantly greater in muscles treated with SDF-1α loaded microparticles than unloaded microparticles or injury alone. Our results indicate that SDF-1α loaded microparticles may be a novel approach to shift the cellular composition within the supraspinatus muscle and create a more pro-regenerative milieu, which may provide a platform to improve muscle repair following rotator cuff injury in the future.

Cubital tunnel syndrome is the most common cause of symptomatic ulnar neuropathy. The unique anatomic course of the ulnar nerve around the elbow makes it particularly vulnerable at a location far from its terminal destination. The natural progression of cubital tunnel syndrome allows patients who have mild symptoms to be adequately treated nonsurgically. Minor changes in activity combined with appropriate splinting may acceptably alleviate symptoms. Surgical intervention is recommended for patients who have more severe symptoms. Current data confirm that in situ ulnar nerve decompression, partial medial epicondylectomy, and anterior transposition result in equal success rates; however, more invasive techniques may increase the risk for complications. If primary surgical intervention fails, revision surgery can provide good results. Modern techniques for revision surgery incorporate the placement of a protective circumferential barrier around the pathologic nerve to mitigate cicatrix formation. Although several attractive options are currently available for the management of cubital tunnel syndrome, further research is necessary to guide treatment.

Background: Subscapularis dysfunction remains a significant problem after shoulder arthroplasty. Published techniques have variable recommendations for placing a rotator interval closing suture in attempts to off-load the subscapularis repair site, the implications of which have yet to be examined in the literature. The goals of this study were to investigate the biomechanical benefit of the rotator interval closing suture on the subscapularis repair strength and to analyze the effect on shoulder range of motion., Methods: Sixteen matched cadaveric shoulders underwent a subscapularis tenotomy and shoulder arthroplasty. The subscapularis tenotomy was repaired, and motion at physiologic torsional force was recorded. One of each matched pair was randomly assigned to receive an additional rotator interval closure suture. Each specimen then underwent a standardized cyclic loading with measurement of gap formation and load to failure., Results: The rotator interval closing suture significantly increased the ultimate load to failure of the subscapularis repair (452 N vs. 219 N; P = .002) and decreased gap formation at the subscapularis repair site. Measurement of the shoulder motion showed no significant difference between shoulders with and without the rotator interval closing suture., Discussion: We report the additional biomechanical benefit that the rotator interval closing suture provides to the subscapularis repair site after shoulder arthroplasty. This suture acts to improve the load to failure of the subscapularis repair and to decrease gap formation under cyclic load. Furthermore, it does not detrimentally affect shoulder external rotation or overall arc of rotation. Our findings support the application of this off-loading technique after subscapularis repair during shoulder arthroplasty., (Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Delayed diagnosis of jersey finger injuries often results in retraction of the flexor digitorum profundus tendon. Current practice recommends limiting tendon advancement to 1 cm in delayed repairs. The purpose of this study was to investigate the biomechanical consequences of tendon shortening on the force required to form a fist. The flexor digitorum profundus muscle was isolated in ten cadaveric forearms and the force required to form a fist was recorded. Simulated jersey finger injuries to the ring finger were then created and repaired. The forces required to pull the fingertips to the palm after serial tendon advancements were measured. There was a near linear increase in the force required for making a fist with shortening up to 2.5 cm. The force required to make a fist should be taken into account when considering the limit of 'safe' tendon shortening in delayed repair of jersey finger injuries., (© The Author(s) 2015.)

Every year approximately 18 million Americans report shoulder pain, a large percentage of which are a result of rotator cuff disease. Rotator cuff tear progression can be difficult to predict. Factors associated with tear enlargement include increasing symptoms, advanced age, involvement of 2 or more tendons, and rotator cable lesion. Nonsurgical treatment can be effective for patients with full-thickness tears. When conservative treatment fails, surgical repair provides a reliable treatment alternative. Recurrent tears after surgery can compromise outcomes, particularly for younger patients with physically demanding occupations. Revision surgery provides satisfactory results for those with symptomatic re-tears. If the tear is deemed irreparable, addressing concomitant biceps pathology or performing partial repairs can reliably improve pain and potentially reverse pseudoparalysis. The reverse shoulder arthroplasty has limited indications in the setting of rotator cuff tears and should be reserved for patients with painful pseudoparalysis and associated arthropathy., (Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine whether a screw placed perpendicular to the fracture line in an oblique scaphoid fracture will provide fixation strength that is comparable with that of a centrally placed screw., Methods: Oblique osteotomies were made along the dorsal sulcus of 8 matched pairs of cadaveric scaphoids. One scaphoid from each pair was randomized to receive a screw placed centrally down the long axis. In the other scaphoid, a screw was placed perpendicular to the osteotomy. Each scaphoid underwent cyclic loading from 80 N to 120 N at 1 Hz. Cyclic loading was carried out until 2 mm of fracture displacement occurred or 4,000 cycles was reached. The specimens that reached the 4,000-cycle limit were then loaded to failure. Screw length, number of cycles, and load to failure were compared between the groups., Results: We found no difference in number of cycles or load to failure between the 2 groups. Screws placed perpendicular to the fracture line were significantly shorter than screws placed down the central axis., Conclusions: A perpendicularly placed screw provides equivalent strength to one placed along the central axis., Clinical Relevance: Compared with a screw placed centrally in an oblique scaphoid fracture, a screw placed perpendicular to the fracture line allows the use of a shorter screw without sacrificing strength of fixation., (Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Lesser tuberosity osteotomy has been shown to decrease postoperative subscapularis dysfunction. The purpose of this study was to determine the effect of osteotomy thickness and suture configuration on repair integrity., Materials and Methods: One side of 12 matched-pair cadaveric shoulders was randomly assigned to either a thick osteotomy (100% of lesser tuberosity height) or a thin osteotomy (50% of height). Both sides of the matched pairs were given the same repair, either (1) compression sutures or (2) compression sutures plus 1 tension suture. This created 4 groups of 6 paired specimens. Computed tomography imaging was used to measure tuberosity dimensions before and after osteotomy to validate fragment height and area. The repairs were loaded cyclically and then loaded to failure. A video system measured fragment displacement. The percent area of osteotomy contact was calculated from the computed tomography and displacement data., Results: The average initial displacement was less in the thin osteotomy groups (P = .011). Adding a tension suture negated this difference. A significant number of thin repair sites compared with thick repair sites remained intact during load-to-failure testing (P = .001). No difference occurred because of maximum load between the repair groups (P = .401), and construct stiffness was greater when a tension suture was used (P = .032). The percent area of osteotomy contact showed no differences between the osteotomy (P = .431) and repair (P = .251) groups., Conclusion: The study showed that thin osteotomies displaced less than thick osteotomies. Adding a tension band improved construct stability and eliminated some failure modes. Our ideal repair was a thin wafer with both tension and compression sutures. This construct had smaller total displacement, a high osteotomy percent contact area, and a high maximum load., (Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Purpose: To compare the biomechanical strength of a knotless suture anchor repair and the traditional outside-in repair of peripheral triangular fibrocartilage complex (TFCC) tears in a cadaveric model., Methods: We dissected the distal ulna and TFCC from 6 matched cadaveric wrist pairs and made iatrogenic complete peripheral TFCC tears in each wrist. In 6 wrists, the TFCC tears were repaired using the standard outside-in technique using 2 2-0 polydioxane sutures placed in a vertical mattress fashion. In the other 6 wrists, we repaired the TFCC tears using mini-pushlock suture anchors to the fovea. The strength of the repairs was then determined using a materials testing machine with the load placed across the repair site. We loaded the repairs until a gap of 2 mm formed across the repair site, and then subsequently loaded them to failure. Thus, for each repair we obtained the load at 2-mm gap formation, load to failure, and mode of failure., Results: At the 2-mm gap formation, the suture anchor repairs were statistically stronger than the outside-in repairs. For load to failure, the suture anchor repairs were also statistically stronger than the outside-in repairs. Failure in both techniques occurred most commonly as suture pull-out from the soft tissues., Conclusions: The all-arthroscopic suture anchor TFCC repair was biomechanically stronger than an outside-in repair., Clinical Relevance: The suture anchor technique allows for repair of both the superficial and deep layers of the articular disk directly to bone, restoring the native TFCC anatomy. By being knotless, the suture anchor repair avoids irritation to the surrounding soft tissues by suture knots., (Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

The reverse shoulder arthroplasty is considered to be one of the most significant technological advancements in shoulder reconstructive surgery over the past 30 years. It is able to successfully decrease pain and improve function for patients with rotator cuff-deficient shoulders. The glenoid is transformed into a sphere that articulates with a humeral socket. The current reverse prosthesis shifts the center of rotation more medial and distal, improving the deltoid's mechanical advantage. This design has resulted in successful improvement in both active shoulder elevation and in quality of life., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Distal biceps tendon ruptures continue to be an important injury seen and treated by upper extremity surgeons. Since the mid-1980s, the emphasis has been placed on techniques that limit complications or improve initial tendon-to-bone fixation strength. Recently, basic science research has expanded the knowledge base regarding the biceps tendon structure, footprint anatomy, and biomechanics. Clinical data have further delineated the results of conservative and surgical management of both partial and complete tears in acute or chronic states. The current literature on the distal biceps tendon is described in detail., (Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Prophylactic release of the ulnar nerve in patients undergoing capsular release for severe elbow contractures has been recommended, although there are limited data to support this recommendation. Our hypothesis was that more severely limited preoperative flexion and extension would be associated with a higher incidence of postoperative ulnar nerve symptoms in patients undergoing capsular release., Materials and Methods: We conducted a retrospective review of 164 consecutive patients who underwent open or arthroscopic elbow capsular release for stiffness between 2003 and 2010. The ulnar nerve was decompressed if the patient had preoperative ulnar nerve symptoms or a positive Tinel test. Preoperative and postoperative range of motion and incidence of ulnar nerve symptoms were recorded., Results: The mean improvement in the arc of motion of was 36.7°. New-onset postoperative ulnar nerve symptoms developed in 7 of 87 patients (8.1%) who did not undergo ulnar nerve decompression; eventually, 5 of these patients with persistent symptoms underwent ulnar nerve decompression. The rate of developing postoperative symptoms was higher if patients had preoperative flexion ≤ 100° (15.2%) compared with those with preoperative flexion >100° (3.7%). There was no association between preoperative extension or gain in motion arc and postoperative symptoms., Conclusions: The overall rate of ulnar nerve symptoms after elbow contracture release was low if ulnar nerve decompression was performed in patients with preoperative symptoms or a positive Tinel test. There was a higher rate of ulnar nerve symptoms in patients with more severe contractures (≤ 100° of preoperative flexion), which did not reach statistical significance., (Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Ulnar-sided wrist pain is a frequent cause for loss of practice time and competitive play for athletes. Ulnocarpal abutment, a common source of ulnar-sided pain, typically burdens athletes who participate in gymnastics, racket sports, and baseball. Although many athletes respond to nonoperative management, surgical intervention should be considered when symptoms persist. Surgical options include arthroscopic debridement, arthroscopic wafer, open wafer, or ulnar-shortening osteotomy. Treatment should be tailored to the athletes' level of function, expectations, and goals. The timing of interventions also influences the treatment algorithm. A successful outcome can be anticipated when appropriate treatment is rendered., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Hypothesis: The short head bundle of the distal biceps tendon is more efficient at elbow flexion, and the long head is more efficient at forearm supination., Methods: The short and long head bundles of the distal biceps tendon were separated to the bicipital tuberosity in 6 cadavers. The area and centroid of each bundle insertion were computed from surface points measured within each footprint. Each bundle was individually loaded. The supination torque and flexion load generated were recorded at 90° of elbow flexion. The slope of the torque generated versus biceps load was used to define the supination moment arm. The ratio of the flexion load generated to biceps load applied was used to define the relative flexion efficiency., Results: The short head insertion was positioned distal and anterior relative to the long head and typically included the apex of the tuberosity. The areas of the long and short heads were 59 ± 15 and 94 ± 44 mm(2) (P = .07), respectively. The long head moment arm was significantly higher in supination. The short head had a significantly higher moment arm in neutral and pronation. The ratio of the flexion load to biceps load was 15% higher for the short head., Conclusion: The short and long heads of the biceps have distinct insertions. The short head's insertion allows it to be relatively more efficient at elbow flexion at 90°. In the neutral and pronated forearm, the short head is the relatively more efficient supinator. In the supinated forearm, the long head becomes relatively more efficient at supination., (Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Given the growing prevalence of obesity around the world and its association with osteoarthritis of the knee, orthopaedic surgeons need to be familiar with the management of the obese patient with degenerative knee pain. The precise mechanism by which obesity leads to osteoarthritis remains unknown, but is likely to be due to a combination of mechanical, humoral and genetic factors. Weight loss has clear medical benefits for the obese patient and seems to be a logical way of relieving joint pain associated with degenerative arthritis. There are a variety of ways in which this may be done including diet and exercise, and treatment with drugs and bariatric surgery. Whether substantial weight loss can delay or even reverse the symptoms associated with osteoarthritis remains to be seen. Surgery for osteoarthritis in the obese patient can be technically more challenging and carries a risk of additional complications. Substantial weight loss before undertaking total knee replacement is advisable. More prospective studies that evaluate the effect of significant weight loss on the evolution of symptomatic osteoarthritis of the knee are needed so that orthopaedic surgeons can treat this patient group appropriately.

The goal of this article is to summarize the current concepts on rotator cuff disease with an emphasis on arthroscopic treatment. Most rotator cuff tears are the result of an ongoing attritional process. Once present, a tear is likely to gradually increase in size. Partial-thickness and subscapularis tears can both be successfully treated arthroscopically if conservative management fails. Partial tears involving greater than 50% of tendon thickness should be repaired. Articular-sided partial tears involving less than 50% of the rotator cuff can reliably be treated with debridement. A more aggressive approach should be considered for low-grade tears (<50%) if they occur on the bursal side. Biomechanical and anatomic studies have shown clear superiority with dual-row fixation compared with single-row techniques. However, current studies have yet to show clear clinical advantage with dual-row over single-row repairs. Biceps tenotomy or tenodesis can reliably provide symptomatic improvement in patients with irreparable massive tears. True pseudoparalysis of the shoulder is a contraindication to this procedure alone and other alternatives should be considered., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: An anatomic study specifically investigating the optimal location for proximal biceps tenodesis and detailing the topographic relationship to neurovascular structures has not been conducted., Methods: Twelve cadaveric upper extremities were dissected to identify the proximal biceps musculotendinous junction and topographic relationships to neighboring neurovascular structures., Results: The musculotendinous junction of the long head of the biceps tendon was on average 2.2 cm distal to the superior border and 3.1 cm proximal from the inferior border of the pectoralis major tendon. The musculocutaneous nerve was on average 2.6 cm medial to the long head of the biceps at the musculotendinous junction. The distance from the lesser tuberosity to the musculotendinous junction of the long head of the biceps averaged 5.4 cm. The distance from the anterior humeral circumflex vessels to the musculotendinous junction of the long head of the biceps was 4.6 cm on average. The distance from the musculotendinous junction of the long head of the biceps to the musculocutaneous nerve as it pierces the coracobrachialis was 4.6 cm., Conclusion: In order to restore the appropriate length-tension relationship of the biceps muscle, proximal biceps tenodesis should possibly be placed closer to the superior border of the pectoralis major tendon than previously thought. The lesser tuberosity can be used as a tactile landmark for appropriate intraoperative placement. Although there is a relatively safe "buffer zone" between the location of the tenodesis and adjacent neurovascular structures, extreme caution must be used., (Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

We compared the biomechanical strength of the 2.5 mm PushLock suture anchor with a traditional Bio-SutureTak suture anchor in repair of ulnar collateral ligament injuries. Iatrogenic ulnar collateral ligament injuries in 18 cadaveric thumbs were repaired and used to test for load to failure and cyclic loading. The average force required to generate a 2 mm gap was 7.7 N for the 2.5 mm PushLock and 6.3 N for the Bio-SutureTak (p = 0.04). The ultimate load to failure was 28.0 N for the 2.5 mm PushLock and 18.8 N for the Bio-SutureTak (p = 0.16). There were no statistical differences between the two suture anchors under cyclic loading. The 2.5 mm PushLock suture anchor provides significantly stronger resistance to 2 mm gap formation at the repair site and is less likely to fail at the suture-ligament interface. However, there was no difference in the load to failure between the two suture anchors.

Study Design: Retrospective review, Objective: To compare the incidence and type of exposure-related complications for anterior lumbar surgery performed with and without an "access" surgeon., Summary of Background Data: No data exist comparing the incidence and type of exposure-related complications for anterior lumbar surgery performed with and without a vascular surgeon's assistance., Methods: A retrospective review was performed for 265 consecutive patients who underwent anterior lumbar spine surgery at our institution from 2003 to 2005. Each patient's records were reviewed for diagnosis, procedure, whether the surgical exposure was conducted by the spine surgeon (Spine) or with a vascular surgeon's assistance (Team), levels exposed, complications, and any lasting sequelae., Results: The percentage of patients with at least 1 intraoperative complication was 8% and 12% for the Spine and Team cases, respectively. Two percent of the Spine patients experienced an intraoperative vascular complication compared with 7% of the Team cases. No intraoperative vascular complication occurred in the single-level Spine exposures. Four percent of the patients with single-level exposures with Team approaches sustained an intraoperative vascular complication. Eight percent of the multilevel Spine cases sustained an intraoperative vascular complication compared with 9% of the multilevel Team exposures. There were 14 vascular injuries appreciated intraoperatively in a total of 13 patients. These injuries were directly repaired in 10 patients without any residual sequelae. The rate of vascular complications was statistically higher for multiple-level exposures (9%) versus single-level exposure (3%; P = 0.0357). The rate of retrograde ejaculation was 6% in the Spine cases whereas it was 7% in the Team approach., Conclusions: Our results do not support the notion that the presence of an "access" surgeon will change the type and rate of complications. With adequate training and judgment, spine surgeons may safely perform such exposures, provided vascular surgical assistance is readily available.

Objective of this study was to investigate the factors influencing the postoperative rehabilitation of T2DM-RCI patients. Methods: Data was collected using a descriptive qualitative research design. The sample included 22 interviewees, who were recruited in Subei People's Hospital according to the purposive sampling method. Colaizzi's method was employed for the purpose of evaluation in the course of the data analysis. Findings: Thematic analysis of the postoperative rehabilitation views of the interviewees identified eight sub-themes connected to three main themes in accordance with the Behaviour Change Wheel Theory. These were capability-related, opportunity-related, and motivation-related factors. Conclusion: It is imperative to enhance the glycaemic control and health perception of T2DM-RCI patients. To this end, rehabilitation programmes, comprising exercise and dietary modifications, must be tailored to the specific needs of each patient. Furthermore, it is crucial to harness the potential of family and social support to motivate patients to maintain a positive outlook. [ABSTRACT FROM AUTHOR]

Background: Investigating the spatial distribution of muscle activity would facilitate understanding the underlying mechanism of spasticity. The purpose of this study is to investigate the characteristics of spastic muscles during passive stretch and active contraction by high-density surface electromyography (HD-sEMG). Methods: Fourteen spastic hemiparetic subjects and ten healthy subjects were recruited. The biceps brachii (BB) muscle activity of each subject was recorded by HD-sEMG during passive stretch at four stretch velocities (10, 60, 120, 180˚/s) and active contraction at three submaximal contraction levels (20, 50, 80%MVC). The intensity and spatial distribution of the BB activity were compared by the means of two-way analysis of variance, independent sample t-test, and paired sample t-test. Results: Compared with healthy subjects, spastic hemiparetic subjects showed significantly higher intensity with velocity-dependent heterogeneous activation during passive stretch and more lateral and proximal activation distribution during active contraction. In addition, spastic hemiparetic subjects displayed almost non-overlapping activation areas during passive stretch and active contraction. The activation distribution of passive stretch was more distal when compared with the active contraction. Conclusions: These alterations of the BB activity could be the consequence of deficits in the descending central control after stroke. The complementary spatial distribution of spastic BB activity reflected their opposite motor units (MUs) recruitment patterns between passive stretch and active contraction. This HD-sEMG study provides new neurophysiological evidence for the spatial relationship of spastic BB activity between passive stretch and active contraction, advancing our knowledge on the mechanism of spasticity. Trial registration: ChiCTR2000032245. [ABSTRACT FROM AUTHOR]

Although surgical release of upper extremity nerve compression syndromes is highly effective, persistence or recurrence of symptoms and signs may occur. Thorough investigation is necessary in this situation before treatment is recommended. If the symptoms cannot be explained by other pathology than compression of the affected nerve and if conservative management has not provided improvement, reoperation may be considered. This review provides an overview of the diagnostic and surgical considerations in the revision of carpal tunnel syndrome, cubital tunnel syndrome and thoracic outlet syndrome. Level of evidence: V [ABSTRACT FROM AUTHOR]

Background: Surgical repair is recommended for the treatment of high-grade partial and full thickness rotator cuff tears, although evidence shows surgery is not necessarily superior to non-surgical therapy. The purpose of this study was to compare percutaneous orthobiologic treatment to a home exercise therapy program for supraspinatus tears. Methods: In this randomized-controlled, crossover design, participants with a torn supraspinatus tendon received either 'BMC treatment', consisting of a combination of autologous bone marrow concentrate (BMC) and platelet products, or underwent a home exercise therapy program. After three months, patients randomized to exercise therapy could crossover to receive BMC treatment if not satisfied with shoulder progression. Patient-reported outcomes of Numeric Pain Scale (NPS), Disabilities of the Arm, Shoulder, and Hand, (DASH), and a modified Single Assessment Numeric Evaluation (SANE) were collected at 1, 3, 6, 12, and 24 months. Pre- and post-treatment MRI were assessed using the Snyder Classification system. Results: Fifty-one patients were enrolled and randomized to the BMC treatment group (n = 34) or the exercise therapy group (n = 17). Significantly greater improvement in median ΔDASH, ΔNPS, and SANE scores were reported by the BMC treatment group compared to the exercise therapy group (-11.7 vs -3.8, P = 0.01; -2.0 vs 0.5, P = 0.004; and 50.0 vs 0.0, P < 0.001; respectively) after three months. Patient-reported outcomes continued to progress through the study's two-year follow-up period without a serious adverse event. Of patients with both pre- and post-treatment MRIs, a majority (73%) showed evidence of healing post-BMC treatment. Conclusions: Patients reported significantly greater changes in function, pain, and overall improvement following BMC treatment compared to exercise therapy for high grade partial and full thickness supraspinatus tears. Trial registration: This protocol was registered with www.clinicaltrials.gov (NCT01788683; 11/02/2013). [ABSTRACT FROM AUTHOR]

Background: During arthroscopic rotator cuff repair (ARCR), clear surgical field visibility (SFV) is the basis of successful surgery, but the choice of anesthesia maintenance drugs may have different effects on SFV. In this study, we aimed to compare the effects of propofol- and sevoflurane-based general anesthesia on SFV in patients undergoing ARCR. Methods: Patients (n = 130) undergoing elective ARCR in the lateral decubitus position were randomized into either the propofol group or sevoflurane group (65 per group). The duration of surgery and increased pressure irrigation (IPI), Boezaart score, rocuronium consumption and usage of remifentanil were recorded. The time of both spontaneous respiration recovery and extubation and the incidences of postoperative nausea and vomiting and agitation were also recorded. Results: The Boezaart score, duration of IPI and ratio of the duration of IPI to the duration of surgery (IPI/S ratio) were similar between the groups (P > 0.05). Rocuronium consumption, number of patients requiring remifentanil infusion and total remifentanil consumption were significantly lower in the sevoflurane group (P < 0.05). The spontaneous respiration recovery time was significantly longer in the propofol group (P < 0.05), but there were no differences in the extubation time between the groups(P > 0.05). Conclusions: Compared with propofol, sevoflurane provides equally clear SFV while improving the convenience of anesthesia maintenance in ARCR patients with interscalene plexus (ISB) combined with general anesthesia. Trial registration: This single-center, prospective, RCT was retrospective registered at Chinese Clinical Trial Registry with the registration number ChiCTR2300072110 (02/06/2023). [ABSTRACT FROM AUTHOR]

Background: Rotator cuff tears (RCT) is a common musculoskeletal disorder in the shoulder which cause pain and functional disability. Diabetes mellitus (DM) is characterized by impaired ability of producing or responding to insulin and has been reported to act as a risk factor of the progression of rotator cuff tendinopathy and tear. Long non-coding RNAs (lncRNAs) are involved in the development of various diseases, but little is known about their potential roles involved in RCT of diabetic patients. Methods: RNA-Sequencing (RNA-Seq) was used in this study to profile differentially expressed lncRNAs and mRNAs in RCT samples between 3 diabetic and 3 nondiabetic patients. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis were performed to annotate the function of the differentially expressed genes (DEGs). LncRNA-mRNA co-expression network and competing endogenous RNA (ceRNA) network were constructed to elucidate the potential molecular mechanisms of DM affecting RCT. Results: In total, 505 lncRNAs and 388 mRNAs were detected to be differentially expressed in RCT samples between diabetic and nondiabetic patients. GO functional analysis indicated that related lncRNAs and mRNAs were involved in metabolic process, immune system process and others. KEGG pathway analysis indicated that related mRNAs were involved in ferroptosis, PI3K-Akt signaling pathway, Wnt signaling pathway, JAK-STAT signaling pathway and IL-17 signaling pathway and others. LncRNA-mRNA co-expression network was constructed, and ceRNA network showed the interaction of differentially expressed RNAs, comprising 5 lncRNAs, 2 mRNAs, and 142 miRNAs. TF regulation analysis revealed that STAT affected the progression of RCT by regulating the apoptosis pathway in diabetic patients. Conclusions: We preliminarily dissected the differential expression profile of lncRNAs and mRNAs in torn rotator cuff tendon between diabetic and nondiabetic patients. And the bioinformatic analysis suggested some important RNAs and signaling pathways regarding inflammation and apoptosis were involved in diabetic RCT. Our findings offer a new perspective on the association between DM and progression of RCT. [ABSTRACT FROM AUTHOR]

Introduction: Dislocations of the elbow are the second most frequent upper-body injury after shoulder dislocations, comprising 11-28% of all elbow injuries. Complex elbow dislocations pose challenging management due to the involvement of critical stabilizing structures. This study aimed to investigate functional and subjective outcomes (MEPS, DASH, Oxford score) in 44 patients with complex elbow dislocations who underwent surgery between 2018 and 2020, with subgroup analysis focusing on gender and age differences., Material and Methods: A retrospective analysis was conducted on patients treated at C.T.O. Hospital, Turin, for complex elbow dislocations between January 2018 and December 2020. Surgical approaches included radial head synthesis, coronoid fixation, ligamentous repair, and ulnar nerve management. Postoperatively, patients followed a standardized or individualized program. Data analysis involved t-tests to assess score differences between subgroups., Results: Among the 44 analyzed patients, the mean age was 48 years, and the mean follow-up time was 29 months. Various types of complex dislocations were identified, with radial head and coronoid fractures classified accordingly. Surgical approaches included multiple methods of reduction and synthesis. While most patients adhered to postoperative programs, subsequent reoperations were conducted in 11% of cases. Scores did not significantly differ between genders, although a trend toward better DASH scores in males was observed. Younger patients showed better, though not statistically significant, outcomes in mobility and functional measures., Conclusion: This study underscores the importance of pre-operative assessment for positive surgical outcomes in complex elbow dislocations. Additionally, findings suggest that younger age may correlate with slightly better functional outcomes. Despite limitations such as retrospective design and sample size, the study enhances our understanding of complex dislocation outcomes and provides valuable insights for future interventions., (© 2024. The Author(s).)

Instability of the anatomic total shoulder arthroplasty is a challenging problem. With an incidence of 1% to 5% reported in the literature, it is critical for shoulder surgeons to understand and be capable of addressing this complication. Etiology is multifactorial and related to soft-tissue imbalance, osseous pathology, implant malposition, or more commonly, a combination of these various causes. Historically, high rates of failure have been reported after revision procedures, prompting a movement toward the more inherently stable reverse shoulder arthroplasty as a reliable form of management. However, this may not be the ideal solution for all patients, particularly the young and active population. Consequently, the purpose of this article was to provide a review of the literature on the management of postoperative instability and intraoperative strategies to prevent this complication during the index procedure., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Rotator cuff pathology is the main cause of shoulder pain and dysfunction in older adults. When a rotator cuff tear involves the subscapularis tendon, the symptoms are usually more severe and the prognosis after surgery must be guarded. Isolated subscapularis tears represent 18% of all rotator cuff tears and arthroscopic repair is a good alternative primary treatment. However, when the tendon is deemed irreparable, tendon transfers are the only option for younger or high-functioning patients. The aim of this review is to describe the indications, biomechanical principles, and outcomes which have been reported for tendon transfers, which are available for the treatment of irreparable subscapularis tears. The best tendon to be transferred remains controversial. Pectoralis major transfer was described more than 30 years ago to treat patients with failed surgery for instability of the shoulder. It has subsequently been used extensively to manage irreparable subscapularis tendon tears in many clinical settings. Although pectoralis major reproduces the position and orientation of the subscapularis in the coronal plane, its position in the axial plane - anterior to the rib cage - is clearly different and does not allow it to function as an ideal transfer. Consistent relief of pain and moderate recovery of strength and function have been reported following the use of this transfer. In an attempt to improve on these results, latissimus dorsi tendon transfer was proposed as an alternative and the technique has evolved from an open to an arthroscopic procedure. Satisfactory relief of pain and improvements in functional shoulder scores have recently been reported following its use. Both pectoralis minor and upper trapezius transfers have also been used in these patients, but the outcomes that have been reported do not support their widespread use., Competing Interests: J. L. Ávila Lafuente reports consulting fees, support for attending meetings and/or travel, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Smith & Nephew, unrelated to this article. B. Elhassan reports royalties or licenses, consulting fees, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events, and support for attending meetings and/or travel from DJO Global, unrelated to this article. A. Hachem reports consulting fees, and support for attending meetings and/or travel from Arthrex and Stryker, unrelated to this article. M. A. Ruiz Ibán reports institutional research grants, and individual speaker payments, from Smith & Nephew and Link, unrelated to this article., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

The aim of the present anatomical study was to assess the dorso-radial approach for percutaneous fixation of scaphoid wist fractures. Through the anatomical snuffbox, cannulated screws or 1.2 mm K-wires were inserted into the scaphoids of 20 fresh-frozen cadavers. No tendon injuries were observed. There were two lesions of the radial artery, and three lesions of the sensory branches of the radial nerve. After dissection and three-dimensional CT reconstruction, the K-wire or screw position was described in relation to the scaphoid centroid and its longitudinal axis. The mean distance between the device and the scaphoid centroid was 2.8 mm (SD 1.4, range 0.6 to 6.1). The mean angle between the device and the scaphoid's longitudinal axis was 29° (SD 11, range 6.5 to 54). Rather than percutaneous fixation, an open approach with a modest incision might be safer for identifying and protecting both the radial artery and the sensory nerves. This approach would make perpendicular fixation possible for specific patterns of scaphoid fracture orientated approximately 60° from the longitudinal axis. [ABSTRACT FROM AUTHOR]

Background: There is minimal literature on the morphology of partial distal biceps tendon (DBT) tears. We sought to investigate tear morphology by retrospectively reviewing 3-Tesla magnetic resonance imaging (3T MRI) scans of elbows with partial DBT tears and to propose a basic classification system. Methods: 3T MRI scans of elbows with partial DBT tears were retrospectively reviewed by two experienced observers. Basic demographic data were collected. Tear morphology was recorded including type, presence of retraction (>5 mm), and presence of discrete long-head and short-head tendons at the DBT insertion. Results: For analysis, 44 3T MRI scans of 44 elbows with partial DBT tears were included. There were 9 isolated long-head tears (20%), 13 isolated short-head tears (30%), 2 complete long-head tears with a partial short-head tear (5%), 5 complete short-head tears with a partial long-head tear (11%), and 15 peel-off tears (34%). Retraction was seen in 5 or 44 partial tears (11%), and 13 of the 44 DBTs were bifid tendons at the insertion (30%). Conclusions: Partial DBT tears can be classified into five sub-types: long-head isolated tears, short-head isolated tears, complete long-head tears with partial short-head involvement, complete short-head tears with partial long-head involvement, and peel-off tears. Classification of tears may have implications for operative and non-operative management. [ABSTRACT FROM AUTHOR]

Copyright of Obere Extremitat is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The objective of this study is to investigate changes in willingness for total knee replacement (TKR) surgery following a randomised control trial (RCT) of an osteoarthritis management program, and to extrapolate orthopaedic cost consequences for private health insurers (PHI). Methods: Willingness for surgery data from the RCT is analysed using a multinomial logistic regression model. A decision analytic model is used to conduct a break-even cost benefit analysis of the intervention from a PHI payer perspective. The analysis estimates the minimum probability of progression to surgery required for the intervention to be cost-neutral when considering savings limited to reduced orthopaedic costs. Cost data and orthopaedic pathway probabilities are sourced from payer data. Results: At baseline, 39% of participants in the treatment and control group were willing for surgery. At 12 months, 16% of participants in the treatment group remained willing for surgery, versus 36% in the control group. Participants in the treatment group are 2.96 (95% CI: 1.01–8.66) times more likely than those in the control group to move from initially willing for surgery, to unsure or unwilling at 12 months. The analysis indicates that the intervention is likely to be cost saving when at least 60% of initially willing participants progress to surgery over a 5-year time horizon. Conclusion: Our study estimates that an education, exercise and weight loss intervention can deliver both improved participant outcomes and a return on investment to Australian PHIs through a reduction in TKR surgery incidence. [ABSTRACT FROM AUTHOR]

Background: Obstetric brachial plexus injury (OBPI) is a weakening or paralysis of the upper arm caused by brachial plexus injury followed by a muscle paralysis with severe repercussions on the movement of the shoulder joint following a progressive glenohumeral joint deformity. This case series analyzes the clinical and radiological outcomes of reverse total shoulder arthroplasty (RSA) in OBPI patients with a follow-up of 2 years. Materials and methods: OBPI patients with secondary end-stage glenohumeral arthritis were enrolled in the study and they were treated with RSA. Patient demographics and clinical outcomes [Range of Motion (ROM), Visual Analog Scale (VAS), Oxford Shoulder Score (OSS)] were evaluated. A novel Shoulder motion analysis was carried out to investigate specific movement patterns of scapulothoracic movements in these patients. This study is a prospective cohort study. Results: Four Patients (M: F = 1:3) were enrolled in the study, the mean age was 49.3 years (+ 2.75), the mean OSS (Oxford Shoulder Score) decreased from 48.8 (± 2.5) preoperatively to 18.30 (± 2.78), the mean VAS (Visual Analog Scale) decreased from 7.25 (± 0.5) to 1.7 (± 0.3) in the follow up (∆% relative pain reduction:− 76.5%), Shoulder ROM obtained an improvement (p < 0.05) except for abduction and external rotation. The average follow-up time was 26.3 months (+− 4.5). Shoulder motion analysis showed a complete loss of the scapular tilting above 90 degrees of flexion compared to the typical one of standard RSA with a pattern shifted towards scapular retraction (engaging trapezius and rhomboid muscles) to compensate the loss of the posterior tilting. Conclusions: RSA in OBPI patients demonstrated a significant improvement of pain symptoms and a moderate improvement in daily activities, anyway with a more appreciable quality of life over time even if the marked hypotrophy especially of the posterior shoulder muscles showed some limits in maintaining suspension of the upper limb and a minor external rotation, with an internal rotation attitude during the movements. Level of evidence: Level IV, Case series. [ABSTRACT FROM AUTHOR]

Background: Palmer type 1B triangular fibrocartilage complex (TFCC) tears are a common cause of distal radioulnar joint (DRUJ) instability. Unfortunately, the best surgical technique for TFCC reinsertion is still unknown, and up to a quarter of patients report instability after repair. The purpose of this systematic review of cadaver studies was to compare the biomechanical outcomes of different surgical techniques used for Palmer 1B TFCC tears. Methods: A systemic review of all cadaver studies published before January 2022 was performed using the PubMed and EMBASE databases. Only cadaver studies on reinsertion techniques for Palmer type 1B lesions were included. Biochemical outcome parameters evaluated were stability of the DRUJ and strength of the repair. Results: A total of 248 articles were identified. Five articles fulfilled the inclusion criteria. Four different surgical techniques were identified. In 3 studies, transosseous tunnel repair was tested and resulted in the most stable DRUJ and strongest TFCC repair compared with the suture anchor repair, the peripheral capsular repair, and the outside-in repair. Conclusions: These results suggest that the transosseous tunnel repair might be a good technique for restoring DRUJ stability. However, more cadaver studies are needed to identify the most optimal technique. [ABSTRACT FROM AUTHOR]

Purpose of Review: Reverse shoulder arthroplasty (rTSA) is a commonly performed procedure to treat degenerative conditions of the shoulder. With its growing utilization, techniques to reliably diagnose and treat prosthetic joint infection (PJI) have become increasingly important. In this review we outline the current research and prevention methods of prosthetic joint infection in rTSA. This includes preoperative considerations, intraoperative, and postoperative treatment algorithms., Recent Findings: There is currently no established standardized protocol for preoperative infection prevention or post operative management. However, recent studies have identified risk factors for infection, as well as successful prevention techniques that can be implemented to minimize infection risk. Although there is no standardized protocol currently utilized to diagnose and treat shoulder PJI, we outline a potential set of preventative measures and postoperative management strategies that clinicians can use to properly diagnose and treat patients with this difficult condition., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Rotator Cuff (RC) lesions are classified in full-thickness and partial-thickness tears (PTRCTs). To our knowledge, no studies investigated the mean size of shoulder tendons in healthy and PTRCT patients using MRI scans. The aim of the study was to provide data to obtain and compare the mean value of tendon sizes in healthy and PTRCTs groups. Methods: From 2014 to 2020, 500 were included in the study. They were divided into two groups: Group 1 (100 subjects) was composed of people positive for partial-thickness rotator cuff tears (PTRCTs), while the 400 subjects in Group 2 were negative for PTRCTs. Results: Overall, of the patients included in the study, 231 were females and 269 were males. The mean age of the patients was 49 ± 12.7 years. The mean thickness of the supraspinatus tendon (SSP) was 5.7 ± 0.6 mm in Group 1, 5.9 ± 0.6 mm in Group 2 (p < 0.001). The mean length of the ISP tendon was 27.4 ± 3.2 mm in Group 1, 28.3 ± 3.8 mm in Group 2 (p = 0.004). The mean width of the SSP tendon was 17 ± 1.6 mm in Group 1, 17.6 ± 2 mm in Group 2 (p = 0.004). The mean width of the infraspinatus tendon (ISP) tendon was 17.7 ± 1.4 mm in Group 1, 18.3 ± 2.1 mm in Group 2 (p = 0.02). Conclusion: The anatomical data present in this paper may serve as a tool for surgeons to properly manage PTRCTs. The findings of the present study aimed to set the first step towards reaching unanimity to establish international cut-off values to perform surgery. Additionally, they could widely increase diagnostic accuracy, improving both conservative and surgical approaches. Lastly, further clinical trials using more accurate diagnostic MRI tools are required to better define the anatomical differences between PTRCT and healthy patients. Level of evidence: Level II, Retrospective Comparative Trial [ABSTRACT FROM AUTHOR]

Background: A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR. Methods: We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance. Results: The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, -8.51 points; 95% confidence interval [CI],-32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI,-2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data. Conclusions: Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR. Level of evidence: I [ABSTRACT FROM AUTHOR]

Anatomic total shoulder arthroplasty (aTSA) is an accepted treatment for a variety of degenerative conditions of the glenohumeral joint. The manner in which the subscapularis tendon is handled during the approach in aTSA is not universally agreed on. Failure of the repair after aTSA has been shown to be associated with poorer outcomes in some cases. There is no consensus on how to treat failures, as all techniques described in the literature demonstrate shortcomings. The purpose of this review is to evaluate the methods of handling the tendon in aTSA and to review options for treating failure following surgery. [Orthopedics. 2023;46(5):e264–e272.] [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between the morphological parameters of the shoulder joint and supraspinatus tendinosis. Methods: A patient group (n=44) was formed from patients diagnosed with supraspinatus tendinosis from medical records and magnetic resonance imaging (MRI) findings. A control group (n=44) was formed by randomly selecting people of similar age and gender to the patient group, who met the exclusion criteria for the patient group, and had normal rotator cuffs on MRI. Coracoacromial ligament thickness (CLT), acromial angle [(AA), delta angle], acromioglenoid angle (AGA), supraspinatus fossa (SFA) glenoid angle on the axial (SGAX) views, SFA glenoid angle on the anterior-posterior (SGAP) views, acromiohumeral distance (AHD), and coracoacromial arch angle (CAA) were measured on MRI images in both groups. Morphological differences between groups were compared using Student’s t-test. Results: Patient group had statistically significant higher CLT and lower AHD values (0.73±0.33 mm and 6.55±0.97 mm, respectively; p=0.007) than control group (1.02±0.53 mm and 7.45±1.61 mm, respectively; p=0.006). Also, there were statistically significant differences between the groups in terms of acromial angle (3.09±5.04° for patient group and 7.9±8.1° for control group; p=0.006). However, there were no statistically significant differences between the groups for AGA, SGAX, SGAP, and CAA (p>0.05). Conclusion: These findings suggest that CLT, AA, and AHD are important predisposing anatomical factors for developing supraspinatus tendinosis. [ABSTRACT FROM AUTHOR]

Background: Elbow capsular release can be performed arthroscopically or through an open method to improve range of motion (ROM). However, it is unclear how frequently patients require an open capsular release after unsatisfactory results from an arthroscopic release. Purpose/Hypothesis: The purpose of this study was to determine the percentage of patients who underwent an arthroscopic elbow release for loss of motion who then required a repeat elbow capsular release or other subsequent surgery on the same elbow. It was hypothesized that patients who underwent arthroscopic elbow release would rarely (<5%) require a subsequent elbow release. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic elbow capsular release from January 1, 2010, to December 31, 2019, were identified by chart review and procedure code. Demographic parameters, pre- and postoperative ROM, and surgical history were collected by chart review. Follow-up data included patient satisfaction and the Timmerman-Andrews (TA) elbow score. Data were compared between patients who did and those who did not require subsequent elbow surgery. Results: Overall, of 140 study patients (116 male, 24 female; mean age, 49.6 years), 18 (12.9%) required subsequent surgery, including 6 capsular releases (4.3%; 1 open and 5 arthroscopic). The most common follow-up procedure was ulnar nerve releases/transpositions (n = 7). Total arc of elbow motion (flexion to extension) improved by a mean of 51.4°. The mean TA score was 76.5 ± 20.4 at a mean of 5.25 years postoperatively. Mean satisfaction score was 77.6 ± 26.3. In this study, 82.4% of patients stated that their symptoms either improved or resolved completely. Patients who required subsequent surgery had a significantly lower preoperative total arc of elbow motion versus those who did not require subsequent surgery (P =.046). There was no difference between the groups in symptom resolution, satisfaction, ROM, or TA score (P ≥.279 for all). Conclusion: After arthroscopic elbow release, <5% of patients required a repeat elbow capsular release, 12.9% required some form of follow-up elbow surgery, and 4.3% had a new injury of the elbow. Overall, patients saw improvement in elbow ROM, but many still had residual symptoms from their underlying disease after arthroscopic elbow capsular release. [ABSTRACT FROM AUTHOR]