[The athlete's shoulder : overview of the typical clinical presentations]. / L'épaule du sportif : tour d'horizon des tableaux cliniques typiques.

Shoulder injuries are common in athlete population. They can be due to trauma or overuse. Traumatic lesions are roughly the same in the non-athlete population. On the other hand, overuse lesions are specific to the sport, depending on the movements performed by the athlete. The majority of the early literature studied baseball pitchers. Pathophysiological theories have been applied to other overhead sport. In this article, we discuss briefly the main specificities and conditions of the painful athlete's shoulder.

Les blessures de l'épaule sont fréquentes chez le sportif. Elles peuvent être secondaires à un traumatisme ou liées à une surcharge mécanique. Les lésions traumatiques diffèrent peu des lésions que l'on peut retrouver dans la population non sportive. Par contre, concernant les lésions de surcharge, on constate des blessures spécifiques du sportif, en lien avec la gestuelle du sport pratiqué. Une grande partie de la littérature vient des États-Unis à travers l'étude du lanceur au baseball (pitcher). Les concepts physiopathologiques ont largement été appliqués à d'autres sports nécessitant une gestuelle au-dessus des épaules (overhead athlete). Nous parcourons brièvement les principales spécificités et tableaux cliniques de l'épaule douloureuse chez le sportif.

Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study.

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53-0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

Hydrodilatation with corticosteroids is the most effective conservative management for frozen shoulder.

PURPOSE: The purpose of this overview is to summarise the findings of meta-analyses of randomised controlled trials that compare conservative treatment options for frozen shoulder. METHODS: The authors conducted an electronic literature search for meta-analyses published using PubMed, Web of Science and the Cochrane Library. Two researchers independently applied selection criteria and assessed quality of meta-analyses using A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2). Short-, medium- and long-term outcomes were synthesised narratively. RESULTS: A total of 319 studies were identified, of which 8 meta-analyses were eligible for inclusion. All included meta-analyses were judged to be low or critically low quality according to AMSTAR-2, however, their data synthesis and interpretation was considered valid. Physiotherapy, intra-articular and subacromial corticosteroid injection (CSI), and arthrographic distension/hydrodilatation with corticosteroid were reported with sufficient evidence. Intra-articular CSI and arthrographic distension/hydrodilatation with corticosteroid provide advantages over placebo in short-term pain relief, range of motion (ROM) and shoulder function, with improvements in ROM continuing into the medium and long term. Arthrographic distension/hydrodilatation with corticosteroid provides medium-term and long-term improvements in ROM over intra-articular CSI and physiotherapy. Proprioceptive neuromuscular facilitation provides advantages over conventional physiotherapy for pain improvement and external rotation in the short term. CONCLUSIONS: Arthrographic distension/hydrodilatation with corticosteroid provides superior pain relief in the short term and improvement in range of motion across all time frames for frozen shoulder when compared to CSI or physiotherapy. LEVEL OF EVIDENCE: Level IV.

Early and delayed acromioclavicular joint reconstruction provide equivalent outcomes.

BACKGROUND: Some comparative studies have reported improved outcomes for early compared with delayed reconstruction for high-grade acromioclavicular (AC) joint dislocations. However, most are based on older techniques and did not specifically involve reconstruction of both the coracoclavicular (CC) and AC joint ligaments. The purpose of this study was to compare functional outcomes of early vs. delayed surgical intervention of AC joint dislocations managed with combined CC and AC ligament reconstruction. METHODS: A retrospective comparative study was performed of 53 patients who underwent early (<2 weeks after injury) or delayed (≥2 weeks after injury) open stabilization for AC joint dislocation. All patients were managed with the same surgical technique of combined CC reconstruction and stabilization of the AC joint, except for the addition of a gracilis allograft for biologic CC reconstruction in delayed intervention. Outcome was determined at a minimum follow-up of 12 months, using the Acromioclavicular Joint Instability (ACJI) score, Taft score, Subjective Shoulder Value (SSV), visual analog scale (VAS) for pain, and overall satisfaction (0-10). Multivariable regression analyses were performed to test associations of ACJI and Taft scores with 5 independent variables (early vs. delayed surgery, age, sex, manual worker, and Rockwood type). RESULTS: The cohort comprised 47 men (89%) and 6 women (11%) aged 40.1 ± 11.2 years (range, 22-63 years). The early group (n = 31) underwent surgery 1.1 ± 0.5 weeks after injury, whereas the delayed group (n = 22) underwent surgery 84.3 ± 99.1 weeks after injury. There were no significant differences in ACJI scores (87 ± 14 vs. 89 ± 14, P = .267), Taft scores (10.1 ± 1.3 vs. 10.7 ± 1.3, P = .084), pain on VAS (0.3 ± 0.7 vs. 0.6 ± 1.1, P = .541), SSV (95 ± 7 vs. 93 ± 9, P = .427), or overall satisfaction (9.6 ± 0.9 vs. 9.4 ± 1.1, P = .491). Multivariable analyses revealed no associations between any of the independent variables and ACJI or Taft score. CONCLUSIONS: Early and delayed surgical interventions of high-grade AC joint dislocation provide equivalent clinical scores when combined CC and AC joint fixation is used for stabilization. Rapid surgical intervention for high-grade AC joint dislocation may not be necessary, as most patients can still benefit from surgery at a later stage.

Do short stems influence the cervico-diaphyseal angle and the medullary filling after reverse shoulder arthroplasties?

BACKGROUND: Shorter humeral stems were developed to improve bone preservation, vascularity and osteointegration in reverse total shoulder arthroplasty (RSA). While some studies examined the relationship between canal filling and radiographic changes, none evaluated the association between stem alignment and canal fill ratio (CFR). HYPOTHESIS: The hypothesis was that stem misalignment after RSA would be associated with lower CFR. PATIENTS AND METHODS: The authors retrospectively reviewed immediate postoperative radiographs of 157 patients, comprising 56 men (36%), who underwent RSA with a short uncemented stem with neck shaft angle (NSA) default of 145°. The parameters included postoperative NSA and metaphyseal CFR, both measured with excellent inter-observer agreement. Uni- and multivariable linear regressions were performed to determine associations between postoperative NSA and 5 variables (CFR, gender, age, BMI, and surgical approach). RESULTS: Postoperative NSA was 149°±8°, exceeding 5° of varus in 15 shoulders (9%) and 5° of valgus in 60 shoulders (38%), and CFR was 58%±8%. CFR was lower in shoulders with varus stem alignment (54%±6%) than shoulders with neutral stem alignment (59%±8%, p=0.033). Multivariable regression revealed that postoperative NSA increased with age (beta: 0.20; p=0.008), was higher for shoulders operated with the subscapularis- and deltoid-sparing approach (beta: 3.82; p=0.040) but lower for men (beta: -4.14; p=0.002). CONCLUSIONS: Stem misalignment exceeded 5° in 47% of the shoulders. Women, older age, and subscapularis- and deltoid-sparing approach are associated with greater risks of valgus stem positioning, while lower CFR seems to be associated with greater risks of varus stem positioning. LEVEL OF EVIDENCE: IV; case series.

Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty.

OBJECTIVES: To date, no study has considered the impact of acromial morphology on shoulder range of movement (ROM). The purpose of our study was to evaluate the effects of lateralization of the centre of rotation (COR) and neck-shaft angle (NSA) on shoulder ROM after reverse shoulder arthroplasty (RSA) in patients with different scapular morphologies. METHODS: 3D computer models were constructed from CT scans of 12 patients with a critical shoulder angle (CSA) of 25°, 30°, 35°, and 40°. For each model, shoulder ROM was evaluated at a NSA of 135° and 145°, and lateralization of 0 mm, 5 mm, and 10 mm for seven standardized movements: glenohumeral abduction, adduction, forward flexion, extension, internal rotation with the arm at 90° of abduction, as well as external rotation with the arm at 10° and 90° of abduction. RESULTS: CSA did not seem to influence ROM in any of the models, but greater lateralization achieved greater ROM for all movements in all configurations. Internal and external rotation at 90° of abduction were impossible in most configurations, except in models with a CSA of 25°. CONCLUSION: Postoperative ROM following RSA depends on multiple patient and surgical factors. This study, based on computer simulation, suggests that CSA has no influence on ROM after RSA, while lateralization increases ROM in all configurations. Furthermore, increasing subacromial space is important to grant sufficient rotation at 90° of abduction. In summary, increased lateralization of the COR and increased subacromial space improve ROM in all CSA configurations.Cite this article: A. Lädermann, E. Tay, P. Collin, S. Piotton, C-H Chiu, A. Michelet, C. Charbonnier. Effect of critical shoulder angle, glenoid lateralization, and humeral inclination on range of movement in reverse shoulder arthroplasty. Bone Joint Res 2019;8:378-386. DOI: 10.1302/2046-3758.88.BJR-2018-0293.R1.