Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates.

PURPOSE: The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure. METHODS: Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist. RESULTS: In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures. CONCLUSION: While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder. LEVEL OF EVIDENCE: Level IV, systematic review of level II to IV studies.

A population-based comparison of joint survival of hemiarthroplasty versus total shoulder arthroplasty in osteoarthritis and rheumatoid arthritis.

AIMS: Few studies have compared survivorship of total shoulder arthroplasty (TSA) with hemiarthroplasty (HA). This observational study compared survivorship of TSA with HA while controlling for important covariables and accounting for death as a competing risk. PATIENTS AND METHODS: All patients who underwent shoulder arthroplasty in Ontario, Canada between April 2002 and March 2012 were identified using population-based health administrative data. We used the Fine-Gray sub-distribution hazard model to measure the association of arthroplasty type with time to revision surgery (accounting for death as a competing risk) controlling for age, gender, Charlson Comorbidity Index, income quintile, diagnosis, and surgeon factors. RESULTS: During the study period, 5777 patients underwent shoulder arthroplasty (4079 TSA, 70.6%; 1698 HA, 29.4%), 321 (5.6%) underwent revision, and 1090 (18.9%) died. TSA patients were older (TSA mean age 68.4 years (sd 10.2) vs HA mean age 66.5 years (sd 12.7); p = 0.001). The proportion of female patients was slightly lower in the TSA group (58.0% vs 58.4%). The adjusted association between surgery type and time to shoulder revision interacted significantly with patient age. Compared with TSA patients, revision was more common in the HA group (adjusted-health ratio (HR) 1.214, 95% confidence interval (CI) 0.96 to 1.53) but this did not reach statistical significance. CONCLUSION: Although there was a trend towards higher revision risk in patients undergoing HA, we found no statistically significant difference in survivorship between patients undergoing TSA or HA. Cite this article: Bone Joint J 2019;101-B:454-460.

Anatomic Shoulder Arthroplasty: Technical Considerations.

Osteoarthritis of the shoulder is a common condition in the aging population, and it can have profound effects on patients' quality of life. The anatomic total shoulder arthroplasty is a well-described treatment modality resulting generally excellent outcomes. The objective of this review is to discuss the technical aspects of primary anatomic total shoulder arthroplasty, and to provide a framework to follow to achieve a successful surgical result. The topics covered include preoperative planning, surgical considerations, and approaches, humeral preparation, glenoid bone loss and the emerging concept of using the reverse total shoulder arthroplasty for the type B2 glenoid.

Perianal fetal rhabdomyoma: case report.

A 4-week-old female was referred with a firm, enlarging perianal mass present since birth. At surgery, the lesion appeared to be arising from the subcutaneous external sphincter. Local excision was successful with preservation of the external sphincter. Histologic examination showed a mixture of undifferentiated spindle cells as well as immature and maturing myofibers consistent with a fetal rhabdomyoma. This report represents the second case of a fetal rhabdomyoma arising in the perianal location. All pediatric cases of fetal rhabdomyoma in the literature are reviewed.

Children in crashes: mechanisms of injury and restraint systems.

OBJECTIVES: To explore the levels of protection offered to children involved in motor vehicle collisions. DESIGN: A joint study by the Children's Hospital of Eastern Ontario (CHEO) and Transport Canada, Ottawa, conducted in 2 phases: retrospective from 1990 to 1997 and prospective from 1998 to 2000. SETTING: CHEO, a university affiliated tertiary care centre. PATIENTS: Children admitted to CHEO between 1990 and 2000 with spinal trauma due to motor vehical crashes (MVCs). Phase I of the study involved analysis, in a series of 45 children after MVAs, by location of spinal injury versus belt type. Phase 2 was a prospective study of 22 children injured in 15 MVAs. INTERVENTIONS: A biomechanical assessment of the vehicle and its influence on the injuries sustained. MAIN OUTCOME MEASURES: The nature and extent of the injuries sustained, and the vehicle dynamics and associated occupant kinematics. RESULTS: The odds ratio of sustaining a spinal injury while wearing a 2-point belt versus a 3-point belt was 24 (95% confidence interval 2.0-2.45, p < 0.1), indicating a much higher incidence with a lap belt than a shoulder strap. CONCLUSIONS: Proper seat-belt restraint reduces the morbidity in children involved in MVCs. Children under the age of 12 years should not be front-seat passengers until the sensitivity of air bags has been improved. Three-point pediatric seat belts should be available for family automobiles to reduce childhood trauma in MVCs.