Indications, technique, and results of total shoulder arthroplasty in osteoarthritis.

Osteoarthritis is a slowly progressive disease of one or more joints that appears to primarily affect articular cartilage. A joint affected by osteoarthritis develops cartilage thinning and, ultimately, patches of complete cartilage loss. The main symptom of osteoarthritis in the glenohumeral joint is diffuse, achy, and insidiously progressive pain. Total shoulder arthroplasty has become the standard treatment for advanced osteoarthritis of the glenohumeral joint.

Intra-articular ganglion cyst arising from the anterior cruciate ligament: a case report.

Intra-articular ganglion cysts have been reported in the medical literature but are extremely rare. A MEDLINE search from 1966 to July 1995 revealed no reported cases in the Physical Medicine literature. This case report details the presentation, evaluation and treatment course of a patient with knee complaints who was subsequently diagnosed to have a ganglion cyst arising from the anterior cruciate ligament. The patient was a 38-year-old woman with a 6-month history of knee swelling and pain. She had difficulty walking. Non-steroidal anti-inflammatory agents had not alleviated her symptoms significantly. Physiatric evaluation revealed a supra-patellar effusion and a mass lateral to the patellar tendon. MRI evaluation revealed an intra-articular cyst. The patient underwent surgical removal of what was subsequently determined to be an intra-articular ganglion cyst arising from the anterior cruciate ligament. The patient has had progressive resolution of her knee symptoms post-operatively. Physiatrists need to be aware of this cause of mechanical knee symptoms.

Anterior acromioplasty: effect of litigation and workers' compensation.

Seventy-five consecutive anterior acromioplasties were performed in 74 patients with chronic inflammation of the supraspinatus tendon caused by the impingement syndrome. Thirty-six patients (49%) had filed workers' compensation claims (group 1), 21 patients (28%) were involved in accident litigation (group 2), and 17 patients (23%) had no financial gain associated with their shoulder pain (group 3). The patients were followed up for a minimum of 12 months after surgery (range 12 to 48 months). Sixty-one patients (82%) had excellent results, 11 patients (15%) had good results, and 2 patients (3%) failed to improve from surgery. Ninety-one percent of employed patients were able to return to full employment. Although group 1 patients required a significantly longer time to return to work (average 14.2 weeks vs. 4.7 weeks in group 2 and 2.5 weeks in group 3), these patients were all involved in heavy labor demanding a more complete return of shoulder endurance. Satisfactory pain relief and return to preinjury work activities can be achieved by acromioplasty in patients who have the potential for secondary gain.

Effusion criteria and clinical importance of glenohumeral joint fluid: MR imaging evaluation.

PURPOSE: To investigate the clinical importance of glenohumeral joint (GHJ) fluid. MATERIALS AND METHODS: The amount of GHJ fluid in 17 volunteers and 208 consecutive patients was graded at magnetic resonance imaging with T2-weighted fat-suppressed coronal oblique images by two blinded observers. Thorough historical data and physical examination results were available for 108 patients. Presence and grade of GHJ fluid were correlated with age, sex, presence of osteophytes activity scale, supraspinatus tenderness, clinical impingement, prior subacromial injections, rotator cuff tears (RCTs), joint tenderness, joint pain, and history of trauma. RESULTS: GHJ fluid was seen in 40% (n = 83) of patients and in only 6% (n = 1) of volunteers. The volume of fluid correlated with osteophytes (P = .04), increasing age (P = .0001), and RCTs (P = .005). No correlation was found with activity rating, focal tenderness, joint pain, diagnosis of impingement, impingement grade, supraspinatus insertional tenderness, subacromial injection, prior trauma, or sex. CONCLUSION: The presence of GHJ fluid appears to be abnormal and in most cases is related to RCTs and osteoarthritis. It seems to be unrelated to activity, tenderness, or impingement.

Rotator cuff disorders: interobserver and intraobserver variation in diagnosis with MR imaging.

PURPOSE: To determine interobserver and intraobserver variation in the interpretation of magnetic resonance (MR) images in rotator cuff disorders. MATERIALS AND METHODS: MR images of the shoulder in 97 patients were retrospectively reviewed twice, with a 3-week interval. Surgical findings indicated a full-thickness tear in 29 patients, grade 1 impingement in 19 (tendinitis), and grade 2 impingement (partial tear) in 26. The control population comprised 23 asymptomatic volunteers or patients. RESULTS: All observers were accurate in the diagnosis of a full-thickness tear (89%-98%), with good intraobserver (kappa = 0.67-0.84) and interobserver agreement (kappa = 0.74-0.92). In diagnoses of tendinitis, partial tear, and normal cuff, there were wide ranges of sensitivity (13%-74%) and specificity (72%-93%), as well as poor interobserver (kappa = 0.12-0.60) and intraobserver agreement (kappa = 0.35-0.78). CONCLUSION: Full-thickness tears of the rotator cuff can be accurately identified at MR imaging with little observer variation. Consistent differentiation of normal rotator cuff, tendinitis, and partial thickness tears is more difficult.

Modular total shoulder replacement. Design rationale, indications, and results.

Modular total shoulder systems offer many advantages over nonmodular designs. Modularity facilitates precise placement of the humeral head with respect to the rotator cuff and tuberosities, allows for soft tissue tensioning and balance with variable neck lengths, and simplifies revision surgery by allowing removal of the humeral head while maintaining a well-fixed humeral stem. This review includes 47 total shoulder arthroplasties performed in 40 patients from 1986 to 1991. The average patient age was 62.3 years, with followup averaging 54 months. Seventeen patients had rheumatoid arthritis, and 22 had osteoarthritis. In the remaining 8 patients, 5 had posttraumatic arthritis, 2 had avascular necrosis, and 1 had cuff tear arthropathy. Glenoid revision was required in 3 patients, and symptomatic loosening occurred in only 1. Pain relief was achieved in 93.5% of patients. Range of motion improved 34.9 degrees in forward flexion, 18.1 degrees in external rotation, and 4 vertebral levels of internal rotation. Lucent lines were evaluated on the anteroposterior (AP) and axillary radiographs. On the AP radiograph, 16 shoulders demonstrated lucency about the glenoid component. Progression beyond 2 mm occurred in 5 shoulders, and symptoms requiring revision developed in one patient. Twenty-two patients demonstrated a lucency on the axillary radiograph, and 9 patients progressed beyond 2 mm. None required revision. The authors present the results and discuss surgical and design considerations of modular total shoulder arthroplasty.

Acromioclavicular joint fluid: determination of clinical significance with MR imaging.

PURPOSE: To determine the clinical significance of fluid in the acromioclavicular (AC) joint. MATERIALS AND METHODS: A total of 108 patients with clinical shoulder problems and 16 volunteers underwent MR imaging with a 1.5-T unit. Coronal T1- and T2-weighted images were evaluated for the presence of AC joint fluid, glenohumeral joint fluid, and AC joint osteophytes. Medical records were reviewed for the presence of clinical signs and symptoms. RESULTS: AC joint fluid was commonly seen in the patients (67%) but was rare in the volunteers (12%). The presence of AC joint fluid was associated with advancing patient age, presence of osteophytes, and fluid in the glenohumeral joint. AC joint fluid was not associated with focal tenderness, prior corticosteroid injections, history of trauma, findings of impingement, evidence of rotator cuff tear on MR images, or gender. CONCLUSION: AC joint fluid appears to be an asymptomatic manifestation of osteoarthritis.

Rotator cuff disease: a review of diagnosis, pathophysiology, and current trends in treatment.

This article reviews the anatomy, pathophysiology, and treatment of rotator cuff disease. A plan is presented to assist the clinician in making the appropriate diagnosis and proceed with adequate workup and treatment of a patient with shoulder pain.

Hooked acromion: prevalence on MR images of painful shoulders.

An association between the morphology of the acromion and the occurrence of rotator cuff tear (RCT) has been suggested by findings at both pathologic examination and routine radiography. As a tomographic technique, magnetic resonance (MR) assessment of acromial shape may be more accurate than routine radiography. The authors studied acromial morphology on sagittal oblique MR images of a control population (47 shoulders), of patients with isolated impingement (30 shoulders), and of patients with full-thickness RCTs (34 shoulders) to assess the association of acromial shape with disorders of the rotator cuff. Acromions were classified as flat (type 1), smoothly curved (type 2), or hooked (type 3). Data were collected by two observers, blinded to clinical and surgical information, who acted in consensus. Patients with RCT had a significantly increased prevalence of type 3 acromions compared with control patients (62% vs 13%, P < .001). Type 3 acromions tended to be more prevalent in the group with impingement (30%, P = .17). There was no significant difference in the distribution of acromion types among control patients with respect to age or gender.