Novel angle measurements for assessment of shoulder location using the scapular y radiograph.

Shoulder dislocation is an injury with potential long-term consequences that requires prompt diagnosis and treatment. Patient positioning and imperfect radiographic views may result in discomfort, added examination time, and problematic diagnosis. The scapular Y radiograph has been shown to be useful in diagnosing shoulder dislocation but is not considered sufficient in isolation. Using a synthetic bone shoulder model, we propose a novel technique wherein osseous landmarks are used to form angles that significantly improved diagnostic accuracy for shoulder dislocation, even in significantly rotated and otherwise indeterminate scapular Y radiographs.

Hemiarthroplasty for the rotator cuff-deficient shoulder.

BACKGROUND: Hemiarthroplasty is a common treatment for cuff tear arthropathy and glenohumeral arthritis associated with a massive tear of the rotator cuff; however, to our knowledge, long-term outcomes and preoperative factors affecting results have not been reported. METHODS: Thirty-four shoulders in thirty-one patients with cuff tear arthropathy or a massive rotator cuff tear with glenohumeral arthritis underwent hemiarthroplasty at an average age of seventy-two years. Outcomes in all patients were evaluated by direct physical examination and according to the limited goals criteria of Neer et al. at a mean of 3.7 years postoperatively. In twenty-five shoulders, long-term outcomes were measured with use of the American Shoulder and Elbow Surgeons (ASES) scoring system and follow-up data were obtained at a mean of ten years (range, four to sixteen years) postoperatively. RESULTS: Twenty-six of thirty-four shoulders satisfied the limited goals criteria described by Neer et al. The mean active forward elevation improved from 78 degrees preoperatively to 111 degrees postoperatively (p < 0.001). The mean active external rotation improved from 15 degrees preoperatively to 38 degrees postoperatively (p < 0.0001). One patient with a history of four failed rotator cuff repairs had anterosuperior instability develop after surgery. The mean final total ASES score was 67 points (range, 35 to 100 points). Of the sixteen shoulders in patients who could actively elevate the arm to >or=90 degrees preoperatively, fourteen achieved satisfactory results according to the limited goals criteria of Neer et al. Patients who could actively elevate the arm to 90 degrees had significantly better function (mean ASES function score, 31 compared with 23 points; p = 0.05), pain relief (mean ASES pain score, 48 compared with 30 points; p = 0.002), and higher total ASES scores (mean, 80 compared with 54 points; p < 0.001) than the patients who were unable to actively elevate the arm to 90 degrees . CONCLUSIONS: Hemiarthroplasty can provide good long-term results in rotator cuff-deficient patients with glenohumeral arthritis. Patients who have preoperative forward elevation of >or=90 degrees benefit the most. A low complication rate can be expected for this procedure.

Nonoperative management of idiopathic adhesive capsulitis.

Adhesive capsulitis of the shoulder is a common disorder, yet literature on its natural history is limited. This study examined patient characteristics, treatment patterns, and response to treatment of the disease in a large series of patients with this condition. Charts of 234 patients treated at our institution for adhesive capsulitis were reviewed retrospectively. The end points for the study were defined as resolution of symptoms with nonoperative treatment or operative treatment. A total of 105 shoulders in 98 patients were identified with follow-up to end point. Of these, 89.5% resolved with nonoperative treatment, including 17 (89.5%) of 19 diabetic shoulders. The average age of patients who went on to surgery was 51 years, whereas the average age of patients treated nonoperatively was significantly higher at 56. No significant difference was found for success of nonoperative treatment versus operative treatment or patient gender. All patients received nonsteroidal antiinflammatory medications, 52.4% received physical therapy without cortisone injection, and 37.1% received therapy with at least 1 corticosteroid injection. Duration of treatment in successfully nonoperatively treated patients averaged 3.8 +/- 3.6 months. Patients who required surgery were treated with an average of 12.4 +/- 12.1 months of nonoperative treatment. Initial forward elevation averaged 118 degrees +/- 22 degrees with average forward elevation at resolution of 164 degrees +/- 17 degrees. External rotation improved from an average of 26 degrees +/- 16 degrees pretreatment to 59 degrees +/- 18 degrees posttreatment. With supervised treatment, most patients with adhesive capsulitis will experience resolution with nonoperative measures in a relatively short period. Only a small percentage of patients eventually require operative treatment.