Predictive factors of scapular notching in patients with reverse shoulder arthroplasty

AbstractIntroductionThe main complication of reverse shoulder arthroplasty is the development of notches in the scapular pillar, which occurs in 44% to 100% of cases. Furthermore the functional score has been shown to be poorer in patients with high-grade notches. Many options have been proposed to reduce this risk. The purpose of this study was to evaluate the predictive factors of the development of scapular notches.Materials and methodsWe retrospectively evaluated 133 shoulders in 121 patients with reverse shoulder arthroplasty. We performed a radiographic assessment of the effect of positioning the glenoid component with inferior overhang of the glenosphere and the glenometaphyseal angle. All patients were reviewed after 2years follow-up, including a clinical assessment based on the Constant score and X-rays to assess the presence of notches.ResultsNineteen complications were reported, and 14 required revision surgery. We excluded patients in whom prosthetic components were changed. The quality of the X-rays was not satisfactory enough to be analyzed in over 15 patients so they were excluded. One hundred five patients were reviewed. At 2years follow-up, 50.4% of shoulders presented with notches. The Constant score was 69.3 points (54–83) in shoulders without notches, and 66.4 points (38–82) in shoulders with notches. The average glenosphere overhang was 3.5mm (−1 – 8mm). Notches were present in 65.5% if it was less than 3mm and 39.6% if it was more than 2mm (P<0. 05). The average glenometaphyseal angle was 27.3° (4–59°), and notches developed in 72.2% if it was more than 28° and 26.5% if it was less than 28° (P<0.05).ConclusionThe position of the metaglene influences the development of notches. The risk decreases if the glenosphere overhangs the glenoid. The degree of adduction of the arm influences the development of notches and can be correlated with the patient's BMI.Level of evidenceLevel IV retrospective study

Occupational prognosis factors for ulnar nerve entrapment at the elbow A systematic review

International audienceAlthough ulnar nerve entrapment is the second most common entrapment neuropathy, there is a dearth of studies identifying occupational prognosis factors. We carried out a systematic review of the occupational prognosis factors for ulnar nerve entrapment in order to identify professions at risks and allow better follow-up for their workers. Using the key words, "ulnar OR cubital", "neuropathy OR tunnel", and "work OR occupational" without limitations, original prospective studies were selected from four databases (PubMed, Embase, Web of Science, Cochrane Library) after two rounds (valid design, valid prognosis outcome reported, valid work exposure). Associations between prognosis for ulnar neuropathy and occupational factors were extracted and analyzed qualitatively. Dating from 1981 to 2013, three prospective studies were included; 1420 cases of ulnar nerve entrapment were followed for an average of 4 years and occupational exposure was retrieved. The only high-quality study (related to this question) found a significant relationship between occupational exposure and prognosis with an odds ratio for ulnar nerve entrapment of 1.78 (1.10-2.88). The two other studies were less focused on the occupational prognosis factors; one found that work activity requiring effort had worse prognosis after surgery, while the other found no significant relationship between occupational hand exposure and prognosis. Occupations requiring high effort may be associated with more severe ulnar neuropathies, but further studies (exposure as well as associated disorders) are mandatory for clinicians to provide work task information to their patients