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PubMed2005

Post-stroke shoulder subluxation: a concern for neuroscience nurses.

Approximately 84% of all stroke patients with hemiplegia will experience shoulder injury and pain. The importance of maintaining proper posture while positioning and transferring a stroke patient is key to decreasing risk for shoulder injury. Shoulder subluxation injury post-stroke is a consequence of sustained hemiplegia and spasticity. Current research evidence suggests that using therapies such as gentle range of motion and functional electrical stimulation may reduce and prevent shoulder subluxation and hemiplegic shoulder pain. However, physiotherapists are currently the only professionals who can implement such therapies. Considering that stroke care provided by neuroscience nurses includes transferring, positioning and assisting in activities of daily living, it is clear that nurses are an important part of the therapy process. Therefore, the question is: "What is the role of the neuroscience nurse in the reduction and prevention of shoulder pain post-stroke?" The purposes of this paper are to i) discuss the causes of shoulder subluxation and related pain post-stroke, ii) review current best practice in prevention and treatment of shoulder subluxation, and iii) explore ways in which the acute neuroscience nurse can prevent or reduce shoulder subluxation in the hemiplegic stroke patient.

Activities of Daily Living↗
PubMed2006

Difference in isokinetic strength of the muscles around dominant and nondominant shoulders.

BACKGROUND: Muscle training usually plays an important role in the treatment of shoulder disorders. Clinicians traditionally predict the pre-injury strength of an injured shoulder by using the contralateral uninjured side as the baseline data. OBJECTIVE: The primary purpose of the present study was to determine the difference in isokinetic peak torque of dominant and nondominant shoulders. MATERIAL AND METHOD: Both shoulders of 39 healthy subjects (24 men, 15 women) were tested isokinetically by using the CON-TREX MJ dynamometer at two angular velocities (60 and 180 degrees/sec) during abduction, adduction, flexion, extension, internal rotation and external rotation. RESULT: There were statistical differences of contralateral peak torque in almost all directions of shoulder muscle contractions except in shoulder flexion at both speeds. Peak torque of shoulder adduction, extension, and internal rotation were greater in the dominant side. Shoulder abduction and external rotation peak torque were greater in the nondominant side. CONCLUSION: Therefore, clinicians should not directly use the isokinetic strength of the contralateral shoulder as normal baseline data for an injured side without consideration.

Adult↗
PubMed1987

Locked posterior dislocation of the shoulder.

Of forty patients with forty-one locked posterior dislocations of the shoulder, the diagnosis had been missed by the initial physician in the majority. A motor-vehicle accident, a seizure, an alcohol-related injury, or electroshock therapy had caused the dislocation in these patients, and the average interval from injury to diagnosis was one year. Twenty-five of the forty-one dislocations had been diagnosed in less than six months. An axillary radiograph confirmed the diagnosis in all shoulders and demonstrated the approximate size of the impression defect. There were no associated displaced fractures of the humerus, but in twenty of the shoulders there was an undisplaced fracture of the proximal part of the humerus. The average length of follow-up was 5.5 years. For seven shoulders the deformity was accepted. Treatment in the others consisted of closed reduction, which was attempted in twelve shoulders and was successful in six of the twelve; transfer of the subscapularis tendon, which was attempted in nine shoulders and was successful in four; transfer of the lesser tuberosity, which was successful in all four shoulders that were so treated; hemiarthroplasty, which was performed in nine shoulders and was successful in six (the other three required revision); and total arthroplasty in ten shoulders, one of which dislocated postoperatively and was not treated. Once the diagnosis is established, the majority of patients with this lesion can be successfully managed.

Adolescent↗
PubMed1983

Rheumatologic aspects of painful conditions affecting the shoulder.

Patients with shoulder arthritis present to the orthopedic surgeon due to joint pain and loss of shoulder motion. A differential diagnosis is established, based on the history and physical examination and selected laboratory tests and roentgenograms. Synovial fluid analysis is often very helpful in the diagnosis of shoulder arthritis and critical for differential diagnosis of inflammatory, degenerative, and septic arthritis. Shoulder involvement in primary osteoarthritis is uncommon. The shoulder is rarely the initial joint involved in rheumatoid arthritis. Several uncommon conditions, e.g., amyloid arthropathy and reflex sympathetic dystrophy syndrome, may present early and frequently in the form of shoulder pain. The results of treatment are determined by etiology of shoulder joint disease. Patients with shoulder involvement in rheumatoid arthritis generally respond to the basic management for rheumatoid arthritis. Physical therapy to improve the range of motion of the shoulder and anti-inflammatory medications, including intra-articular corticosteroids, are helpful in most cases.

Amyloidosis↗
PubMed1997

Technetium-99m-MDP patterns in patients with painful shoulder lesions.

UNLABELLED: There is no consensus on the optimum mode of imaging in patients with painful shoulder lesions. There is a particular paucity of scintigraphic data. As a result, the strengths and weaknesses of scintigraphy cannot be adequately compared to other imaging techniques used in shoulder imaging. This study evaluated whether specific patterns of scintigraphic abnormality could be detected in patients with painful shoulders seen in rheumatological practice using 99mTc-methylene diphosphonate (MDP). METHODS: Scintigraphic abnormalities were recorded in consecutive patients presenting to a rheumatology clinic with unilateral shoulder pain. Patients were subdivided according to patterns of clinical abnormality consistent with a working diagnosis of a lesion located in the subacromial region, adhesive capsulitis (frozen shoulder) or a lesion likely to be located in the glenohumeral joint. Patterns of radiopharmaceutical distribution in different regions of the shoulder were evaluated in the light of clinical data and the results of shoulder radiographs. RESULTS: Technetium-99m-MDP scans were abnormal in 19 of 24 (79%) patients, and radiographs were abnormal in 8 of 24 (33%) patients. Distinct patterns of 99mTc-MDP image abnormality were identified: an increase in 99mTc-MDP uptake in the coracoid, acromion and medial humeral head on anterior planar images, together with an absence of posterior planar image abnormality, frequently occurred in association with a working diagnosis of a lesion located in the subacromial region. Posterior planar 99mTc-MDP image abnormalities always occurred in patients with clinical features consistent with a diagnosis of adhesive capsulitis. There was an 85% agreement between two observers' scores when 99mTc-MDP distribution in specific shoulder regions was graded. CONCLUSION: Distinct patterns of 99mTc-MDP distribution may be associated with clinically-distinct patterns of abnormality in patients with painful shoulder lesions. Further studies to elucidate a role for 99mTc-MDP scintigraphy in this patient group are warranted.

Humans↗
PubMed1998

Abnormalities of the adult shoulder due to sickle cell osteonecrosis during childhood.

PATIENTS AND METHODS: A retrospective study of 110 adults with sickle cell anemia (SS genotype) was conducted to determine the frequency of complications of sickle cell osteonecrosis of the shoulder in childhood. The glenohumeral joint was evaluated on plain anteroposterior and lateral radiographs of the shoulder. RESULTS: Mean time since osteonecrosis of the shoulder was 24 years. Radiographic abnormalities were seen in 106 of the 220 shoulders (48.2%). Both shoulders were affected in 86% of cases and at least one hip in 96%. Radiographic abnormalities included isolated caput magna, caput plana, a short humeral neck and ascension of the tuberosities. Twelve shoulders exhibited glenoid fossa abnormalities, which consisted in complete or partial hypoplasia. Evidence of glenohumeral osteoarthritis was seen in 11 shoulders. DISCUSSION: The shoulder abnormalities seen in our patients were probably due to growth disturbances in the proximal humerus secondary to osteonecrosis of the humeral head during childhood. They were common but less likely to produce functional impairment than osteonecrosis-related lesions of the hip. However, some patients had premature osteoarthritis and geometric shoulder abnormalities responsible for functional loss in adulthood.

Adolescent↗
PubMed1998

Predictors of chronic shoulder pain: a population based prospective study.

OBJECTIVE: To determine the natural history of shoulder pain in the population, and predictors of outcome on the basis of clinical and individual factors. In addition, to determine whether outcome is influenced by the definition of shoulder pain used. METHODS: A prospective cohort study, over a 3 year period, of subjects recruited from a cross sectional population screening study of shoulder pain, conducted in the Greater Manchester area of the UK. RESULTS: Of 92 subjects classified as having shoulder pain in the cross sectional study, 50 (54%) reported shoulder pain at followup about 3 years later. In 90% of cases this was accompanied by some disability specifically relating to the symptoms. Baseline factors that predicted symptoms at followup were: pain (indicated on a manikin) within a more narrowly defined shoulder region, shoulder pain related disability, pain on the day of examination, symptoms lasting more than one year, and a high score on the General Health Questionnaire, a measure of psychological distress. CONCLUSION: Shoulder pain in the population is a longterm disabling symptom, although many subjects do not seek early medical consultation. Disability (independent of whether there was restriction of movement on examination) is a strong predictor of continuing symptoms. The outcome observed in epidemiological studies of shoulder pain will be influenced by the initial definition of symptoms.

Adolescent↗
PubMed2003

Accuracy of ultrasound imaging of the rotator cuff in shoulders that are painful postoperatively.

BACKGROUND: Evaluation of the rotator cuff in a shoulder that has been persistently painful postoperatively could be challenging. Magnetic resonance imaging has been the preferred imaging method, but accuracy rates have been lower for those shoulders than for shoulders that have not been operated on; also, magnetic resonance imaging is susceptible to suture anchor artifact. The purpose of this study was to evaluate the diagnostic accuracy of ultrasound for evaluating the rotator cuff in shoulders that are painful postoperatively. METHODS: The records of forty-four consecutive patients who had undergone both a high-resolution ultrasound examination and subsequent shoulder arthroscopy were retrospectively reviewed. Thirty-four patients underwent rotator cuff repair at the time of the arthroscopy, and ten had subacromial decompression or another procedure without cuff repair. The results of the ultrasound examination were compared with the intraoperative findings of the arthroscopic examination (the "gold standard"). RESULTS: Ultrasound led to a correct diagnosis for forty of the forty-four patients. Twenty-two recurrent rotator cuff tears and twenty-two intact rotator cuffs were found at surgery. Ultrasound correctly identified twenty of the twenty-two rotator cuff tears (true-positive results) and twenty of the twenty-two intact rotator cuffs (true-negative results). Two intact cuffs were identified as having a full-thickness tear (false-positive results), and two cuffs with a full-thickness rotator cuff tear were identified as being intact (false-negative results). The sensitivity and specificity of ultrasound for identifying rotator cuff integrity postoperatively were 91% and 86%, respectively. The accuracy was 89%. CONCLUSIONS: Ultrasound is a highly accurate imaging study for evaluating the integrity of the rotator cuff in shoulders that have undergone an operation. Its accuracy for operatively treated shoulders appears to be comparable with that previously reported for shoulders that had not been operated on.

Adult↗
PubMed2004

[Shoulder arthroplasty in traumatological indications, surgical technique].

PURPOSE OF THE STUDY: Shoulder arthroplasty in traumatological indications has a considerably worse prognosis than when the indication is osteoarthritis or rheumatoid arthritis. The problem lies in the technique of rotator cuff reconstruction and the restoration of adequate bio-mechanical properties of the shoulder joint. In this study, the difficult reconstruction of four-part fractures of the proximal end of the humerus was improved by the development of a new type of shoulder joint endoprosthesis. MATERIAL AND METHODS: Our endoprosthesis permits fixation of bone fragments of the greater and lesser tubercles to the shaft and to the diaphyseal fragment by using screws or a toothed plate designed for this purpose and produced in various shapes. In addition to the modularity of the head, the endoprosthesis has a component facilitating better recovery of biomechanical properties of the proximal end of the humerus, and this is a variable neck of the prosthesis. The modularity of the neck makes it possible to adjust the colodiaphysal angle and to adjust the head in relation to the stem in eight different positions. The shoulder replacement described, produced in two modifications by ProSpon (Czech Republic) and MIL (France), was used in surgical treatment of 43 acute fractures and 33 cases of post-traumatic destruction. The clinical outcome was assessed using the Constant rating score. RESULTS: In patients with acute trauma of a shoulder, an average of 59 points (range, 23-82) was achieved. The average maximal elevation was 88 degrees, with a range of 40 to 140 degrees. In 25% of the patients, no postoperative pain was present; mild pain at strain was reported by 73% of the patients and pain limiting the arm's activity by 3%. In patients with post-traumatic destruction of a shoulder, the average value vas 53.5 points (range, 20-88) and the average maximal elevation was 85 degrees (range, 30-130). No postoperative pain was reported by 36%, mild pain at strain was recorded in 52% and activity-limiting pain in 12% of the patients. DISCUSSION: The currently reported views are in agreement with our opinion that, at present, every method of shoulder replacement should enable the surgeon to achieve, as easy and reliably as possible, the reconstruction of fragments with the attachments of the rotator cuff. With our system, shoulder arthroplasty for the reconstruction of the proximal humerus, using the supplementary fixation components described, allowed us to treat even the most serious cases of traumatic destruction of the proximal humerus. CONCLUSIONS: To facilitate the treatment of trauma in displaced, three- or four-part fractures of the proximal end of the humerus, a new technique of reconstruction with the use of an endoprosthesis designed by us was developed. Fixation and reconstruction of fragments of the greater and lesser tubercles are carried out with screws and a special toothed plate that provides good fixation of the fragments to the stem. Compared with the current method of fragment fixation with simple suture, this technique offers an easy way of restoring the biomechanical properties in the region of the proximal end of the humerus and improves the stability of osteosynthesis. This aids in early mobilization and functional therapy of the patient, which results in a better overall outcome of the treatment.

Arthroplasty, Replacement↗
PubMed2001

Shoulder belts in motor vehicle crashes: a statewide analysis of restraint efficacy.

The purpose of our study was to evaluate the impact of shoulder belt use on motor vehicle crash ejection, morbidity and mortality. We analyzed motor vehicle crash records linked to hospital inpatient data for front seat occupants of passenger cars in Utah between 1994 and 1996 (n = 103,035). Stochastic simulations were used to adjust for possible seatbelt misclassification. There were 276 (0.3%) occupants coded as using only a shoulder belt. The adjusted odds of ejection for shoulder only belted occupants was higher compared to lap-shoulder belted (odds ratio (OR) = 18.9; 95% confidence interval (CI) = 15.1, 25.1) and lap only belted occupants (OR = 4.3; 95% Cl = 2.9, 7.7). There was no difference in the odds of ejection for an occupant using a shoulder belt only and an occupant using no seatbelt (OR = 1.1; 95% CI = 1.0, 1.3). Occupants using a shoulder belt only were more likely to sustain a fatal or hospitalizing injury than lap-shoulder belted (OR = 2.3; 95% Cl = 1.9, 3.0), and lap only belted occupants (OR = 1.8; 95% CI = 1.3, 2.7), while controlling for other covariates. Occupants using only a shoulder belt had the same odds of a fatal or hospitalizing injury as unbelted occupants (OR = 1.1; 95% Cl = 0.9, 1.4). Average hospital inpatient length of stay, charges and injury severity scores were similar for all restraint types. These results stress the need for the use of a lap belt in conjunction with the shoulder belt.

Accidents, Traffic↗
PubMed1996

Surface roughness of tooth shoulder preparations created by rotary instrumentation, hand planing, and ultrasonic oscillation.

A dentinal shoulder with a smooth surface is necessary to ensure accurate adaptation of a porcelain crown. The surface roughness of dentinal shoulders prepared with different instruments was investigated in this in vitro study. Sixty shoulders, 1 mm wide, were prepared with coarse grit diamonds in extracted formalin-stored teeth. Of these 60 shoulders 20 were further refined with fine grit, and 20 more shoulders were refined with super-fine grit diamonds. The surface roughness (Ra) of the dentinal shoulders was recorded after each procedure. Thirty surfaces were further finished and refined with a hand chisel, and the other 30 surfaces were finished with a flat-ended diamond tip held in an ultrasonic generating device; the Ra was then recorded. These shoulder preparations were examined under a scanning electron microscope. The Ra of the dentinal shoulders prepared by the ends of the different grit diamonds was not significantly different (p > 0.05). Hand planing did not improve the Ra, and ultrasonic planing significantly increased the Ra (p < 0.05). Scanning electron micrographs revealed no apparent qualitative differences between surface roughness of the shoulders prepared by the diamonds or by the hand-planed surface. However, deeper scratches were evident at ultrasonically planed surfaces.

Crowns↗
PubMed1997

Chinrest pressure in violin playing: type of music, chin rest, and shoulder pad as possible mediators.

INTRODUCTION:: This study was conducted to determine if there are differences in pressure on a violin chin rest during performance due to changes in shoulder pads, chin rests, or pieces of music performed. It was also hypothesized that these differences would correlate with anthropometric measurements made of the subjects' necks and shoulders. METHODS::: A Novel EMED pad was used over the chin rest, containing 120 sensors, each one centimetre squared. The sampling rate was 50 Hz. A total of ten subjects, all professional violinists, performed excerpts from a Bruch violin concerto and a Handel sonata. Anthropometric measurements were made of the subjects' necks and shoulders. Each subject began by using his own violin with his usual shoulder pad and chin rest set-up, and then with the author's violin. Two different shoulder pads and three different chin rests were placed on the violin, in all possible combinations, for both pieces of music. This resulted in a total of fourteen conditions given in randomized order for each subject. Subjects were asked to give verbal feedback regarding the comfort and ease of playing of each shoulder pad and chin rest. Data was collected for three trials of each condition, and a mean for the three trials was obtained for each dependent variable. The five dependent variables were: peak pressure, maximum force, pressure/time integral and force/time integral, and total contact area. Intraclass coefficients of reliability were calculated for the dependent variables. Pearson's correlation coefficients were computed to determine if there were significant relationships between the five dependent variables and violin height, shoulder width, and neck length. RESULTS:: Pressure/time integral achieved the highest reliability with a coefficient of 0.9310, followed by peak pressure at 0.9152, force/time integral at 0.8817, maximum force at 0.8685, and total area at 0.8571. Multivariate analysis of variance detected significant differences in levels of pressure and force for the different conditions. Subsequent one-way ANOVAS andt -tests determined significantly less pressure on the Wolf chinrest as compared to the other chinrests. There were also reliable differences in pressure between the two pieces of music, with the Handel sonata excerpt showing significantly less pressure. There were no differences detected between the two shoulder pads. Significant relationships between neck length and shoulder width, and peak pressure, pressure/time integral, maximum force, force/time integral, and total contact area were found. A discussion of these results, and conclusions and implications for further study, are currently in progress.

Journal Article↗
PubMed1987

[External over-rotation of the head in the treatment of high longitudinal shoulder position].

The shoulder dystocias are an anomaly of shoulder presentation which render difficult or prevent complete extraction of the trunk following birth of the head. Acute hypoxia ensues, threatening the infant's life. Additionally, termination of delivery, which must be effected without delay and is surgically difficult, is frequently associated with often permanent damage to the upper limbs. Macrosomatia of the child and a vaginal-surgical delivery initiated before the preceding part has reached the pelvic floor increase the probability of high longitudinal shoulder position occurring. Early and forced application of Kristeller's method also encourages manifestation of the condition and simultaneous wedging of the shoulders in the pelvic inlet. Taking into account the inadequate shoulder rotation above the pelvic inlet, "external over-rotation of the head" is recommended as a treatment for high longitudinal shoulder position. The technique is described in detail. As soon as the condition appears likely to occur, the head is grasped in the hands (applied flat) and turned, in first position with the back of the head toward the right, in second position with the back of the head toward the left. This must be done early, i.e., if possible before the shoulders are finally locked in the pelvic inlet. Further expression of the trunk must not be assisted by Kristeller's method until high transverse position of the shoulders has been achieved. Clinicosurgical experience gathered so far and the early morbidity of the 24 children in whom high longitudinal shoulder position was overcome in this way justify the recommendation of "external over-rotation of the head" as an effective primary treatment method.

Birth Injuries↗
PubMed1999

Reduced fatalities related to rear seat shoulder belts.

OBJECTIVE: To determine the effect on fatality rates in crashes of installation of shoulder belts in automobile back seats. METHODS: During 1988-96, fatalities to rear outboard seat occupants of passenger cars, classified by age of occupant and vehicle curb weight were matched to data on model year in which shoulder belts became standard equipment. The same data were obtained from the same years on back seat occupants in crashes from the Crashworthiness Data System. Weighted regression was performed on death rates per occupants in crashes by belt equipment, occupant age, and vehicle weight for all occupants and occupants who claimed to be restrained. RESULTS: The risk of death is significantly lower in vehicles equipped with shoulder belts, midsized to larger cars, and among children. Claimed child restraint use is higher in cars with shoulder belts and claimed use of shoulder belts is higher among adolescents and young adults but lower among those 35 and older. However, older occupants have lower death rates in shoulder belt equipped cars. CONCLUSIONS: Shoulder belts substantially reduce risk of death relative to lap belts at prevalent use rates in each age group. Belt effectiveness when used cannot be estimated precisely because of invalid claimed use, but the lowered rates among vehicles with shoulder belts indicates that effectiveness given prevalent use is far more efficacious than lap belts without shoulder belts.

Accidents, Traffic↗
PubMed2002

Shoulder dystocia and brachial plexus injury: a population-based study.

The objective of this work was to identify and evaluate risk factors for shoulder dystocia and for brachial plexus injury in a population-based study. In all, 1,397 parturients with shoulder dystocia occurring in Sweden between 1987 and 1996 were identified among 1,076,545 deliveries using information stored in the Medical Birth Registry (MBR) of the National Board of Health and Welfare, Stockholm. Information is missing for about 1.0% of singleton deliveries in the MBR. Validation of the diagnosis 'shoulder dystocia' in the MBR was performed using data of 4 of 63 delivery units and was confirmed in 96.5% of the original medical records. A total of 368 infants had brachial plexus injury (26.3%). However, a considerable variation in the rate of recorded shoulder dystocia was evident when comparing the 63 delivery units throughout Sweden. Overall, the incidence was 1.3 per 1,000 deliveries. A close association was found between birth weight and shoulder dystocia, with an odds ratio (OR) over 30 for a birth weight > or = 5,000 g. In the presence of maternal diabetes mellitus or gestational diabetes, the OR for shoulder dystocia was significantly increased in newborns weighing > or = 4,000 g. The overall perinatal mortality because of shoulder dystocia was 1.2%. This was increased to 6.4% if the mother had diabetes mellitus. About 25% of all infants suffered a brachial plexus injury. This potentially serious injury even occurred in connection with birth by cesarean section, and an OR for plexus injury over unity was seen in 7 of 9 weight groups; a significantly increased OR was seen for birth weights > or = 4,500 g. The birth weight is a strong risk factor for shoulder dystocia, as is diabetes mellitus. A considerable variation in the rate of shoulder dystocia was observed among the different delivery units, probably reflecting difficulties in definition. Brachial plexus injury is observed even after cesarean section, especially if the birth weight is > or = 4,500 g.

Birth Injuries↗
PubMed2004

The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty.

BACKGROUND: As far as we know, no previous study has determined the relationship between volume and outcomes for shoulder arthroplasty. We hypothesized that surgeons and hospitals with higher caseloads of total shoulder arthroplasties and hemiarthroplasties have better outcomes as measured by decreased mortality rate, shorter length of stay in the hospital, reduced postoperative complications, and routine disposition of patients on discharge. METHODS: Data on patients undergoing shoulder arthroplasty were extracted from the Nationwide Inpatient Sample databases for the years 1988 through 2000. Logistic regression with generalized estimating equations and multiple linear regression models were used to estimate the adjusted association between surgeon and hospital volume and outcomes for total shoulder arthroplasty and hemiarthroplasty after adjusting for comorbidity, age, race, household income, and sex. RESULTS: The mortality rates for patients who had a total shoulder arthroplasty performed by surgeons who did fewer than two procedures per year (0.36%) or who did between two and fewer than four procedures per year (0.32%) were higher than those for patients who had a total shoulder arthroplasty performed by surgeons who did four procedures or more per year (0.20%). The risk-adjusted rate of postoperative complications after hemiarthroplasty was significantly higher for patients managed by surgeons who performed fewer than two procedures per year (1.68%) than for those managed by surgeons with a volume of five procedures or more per year (0.97%). The possibility of postoperative complications when total shoulder arthroplasty was performed in hospitals with a volume of fewer than five procedures (1.44%) or in those with a volume of five to ten procedures per year (1.45%) was significantly higher than that in hospitals where ten procedures or more were performed every year (0.64%). The mean lengths of stay in the hospital after total shoulder arthroplasty and hemiarthroplasty were significantly longer when the operations were performed by surgeons who did fewer than two procedures per year or when they were done in hospitals with a volume of fewer than five procedures per year or with a volume of five to fewer than ten procedures per year than when they were done in hospitals or by surgeons in the highest volume category (p < 0.001). CONCLUSIONS: Patients who have a total shoulder arthroplasty or hemiarthroplasty performed by a high-volume surgeon or in a high-volume hospital are more likely to have a better outcome. LEVEL OF EVIDENCE: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Aged↗
PubMed2005

The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.

BACKGROUND: Patients who have pain and dysfunction from glenohumeral arthritis associated with severe rotator cuff deficiency have few treatment options. The goal of this study was to retrospectively evaluate the short-term results of arthroplasty with use of the Reverse Shoulder Prosthesis in the management of this problem. METHODS: We report the results for sixty patients (sixty shoulders) with a rotator cuff deficiency and glenohumeral arthritis who were followed for a minimum of two years. Thirty-five patients had no previous shoulder surgery, whereas twenty-three had had either an open or arthroscopic rotator cuff repair, one had had a subacromial decompression, and one had had a biceps tendon repair. All patients were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons scoring system for pain and function and with visual analog scales for pain and function. They were also asked to rate their satisfaction with the outcome. The shoulder range of motion was measured preoperatively and postoperatively. RESULTS: The average age of the patients was seventy-one years. The average duration of follow-up was thirty-three months. All measures improved significantly (p < 0.0001). The mean total score on the American Shoulder and Elbow Surgeons system improved from 34.3 to 68.2; the mean function score, from 16.1 to 29.4; and the mean pain score, from 18.2 to 38.7. The score for function on the visual analog scale improved from 2.7 to 6.0, and the score for pain on the visual analog scale improved from 6.3 to 2.2. Forward flexion increased from 55.0 degrees to 105.1 degrees, and abduction increased from 41.4 degrees to 101.8 degrees. Forty-one of the sixty patients rated the outcome as good or excellent; sixteen were satisfied, and three were dissatisfied. There were a total of thirteen complications in ten patients (17%). Seven patients (12%) had eight failures, requiring revision surgery to another Reverse Shoulder Prosthesis in five patients (one shoulder had two revisions) and revision to a hemiarthroplasty in two patients because of deep infection. CONCLUSIONS: The data from this study suggest that arthroplasty with the Reverse Shoulder Prosthesis may be a viable treatment for patients with glenohumeral arthritis and a massive rotator cuff tear. However, future studies will be necessary to determine the longevity of the implant and whether it will provide continued improvement in function.

Adult↗
PubMed2006

The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. a minimum two-year follow-up study of sixty patients surgical technique.

BACKGROUND: Patients who have pain and dysfunction from glenohumeral arthritis associated with severe rotator cuff deficiency have few treatment options. The goal of this study was to retrospectively evaluate the short-term results of arthroplasty with use of the Reverse Shoulder Prosthesis in the management of this problem. METHODS: We report the results for sixty patients (sixty shoulders) with a rotator cuff deficiency and glenohumeral arthritis who were followed for a minimum of two years. Thirty-five patients had no previous shoulder surgery, whereas twenty-three had had either an open or arthroscopic rotator cuff repair, one had had a subacromial decompression, and one had had a biceps tendon repair. All patients were assessed preoperatively and postoperatively with the American Shoulder and Elbow Surgeons scoring system for pain and function and with visual analog scales for pain and function. They were also asked to rate their satisfaction with the outcome. The shoulder range of motion was measured preoperatively and postoperatively. RESULTS: The average age of the patients was seventy-one years. The average duration of follow-up was thirty-three months. All measures improved significantly (p < 0.0001). The mean total score on the American Shoulder and Elbow Surgeons system improved from 34.3 to 68.2; the mean function score, from 16.1 to 29.4; and the mean pain score, from 18.2 to 38.7. The score for function on the visual analog scale improved from 2.7 to 6.0, and the score for pain on the visual analog scale improved from 6.3 to 2.2. Forward flexion increased from 55.0 degrees to 105.1 degrees , and abduction increased from 41.4 degrees to 101.8 degrees . Forty-one of the sixty patients rated the outcome as good or excellent; sixteen were satisfied, and three were dissatisfied. There were a total of thirteen complications in ten patients (17%). Seven patients (12%) had eight failures, requiring revision surgery to another Reverse Shoulder Prosthesis in five patients (one shoulder had two revisions) and revision to a hemiarthroplasty in two patients because of deep infection. CONCLUSIONS: The data from this study suggest that arthroplasty with the Reverse Shoulder Prosthesis may be a viable treatment for patients with glenohumeral arthritis and a massive rotator cuff tear. However, future studies will be necessary to determine the longevity of the implant and whether it will provide continued improvement in function.

Adult↗