Isolated Large Glenoid Fracture in Acute Glenohumeral Dislocation in the Elderly: A Novel Indication for Reverse Shoulder Arthroplasty.

CASE: Two elderly males presented with traumatic shoulder dislocation and bony Bankart fracture consisting of greater than 25% of the glenoid width. Due to several concomitant factors such as polytrauma, activity level, rotator cuff pathology, optimization of comorbidities, risk of complications, and potential for revision surgery, the patients were treated with reverse shoulder arthroplasty (RSA). CONCLUSION: RSA may be a satisfactory treatment option for isolated, large glenoid fractures associated with anterior glenohumeral instability in the elderly. These patients are susceptible to rapid deconditioning with prolonged immobilization and may not be medically suited to undergo the prolonged recovery period associated with open reduction internal fixation or potentially undergo revision operations.

Subscapularis Function After Total Shoulder Arthroplasty Using Lesser Tuberosity Osteotomy or Tenotomy.

INTRODUCTION: Subscapularis dysfunction is a recognized complication after total shoulder arthroplasty (TSA). However, optimal subscapularis management during TSA is controversial. Subscapularis tenotomy (ST) has been used, whereas lesser tuberosity osteotomy (LTO) has gained popularity. This study compares the clinical outcomes in patients undergoing TSA with either ST or LTO, focusing on subscapularis strength and overall function. METHODS: Records were reviewed for TSA performed from 2010 to 2016 by a single surgeon at one institution. Patient age, sex, hand dominance, and the time of follow-up were recorded. Radiographs were obtained and interpreted. Range of motion was measured and the American Shoulder and Elbow Surgeons scores obtained. A graded belly-press test was used to determine the overall subscapularis function. Subscapularis strength was measured during a resisted belly-press maneuver. Statistical analysis was performed using a paired Student t-test or Fisher exact test, with P < 0.05 determining statistical significance. RESULTS: Overall, 28 shoulders constituted the LTO group with 37 in the ST group. No difference was found regarding age, whether their surgical site was their dominant extremity, or the time to follow-up. Radiographically, all osteotomies went on to union, with one malunion noted. Range of motion was equivalent. No statistical difference was noted in subscapularis strength or in the American Shoulder and Elbow Surgeons scores. The overall subscapularis function also failed to show any notable difference. DISCUSSION: In conclusion, either LTO or ST can be used during TSA to achieve successful clinical outcomes. The method of subscapularis management did not affect the subscapularis strength or overall function.

Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment.

BACKGROUND: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals of this study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decision-making of shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system for primary osteoarthritis of the shoulder. METHODS: Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a different combination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose a treatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations and chi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performed on surgical cases. An intra-class correlation (ICC) was used to assess observer agreement. RESULTS: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the sub-analysis of operative cases, the significant correlations were: KL grade [0.64], age [0.39], and activity level [-0.10]. The chi square analysis was significant (P<0.01) for all factors, but the practical significance of activity level was minimal. The ICCs were [inter](intra): KL [0.79] (0.84), patient management [0.54]. CONCLUSION: When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors most strongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operation were the patient's KL grade and age. Additionally, the KL classification demonstrated excellent observer reliability. However, there was only moderate agreement among shoulder specialists regarding treatment, indicating that this remains a controversial topic.

Shoulder injuries in the throwing athlete.

Shoulder injuries in the throwing athlete are becoming more frequent. Sports specialization at a younger age, playing multiple seasons, increased awareness of injury and injury prevention, advances in diagnosis, and surgical treatment all play a part in the increase in diagnosis of these injuries. Understanding the biomechanics of throwing and pathologies that are encountered in the throwing athlete can aid the clinician in successful diagnosis and nonoperative/operative treatment of the throwing athlete. This article discusses the relevant anatomy, biomechanics, and pathoanatomy of the throwing shoulder. Additionally, understanding the kinetic chain can assist in the nonoperative rehabilitation of the injured shoulder. Surgical reconstruction is indicated when nonoperative efforts have been exhausted and is directed based on the extent of the pathology to the capsuloligamentous structures, labrum, and rotator cuff.