Are Shoulder Surgeons any good at Diagnosing Rotator Cuff tears using Ultrasound ? A Comparative Analysis of Surgeon vs Radiologist

High-resolution ultrasound has gained increasing popularity as an aid in the diagnosis of rotator cuff pathology. With the advent of portable machines; ultrasound has become accessible to clinicians. Aim: This study was conducted to evaluate the accuracy and reliability of ultrasound in diagnosing rotator cuff tears by a shoulder surgeon and comparing their ability to that of a musculoskeletal radiologist. Materials and Methods: Seventy patients undergoing shoulder arthroscopy for rotator cuff pathology underwent preoperative ultrasonography (US). All patients were of similar demographics and pathology. The surgeon used a Sonosite Micromax portable ultrasound machine with a 10-MHz high frequency linear array transducer and the radiologist used a 9-12 MHz linear array probe on a Siemens Antares machine. Arthroscopic diagnosis was the reference standard to which ultrasound findings were compared. Results: The sensitivity in detecting full thickness tears was similar for both the surgeon (92) and the radiologist (94). The radiologist had 100sensitivity in diagnosing partial thickness tears; compared to 85.7for the surgeon. The specificity for the surgeon was 94and 85for the radiologist. Discussion: Our study shows that the surgeons are capable of diagnosing rotator cuff tears with the use of high-resolution portable ultrasound in the outpatient setting. Conclusion: Office ultrasound; by a trained clinician; is a powerful diagnostic tool in diagnosing rotator cuff tears and can be used effectively in running one-stop shoulder clinics

An optimised method for quantifying glenoid orientation

A robust quantification method is essential for inter-subject glenoid comparison and planning of total shoulder arthroplasty. This study compared various scapular and glenoid axes with each other in order to optimally define the most appropriate method of quantifying glenoid version and inclination. Six glenoid and eight scapular axes were defined and quantified from identifiable landmarks of twenty-one scapular image scans. Pathology independency and insensitivity of each axis to inter-subject morphological variation within its region was tested. Glenoid version and inclination were calculated using the best axes from the two regions. The best glenoid axis was the normal to a least-square plane fit on the glenoid rim, directed approximately medio-laterally. The best scapular axis was the normal to a plane formed by the spine root and lateral border ridge. Glenoid inclination was 15.7° ± 5.1° superiorly and version was 4.9° ± 6.1°, retroversion. The choice of axes in the present technique makes it insensitive to pathology and scapular morphological variabilities. Its application would effectively improve inter-subject glenoid version comparison, surgical planning and design of prostheses for shoulder arthroplasty

Pulmonary embolism following rotator cuff repair

Background: Previous studies have provided data on the incidence of pulmonary embolism following shoulder arthroplasty and repair of fractures of the proximal humerus. However; there is no information on the risk of pulmonary embolism following the surgical management of rotator cuff tears. Methods: We performed a review of 1176 patients who underwent operative procedures for rotator cuff tears between January 1 st ; 2001 and December 31 st ; 2005 to identify all patients who developed a symptomatic pulmonary embolism postoperatively. Results: Three patients developed pulmonary embolisms that were diagnosed with computed tomography angiography. The overall incidence was calculated to be 0.26. None of the patients died as a result of the pulmonary embolism. Conclusions: The data from this review indicates that the risk of pulmonary embolism following surgery for rotator cuff repair is low; but not nonexistent. The most common presenting symptoms of pulmonary embolism were chest pain; shortness of breath; and hypoxia. This study should raise surgeons' awareness about this possible complication following rotator cuff repair surgery

An Unusual Variation of Deltoid Muscle

An unusual anatomic variation of the deltoid muscle was found in a 45-year-old female cadaver during dissection of the right upper extremity. The posterior fibers of the right deltoid muscle were enclosed in a distinct fascial sheet and the deltoid muscle was seen to arise from the middle 1/3 of the medial border of the scapula. There was no accompanying vascular or neural anomaly of the deltoid muscle. To the best of our knowledge; unilateral posterior separation of the deltoid muscle with a distinct fascia has not been described previously. While dissecting deltoid; posterior deltoid; or scapular flaps; the surgeon needs to look out for this variation because it may cause confusion