Neuropathy of the suprascapular and axillary nerves in rotator cuff arthropathy: a prospective electrodiagnostic study.

PURPOSE: Prevalence of axillary (AN) and/or suprascapular (SSN) neuropathy in rotator cuff tear arthropathy (RCTA) is unknown. We aimed to prospectively evaluate for preoperative neurodiagnostic abnormalities in order to determine their prevalence, location, and influence on reverse shoulder arthroplasty (RSA) outcomes. METHODS: Patients who underwent RSA for RCTA were prospectively included. An electromyography and nerve conduction study were performed pre and post-surgery. Clinical situation: VAS, Relative Constant-Murley Score (rCMS) and ROM over a minimum of two years follow-up. RESULTS: Forty patients met the inclusion criteria; mean follow-up was 28.4 months (SD 4.4). Injuries in RCTA were present in 83.9% (77.4% in AN and 45.2% in SSN). There were no differences on preoperative VAS, ROM, and rCMS between patients with and without preoperative nerve injuries. Four acute postoperative neurological injuries were registered under chronic preoperative injuries. Six months after RSA, 69% of preoperative neuropathies had improved (82.14% chronic injuries and 77.7% disuse injuries). No differences in improvement between disuse and chronic injuries were found, but patients with preoperative neuropathy that had not improved at the postoperative electromyographic study at six months, scored worse on the VAS (1.44 vs 2.66; p .14) and rCMS (91.6 vs 89.04; p .27). CONCLUSIONS: The frequency of axillary and suprascapular neuropathies in RCTA is much higher than expected. Most of these injuries improve after surgery, with almost complete neurophysiological recovery and little functional impact on RSA. However, those patients with preoperative neuropathies and absence of neurophysiological improvement six months after surgery have lower functional results.

Suprascapular nerve injury after reverse total shoulder arthroplasty: correlation with screw out of vault penetration and functional situation: prospective study.

BACKGROUND: Baseplate screws have been suggested as a possible cause of suprascapular neuropathy after reverse total shoulder arthroplasty. This study aims to investigate the association between screw penetration out of the vault, electromyographic study, and the clinical outcomes. METHODS: A total of 31 patients who underwent reverse total shoulder arthroplasty for cuff tear arthropathy were prospectively enrolled. They were followed up for a minimum of 24 months. All patients underwent computed tomography 6 months postoperatively to determine the extraosseous position of the screws (perforation of the second bone cortex and protrusion into the supra- or infraspinatus fossa). Electrodiagnostic evaluation was performed preoperatively and postoperatively to stablish any relation between cortex perforation of the screw and suprascapular nerve (SSN) injury. Clinical outcomes pre- and postoperatively (Constant score, ranges of motion, and visual analog scale) of patients with and without documented injury were recorded. RESULTS: A total of 14 patients (45.2%) had an abnormal preoperative SSN electrodiagnostic study (chronic or disuse injuries), and 6 patients (19.4%) had an abnormal postoperative study (acute injury). Of the 6 patients, 2 cases appeared over the pre-existing lesion and 4 appeared over an intact preoperative nerve, all of them affecting the infraspinatus branch of the SSN. Perforation of the second cortex was detected for 60% of superior screws and 40% of posterior screws. The mean lengths of the superior and posterior screws were 30 and 18.2 mm, respectively. Patients with screw perforation of the second cortex were assessed as having a high risk of nerve injury (40% vs. 9.5%). CONCLUSIONS: Preoperative SSN injuries do not have a significant clinical impact and do not predispose to an acute postoperative SSN lesion. The Constant score and visual analog scale score for patients with acute SSN injuries were not statistically different from those without SSN injury. The extraosseous position of the screw increases the probability of an SSN injury to 31%. This risk is higher with the posterior screw, which leads us to question whether it is really necessary to use it.

Subspine femoroacetabular impingement: retrospective study of a series of patients treated by hip arthroscopic resection.

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a common hip pathology that causes pain and functional limitation in young patients. subspine femoroacetabular impingement (SFAI) is an increasingly diagnosed extra-articular subtype that occurs from mechanical conflict of the anteroinferior iliac spine (AIIS) with the cervico-diaphyseal junction during hip flexion, which is poorly described in the literature. QUESTIONS/PURPOSES: We aimed to describe the clinical, functional, and radiological results of the arthroscopic treatment of a group of patients with SFAI treated in our Hip Unit. STUDY DESIGN: Case series. METHODS: We present a retrospective study of ten patients with SFAI treated between 2013 and 2020 with arthroscopic resection. Clinical results were assessed with scales such as visual analog scale (VAS); modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Radiological results were assessed with radiological measurements, magnetic resonance imaging (MRI), and computed tomography (CT) reconstructions. RESULTS: Six patients had a Type III AIIS and four of them had Type II. Two patients had previously been surgically treated for FAIS. The range of motion improved in flexion from 107 ± 11 degrees before surgery to 127.5 ± 6 degrees (p = 0.005). MHHS improved from 48.1 (38-75.3) before surgery to 83.1 (57-91) (p = 0.007) and HOOS improved from 65.2 (58-75) to 89 (68.1-100) (p = 0.007). VAS improved from 7.3 (5-9) pre-surgical to 2.5 (0-8) post-surgical (p = 0.005). We did not have significant complications except for an asymptomatic case of heterotopic ossification (Brooker I). CONCLUSION: Arthroscopic decompression of AIIS in SFAI patients is a safe procedure that provides satisfactory short-term functional results, improving clinical symptoms, function, sports performance, and range of motion in our study.

Reverse total shoulder arhroplasty for the treatment of failed fixation in proximal humeral fractures.

BACKGROUND: This study evaluates the clinical outcomes in patients with proximal humerus fractures (PHF) treated with reverse total shoulder arthroplasty (RTSA) as a revision procedure for failed fixation that have more than 5 years of follow-up. MATERIALS AND METHODS: This is a retrospective study of 270 RTSA. The inclusion criteria for this study consisted of patients initially treated with either open reduction and plate fixation (ORIF) or fixation using an intramedullary nail (IMN), who were managed with a single-stage revision to a RTSA, and had a minimum of 24 months clinical and radiological follow-up. Six patients with failed fixation of displaced PHF were revised with RTSA. One patient was excluded from the study because she died. Five shoulders were reviewed for the purpose of this study. The patients were evaluated using Constant score, relative Constant score and visual analogue scale for pain. RESULTS: The mean follow-up was 89 months (65-108). The mean absolute Constant score improved from 31, 81 to 44, 2 and the relative Constant score improved from 31,81% to 67,2%. Mean VAS improved from 6, 8 to 2. One patient rated their outcome excellent, 1good, 1 satisfied and 2 poor. CONCLUSION: RTSA is an appropriate treatment as a revision surgery for failed fixation of PHF. Patients should be adequately warned that they will improve their function but may have complications following this salvage procedure.

Injury to the axillary and suprascapular nerves in rotator cuff arthropathy and after reverse shoulder arthroplasty: a prospective electromyographic analysis.

BACKGROUND: Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. METHODS: Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. RESULTS: Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injuries remain unchanged, and the rest improved or normalized. The mean postsurgery rCS of the entire cohort at 6-month follow-up was 78 ± 6.5. Mean postoperative rCS for acute postoperative nerve injury was 71 ± 3 for the axillary nerve and 64 ± 5 for SSN. CONCLUSIONS: Axillary and SSN injuries in RCTA have a much higher incidence than expected. Most of these axillary lesions are transient, with an almost complete recovery seen on electromyography at 6 months and with scarce functional impact. However, SSN lesions appear to behave differently, with poor functional results and having a lower potential for a complete recovery.

Open reduction and internal fixation of coronal fractures of the capitellum in patients older than 65 years.

BACKGROUND: The aim of this study was to describe the fracture patterns of capitellum coronal fractures and to evaluate the complications and functional and radiographic outcomes of open reduction and internal fixation in patients older than 65 years. METHODS: A retrospective study of 23 patients with a mean follow-up of 48 months (36-105) was performed. Fractures were classified according to the Dubberley classification. All patients were evaluated by the Mayo Elbow Performance Index (MEPI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS: Three patients were lost to follow-up. There were 16 type 1 and 4 type 2 fractures. The mean age was 71 years (66-79), and 65% were women. The mean MEPI score was 92 (60-100), and the mean DASH score was 9 (0-75). Either a concomitant fracture or an elbow dislocation was present in 50% of the patients. Mean sagittal plane range of motion at last follow-up was 122° ± 8°, with lower extension in type 2 and worse scores on MEPI (91 vs. 97) and DASH (3 vs. 0) scales. Placement of the screws in the posteroanterior direction was associated with better range of motion in flexion (130° vs. 122°) and better outcomes in functional scores (MEPI, 97 vs. 89; QuickDASH, 0 vs. 4). Complications were post-traumatic osteoarthritis in 3 patients, avascular necrosis in 1 patient, and heterotopic ossification in 5 patients. One patient required reoperation. CONCLUSIONS: Patients older than 65 years have no substantial risk of complex fracture patterns, but they have a large number of concomitant injuries. Open reduction and internal fixation with cannulated screws allow stable fixation and provide satisfactory functional results with a lower complication rate.

Fracturas de estrés de la escápula tras artroplastia invertida en artropatía de manguito: ¿cuál es su repercusión funcional? / Scapula insufficiency fractures after reverse total shoulder arthroplasty in rotator cuff arthropathy: What is their functional impact?

Introducción-objetivos. Describir la incidencia, factores etiológicos, repercusión funcional y actitud terapéutica de las fracturas de acromion y espina de la escápula tras artroplastia invertida por artropatía de manguito rotador. Material y método. Análisis retrospectivo de 126 artroplastias inversas entre los años 2009-2011. Se identificaron 4 fracturas que se compararon con un grupo control de 40 pacientes. Se analizan variables relacionadas con el proceso quirúrgico, funcionales y de calidad de vida (escala Constant, EQ-5D). Resultados. La incidencia de la fractura fue 3,28% (4 pacientes), edad media 74,7 años y tiempo medio hasta el diagnóstico 11,9 meses. El Constant preoperatorio del grupo control fue de 37,3% y de los pacientes con fractura 34,7% (p > 0,05); el postoperatorio 81,2% y 66,5%, respectivamente (p < 0,001). La anteversión y abducción en los pacientes con fractura descendieron en 39° (p = 0,02) y 34° (p = 0,057) respectivamente con respecto al grupo control. La calidad de vida percibida (EQ-VAS) es inferior en el grupo de fractura (60 vs 76) (p = 0,002). En ninguno de los casos de fractura se observó inestabilidad, no precisando cirugías de revisión. La tasa de consolidación fue de un 50% tras un seguimiento medio de 39,6 meses. Conclusiones. La fractura de escápula tras artroplastia invertida es una complicación poco frecuente. A pesar de su aparición los resultados funcionales y de calidad de vida de estos pacientes son superiores a los presentes preoperatoriamente, sin embargo, resultan inferiores a los de los pacientes intervenidos en los que no se encuentra dicha complicación. Son necesarios más estudios prospectivos que nos ayuden a definir las pautas de actuación terapéutica ante esta complicación (AU)

Introduction-objectives. To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy. Material and method. A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D). Results. The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P > .05); postoperative Constant score: 81.2 and 66.5%, respectively (P > .001). Forward elevation and abduction in fracture patients decreased by 39° (P = .02), and 34° (P = .057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P = .002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months. Conclusions. Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication (AU)

Scapula insufficiency fractures after reverse total shoulder arthroplasty in rotator cuff arthropathy: What is their functional impact?

INTRODUCTION-OBJECTIVES: To describe the incidence, etiological factors, functional impairment and therapeutic management of scapular fractures after reverse shoulder arthroplasty (RSA) in rotator cuff arthropathy. MATERIAL AND METHOD: A retrospective study was conducted on 126 RSA between 2009 and 2011, in which 4 fractures were identified that were compared with a control group of 40 patients. An analysis was performed on the variables related to the surgical technique, functional results, and quality of life (Constant scale, EQ-5D). RESULTS: The fracture incidence was 3.28% with a mean age of 74.7 years. The mean time until diagnosis was 11.9 months. The preoperative Constant score in the control group was 37.3%, and 34.7% in the fracture group (P>.05); postoperative Constant score: 81.2 and 66.5%, respectively (P>.001). Forward elevation and abduction in fracture patients decreased by 39° (P=.02), and 34° (P=.057) respectively. The perceived quality of life (EQ-VAS) was lower in the fracture group (60 vs. 76) (P=.002). There were no instability cases, and no revision surgery was required. The union rate was 50% after a mean follow-up 39.6 months. CONCLUSIONS: Scapular fracture after RSA is a rare complication. Despite its presence, the functional outcomes and quality of life of these patients are higher than preoperatively; however, they are lower than that obtained in patients with RSA without this complication. More prospective studies are needed to define guidelines for therapeutic action against this complication.