The return of subscapularis strength after shoulder arthroplasty

© 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Background: During shoulder arthroplasty, the subscapularis tendon is released and repaired. Whether subscapularis strength subsequently returns to normal is poorly understood. This study\u27s purpose was to determine whether subscapularis strength returns to normal after shoulder replacement and whether any preoperative factors predict the return of strength postoperatively. Methods: Sixty-four patients underwent unilateral shoulder arthroplasty. Subscapularis strength was compared between the surgical and contralateral (normal) limbs at baseline (preoperatively) and follow-up. In addition, operative arm subscapularis strength recovery was compared with ipsilateral supraspinatus strength recovery. Independent variables were assessed for their effect on subscapularis strength, including sex, age, dominant-side surgery, preoperative strength, preoperative external rotation, subscapularis management technique, and fatty infiltration. Results: The mean subscapularis strength ratio at 24months from baseline was 1.19±2.23 (. P=.0007). The normal side was significantly stronger than the operative side at all time points (. P.05) between the independent variables studied and final subscapularis strength. Discussion: Although significant strength improvement from baseline was observed at 2years after shoulder arthroplasty, subscapularis strength returned to normal in only a minority of patients. Potential prognostic variables associated with final subscapularis strength remain elusive

Design and implementation of the 2012 Canadian shoulder course for senior orthopedic residents

© 2016 Background The objective of the present paper is to analyze the first edition of a comprehensive shoulder course for senior orthopedic surgery residents and the chosen evaluation tools. Hypothesis A course focusing on shoulder surgery, requested by graduating residents in orthopedic surgery, will have a strong level of satisfaction and help improve skills, knowledge, and problem solving abilities in this domain as measured by a pre and post-test. Material and methods A two-day course was created with practical sessions, lectures, and case studies. Participants were given a multiple choice pre and post course test and evaluation questionnaires after each session. Results Sixty residents attended the course. Nine of the fifteen sessions scored above the 90% satisfaction cut-off; none of the sessions scored below 80%. However, only one question showed a statistically significant improvement after the course. Discussion Response to this course was overwhelmingly positive and the sessions received positive evaluations. However, the method to evaluate residents was not adequate; residents reported learning on their freeform evaluations but this was not represented on the multiple choice evaluation method. Evaluation tools and course duration will be modified in future iterations to improve assessment and teaching. Level of evidence IV. Study design Observational

Distal humerus hemiarthroplasty: surgical technique

Distal humerus hemiarthroplasty (DHH) is a recent therapeutic option for the treatment of some acute unreconstructable humeral fractures, for the salvage of sequelae related to non-operative management or failed internal humeral fixation as well as in other rare pathological conditions. Standard anterior-posterior and lateral view X-rays and a CT scans are mandatory for an adequate preoperative planning. The main osseous and soft tissue stabilizers of the elbow should be intact or at least reparable because elbow stability is mandatory to be able to perform a DHH; in addition, both the medial and lateral columns should be either intact or reconstructable to guarantee an adequate soft tissue reinsertion and healing. This chapter aims to describe in detail the surgical technique of DHH. In particular the choice of the articular spool size, the orientation of the flexion-extension axis, and the reconstruction of soft tissue stabilizers represent the main key points for an optimal implantation