Reverse Fosbury Flop Tear of the Rotator Cuff

Introduction. “Fosbury flop” tear is an avulsion of the posterosuperior rotator cuff from the bone with reversal healing on its medial bursal-side. This case report describes a unique variant of Fosbury flop tear with a lesion of the musculotendinous junction that healed, for its tendon part, on the anterior humerus and coracoid process. Case Presentation. A 62-year-old man developed a posttraumatic painful shoulder with active loss of range of motion. Magnetic resonance arthrography demonstrated a lesion of the musculotendinous junction of the supraspinatus with healing of the tendon on the above-mentioned structures (reverse Fosbury flop). During arthroscopic evaluation, tendon repair was not possible and a debridement to avoid subacromial and anterior impingement associated with a tenotomy of the long head of the biceps were carried out. One year postoperatively, the patient had complete range of motion and was satisfied with the clinical results. Discussion and Conclusion. Different Fosbury flop tears exist. Radiologists and orthopedic surgeons should be aware of these tear patterns as failure to recognize them may lead to inadequate treatment

Medial coracoclavicular ligament revisited: an anatomic study and review of the literature

The medial coracoclavicular ligament (MCCL), up to now rarely reported in the literature, was studied in a formol-fixed cadaver by means of dissection, morphometry, and light microscopy. This entity represents a true ligament within the coracoclavicular fascia. Although longer and narrower than its lateral counterpart, the medial coracoclavicular ligament follows the same morphological pattern, including the cartilage at the level of the coracoidal attachment. Its clinical significance and implications together with a review of the literature is presente

Evaluating postoperative rotator cuff healing: Prospective comparison of MRI and ultrasound

AbstractBackgroundThe objective of this prospective comparative single centre study was to compare postoperative rotator cuff healing rates as assessed by magnetic resonance imaging (MRI) versus ultrasonography (US).Material and methodsBetween October 2012 and February 2013, 61 patients underwent arthroscopic repair of postero-superior rotator cuff tears. Each patient underwent MRI and US 6 months later. The findings were assessed independently by two observers. We compared intra-observer and inter-observer levels of agreement regarding healing rates assessed by MRI and US.ResultsIntra-observer agreement regarding the MRI interpretation was 95% (κ coefficient, 0.83) for one observer and 98% (κ coefficient, 0.94) for the other. Values of κ for inter-observer agreement ranged across readings from 0.76 to 0.90. When MRI was taken as the reference, US had 80% sensitivity and 98% specificity.DiscussionMRI and US provide similar assessments of postoperative rotator cuff healing, although US is less sensitive. Intra-observer and inter-observer agreements are very good.Level of evidenceIII

Risk factors for dislocation arthropathy after Latarjet procedure: a long-term study

Purpose: The purpose of this study was to analyse the long-term incidence of dislocation arthropathy after a modified Latarjet procedure for glenohumeral instability. Methods: Long-term follow-up information was obtained from a consecutive series of patients who had undergone a modified Latarjet procedure by one surgeon between 1986 and 1999. Multivariable regression analysis was performed to examine the relation between the development of a dislocation arthropathy and patients and surgery-related factors. Results: There were 117 patients (117 shoulders) for evaluation, (35 women and 82 men) with a mean age 28.4 ± 8.5 (range, 16-55). The mean follow-up was 16.2years (range, ten to 22.2years). Signs of dislocation arthropathy were found in 36% of patients, graded as Samilson 1 in 30%, Samilson 2 in 3%, and 3% Samilson 3 in 3% of patients. Risk factors for dislocation arthropathy included surgery in patients older than 40years of age (64.3 vs. 34.4%; adjusted RR 2.2, 95% CI 1.7-2.9) and lateral positioning of the transferred coracoid process in relation to the glenoid rim (82.4 vs. 30.4%; adjusted RR 2.3, 95% CI 1.7-3.2). Patients with hyperlaxity developed less dislocation arthropathy (15 vs. 42.5%; adjusted RR 0.4, 95% CI 0.1-0.95). Conclusion: The development of dislocation arthropathy after the Latarjet procedure remains a source of concern in the long term. It correlates with surgery after the age of 40 and lateral coracoid transfer in relation to the glenoid rim. On the other hand, hyperlaxity seems to have a protective effect on the development of dislocation arthropath

Influence of surgical approach on functional outcome in reverse shoulder arthroplasty

SummaryIntroductionReverse shoulder arthroplasties (RSA) can be performed using a Deltopectoral (DP) or alternatively a Transdeltoid (TD) approach.HypothesisAlthough the humeral cut is lower by TD approach, this should not affect postoperative functional results.Material and methodsThis retrospective multicentric study evaluated the complete medical records of RSA implanted between October 2003 and December 2008. Inclusion criteria were: follow-up of at least 1year, a complete file including a comparative radiological work-up making it possible to analyze eventual arm and humeral lengthening. Evaluation of postoperative function was based on Active Anterior Elevation (AAE).ResultsWe studied 144 RSA in 142 patients. One hundred and nine RSA were implanted by the DP approach and 35 by the TD approach. Mean lengthening of the humerus compared to the controlateral side by DP approach was 0.5±1.3cm while there was a mean shortening of −0.5±1.0cm by TD approach (P<0.001). The difference in cut was partially compensated by using thicker polyethylene inserts with the TD approach. Mean arm lengthening compared to the controlateral side was 1.7±1.7cm by DP approach and 1.2±1.4cm by TD approach (mean difference 0.5cm; (95% CI −0.1; 1.2). AAE for RSA by DP approach was 145±22° and 135±29° by TD approach (mean difference 10°, 95% CI −1; 21).DiscussionRSA results in improved AAE because of restored deltoid tension and an increase in the deltoid lever arm. The humeral cut by TD is lower, but this was partially corrected in this study by the use of thicker polyethylene inserts. Nevertheless there is no significant clinical difference in postoperative function between the two approaches.Level of EvidenceLevel IV. Retrospective therapeutic study

Articular nodular fasciitis in the glenohumeral joint

We describe a case of multiple intra-articular masses in the glenohumeral joint of a 15-year-old patient. The patient was treated with arthroscopic excision of the masses and synovectomy. Histological and immunohistochemical studies were consistent with those of a nodular fasciitis. Follow-up examination did not reveal recurrence at 6months. In this article we report the first case of articular nodular fasciitis in the glenohumeral joint with unusual imaging finding

Evaluation of the subscapularis split created with passive rotation during arthroscopic dynamic anterior stabilization (DAS): A cadaveric study.

Abstract Introduction The purpose of the present study was to analyze the ability to create a subscapularis split by passive rotation of the arm during dynamic anterior stabilization (DAS) and to analyze the new geometry of the long head of the biceps LHB. Hypothesis The hypothesis was that this passive simple technique can create subscapularis split without additional dissection giving rise to new position of LHB with a new stabilization function. Material and methods A technique of subscapularis split using the LHB was used in 12 fresh-frozen human cadaveric shoulders. A subscapularis split was created by passive rotation of the arm after the LHB is shuttled into the joint during DAS. The length of the subscapularis split, post-DAS position and length of the LHB, and the angulation of the LHB relative to bicipital groove were measured after DAS and if this new geometry can give a new dynamic effect on subscapularis muscle. Results The mean length of the subscapular split after maximal rotation was 20.4 ± 6.0 mm (range: 10–32 mm). The mean elongation of the LHB was 0.6 ± 1.4 mm (range: −1 to +3 mm). The final angle of the LHB relative to the bicipital groove was 45 ± 5 degrees (range: 41 to 55 degrees). Discussion There is no need to create a distinct split prior to DAS. Additionally, DAS maintains the length-tension relationship of the LHB. The post-procedure medial angulation of the LHB relative to the bicipital groove may provide a lowering of the subscapularis, helping explain the anterior reinforcement of this technique. Level of evidence Basic science study, cadaver study

Thrower\u27s Exostosis of the Shoulder: A Systematic Review with a Novel Classification

Background: A variety of thrower\u27s exostoses are grouped under the term Bennett lesion, which makes understanding diagnosis and treatment difficult. Purpose: To identify all types of reported thrower\u27s and overhead athlete\u27s exostoses and categorize them into a classification system to allow a morphology-based classification. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of all articles pertaining to Bennett lesions and thrower\u27s exostosis was performed. The classification and treatments were evaluated to describe the types, proposed causes, diagnosis, and treatment options. Results: A total of 27 studies were included in the systematic review. The anatomic locations referenced in the study demonstrated posteroinferior, posterior, and posterosuperior glenoid lesions. Aggregate radiographic data demonstrated 158 of 306 patients (52%) with a thrower\u27s exostosis of any type and location. Of these 158 patients with a radiographic lesion, 119 (75%) patients were symptomatic. The locations were posteroinferior in 110 patients (70%), directly posterior in 2 patients (1.3%), posterosuperior in 44 patients (28%), and unknown in 2 patients (1.3%). Avulsed lesions were present in 9 (5.7%) posteroinferior lesions, 0 direct posterior lesions, and 2 (1.3%) posterosuperior lesions. Treatment plans included both nonoperative and operative strategies, but operative intervention was more commonly reported for detached lesions. After operative intervention, only 61% of reported athletes returned to preinjury performance. Conclusion: Based on a comprehensive review of the literature, we identified several anatomic locations for a thrower\u27s exostosis beyond the classic Bennett lesion. We categorized the reported exostoses into a new classification system for description of location and type (subperiosteal or free fragment) of the thrower\u27s exostosis, which may be used to study future treatments. Current treatment strategies recommend that surgical treatment of thrower\u27s exostosis is considered only after exhausting nonoperative management because reported return to sport is variable after surgery. The effectiveness of excision or repair for both subperiosteal and detached lesions has not been established

Shoulder biomechanics in normal and selected pathological conditions

The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers.Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions.Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing

Arm lengthening after reverse shoulder arthroplasty: a review

Purpose: The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications. Methods: Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I-IV relevant to search terms. Results: Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15mm to 27mm. The acromiohumeral distance averaged 23mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent. Conclusions: Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment