Glenohumeral Arthropathy After Arthroscopic Surgery for Shoulder Instability: Outcomes at 16-Year Follow-up.

Background: Glenohumeral arthropathy after surgery for traumatic shoulder instability is a condition whose etiology and long-term course are still unknown. Purpose: To evaluate the risk factors for the onset of arthropathy and to assess the relationship between the degree of arthropathy and final outcomes. Study Design: Case series; Level of evidence, 4. Methods: We included patients who underwent surgery for a shoulder instability at a single institution between 2000 and 2004. The following variables were studied for relationship with functional outcomes: sex, age, body mass index, smoking at the time of surgery, number of episodes of shoulder dislocation, and time from first dislocation to surgery. The number of anchors used and their position were also evaluated. Functional outcomes were assessed using the Constant-Murley, Western Ontario Shoulder Instability Index, and Rowe scores, and results were compared with the onset of arthropathy according to Buscayret classification. Spearman and Pearson correlations were performed for the association between glenohumeral arthritis (Buscayret grade) and the study variables, the Mann-Whitney U test and Student t test were used to compare outcome scores with the study variables, and the Kruskal-Wallis test was used to compare Buscayret grade and outcome scores. Results: A total of 26 shoulders in 25 patients were analyzed, finding a high rate (54%) of arthropathy at a minimum follow-up of 16 years. Patients with Buscayret grade 4 had the worst functional results (P = .007). However, 80% of patients with Buscayret grade ≤3 had excellent Constant-Murley scores. A significant relationship was found between degree of arthropathy and patients who were smokers before surgery (P < .01). No relationship was found between the onset of arthropathy and the other variables analyzed. Conclusion: Postinstability glenohumeral arthropathy was not correlated with functional outcomes except in those patients with advanced arthroplasty (Buscayret grade 4). A direct relationship was found between smoking before surgery and the onset of glenohumeral arthropathy.

Intraoperative pulmonary embolism in shoulder arthroscopy in a patient with previous SARS-CoV-2 infection: a case report.

The objective of this article is to describe intraoperative pulmonary embolism during shoulder arthroscopy in a patient with previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Further, we describe how the pandemic has influenced the population by increasing the rate of embolisms. Awareness of such cases will help to increase knowledge regarding SARS-Cov-2 and to determine if such patients should receive routine antithrombotic prophylaxis.

Reverse shoulder arthroplasty in complex fractures of the proximal humerus: results after 7 years of follow-up.

BACKGROUND: There is still little information about the long-term results of clinical and radiological evolution in patients older than 65 years with complex proximal humerus fractures (CPHF) treated acutely with reverse shoulder arthroplasty (RSA). The aim of this paper was to evaluate function and results 7 years after surgery. MATERIAL AND METHODS: A prospective cross-sectional cohort study was designed for this purpose. Patients who underwent RSA surgery during 2012 because of a CPHF were included. The surgical approach was randomized (deltopectoral vs anterosuperior). Functional activity, evolution of tuberosities and evidence of scapular notching 7 years after surgery were analyzed. RESULTS: After evaluating 32 patients, the Constant score improved from 64.83 in the first year to 69.54 at 7 years postoperative. Results were independent of the approach used. Functional outcomes were poorer in patients with scapular notching and when tuberosities were resorbed or displaced. CONCLUSIONS: At 7 years, function in patients undergoing RSA after CPHF demonstrated improvement in all patients except those who developed scapular notching or when tuberosities did not consolidate in an anatomical position. These results are completely independent of the approach used. LEVEL OF EVIDENCE: III Controlled cohort study.

Inestabilidad multidireccional atraumática del hombro / Multidirectional atraumatic shoulder instability

Se ha realizado un estudio prospectivo de una serie de casos consecutivos de pacientes con una inestabilidad atraumática de hombro tratados mediante una plicatura capsular artroscópica anterior y posterior. El objetivo de este trabajo es evaluar los resultados de esta técnica. Para ello, se analizó el balance articular, el test de Constant y la reincorporación laboral y deportiva. A los seis meses, se obtuvieron unos resultados satisfactorios en la evaluación clínica de los pacientes, sin encontrar ninguna complicación. Creemos que es por tanto una técnica quirúrgica apropiada para el tratamiento de esta patología

A prospective study of a series of cases of patients with atraumatic shoulder instability undergoing an anterior and posterior arthroscopic capsular plication was carried out. The aim of this report is to assess the outcome of this procedure. To that view, the range of motion, the Constant score and reintegration into working and sport life were analysed. Satisfactory results were achieved following the clinical re-evaluation of the patients at 6 months. Serious complications did not arise during this period of time. The authors therefore believe that this surgical technique is most suited to address the disorder outlined above

Reverse shoulder arthroplasty in obese patients: analysis of functionality in the medium-term.

INTRODUCTION: Obesity is an epidemic nowadays and this fact conditions results in orthopaedic surgery. Very few studies evaluates if obesity is a risk factor for reverse shoulder arthroplasty. The aim of this study is to confirm if there are differences with regard to the outcomes in patients undergoing reverse shoulder arthroplasty according to their body mass index (BMI). MATERIALS AND METHODS: A total of 35 patients were enrolled in the study. Then divided into subpopulations according to their BMI and analyzed twice. First analysis set a division 30 of BMI and second set it in 35. ASES score, major complications, length of the hospital stay, radiolucent lines in components as well as scapular notching were assessed. RESULTS: No major complications were described in our patients. No differences were found related to hospital stay, radiolucent lines or scapular notching. However, in the second analysis (BMI < 35 and ≥ 35) statistical differences were found regarding ASES score. Poorer functional outcomes were described in the type-II obese and morbidly obese population. CONCLUSION: Functional outcomes of reverse shoulder arthroplasty are worse in patients with a BMI over 35.

Rotura del tendón distal del tríceps braquial. Diagnóstico y tratamiento / Rupture of the distal triceps brachii tendon. Diagnosis and treatment

La lesión del tendón distal del tríceps braquial es una lesión infrecuente que afecta principalmente a varones y que generalmente se asocia a lesiones deportivas y al uso de esteroides. El diagnóstico y tratamiento precoces son importantes en el manejo de estas lesiones ya que de ello dependen los resultados funcionales posteriores. El diagnóstico es habitualmente clínico, apoyado por pruebas de imagen como la radiografía simple de codo, la ecografía y la resonancia magnética nuclear. El tratamiento puede ser controvertido y debe individualizarse; depende tanto de las características del paciente como del grado y tiempo transcurrido desde la lesión. El tratamiento quirúrgico de las lesiones agudas se basa en el reanclaje anatómico del tendón al hueso, teniendo resultados de buenos a excelentes independientemente de la técnica elegida, mientras que aquellas lesiones crónicas o con mala calidad del tejido, que requieren técnicas de reconstrucción con injertos tendinosos o colgajos, obtienen resultados más impredecibles

The lesion of the distal triceps brachii tendon is an uncommon injury that mainly affects males and is usually associated with sports injuries and the use of steroids. An early diagnosis and treatment of these lesions are important because the functional outcomes depend on them. Diagnosis is usually clinical, supported by imaging tests such as plain radiography elbow, ultrasonography and nuclear magnetic resonance. The treatment may be controversial and must be individualized; depends on the patient characteristics and the degree and time since the injury. Surgical treatment of acute injuries is based on the anatomic reattachment of the tendon to the bone, with good to excellent results regardless of the surgical technique, while chronic injuries or those with bad quality tissue that require reconstruction techniques with tendon grafts or flaps, have unpredictable results