Ninety-day complication rate based on 532 Latarjet procedures in Dutch hospitals with different operation volumes.

BACKGROUND: In this study, we aimed to provide insight into the 90-day complication rates following the Latarjet procedure. Data from 2015 were collected from multiple hospitals in the Netherlands, with different volumes of Latarjet procedures. Our second aim was to examine which patient and surgical factors were associated with complications. METHODS: We conducted a retrospective chart review of 13 hospitals between 2015 and 2022. Data regarding complications within 90 days of Latarjet procedures were extracted. The effect of sex, age, body mass index (BMI), smoking, previous shoulder operations, fixation material, hospital volume, screw size, and operation time on the complication rate was assessed by multivariable logistic regression analysis. RESULTS: Of the 532 included patients, 58 (10.9%) had complications. The most common complications were material failure (n = 19, 3.6%) and nerve injury (n = 13, 2.4%). The risk of complications was lower for male patients than for female patients (odds ratio, 0.40; 95% confidence interval, 0.21-0.77; P = .006). Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time were not associated with complications. CONCLUSION: The 90-day complication rate after the Latarjet procedure was 10.9% and was higher in female patients than in male patients. Age, BMI, smoking, previous shoulder operations, type of fixation material, hospital volume, screw size, and operation time did not affect complication rates. We advise setting up a national registry to prevent under-reporting of complications.

Shoulder kinematics and muscle activity following latissimus dorsi transfer for massive irreparable posterosuperior rotator cuff tears in shoulders with pseudoparalysis.

BACKGROUND: The aim of this study was to evaluate the thoracohumeral (TH) and glenohumeral (GH) motion with muscle activity after latissimus dorsi transfer (LDT) in a shoulder with a massive irreparable posterosuperior rotator cuff tear (MIRT) and pseudoparalysis compared with the asymptomatic contralateral shoulder (ACS). METHODS: We recruited and evaluated 13 patients after LDT in a shoulder with preoperative clinical pseudoparalysis and an MIRT on magnetic resonance imaging, with a minimum follow-up period of 1 year, and with a Hamada stage of 3 or less. Three-dimensional electromagnetic tracking was used to assess shoulder active range of motion in both the LDT shoulder and the ACS. The maximal active elevation of the shoulder (MAES) was assessed and consisted of forward flexion, scapular abduction, and abduction in the coronal plane. Maximal active internal rotation and external rotation were assessed separately. Surface electromyography (EMG) was performed to track activation of the latissimus dorsi (LD) and deltoid muscles during shoulder motion. EMG was scaled to its maximal isometric voluntary contraction recorded in specified strength tests. RESULTS: In MAES, TH motion of the LDT shoulder was not significantly different from that of the ACS (F1,12 = 1.174, P = .300) but the GH contribution was significantly lower in the LDT shoulder for all motions (F1,12 = 11.230, P = .006). External rotation was significantly greater in the ACS (26° ± 10° in LDT shoulder vs. 42° ± 11° in ACS, P < .001). The LD percentage EMG maximum showed no significant difference between the LDT shoulder and ACS during MAES (F1,11 = 0.005, P = .946). During maximal active external rotation of the shoulder, the LDT shoulder showed a higher percentage EMG maximum than the ACS (3.0% ± 2.9% for LDT shoulder vs. 1.2% ± 2.0% for ACS, P = .006). CONCLUSIONS: TH motion improved after LDT in an MIRT with pseudoparalysis and was not different from the ACS except for external rotation. However, GH motion was significantly lower after LDT than in the ACS in active-elevation range of motion. The LD was active after LDT but not more than in the ACS except for active external rotation, which we did not consider relevant as the activity did not rise above 3% EMG maximum. The favorable clinical results of LDT do not seem to be related to a change in LD activation and might be explained by its effect in preventing proximal migration of the humeral head in active elevation.

Dynamic contact area ratio in shoulder instability: an innovative diagnostic technique measuring interplay of bony lesions.

PURPOSE: The hypothesis of this study is that Dynamic Contact Area Ratio of the humerus and glenoid, measured with CT scans, is significantly reduced in patients with anterior shoulder instability compared to the Dynamic Contact Area Ratio in a control group of people without shoulder instability. METHODS: Preoperative CT scans of patients who underwent surgery for anterior shoulder instability were collected. Additionally, the radiologic database was searched for control subjects. Using a validated software tool (Articulis) the CT scans were converted into 3-dimensional models and the amount the joint contact surface during simulated motion was calculated. RESULTS: CT scans of 18 patients and 21 controls were available. The mean Dynamic Contact Area Ratio of patients was 25.2 ± 6.7 compared to 30.1 ± 5.1 in healthy subjects (p = 0.014). CONCLUSION: Dynamic Contact Area Ratio was significantly lower in patients with anterior shoulder instability compared to controls, confirming the hypothesis of the study. The findings of this study indicate that calculating the Dynamic Contact Area Ratio based on CT scan images may help surgeons in diagnosing anterior shoulder instability. LEVEL OF EVIDENCE: III.

A retrospective cohort analysis of arthroscopic Bankart repair with or without remplissage in patients with off-track Hill-Sachs lesion evaluated for functional outcomes, recurrent instability, and range of motion.

BACKGROUND: Lone Bankart repair is associated with high rates of recurrence, especially in off-track Hill-Sachs (HS) lesion. The objective of the study was to assess the impact of remplissage in off-track HS lesion influencing the rate of redislocation and range of motion (ROM) of the shoulder. MATERIAL AND METHOD: We retrospectively reviewed 136 patients for arthroscopic Bankart repair without remplissage (group 1, n = 77) or with remplissage (group 2, n =59) for recurrent anterior dislocation of the shoulder with glenoid bone loss of <25%. Further subgroups of on- and off-track HS lesion were based on computed tomographic assessment. At a minimum follow-up of 2 years; patients were evaluated for functional scores (Rowe, Constant-Murley, Western Ontario Shoulder Instability Index), redislocations, and ROM. RESULTS: At a mean follow-up of 54 and 44 months in group 1 and 2, respectively, there was no difference in postoperative functional scores. There were significantly more dislocations in patients with Bankart repair with off-track lesion than in patients with Bankart repair with on-track lesion (P = .02). There were significantly fewer redislocations in patients with off-track lesion who underwent Bankart repair and remplissage than in those who did not undergo remplissage (P = .0007). Compared with group 1 patients, those in group 2 revealed a statistically significant loss of ROM. CONCLUSIONS: Although a nonremplissaged off-track HS lesion remains an important risk factor for recurrent instability, remplissage also results in significant loss of shoulder ROM compared with those who do not undergo remplissage.

Ten percent re-dislocation rate 13 years after the arthroscopic Bankart procedure.

PURPOSE: The aim of the present study was to determine the long-term outcome after the arthroscopic Bankart procedure, in terms of recurrent instability, shoulder function, glenohumeral arthropathy and patient satisfaction. METHODS: Patients who underwent the arthroscopic Bankart procedure between January 1999 and the end of December 2005 were invited to complete a set of Patient Reported Outcome Measures (PROMs) and visit the hospital for clinical and radiological assessment. PROMs included the Western Ontario Shoulder Instability Index (WOSI), the Oxford Shoulder Instability Score (OSIS) and additional questions on shoulder instability and patient satisfaction. Clinical assessment included the apprehension test and the Constant-Murley score. The Samilson-Prieto classification was used to assess arthropathy on standard radiographs. The primary outcome was a re-dislocation that needed reduction. Secondary outcomes in terms of recurrent instability included patient-reported subluxation and a positive apprehension test. RESULTS: Of 104 consecutive patients, 71 patients with a mean follow-up of 13.1 years completed the PROMs, of which 53 patients (55 shoulders) were also available for clinical and radiological assessment. Re-dislocations had occurred in 7 shoulders (9.6%). Subluxations occurred in 23 patients (31.5%) and the apprehension test was positive in 30 (54.5%) of the 55 shoulders examined. Median functional outcomes were 236 for WOSI, 45 for OSIS, and 103 for the normalized Constant-Murley score. Of all 71 patients (73 shoulders), 29 (39.7%) reported being completely satisfied, 33 (45.2%) reported being mostly satisfied and 8 (11%) reported being somewhat satisfied. Glenohumeral arthropathy was observed in 33 (60%) of the shoulders. CONCLUSION: Despite 10% re-dislocations and frequent other signs of recurrent instability, shoulder function and patient satisfaction at 13 years after arthroscopic Bankart repair were good. LEVEL OF EVIDENCE: Level IV.

Comparative study of total shoulder arthroplasty versus total shoulder surface replacement for glenohumeral osteoarthritis with minimum 2-year follow-up.

BACKGROUND: Compared with total shoulder arthroplasty (TSA), total shoulder surface replacement (TSSR) may offer the advantage of preservation of bone stock and shorter surgical time, possibly at the expense of glenoid component positioning and increasing lateral glenohumeral offset. We hypothesized that in patients treated for osteoarthritis with a sufficient rotator cuff, TSA and TSSR patients have comparable functional outcome, glenoid component version, and lateral glenohumeral offset. METHODS: We conducted a retrospective cohort study with a minimum of 2 years of follow-up. Patients in the TSA and TSSR groups received a cemented, curved, keeled, all-poly glenoid component. A cemented anatomical humeral stem was used in TSA. TSSR involved a humeral surface replacement (all components from Tornier Inc., St Ismier, France). Patients were assessed for functional outcome. Radiographs were assessed for radiolucent lines. Glenoid component position and lateral glenohumeral offset were assessed using computed tomography images. RESULTS: After 29 and 34 months of mean follow-up, respectively, TSA (n = 29) and TSSR (n = 20) groups showed similar median adjusted Constant Scores (84% vs. 88%), Oxford Shoulder Scores (44 vs. 44), Disabilities of the Arm, Shoulder and Hand scores (22 vs. 15), and Dutch Simple Shoulder Test scores (10 vs. 11). Glenoid components showed similar radiolucent line counts (median, 0 vs. 0), similar anteversion angles (mean, 0° vs. 2°), and similar preoperative to postoperative increases in lateral glenohumeral offset (mean, 4 vs. 5 mm). One intraoperative glenoid fracture occurred in the TSSR group. CONCLUSION: Short-term functional and radiographic outcomes were comparable for TSA and TSSR.

Once an arthrodesis, always an arthrodesis?

BACKGROUND: An arthrodesis of the shoulder is historically a solution for severe shoulder joint problems, for which no prosthetic solution is deemed possible. With the introduction of the reverse shoulder arthroplasty (RSA), which is intrinsically stable at the glenohumeral joint, it seems logical to consider conversion of a painful arthrodesis into a RSA, provided that the deltoid was not destroyed during the arthrodesis. METHODS: Four patients (2 men, 2 women; age 46-66 years) with a longstanding arthrodesis (5-11 years) visited our clinic with a painful shoulder (mainly around the scapula) with the request to provide more mobility. In all, the shoulder was fused in 60° to 80° of abduction, 20° to 40° of flexion, and 40° to 50° of internal rotation. All patients refused an osteotomy as treatment for the pain. A preoperative electromyelogram showed activity in at least the posterior or middle parts of the deltoid, or both. They were offered revision of arthrodesis to a reverse prosthesis. All complications, especially instability, were discussed. Surgery was performed through the previous deltopectoral scar. In 3 cases, the osteotomy was lateral to the original joint line, providing some lateralization. RESULTS: Follow-up was 22 to 60 months. The Constant-Murley score improved from 15-21 to 30-60. No dislocations occurred. All patients were satisfied, especially with the increased, although not impressive, rotations. Pain did not disappear but decreased considerably, from visual analog scale 8-10 to 0-4. CONCLUSION: Conversion into a RSA is a safe procedure in patients with a painful arthrodesis and grossly intact deltoid, providing better glenohumeral mobility (especially rotations), leading to improved patient satisfaction.

Does scapular morphology affect the integrity of the rotator cuff?

BACKGROUND: Current evidence suggests that distinct scapular morphologies may predispose patients to a rotator cuff tear. The objective of this longitudinal study was to evaluate the relationship between symptomatic degenerative cuff tears and different radiographic acromial characteristics, including acromion shape, indices (acromial index [AI], critical shoulder angle [CSA]), and acromial spur. METHODS: We divided 166 patients into 3 groups matched for age and sex: group 1, degenerative full-thickness tear; group 2, partial thickness bursal tear; and group 3, normal cuff. Patients were evaluated with standard radiographs and ultrasonography. RESULTS: The presence of an acromial spur was strongly associated with a full-thickness cuff tear (odds ratio, 3.5; P = .001). AI and CSA revealed a statistically significant difference between means of group 1 (P = .006) and group 3 (P < .001). There was no statistically significant difference in means of AI between groups 1 and 2 (P = .695) and between groups 2 and 3, with respect to AI (P = .071) and CSA (P = .125). Receiver operating characteristic curve revealed a higher area for CSA (0.70) than for AI (0.61). Stepwise logistic regression rejected AI as a cuff tear predictor but confirmed CSA and a spur to be stronger predictors of a full-thickness cuff tear. There was no association between the Bigliani acromial type and rotator cuff tear (P = .06). CONCLUSIONS: The presence of an acromion spur is strongly associated with full-thickness cuff tear. Higher AI and CSA are associated with a full-thickness tear but not with partial tears. The type of acromion is not related to cuff tear.

Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial.

BACKGROUND: Platelet-rich plasma (PRP) has the potential to improve tendon-bone healing. The evidence is still controversial as to whether PRP application after repair of medium-sized to large cuff tears leads to superior structural and clinical outcome, especially after single-row repair. METHODS: In a randomized study, 102 patients (PRP group, 52 patients; control group, 50 patients) with medium-sized and large degenerative posterosuperior tears were included for arthroscopic repair with a minimum follow-up of 2 years. Patients were evaluated with clinical scores (visual analog scale score, Constant-Murley score, University of California-Los Angeles score, and American Shoulder and Elbow Surgeons score) and ultrasound to assess retear and vascularity pattern of the cuff. RESULTS: Visual analog scale scores were significantly lower in the PRP group than in controls at 1 month, 3 months, and 6 months but not later. Constant-Murley scores were significantly better in the PRP group compared with controls at 12 and 24 months, whereas University of California-Los Angeles scores were significantly higher in the PRP group at 6 and 12 months (P < .05). The American Shoulder and Elbow Surgeons score in both groups was comparable at all the times. At 24 months, retear in the PRP group (n = 2; 3.8%) was significantly lower than in the control group (n = 10; 20%; P = .01). The retear difference was significant only for large tears (PRP:control group, 1:6; P = .03). Doppler ultrasound examination showed significant vascularity in the PRP group repair site at 3 months postoperatively (P < .05) and in peribursal tissue until 12 months. CONCLUSION: Application of moderately concentrated PRP improves clinical and structural outcome in large cuff tears. PRP also enhances vascularity around the repair site in the early phase.

Measurement properties of the Western Ontario Shoulder Instability index in Dutch patients with shoulder instability.

BACKGROUND: The Western Ontario Shoulder Instability index (WOSI) is a patient-reported outcome measure for patients with shoulder instability. The purpose of this study was to validate the WOSI in a Dutch population by evaluating its structural validity, internal consistency, measurement error, reliability, and construct validity. Floor and ceiling effects were also addressed. METHODS: Two cohorts were recruited, including a total of 138 patients with shoulder instability. Confirmatory factor analysis was used to assess the structural validity and Cronbach's α to assess internal consistency. The measurement error was calculated as the smallest detectable change (SDC). Reliability (test-retest) was estimated in a subgroup of 99 patients who completed the re-test after a mean of 13 days (5-30 days). Reliability was calculated with the intraclass correlation coefficient (ICC). Construct validity was evaluated by comparing the WOSI with the Oxford Shoulder Instability Score (OSIS), the Simple Shoulder Test, the Oxford Shoulder Score, the Disability of the Arm, Shoulder, and Hand assessment (DASH), and the Short Form-36 Health Survey. Measurement properties were evaluated for both the total WOSI score and its four domains. RESULTS: Factor analysis did not confirm the validity of the four domains. Best results were found for a one-factor model. Internal consistency was good, with Cronbach's α ranging from 0.93 to 0.96. Reliability was excellent (ICC 0.88-0.92 for all subscales). The measurement error (SDC) was 23.0% for the total WOSI and 23% to 28% for the subscales (on a scale of 0-100). Regarding the construct validity, 76% of the results were in accordance with the hypotheses, including a high correlation with the OSIS (0.82) and DASH (0.81) assessments. No floor or ceiling effects were found. CONCLUSION: The Dutch version of WOSI showed good reliability and validity in a cohort of patients with shoulder instability, although the factor structure remains unclear.

The quantification of glenoid bone loss in anterior shoulder instability; MR-arthro compared to 3D-CT.

OBJECTIVE: The purpose of this study is to investigate if magnetic resonance imaging with intra-articular contrast (MR-arthro) is as reliable as three-dimensionally reconstructed computed tomography imaging (3D-CT) in quantifying the glenoid bone loss in patients with anterior shoulder instability. MATERIALS AND METHODS: Thirty-five patients were included. Sagittal MR-arthro and 3D-CT images of the glenoid surface were obtained pre-operatively. Two observers measured these images twice with OsiriX software in a randomized and blinded way. The intraclass correlations (ICC) of the intra- and inter-observer reliability within one method and an additional Bland-Altman plot for calculating agreement between the two methods were obtained. RESULTS: The joint estimates of the intra-observer reliability, taking into account the data from both observer A and B, for 3D-CT and MR-arthro were good to excellent. The intra-observer reliability was 0.938 (95% CI: 0.879, 0.968) for 3D-CT and 0.799 (95% CI: 0.639, 0.837) for MR-arthro. The inter-observer reliability between the two observers within one method (3D-CT or MR-arthro) was moderate to good. 3D-CT: 0.724 (95% CI: 0.236, 0.886) and MR-arthro: 0.534 (95% CI: 0.128, 0.762). Comparing both the 3D-CT and MR-arthro method, a Bland-Altman plot showed satisfying differences with the majority of outcomes (89%) within 1 SD. CONCLUSIONS: Good to excellent intra- and moderate to good inter-observer correlations and a satisfying Bland-Altman plot when compared to 3D-CT show tendencies that MR-arthro is reliable and valid for measuring bony defects of the glenoid.

The active and passive kinematic difference between primary reverse and total shoulder prostheses.

BACKGROUND: Reverse shoulder arthroplasty (RSA) and total shoulder arthroplasty (TSA) effectively decrease pain and improve clinical outcome. However, indications and biomechanical properties vary greatly. Our aim was to analyze both active and passive shoulder motion (thoracohumeral [TH], glenohumeral [GH], and scapulothoracic [ST]) and determine the kinematic differences between RSAs and TSAs. METHODS: During 3 range-of-motion (ROM) tasks (forward flexion, abduction, and axial rotation), the motion patterns of 16 RSA patients (19 shoulders), with a mean age of 69 ± 8 years (range, 58-84 years), and 17 TSA patients (20 shoulders), with a mean age of 72 ± 10 years (range, 53-87 years), were measured. The mean length of follow-up was 22 ± 10 months (range, 6-41 months) for RSA patients and 33 ± 18 months (range, 12-87 months) for TSA patients. Kinematic measurements were performed with a 3-dimensional electromagnetic tracking device. RESULTS: All patients showed better passive than active ROM. This difference was significantly larger for RSA patients than for TSA patients (TH in sagittal plane, 20° vs 8° [P = .001]; GH in sagittal plane, 16° vs 7° [P = .003]; TH in scapular plane, 15° vs 2° [P < .001]; GH in scapular plane, 12° vs 0° [P < .001]; and ST in scapular plane, 3° vs -2° [P = .032]). This finding also showed that in the scapular plane, TSA patients showed hardly any difference between active and passive ROM. Furthermore, TSA patients had 16° to 17° larger active TH motion, 15° larger active GH motion, and 8° larger active ST motion compared with RSA patients. The GH-ST ratios showed similar figures for both types of prostheses. CONCLUSION: TSA patients have larger active TH motion because in the scapular plane, they completely use the possible GH motion provided by the prosthetic design. This larger active ROM in TSA patients only applies for elevation and abduction, not for axial rotation or passive ROMs.

Long-term follow-up of Sprengel's deformity treated with the Woodward procedure.

BACKGROUND: Sprengel's deformity is a congenital anomaly of the shoulder with superior displacement and rotation of the hypoplastic scapula. The functional impairment and misshapen appearance of the shoulder can be minimized with different surgical techniques. The aim of this study was to evaluate the long-term results after correction of Sprengel's deformity using the Woodward procedure. METHODS: In this retrospective study, 8 shoulders were examined at 3 different periods in time. The average follow-up was 14.7 years (range, 8-26). Range of motion, Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score, and simple shoulder test (SST) were obtained to evaluate shoulder function. Scapula placement and degenerative disease were assessed by radiographic examination and the Rigault's classification. Cavendish grading was used to evaluate cosmetic appearance. RESULTS: Mean age at the time of surgery had been 8 years and 9 months. Mean follow-up was 13.5 years. Abduction improved by 41° in the first year after surgery, with final improvement of 56° at long-term follow-up. At the latest follow-up evaluation, the mean Constant score was 85 points, the DASH score 14.59 points, and the SST 9.5 points. Radiographs showed superior displacement of the involved scapula in all cases, with no signs of degenerative disease of the shoulder. Cavendish grade improved from grade 3 preoperatively to grade 1 or 2 at the latest follow-up examination. No long-term complications had occurred. CONCLUSION: The Woodward procedure shows to be an effective surgical procedure to improve shoulder function as well as cosmetic appearance in patients with Sprengel's deformity.

Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability.

BACKGROUND: It is unknown which combination of patient information and clinical tests might be optimal for the diagnosis of traumatic anterior shoulder instability. This study aimed to determine the diagnostic value of individual clinical tests and to develop a prediction model that combined patient characteristics, history, and clinical tests for diagnosis of traumatic anterior shoulder instability. MATERIALS AND METHODS: This prospective cohort study included 169 consecutive patients with shoulder complaints who were examined at an orthopaedic outpatient clinic. One experienced clinician conducted 25 clinical tests; of these, 6 were considered to be specific for testing of traumatic anterior shoulder instability (apprehension, relocation, release, anterior drawer, load and shift, and hyperabduction tests). Magnetic resonance arthrography was used to determine the final diagnosis. A prediction model was developed by logistic regression analysis. RESULTS: In this cohort, 60 patients (36%) were diagnosed with anterior shoulder instability on the basis of magnetic resonance arthrography. The overall accuracy of individual clinical tests was 80.5% to 86.4%. Age, previous shoulder dislocation, sudden onset of complaints, and the release test were important predictors for the diagnosis of traumatic anterior shoulder instability. The prediction model demonstrated high discriminative ability (AUC 0.95). CONCLUSION: Individual clinical shoulder tests provide good diagnostic accuracy. Young age, history of shoulder dislocation, sudden onset of complaints, and positive result of the release test were the most important predictors for traumatic anterior shoulder instability.

Are shoulders with a reverse shoulder prosthesis strong enough? A pilot study.

BACKGROUND: It has been suggested that limited active ROM of reverse shoulder prostheses relates to lack of strength. However, the postoperative strength has not been quantified. QUESTIONS/PURPOSES: We therefore measured joint torques in patients with reverse shoulder prostheses and correlated torques with functional scores. METHODS: We recruited 33 patients (age, 72 ± 8 years) with a reverse prosthesis (37 shoulders, 21 primary and 16 revisions). We obtained Constant-Murley, DASH, and Simple Shoulder Test ([D]SST) scores, and performed two isokinetic protocols (abduction/adduction and external/internal rotation) at 60° per second. Minimum followup was 4 months (average, 23 months; range, 4-63 months). RESULTS: Twenty-three patients (24 shoulders; 13 primaries, 11 revisions) were able to perform at least one of the defined tasks. Mean abduction and adduction torques were 15 Nm ± 7 Nm and 16 Nm ± 10 Nm (19%-78% of normal shoulders). External and internal rotation tasks could be performed by only 13 patients (14 shoulders; nine primary, five revisions) generating 9 Nm ± 4 Nm and 8 Nm ± 3 Nm, respectively (13%-71% of normal shoulders). We found moderate correlations between Constant-Murley, DASH and (D)SST (D = Dutch translation) scores and abduction and external rotation. CONCLUSIONS: Patients with a reverse prosthesis had reduced strength when compared with normal values reported in the literature (only 65% of patients could perform the protocol). This effect was greatest for external rotation and might explain clinical outcomes with which a moderately strong relationship was observed. Our observations suggest limited strength is a major factor in reduced ROM.

Validation of the Dutch version of the Simple Shoulder Test.

BACKGROUND: The Simple Shoulder Test (SST) is an internationally used patient-reported outcome for clinical practice and research purposes. It was developed for measuring functional limitations of the affected shoulder in patients with shoulder dysfunction and contains 12 questions (yes/no). The purpose of this study was to create a Dutch translation of the SST and to assess the reliability and validity. MATERIALS AND METHODS: The SST was translated into Dutch using forward and backward translations. A consecutive cohort of patients with shoulder problems visiting an orthopedic clinic completed the Dutch version of the SST twice within 28 days. In addition, the Dutch validated versions of the Disabilities of the Arm, Shoulder and Hand, Oxford Shoulder Score, and Constant-Murley shoulder assessment were completed for assessing construct validity. RESULTS: One hundred ten patients with a mean age of 39 years (SD, 14 years), 72% male, completed the questionnaires. The internal consistency was high (Cronbach α, 0.78). The test-retest reliability was very good (intraclass correlation coefficient, 0.92) (n = 55). The measurement error expressed in the standard error of measurement was 1.18, and the smallest detectable change was 3.3 on a scale from 0 to 12. The construct validity was supported by expected high correlations between the Dutch version of the SST and the Disabilities of the Arm, Shoulder and Hand (r = -0.74) and between the SST and the Oxford Shoulder Score (r = -0.74) and an expected moderate correlation between the SST and the Constant-Murley shoulder assessment (r = 0.59). CONCLUSION: The Dutch version of the SST seems to be a reliable and valid instrument for evaluating functional limitations in patients with shoulder complaints.

[Shoulder complaints]. / Schouderklachten.

Shoulder complaints are a very prevalent condition and a significant cause of morbidity and disability. Most patients with shoulder complaints are primarily seen by general physicians. The guideline, as developed by the Dutch College of General Physicians (NHG) in 2019, formulates a basic algorithm to start early conservative management of shoulder complaints. This article describes several causes of shoulder complaints more extensively and offers possible tools to obtain a more precise diagnosis. With a better knowledge of the multiple causes of shoulder complaints, most shoulder complaints can be adequately managed by general physicians, thus preventing unnecessary referrals.

Shoulder muscle activity after latissimus dorsi transfer in an active elevation.

Background: After latissimus dorsi transfer (LDT), an increase in scapulothoracic (ST) contribution in thoracohumeral (TH) elevation is observed when compared to the asymptomatic shoulder. It is not known which shoulder muscles contribute to this change in shoulder kinematics, and whether the timing of muscle recruitment has altered after LDT. The aim of the study was to identify which shoulder muscles and what timing of muscle recruitment are responsible for the increased ST contribution and shoulder elevation after LDT for a massive irreparable posterosuperior rotator cuff tear (MIRT). Methods: Thirteen patients with a preoperative pseudoparalysis and MIRT were recruited after LDT with a minimum follow-up of 1 year. Three-dimensional electromagnetic tracking was used to assess maximum active elevation of the shoulder (MAES) in both the LDT and the asymptomatic contralateral shoulder (ACS). Surface electromyography (EMG) tracked activation (% EMG max) and activation timing of the latissimus dorsi (LD), deltoid, teres major, trapezius (upper, middle and lower) and serratus anterior muscles were collected. MAES was studied in forward flexion, scapular abduction and abduction in the coronal plane. Results: In MAES, no difference in thoracohumeral motion was observed between the LDT and ACS, P = .300. However, the glenohumeral motion for MAES was significantly lower in LDT shoulders F(1,12) = 11.230, P = .006. The LD % EMG max did not differ between the LDT and ACS in MAES. A higher % EMG max was found for the deltoid F(1,12) = 17.241, P = .001, and upper trapezius F(1,10) = 13.612, P = .004 in the LDT shoulder during MAES. The middle trapezius only showed a higher significant difference in % EMG max for scapular abduction, P = .020 (LDT, 52.3 ± 19.4; ACS, 38.1 ± 19.7).The % EMG max of the lower trapezius, serratus anterior and teres major did not show any difference in all movement types between the LDT and ACS and no difference in timing of recruitment of all the shoulder muscles was observed. Conclusions: After LDT in patients with a MIRT and preoperative pseudoparalysis, the LD muscle did not alter its % EMG max during MAES when compared to the ACS. The cranial transfer of the LD tendon with its native %EMG max, together with the increased %EMG max of the deltoid, middle and upper trapezius muscles could be responsible for the increased ST contribution. The increased glenohumeral joint reaction force could in turn increase active elevation after LDT in a previous pseudoparalytic shoulder.

Trends in Practice Among Shoulder Specialists in the Management of Frozen Shoulder: A Consensus Survey.

Background: The management of frozen shoulder (FS) differs depending on experience level and variation between scientific guidelines and actual practice. Purpose: To determine the current trends and practices in the management of FS among shoulder specialists and compare them with senior shoulder specialists. Study Design: Consensus statement. Methods: A team of 15 senior shoulder specialists (faculty group) prepared a questionnaire comprising 26 questions regarding the definition, terminology, clinical signs, investigations, management, and prognosis of FS. The questionnaire was mailed to all the registered shoulder specialists of Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as well as to the faculty group (n = 15). The responses of the 2 groups were compared, and levels of consensus were determined: strong (>75%), broad (60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%). Result: Overall, 142 of the 230 participants in the specialist group and all 15 participants in the faculty group responded to the survey. Both groups strongly agreed that plain radiographs are required to rule out a secondary cause of FS, routine magnetic resonance imaging is not indicated to confirm FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime, steroid injection (triamcinolone or methylprednisolone) is the next best option if analgesics fail to provide pain relief, passive physical therapy should be avoided in the freezing phase, <10% of patients would require any surgical intervention, and patients with diabetes and thyroid dysfunction tend to fare poorly. There was broad agreement that routine thyroid dysfunction screening is unnecessary for women, a single 40-mg steroid injection via intra-articular route is preferred, and arthroscopic capsular release (ACR) results in a better outcome than manipulation under anesthesia (MUA). Agreement was inconclusive regarding the use of combined random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to screen for diabetes in patients with FS, preference of ACR versus MUA to treat resistant FS, and the timing of surgical intervention. There was disagreement over the most appropriate term for FS, the preferred physical therapy modality for pain relief, the most important movement restriction for early diagnosis of FS, and complications seen after MUA. Conclusion: This survey summarized the trend in prevalent practices regarding FS among the shoulder specialists and senior shoulder surgeons of SESI.

Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow.

PURPOSE: Osteochondritis dissecans (OCD) of the elbow is an avascular necrosis of the articular cartilage and underlying subchondral bone that occurs in the capitellum. The purpose of this review is to evaluate the results of arthroscopic surgery, including debridement, fragment fixation, micro-fracturing, and osteochondral autografting, in athletes with OCD of the elbow. METHODS: We searched PubMed, EMBASE, and the Cochrane library using the following main terms: osteochondritis dissecans, elbow, and surgical intervention. The 9 selected articles were criticized by use of a quality assessment tool derived from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. RESULTS: The included studies had low methodologic quality and showed satisfactory results regarding pain, return to sports, and elbow function. CONCLUSIONS: This review suggests that surgical treatment must be contemplated after a period of unsuccessful conservative therapy for athletes with OCD. Nevertheless, larger studies with enhanced methodologic quality and longer follow-up should be performed to support this conclusion. LEVEL OF EVIDENCE: Level III, systematic review of Level IV studies.