Shoulder function in patients with deltoid paralysis and intact rotator cuff.

INTRODUCTION/HYPOTHESIS: The purpose of this study is to determine the mid/long term shoulder function in patients with complete deltoid paralysis and intact rotator cuff. 27 patients with at least 2-years FU were included. MATERIALS AND METHODS: Outcome measures included pain, range of motion (including the swallowtail test STT), deltoid extension lag test DELT and Bertelli test), subjective fatigability using the injured shoulder and postoperative modified Neer ratings. RESULTS: At an average 68 months FU, mean shoulder abduction was 131°, flexion 153°, external rotation with the arm at the side 58° and 58° with the arm abducted. All patients reported quick fatiguability with repetitive use of the injured arm which did not change over time. Average pain score was 2. Eighteen patients had positive STT and DELT tests and all patients had positive Bertelli test. DISCUSSION: This study demonstrates that patients with deltoid paralysis and intact rotator cuff do maintain most of their shoulder function and this is sustained over time. LEVEL OF EVIDENCE: Level IV; prognostic Study: case series.

Long-term outcomes of cemented versus cementless humeral components in arthroplasty of the shoulder: a propensity score-matched analysis.

AIMS: In the initial development of total shoulder arthroplasty (TSA), the humeral component was usually fixed with cement. Cementless components were subsequently introduced. The aim of this study was to compare the long-term outcome of cemented and cementless humeral components in arthroplasty of the shoulder. PATIENTS AND METHODS: All patients who underwent primary arthroplasty of the shoulder at our institution between 1970 and 2012 were included in the study. There were 4636 patients with 1167 cemented humeral components and 3469 cementless components. Patients with the two types of fixation were matched for nine different covariates using a propensity score analysis. A total of 551 well-balanced pairs of patients with cemented and cementless components were available after matching for comparison of the outcomes. The clinical outcomes which were analysed included loosening of the humeral component determined at revision surgery, periprosthetic fractures, post-operative infection and operating time. RESULTS: The overall five-, ten-, 15- and 20-year rates of survival were 98.9%, 97.2%, 95.5%, and 94.4%, respectively. Survival without loosening at 20 years was 98% for cemented components and 92.4% for cementless components. After propensity score matching including fixation as determined by the design of the component, humeral loosening was also found to be significantly higher in the cementless group. Survival without humeral loosening at 20 years was 98.7% for cemented components and 91.0% for cementless components. There was no significant difference in the risk of intra- or post-operative fracture. The rate of survival without deep infection and the mean operating time were significantly higher in the cemented group. CONCLUSION: Both types of fixation give rates of long-term survival of > 90%. Cemented components have better rates of survival without loosening but this should be weighed against increased operating time and the risk of bony destruction of the proximal humerus at the time of revision of a cemented humeral component. Cite this article: Bone Joint J 2017;99-B:666-73.

Modified percutaneous trigger finger release.

Stenosing tenosynovitis or trigger finger is one of the most common disorders that affect the flexor tendon apparatus of the hand. Percutaneous release has been previously reported to be easier, quicker, less invasive and less costly than open surgery. The purpose of this study was to report the outcome of an alternative percutaneous trigger finger release technique. From March 2008 to January 2014, 92 patients (128 fingers) who underwent the alternative percutaneous trigger finger release, with a minimum of 6 months follow-up were included. Outcomes included size of skin incision, pain, residual symptoms, satisfaction and complications. Percutaneous release was achieved in all fingers, except 1 for which an opening of the skin was necessary to complete the release of the pulley. Eight fingers (6%) required revision open surgery because of persistence of their symptoms. At 1 week after the procedure, no finger swelling was reported, however 4 fingers (3%) were painful and 45 (35%) were stiff and required physiotherapy. Percutaneous release was successful in 120 fingers (94%). At the final follow-up, all the patients were satisfied by the procedure (95 rated their result as much better and 32 as better). This study shows that our alternative percutaneous trigger finger release is a reliable and safe procedure with high patient satisfaction. LEVEL OF EVIDENCE: Level IV, clinical study, therapeutic study.

Ultrasonography for the evaluation of forearm interosseous membrane disruption in a cadaver model.

Recognition of interosseous membrane disruption associated with radial head injury and Essex-Lopresti injury is important, especially if radial head excision is contemplated. Because a widely accepted method to diagnose interosseous membrane disruption does not exist, we evaluated the accuracy of ultrasonography to diagnose this injury in a cadaver model. Nine pairs of cadaver forearms were randomized into 2 groups. The central third of the interosseous membrane of forearms of group 1 was cut, whereas it was visualized but not cut in group 2. A dynamic ultrasound examination was performed to determine interosseous membrane integrity, and static images were made. The static images were evaluated by 2 other radiologists and interpretations were recorded. One radiologist incorrectly interpreted 1 pair of forearms; the other 2 radiologists were 100% accurate. The accuracy of ultrasonography in detecting interosseous injuries was 96% with our methods.