BACKGROUND: Arthroscopic fixations for large and comminuted bony Bankart lesions are technically difficult. We developed an arthroscopic multiple pulled suture (MPS) technique to restore large and comminuted bony Bankart lesions. METHODS: Ten patients (mean age, 49.8 years; range, 31–79 years) underwent bony Bankart repair using the illustrated MPS technique and were then followed for a mean of 27.3 months. A plain radiograph series and three-dimensional computed tomography scans were taken at the initial clinical evaluation and 3 months postoperatively. Outcome measurements included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, University of California at Los Angeles (UCLA) score, and subjective patient satisfaction, along with surgical complications. RESULTS: Union of an osseous fragment with the glenoid rim was confirmed in all patients on a computed tomography scan 3 months after operation. The osseous fragment was restored to proper articular congruence and reduction. The affected shoulder was stable in nine of the 10 patients. One patient presented with a redislocation after a sports injury 3 years postoperatively. The ASES, Rowe, and UCLA scores improved at the final evaluation, and median patient satisfaction at the final follow-up was 9 of 10 points (range, 6–10 points). CONCLUSIONS: The arthroscopic MPS technique for bony Bankart lesions with large or comminuted osseous fragments was a relatively easy and safe method for stable fixation of the osseous fragment. Therefore, the arthroscopic MPS technique resulted in good restoration of stability with high patient satisfaction and low complication rates.
Athletic Injuries ; California ; Elbow ; Follow-Up Studies ; Humans ; Methods ; Patient Satisfaction ; Shoulder ; Surgeons ; Sutures

BACKGROUND: To compare the clinical outcomes of arthroscopic capsular release in patients with and without inferior capsular release for shoulder stiffness. METHODS: Between January 2010 and December 2015, 39 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into two groups. In group I, 19 patients underwent arthroscopic capsular release of the rotator interval and anterior capsule. In group II, 20 patients underwent arthroscopic capsular release of the anterior to inferior capsule, including the rotator interval. The American Shoulder and Elbow Surgeons score, Constant scoring system, Simple Shoulder Test, visual analogue scale for pain, and range of motion (ROM) were used for evaluation before surgery, at 3, 6, and 12 months after surgery and on the last follow-up. RESULTS: Preoperative demographic data revealed no significant differences (p<0.05). The average follow-up was 16.07 months. Both groups showed significantly increased ROM at the last follow-up compared with preoperative (p<0.05). At the last follow-up, no statistical differences were found (p<0.05) between groups I and II in functional scores and ROM (forward flexion, p=0.91; side external rotation, p=0.17; abduction external rotation, p=0.72; internal rotation, p=0.61). But we found that group II gained more flexion compared to group I at 3 months and 6 months (p<0.05) after the surgery. CONCLUSIONS: Both techniques of capsular release are effective for stiffness shoulder. However, the extended inferior capsular release shows superiority in forward flexion over anterior capsular release alone during 6 months of follows-up (level of evidence: Level I, therapeutic randomized controlled trial).
Bursitis ; Elbow ; Follow-Up Studies ; Humans ; Joint Capsule Release* ; Range of Motion, Articular ; Shoulder* ; Surgeons

No abstract available.
Bankart Lesions ; Suture Techniques ; Fractures, Comminuted

Animal shoulder models are important in the investigation of the natural history of various pathologic conditions and for evaluation of the effectiveness of different treatments and biomaterials. The characteristics of animal shoulder models that may be used for rotator cuff related experiments are different with regard to the anatomy, behavioral pattern, advantages and disadvantages in application to each other. The lower primates and all the non-primate species, except the tree kangaroo, were neither functional overhead nor had a true rotator cuff. Utilizing more advanced primates, or perhaps even the tree kangaroo would be ideal and the most relevant to man as they possess a true rotator cuff. However, ethical concerns, costs, and many limitations in obtaining primates generally preclude the use of these animals for such research. Finally we should consider the differences in comparative anatomy and behavioral pattern of each animal model during performance or interpretation of rotator cuff experiments.
Anatomy, Comparative ; Animals ; Biocompatible Materials ; Macropodidae ; Models, Animal ; Natural History ; Primates ; Rotator Cuff* ; Shoulder*

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.
Acromion ; Arthroscopy ; Debridement ; Decompression ; Follow-Up Studies ; Fracture Fixation, Intramedullary* ; Humans ; Humeral Fractures ; Hypertrophy ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Sutures ; Tendons

Pancoast syndrome (PS) is characterized by a malignant neoplasm of the superior sulcus of the lung with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves. The most common initial symptom of PS is shoulder pain; however, cough, dyspnea, and hemoptysis, signs often associated with lung cancer, are not as common. Investigation of PS can be difficult even with plain radiographs of the chest because it is surrounded by osseous structures such as the ribs, vertebral bodies, and manubrium. Due to these characteristics, orthopedic surgeons tend to make a misdiagnosis resulting in delay of appropriate treatment. Here we report on a patient who was supposed to undergo rotator cuff repair for his shoulder pain and weakness, and was eventually diagnosed with PS.
Bays ; Brachial Plexus ; Cough ; Diagnostic Errors ; Dyspnea ; Hemoptysis ; Humans ; Lung ; Lung Neoplasms ; Manubrium ; Orthopedics ; Pancoast Syndrome* ; Ribs ; Rotator Cuff* ; Shoulder Pain ; Superior Vena Cava Syndrome ; Thorax

BACKGROUND: Repair of superior labral anterior to posterior (SLAP) lesion in patients older than 40 years is controversial. The purpose of this study was to evaluate clinical outcomes of arthroscopic repair of SLAP lesions between younger and older patient groups. METHODS: We reviewed 50 patients with isolated type II SLAP lesions who underwent arthroscopic repair. Patients were divided into 2 groups: group 1 included 20 patients aged <40 years, and group 2 included 30 patients aged > or =40 years. Functional outcome at the final follow-up was assessed using a visual analog scale for pain and satisfaction, American Shoulder and Elbow Surgeons form, Constant score, University of California at Los Angeles score, and periodic change in range of motion (ROM). Anatomical outcome was evaluated using computed tomography (CT) arthrography at least 1 year after surgery. RESULTS: No significant differences in functional scores or postoperative ROM were observed between the 2 groups. In group 2, later recovery of ROM (forward flexion, p=0.025; internal rotation, p=0.034) and lower satisfaction score (p=0.06) were observed for atraumatic patients (n=16) compared to patients with traumatic injury (n=14). Fifteen patients in group 1 (15/17, 88%) and 21 patients in group 2 (21/26, 81%) demonstrated a healed labrum on postoperative CT arthrography, and this difference was not significant. CONCLUSIONS: The results of this study suggest that arthroscopic repair of type II SLAP lesions can yield good functional and anatomical outcomes regardless of age, if patient selection is adequate. However, the delay in ROM recovery and lower satisfaction, particularly in older patients without traumatic injury, should be considered.
Arthrography ; Arthroscopy ; California ; Elbow ; Follow-Up Studies ; Humans ; Patient Selection ; Range of Motion, Articular ; Shoulder ; Visual Analog Scale

BACKGROUND: We assessed the effectiveness of arthroscopic capsular release for the treatment of adhesive capsulitis. Further, we tried to ascertain the clinical benefits, if any, of pancapsular release over selective capsular release, where the two differ by performing or not performing a posterior capsular release, respectively. METHODS: Thirty-five consecutive patients with either primary or secondary adhesive capsulitis who failed conservative treatment for more than 6 months were enrolled in the study. A total of 16 patients allocated in group 1 received a pancapsular release that comprises the release of the rotator interval, anteroinferior capsular, and the posterior capsular release, whereas 19 patients in group 2 received a selective capsular release that comprises only the release of the rotator interval release and anteroinferior capsular release. The clinical outcomes, visual analogue scale (VAS) score, Constant score, and range of motion, were assessed preoperative and postoperatively. RESULTS: In both groups, the preoperative VAS score, Constant score, and ROM showed a significant improvement by the 6-month follow-up. We found that the immediate postoperative internal rotation was significantly higher in group 1 than group 2. Despite significant differences seen between the two groups at the initial postoperative period, there were no significant differences in Constant score, VAS score, and the ROM at all the subsequent follow-ups between the two groups. CONCLUSIONS: Arthroscopic capsular release for the treatment of adhesive capsulitis is very effective. However, pancapsular release did not show any advantage over selective capsular release in terms of overall clinical outcome.
Bursitis* ; Follow-Up Studies ; Humans ; Joint Capsule Release* ; Postoperative Period ; Range of Motion, Articular

BACKGROUND: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. METHODS: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. RESULTS: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. CONCLUSIONS: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.
Acromion ; California ; Clavicle* ; Humans ; Osteolysis ; Periprosthetic Fractures ; Shoulder ; Skin

BACKGROUND: The purpose of this study is to assess the range of shoulder motion using an indirect evaluation method without physical examinations of patients based on questionnaires regarding several specific arm postures referenced by patient's own body parts. METHODS: Nine criteria of specific shoulder motion including 4 forward flexion, 2 external rotation, and 3 internal rotation were decided as reference position which can represent a certain shoulder motion. Flexion contains postures such as lifting arm to waist-height, shoulder-height, eye-height, and raising arm above head with arm touching ears. External rotation comprises grasping ears and placing hands on back of the head. Vertebral height in internal rotation is determined by calculating the samples' motions, which are holding on to trouser belts, opposite-elbow, and scapula. These postures are included in questionnaires for patients to evaluate the validity and effectiveness of this indirect method. RESULTS: The range of flexion was 77degrees (60degrees to 100degrees), 96degrees (87degrees to 115degrees), 135degrees (115degrees to 150degrees), and 167degrees (150degrees to 175degrees) when arms go up to waist, shoulder, eye, and high vertically. Range of external rotation was 39.6degrees (30degrees to 50degrees) when grasping ears and 69.2degrees (60degrees to 80degrees) with the hands on the back of the head. Range of internal rotation was L4 when placing trouser belts, T12 for holding opposite elbow, and T9 for reaching scapula. The mismatch rates of flexion, external rotation, and internal rotation were 11.6%, 9.6%, and 7.8%. CONCLUSIONS: The range of shoulder motion using this method is expected to be applied to an established shoulder scoring system which included shoulder motion evaluation item.
Arm ; Ear ; Elbow ; Hand ; Hand Strength ; Head ; Human Body* ; Humans ; Lifting ; Physical Examination ; Posture ; Range of Motion, Articular ; Scapula ; Self-Assessment ; Shoulder Joint ; Shoulder* ; Telephone ; Surveys and Questionnaires