Translation of the glenohumeral joint with the patient under anesthesia.

This study was undertaken to determine glenohumeral translation in the anesthetized patient. Radiographically assessed humeral translation was measured in 18 members of a control group, 10 patients with anterior instability, and 10 patients with multidirectional instability. In the control group stress radiographs revealed anterior translation of 17% (percentage of the diameter of the glenoid from anterior to posterior), posterior of 26%, and inferior to 29% (percentage of diameter of glenoid from superior to inferior). In patients with anterior instability anterior translation was 29%, posterior translation was 21%, and inferior translation was 49%. In patients with multidirectional instability anterior translation was 28%, posterior translation was 52%, and inferior translation was 46%. Overlap in translation was seen between normal members and those with instability. The most practical method to grade anterior and posterior translation of the humeral head within the glenoid fossa involves a clinical assessment of where the center of the humeral head rests in reference to the glenoid rim.

Results of nonoperative management of full-thickness tears of the rotator cuff.

The results of nonoperative management of 53 patients with full-thickness tears of the rotator cuff proven by arthroscopic examination was as follows. Patients were treated with nonsteroidal antiinflammatory medication, stretching, strengthening, and occasional steroid injections. Average age at presentation was 62.2 years. Patients were evaluated at an average of 7.6 years. Forty patients were male, and the dominant limb was involved in 40 cases. Thirty-four patients were reviewed by questionnaire and physical examination, whereas 19 patients were evaluated by telephone interview only. In 40 patients, the onset of symptoms was associated with an injury. In 12 patients, workmen's compensation was involved. At follow-up evaluation, the 34 shoulders that were available for examination were evaluated for pain, range of motion, strength, and function. Thirty-nine of the 53 patients (74%) assessed subjectively had only slight or no shoulder discomfort. Of the 28 shoulders presenting within three months of injury, 24 (86%) were rated as satisfactory at the time of latest evaluation. Of the 16 patients who initially had had shoulder pain for over 6 months, only nine (56%) were rated as satisfactory. Most patients showed improvement with regard to their ability to perform activities of daily living. Average active total elevation was 149 degrees compared with 121 degrees at initial presentation. Thirty-two of the 34 patients examined (94%) had evidence of weakness on muscle testing and 19 (56%) had demonstrable muscle atrophy.