Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients.

BACKGROUND: Treatment for displaced proximal humeral fractures is still under debate. Poor rotator cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation.The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly. MATERIALS AND METHODS: The study has investigated retrospectively a consecutive series of 73 patients over 65 years old (range 65-91) with proximal humeral three- and four- parts fractures, operated from January 2009 to June 2014 with a reversed total shoulder prosthetic replacement or open reduction and internal fixation using an angular stable plate, with at least 1 year follow-up. Participants are admitted in our hospital with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2.The primary outcomes are active ROM and shoulder function (Constant score). Secondary outcomes have been patient self-assessment form (Simple shoulder test) and radiographical details. Follow-up takes place at the moment of clinical observation with rx control. RESULTS: We analyzed a group of 23 patients treated by plate and screws and 21 patients treated by rTSA with these average results. ORIF: Flexion 112.8°, Abduction 99.6°, External rotation at 90° 47.4°, modal Internal rotation hand at Sacroiliac joint, Constant Score 52.9 and Simple Shoulder Test 8.0. RSA: Flexion 133.3°, Abduction 101.4°, External rotation at 90° of abduction 35.5°, modal Internal rotation hand at waist (L3), Constant Score 65.9 and Simple Shoulder Test 9.2. No nerve injuries were reported. No cases of pseudoarthrosis or plate fractures. No arthroplasty implant loosening, infection or dislocation was documented and revision required. CONCLUSION: Our study shows good clinical outcomes and fewer complications in both treatment options. Better clinical and daily living results are reported in RSA compared with ORIF, confirming that rTSA is one of the best treatment in proximal humeral fractures in the elderly patients, which rotator cuff status frequently is poor and degenerating. The few radiological complications do not seem to have influence on active ROM and Constant Score, both the first and the second group of patients. LEVEL OF EVIDENCE: Level IV, Case Series, Surgical.

Effects of one-month continuous passive motion after arthroscopic rotator cuff repair: results at 1-year follow-up of a prospective randomized study.

The study included 100 patients who underwent an arthroscopic rotator cuff repair. All patients suffered about a rotator cuff tear that was repaired arthroscopically with a suture anchor technique. Immediately postoperatively, patients were randomly allocated to one of two different postoperative physiotherapy regimens: passive self-assisted range of motion exercise (controls: 46 patients) versus passive self-assisted range of motion exercise associated with use of continuous passive motion (CPM) for a total of 2 h per day (experimental group: 54 patients), for 4 weeks. After this time, all the patients of both groups underwent the same physical therapy protocol. An independent examiner assessed the patients at 2.5, 6 and 12 months particularly about pain with the VAS scale (0-10) and the range of motion (ROM). Our findings show that postoperative treatment of an arthroscopic rotator cuff repair with passive self-assisted exercises associated with 2-h CPM a day provides a significant advantage in terms of ROM improvement and pain relief when compared to passive self-assisted exercise alone, at the short-term follow-up. No significant differences between the two groups were observed at 1 year postoperatively.

Arthroscopic repair of rotator cuff tear with a modified Mason-Allen stitch: mid-term clinical and ultrasound outcomes.

One of the most discussed point about arthroscopic full-thickness rotator cuff (RTC) repair is the strength of tendon-stitch interface. In the period between November 2003 and September 2004, in a series of 29 patients with primary isolated supraspinatus tear measuring > 2 cm a reconstruction using one titanium anchor and a modified Mason-Allen (MMA) stitch was done. These patients were prospectively collected in this study and then retrospectively evaluated. There were 21 men and 8 women with a mean age of 59.3 years. Patients were examined pre-operatively by a single sport medicine doctor, very experienced on shoulder pathology problem. Constant score, University of California at Los Angeles (UCLA) scale and Simple Shoulder Test (SST) were administered. After a minimum follow-up of 24 months patients were revaluated clinically by the same independent examiner. At the same time patients underwent an ultrasound shoulder examination to evaluate rotator cuff integrity. Clinically there was a significant improvement of Constant score, SST score and UCLA scale at followup. Twenty-five patients (86.2%) were satisfied, whether the other four patients (13.8%) stated that they would decline procedure. Recurrent rotator cuff tear was found in 11 patients (38%), who were all older than 60. All the patients but one with a pre-operative MRI grade III tendon tissue fatty infiltration, had a cuff re-tear. Arthroscopic supraspinatus tendon repair with one single anchor and MMA stitch is a reliable technique leading to a re-tear of 38% that is comparable with results reported in literature.

Chondral print on humeral head: an indirect sign of long head biceps tendon instability.

Long head biceps (LHB) tendon pathologies are becoming increasingly recognized causes of shoulder pain in the published literature. Instability of LHB presenting as dislocation or subluxation has been recently recognized as a possible cause of disabling pain or discomfort of the shoulder. A clinical diagnosis of LHB instability is very difficult and often confounding because of association with other shoulder pathologies. However, an early diagnosis of LHB instability is important in order to prevent the evolution of lesions of the biceps pulley until an internal anterosuperior impingement of the shoulder (ASI) and subscapular tear occur. The advent of arthroscopy contributed to enhance understandings. The goal of this article is to describe an arthroscopic sign, the chondral print on the humeral head, associated with a LHB instability, that when present can be very useful to help the surgeon to make the diagnosis of unstable LHB tendon.