Immediate self-rehabilitation after open Latarjet procedures enables recovery of preoperative shoulder mobility at 3 months.

PURPOSE: To evaluate short-term clinical outcomes of shoulders treated for anterior instability by open Latarjet procedures (OLP) followed by immediate self-rehabilitation. The hypothesis was that patients would recover preoperative function at 3 months with no adverse events related to self-rehabilitation. METHODS: The authors retrieved clinical and radiographic records of 307 consecutive shoulders treated by the same surgeon for anterior instability by OLP with immediate self-rehabilitation. Four shoulders did not meet eligibility criteria and 38 were lost to follow-up, leaving a study cohort of 265 shoulders. Patients performed self-rehabilitation exercises at home from the first postoperative day. Follow-ups at 1 and 3 months evaluated recurrence of instability, postoperative complications, pain, active forward elevation (AFE), passive forward elevation (PFE), external rotation (ER) and internal rotation (IR). RESULTS: The difference between mobility before surgery and at 3 months was 0° for AFE, 0° for PFE, 10° for ER, and 0 spine segments for IR. Thirteen shoulders (5%) which had not followed the self-rehabilitation protocol during the first month had significantly more pain and less improvements in mobility (p < 0.05). Multivariable analyses revealed that patients who adhered to self-rehabilitation in the first month had greater improvements of AFE, PFE, and IR (p < 0.05). CONCLUSIONS: Immediate self-rehabilitation after open Latarjet procedures enabled recovery of preoperative shoulder mobility at 3 months. Patients who did not adhere to immediate self-rehabilitation had more pain and less improvement in mobility. Furthermore, immediate self-rehabilitation was found to be independently associated with better recovery and did not cause any adverse events. LEVEL OF EVIDENCE: Level IV.

Bilateral anatomic total shoulder arthroplasty versus reverse shoulder arthroplasty.

The results of anatomic total shoulder arthroplasty and reverse shoulder arthroplasty have previously been reported separately. Although the indications differ, scenarios exist in which a patient may have a total shoulder arthroplasty on 1 shoulder and a reverse shoulder arthroplasty on the contralateral shoulder.Between 1992 and 2009, twelve patients underwent bilateral sequential primary shoulder arthroplasty with a total shoulder arthroplasty on 1 side and reverse shoulder arthroplasty on the contralateral side. Constant score, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value, and patient satisfaction were obtained a minimum 1 year postoperatively. Mean postoperative Constant score was 77 after total shoulder arthroplasty and 73 after reverse shoulder arthroplasty (P<.2488). Mean postoperative active forward flexion was similar after total shoulder arthroplasty compared with reverse shoulder arthroplasty (P=.8910). Greater external rotation at the side (43° vs 12°; P<.0001) and internal rotation (T8 vs L1; P<.0001) were observed after total shoulder arthroplasty. Mean ASES score was 89.6 after total shoulder arthroplasty compared with 82.4 after reverse shoulder arthroplasty (P=.0125). Patient satisfaction was 92% for both prostheses, and mean subjective shoulder value was similar (85.4% vs 82.5%; P=.6333).Bilateral shoulder arthroplasty performed with a total shoulder arthroplasty and reverse shoulder arthroplasty on opposite shoulders can provide good functional outcome and high patient satisfaction. Although range of motion is better following total shoulder arthroplasty, no difference was observed in final Constant score or subjective patient assessment.

Contribution of clinical tests to the diagnosis of rotator cuff disease: a systematic literature review.

OBJECTIVE: To evaluate the diagnostic performance of clinical tests for degenerative rotator cuff disease, based on a systematic literature review. METHODS: We searched Medline, Embase, and Pascal Biomed until the first half of 2006 inclusive for articles that reported at least the sensitivity and specificity of clinical tests for rotator cuff disease. Predictive values and accuracy were recorded where available. The results were discussed and validated. RESULTS: We selected nine studies, of which three investigated tests for subacromial impingement syndrome and seven tests for rotator cuff tendinopathy. The Neer and Hawkins tests had good sensitivity but low specificity for subacromial impingement syndrome. For diagnosing tears of the supraspinatus or infraspinatus, the Jobe sign and the full can test showed similar performance characteristics to the Patte test and resisted external rotation with the elbow at the side flexed at 90 degrees . For diagnosing tendinopathies with or without tears, active unresisted external rotation for the infraspinatus and the lift off test for the subscapularis were specific but lacked sensitivity. In one study, limitation of the range of active unresisted internal rotation was sensitive and specific for subscapularis tendon disease. The palm up test performed poorly for diagnosing long head of biceps disease. CONCLUSIONS: Data on the diagnostic performance of clinical tests for rotator cuff tendon disease are fragmentary. However objective data exist to support the usefulness of some of these tests. Further studies are needed.

[Non traumatic pathology of the shoulder: when to perform surgery?]. / Pathologie non traumatique de l'épaule: les indications de la chirurgie .

Non traumatic pathology of the shoulder was broken down in four entities: (1) articular stiffness are best treated with rehabilitation and an arthroscopic arthrolysis is rarely recommended; (2) rotator cuff pathology is represented by calcifying and non calcifying tendinitis, partial and full thickness rotator cuff tears; surgical treatment is performed nowadays under arthroscopy; after 50 years old, surgery is indicated after failure of conservative treatment; (3) glenohumeral osteoarthritis and arthritis are best treated with prosthesis; the results are now comparable to hip arthroplasty; (4) chronic acromio-clavicular pathology is usually treated conservatively.