Managing acromio-clavicular joint pain: a scoping review

Background Shoulder pain secondary to acromioclavicular joint pain is a common presentation in primary and secondary care, but often poorly managed due to uncertainty about optimal treatment strategies. Osteoarthritis is the commonest cause. While acromioclavicular pain can be treated non-operatively and operatively, there appears to be no consensus on the best practice pathway of care for these patients with variations in treatment being common place. The objective of this paper was to conduct a scoping review of the current published evidence for the management of isolated acromioclavicular pain (excluding acromioclavicular joint dislocation). Methods A comprehensive search strategy was utilised in multiple medical databases to identify level 1 and 2 randomised controlled trials, non-randomised controlled trials and systematic reviews for appraisal. Results Four systematic reviews and two randomised controlled trials were identified. No direct studies have compared the benefits or risks of conservative versus surgical management in a controlled environment. Discussion High level studies on treatment modalities for acromioclavicular joint pain are limited. As such, there remains little evidence to support one intervention or treatment over another, making it difficult to develop any evidenced based patient pathways of care for this condition.</p

Etiology and Surgical Interventions for Stiff Total Knee Replacements

Stiffness is the most prevalent early local complication of primary total knee replacement, affecting approximately 6 to 7% of patients undergoing surgery. The definition of stiffness after total knee replacement in terms of restriction of the arc of motion has evolved in the last 2 decades as patients and physicians expect better postoperative functional outcomes. Gentle manipulation under anesthesia within 3 to 4 months of surgery improves the range of motion in most patients. However, approximately 1% of patients, including those in which the window for manipulation has passed, will require further surgical interventions, which may include arthroscopy with lysis of adhesions, open debridement with exchange of the polyethylene insert, or revision of one or more components. This review will focus on describing the etiology of the problem and the results of the different surgical interventions for stiffness after total knee replacement