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Sobhi S, Bochat K, Booth G, Mattin A, Moniz S. Clinical and Surgical Outcomes of Shoulder Arthrodesis. J Clin Med 2024; 13:4701. [PMID: 39200843 PMCID: PMC11355288 DOI: 10.3390/jcm13164701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 07/13/2024] [Accepted: 07/18/2024] [Indexed: 09/02/2024] Open
Abstract
Introduction: Shoulder arthrodesis is typically seen as a salvage procedure with limited functional objectives. In appropriately selected patients, it may effectively alleviate pain, provide stable motion, and offer patient function satisfaction. However, there have been few reports on the outcomes following shoulder arthrodesis. Methods: A multicenter, retrospective chart review of patients undergoing shoulder arthrodesis between 2001 and 2023 in Western Australia was conducted. Clinical records and imaging were then reviewed to determine patient demographics. A cross-sectional analysis of Visual Analogue (VAS), Oxford Shoulder (OSS), and American Shoulder and Elbow Surgeons Shoulder (ASES) Scores, satisfaction and complication rates was conducted. Results: In total, 14 patients with a mean age of 39.5 years (range 22-52 years, 71% male) with a mean follow-up of 7.4 years (range 3 months-18 years) were identified. The most common indications for arthrodesis included osteoarthritis (8, 57%) and instability (6, 43%). Major contributory factors were recurrent seizures (5, 36%) and multiple surgeries (4, 29%). Radiographic union was observed in 13 (93%) patients. The mean VAS was 2.8 (range 0-7), mean OSS was 33.0 (range 23-42) and ASES score was 55.4 (range 37-82). In total, 11 patients (79%) reported being satisfied. Five (36%) patients returned to theatre for complications. Conclusions: In this patient series, shoulder arthrodesis demonstrates a notable efficacy in pain reduction, high satisfaction, acceptable function, and complication rates.
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Affiliation(s)
- Salar Sobhi
- Department of Orthopaedic Surgery, The Orthopaedic Research Foundation of Western Australia (ORFWA), Murdoch, WA 6150, Australia
| | - Kieran Bochat
- Department of Orthopaedic Surgery, The Orthopaedic Research Foundation of Western Australia (ORFWA), Murdoch, WA 6150, Australia
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Grant Booth
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Andrew Mattin
- Department of Orthopaedic Surgery, The Orthopaedic Research Foundation of Western Australia (ORFWA), Murdoch, WA 6150, Australia
| | - Sheldon Moniz
- Department of Orthopaedic Surgery, The Orthopaedic Research Foundation of Western Australia (ORFWA), Murdoch, WA 6150, Australia
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Adu-Kwarteng K, Cabell GH, Hurley ET, Amanah AY, Levin JM, Lassiter TE, Boachie-Adjei YD, Klifto CS, Anakwenze O. Glenohumeral arthrodesis outcomes and complications: a systematic review. J Shoulder Elbow Surg 2024; 33:1418-1424. [PMID: 38104717 DOI: 10.1016/j.jse.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The purpose of this study was to systematically review the evidence in the literature to determine the clinical outcomes following glenohumeral arthrodesis. METHODS Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they reported on outcomes following shoulder arthrodesis from the years of 2000-2022. Functional outcomes that were collected included the Subjective Shoulder Value, American Shoulder and Elbow Surgeons shoulder index score, visual analog scale pain score, and Oxford Shoulder Score. Range-of-motion data were also collected. RESULTS This review included 17 studies, with a total of 316 patients, that met the inclusion criteria. The majority of the patients were male (67.4%), and the average age was 38.4 years (range, 7-82 years). The overall fusion rate was 88.7%, and the time to fusion was on average, 3.9 months (range, 2-8 months). Shoulder arthrodesis resulted in improvement in each of the functional outcomes assessed: Subjective Shoulder Value (preoperatively, 18.8; postoperatively, 43.9; and percent change, 132.8%), American Shoulder and Elbow Surgeons shoulder index score (postoperatively, 62.1), visual analog scale pain score (preoperatively, 8.5; postoperatively, 3.03; and percent change, 62.4%), and Oxford Shoulder Score (preoperatively, 9.4; postoperatively, 30.9; and percent change, 328.7%). The abduction, forward flexion, external rotation, and internal rotation range-of-motion measurements postoperatively were 57°, 64°, 3°, and 48°, respectively. Complications were reported in 33.6% of patients, with fractures (20.9%) and infections (18.6%) being the most common sources of complication. CONCLUSION Shoulder arthrodesis provides improvement in functional outcomes for end-stage glenohumeral injuries; however, it is also associated with high rates of complications.
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Affiliation(s)
| | - Grant H Cabell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Yaw D Boachie-Adjei
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Fares MY, Boufadel P, Daher M, Koa J, Khanna A, Abboud JA. Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes. Clin Orthop Surg 2023; 15:521-533. [PMID: 37529197 PMCID: PMC10375816 DOI: 10.4055/cios23018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 04/16/2023] [Indexed: 08/03/2023] Open
Abstract
The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.
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Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Peter Boufadel
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohammad Daher
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Akshay Khanna
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Abstract
Shoulder arthrodesis is an end-stage, salvage procedure for the glenohumeral joint and can provide a pain-free, stable shoulder with varying levels of function. Common indications include brachial plexus injury, chronic instability with rotator cuff and deltoid dysfunction, and failed shoulder arthroplasty. Multiple techniques are described, including intra-articular and extra-articular arthrodeses. Fusion can be accomplished with screw fixation, plate fixation, external fixation, and arthroscopic-assisted techniques. The optimal position of the arm is heavily debated in the literature, but the ideal position is thought to be 30° of flexion, 30° of abduction, and 30° of internal rotation. After successful fusion, the patient should be able to bring their hand to their mouth, reach their back pocket, and cross the midline for hygiene. Complications are not uncommon and include nonunion, malunion, fracture, and infection. With the increasing incidence of shoulder arthroplasty, failed arthroplasties are more commonly encountered. In a salvage situation, shoulder arthrodesis may be considered.
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Del Core MA, Cutler HS, Schacherer T, Khazzam M. Glenohumeral arthrodesis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:367-372. [PMID: 37588713 PMCID: PMC10426629 DOI: 10.1016/j.xrrt.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Glenohumeral arthrodesis is a salvage procedure indicated for brachial plexus palsy, refractory instability, humeral and/or glenoid bone loss, deltoid and rotator cuff insufficiency, and chronic infections. The aim is to provide a painless, stable shoulder that is positioned to maximize function. Scapulothoracic motion as well as motion of the elbow and hand deliver satisfactory function in most patients. Intra-articular, extra-articular, and more commonly, combined techniques involving glenohumeral and humeroacromial fusion, have been described. More recently, authors have reported arthroscopic assisted techniques for shoulder arthrodesis with promising results as well as less complicated conversion from shoulder arthrodesis to reverse total shoulder arthroplasty. Despite advances in materials and techniques, glenohumeral arthrodesis continues to be associated with complication rates as high as 43%. A thorough understanding of the indications, contraindications, outcomes, and complications is paramount to improving patient results. Glenohumeral arthrodesis is a safe and effective procedure for the appropriate indications. The high frequency of complications mandates a frank preoperative discussion to ensure that each patient understands the magnitude of the procedure, its risks, possible complications, and expected outcome.
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Affiliation(s)
- Michael A. Del Core
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Holt S. Cutler
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Timothy Schacherer
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Michael Khazzam
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
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Górecki M, Czarnecki P. The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis. EFORT Open Rev 2021; 6:797-807. [PMID: 34667651 PMCID: PMC8489470 DOI: 10.1302/2058-5241.6.200114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Based on the literature, 294 shoulder arthrodeses after brachial plexus injury in adults were assessed, mostly male; the mean age of the patients was 33 years, and the mean follow-up time was 5.5 years. The most common cause of injury was a traffic accident, especially on a motorcycle. Arthrodesis position ranged from 15 to 40 degrees of flexion, 15 to 60 degrees of abduction, and 0 to 50 degrees of internal rotation with the predominance of position by the 30-30-30 rule. Plates, screws, and external fixation were used for stabilization. The complication rate was at the level of 28%, the most common complication being delayed union or nonunion. Active movements of flexion and abduction averaged 61 and 56 degrees, respectively, while reaching the hand to the mouth, front pocket, and buttock was feasible for 69%, 71%, and 38%, respectively, after surgery. Shoulder pain was present in 77% of patients, and 28% experienced no relevant pain reduction after surgery. The subjective satisfaction rate was 82% based on significant improvement and satisfaction reported by patients after arthrodesis. Arthrodesis of the shoulder, in adult patients after brachial plexus palsy, can reduce shoulder pain, increase stability, and result in a range of motion that increases the possibility of carrying out everyday activities. This affects the high level of subjective patient satisfaction after surgery. Cite this article: EFORT Open Rev 2021;6:797-807. DOI: 10.1302/2058-5241.6.200114
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Affiliation(s)
- Michał Górecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
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Baek S, Shin MH, Kim TM, Im JM, Oh KS, Chung SW. Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211022241. [PMID: 34527751 PMCID: PMC8435932 DOI: 10.1177/23259671211022241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Interposition grafting (IG), also called bridging grafting, and superior capsular reconstruction (SCR) are the most commonly used joint-preserving surgical methods for irreparable rotator cuff tears (RCTs). Purpose: To compare the effectiveness of IG versus SCR to treat patients with irreparable RCTs. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed in MEDLINE, Embase, and Scopus. Included in this review were clinical studies evaluating the effect of IG or SCR in patients with irreparable RCTs with a minimum follow-up of 1 year. Various clinical results from the studies were extracted and compared between IG and SCR, and among them, the results of the American Shoulder and Elbow Surgeons score, graft retear rate, and complication rate were included in the meta-analysis. Results: Of 1638 identified articles, 17 (10 studies of IG involving 321 patients and 7 studies of SCR involving 357 patients) were selected. Both surgical methods showed significantly improved clinical outcomes in all but 1 study; however, the IG group had lower pain visual analog scale score, higher Constant score, and bigger active forward flexion and internal rotation compared with the SCR group (all P < .001). The meta-analysis showed no difference in the American Shoulder and Elbow Surgeons score between groups (P = .44), but showed a significantly lower complication rate in the IG group compared with the SCR group (1.12% vs 8.37%, respectively; P < .001). The graft retear rate was not significantly different between groups (IG = 10.64% vs SCR = 12.67%; P = .79). The meta-analysis of graft type indicated no difference between groups in retear rate (autograft: 95% CI, 0.045-0.601; I2 = 93.28 [IG], 91.27 [SCR]; P = .22; allograft: 95% CI, 0.041-0.216; I2 = 80.39 [IG], 69.12 [SCR]; P = .64) or complication rate (autograft: 95% CI, 0.009-0.150; I2 = 0 [IG], 65.89 [SCR]; P = .25; allograft: 95% CI, 0.012-0.081; I2 = 0 [IG], 30.62 [SCR]; P = .09). Conclusion: Both IG and SCR techniques resulted in improvement in patients with irreparable RCTs. Meta-analysis showed a lower complication rate in the IG group; however, the lack of randomized studies limited our conclusions.
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Affiliation(s)
- Samuel Baek
- Department of Orthopaedic Surgery, Seoul Red Cross Hospital, Seoul, Republic of Korea
| | - Myung Ho Shin
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Je Min Im
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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Biomechanical bases for tendon transfers at the shoulder. HAND SURGERY & REHABILITATION 2021; 41S:S29-S33. [PMID: 34217900 DOI: 10.1016/j.hansur.2018.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/19/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022]
Abstract
Paralysis of the muscles around the shoulder is a debilitating condition that continues to be a very challenging problem. It leads to an inability to position one's hand in space. This greatly compromises the function of the upper limb and can lead to chronic shoulder pain due to inferior glenohumeral subluxation. Management of these complex problems has two main objectives: (i) stabilize the glenohumeral joint to decrease pain related to inferior glenohumeral subluxation; (ii) restore active range of motion in external rotation, abduction, and internal rotation. All the shoulder muscles contract in a coordinated and complex manner to allow the shoulder to move through a complete range of motion. Understanding how the different muscle groups coordinate their contractions and the basic biomechanical principles of tendon transfers is paramount before considering doing a tendon transfer around the shoulder. To function properly, a tendon transfer should have a similar line of pull (similar moment arm), similar tension and similar excursion to that of the muscle it replaces; one tendon transfer should replace only one function and the donor (transferred) muscle should have normal muscle strength (at least M4).
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Rayidi VKR, R S, Appaka JKCV. Functional Evaluation of Levator Scapulae Tendon to Supraspinatus in Adult Brachial Plexus Injuries. Indian J Plast Surg 2021; 54:38-45. [PMID: 33814740 PMCID: PMC8012784 DOI: 10.1055/s-0040-1721865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction
Brachial plexus injuries are severe life-altering injuries. The surgical method to restore shoulder abduction in adult upper brachial plexus injuries involves the usage of nerve grafts and nerve transfers targeting the suprascapular and/or the axillary nerve. When the primary nerve surgery has been unsuccessful or recovery has been incomplete or with a late presentation, muscle transfer procedures are needed to provide or improve shoulder abduction. Levator scapulae to supraspinatus is a transfer to improve shoulder abduction in posttraumatic brachial plexus injuries.
Material and Methods
The study included 13 patients with the age ranging from 17 to 47 years with a mean age of 30 years. All these patients had preop shoulder abduction of Medical Research Council (MRC) grade ≤3. All had a minimum of MRC grade 4 of active elbow flexion. Eleven patients had primary surgery. Only patients with a minimum of 1 year postoperative follow-up were included. All 13 patients underwent levator scapulae transfer only.
Results
All patients had a stable shoulder postoperatively. The average increase in active shoulder abduction was from 6.15°(median: 0°) preoperatively to 61.92°(median: 60°), with an average gain in shoulder abduction of 49.61°(median: 50°).
Conclusions
Transfer of levator scapulae tendon to the supraspinatus is an option to improve shoulder abduction in posttraumatic brachial plexus. In conditions where supraspinatus alone is not functioning, levator scapulae is the best available transfer, considering its strength and maintaining the form of the shoulder unlike trapezius transfer. In patients with previous surgery where supraspinatus has recovered partially but not functionally significant, this tendon transfer can be considered for the augmentation of the existing shoulder abduction.
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Affiliation(s)
- Venkata Koteswara Rao Rayidi
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Srikanth R
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Jagadish Kiran C V Appaka
- Department of Plastic and Reconstructive Surgery, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Takemura Y, Kodama N, Ando K, Takada D, Ueba H, Imai S. Shoulder reconstruction following coracoid chondrosarcoma using liquid nitrogen-treated tumor-bearing bone combined with a vascularized iliac bone graft: A case report. J Orthop Sci 2020:S0949-2658(20)30333-X. [PMID: 33309131 DOI: 10.1016/j.jos.2020.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/01/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshinori Takemura
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowacho Otsu Shiga, 520-2192, Japan.
| | - Narihito Kodama
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowacho Otsu Shiga, 520-2192, Japan.
| | - Kosei Ando
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowacho Otsu Shiga, 520-2192, Japan.
| | - Daisuke Takada
- Trauma Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura-shi, Kanagawa, 247-8533, Japan.
| | - Hiroaki Ueba
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, 185-1 Kohasu, Okocho, Nankoku, Kochi, 783-8505, Japan.
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowacho Otsu Shiga, 520-2192, Japan.
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Arenas-Miquelez A, Arbeloa-Gutierrez L, Familiari F, de Pablos J. Salvage Procedures of the Shoulder: Glenohumeral Arthrodesis and Resection Arthroplasty. Indian J Orthop 2020; 55:27-37. [PMID: 34122752 PMCID: PMC8149774 DOI: 10.1007/s43465-020-00279-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND With the advances of modern medicine and technology there has been an increase of indications of shoulder reconstruction techniques and shoulder arthroplasty. Consequently, the number of complications and failures have increased in parallel. Not negligible number of cases are driven to an end-stage situation where salvage procedures, such as glenohumeral arthrodesis (GHA) and shoulder resection arthroplasty (SRA), are the only remaining solution. METHODS The current literature on glenohumeral arthrodesis and shoulder resection arthroplasty was reviewed to determine the indications, surgical technique, complications and outcomes. The electronic search was conducted using the MEDLINE and EMBASE databases and the strategies used were "glenohumeral arthrodesis", "glenohumeral fusion", "shoulder arthrodesis" and "shoulder resection arthroplasty". RESULTS Indications for glenohumeral arthrodesis (GHA) include brachial plexus injury, tumor resections, chronic infection, failed prosthetic arthroplasty, persistent refractory instability or pseudoparalysis of the shoulder with combined irreparable rotator cuff and deltoid injuries. GHA provides good stability, pain resolution, although function is markedly compromised and relying mostly on scapulothoracic joint. The gold standard surgical technique continues to be open shoulder arthrodesis and still has a high complication rate. Shoulder resection arthroplasty (SRA) indications have evolved through the years, being nowadays a salvage procedure for recalcitrant infection of shoulder arthroplasty the main indication. Shoulder function after SRA is often severely compromised, but has a high infection rate resolution. SRA is not technically demanding and complications are rare, being the persistence of infection the most common one. DISCUSSION Despite GHA and SRA having negative connotations, in selected patients, these procedures can diminish pain, resolve persistent infections and provide an acceptable shoulder function. Hence, they should be retained as part of the treatment algorithm for complex shoulder pathology.
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Affiliation(s)
- Antonio Arenas-Miquelez
- grid.1004.50000 0001 2158 5405Shoulder and Elbow, Orthopaedics, Macquarie University Hospital, Suite 303, 2 Technology Place, Sydney, NSW 2109 Australia
| | | | - Filippo Familiari
- Department of Orthopaedic and Traumatology, Villa del Sole Clinic, Catanzaro, Italy
| | - Julio de Pablos
- Advanced Reconstructive Osseous Surgery, San Juan de Dios Hospital, Pamplona, Spain
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Dogger MN, Bemmel AFV, Alta TDW, van Noort A. Conversion to reverse shoulder arthroplasty fifty-one years after shoulder arthrodesis: A case report. World J Orthop 2020; 11:465-472. [PMID: 33134109 PMCID: PMC7582107 DOI: 10.5312/wjo.v11.i10.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/23/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with a shoulder arthrodesis generally experience restriction in range of motion and limitations in activities of daily living. In addition, up to one-third of the patients deals with serious peri scapular pain. The conversion of a shoulder arthrodesis in a reverse shoulder arthroplasty (RSA) has been described as an effective treatment to achieve better function and decreased pain, although literature is sparse. We present the case of a conversion from a painful shoulder arthrodesis to RSA, after a 51 years interval.
CASE SUMMARY A 71-year-old male presented with severe peri scapular pain and limited function 51 years after shoulder arthrodesis. Preoperative workup showed a normal bone stock of the glenoid and an intact axillary nerve, but atrophic posterior part of the deltoid muscle. The shoulder arthrodesis was successfully converted to RSA. Twelve months postoperative the patient was very satisfied. He has no pain at rest, nor with exercise and experienced definite improvements in activities of daily living, despite his limited range of motion.
CONCLUSION Conversion from shoulder arthrodesis to a RSA can be performed safely, with a high chance of peri scapular pain relief; even after a longstanding arthrodesis.
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Affiliation(s)
- Melissa N Dogger
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, Netherlands
| | | | - Tjarco D W Alta
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, Netherlands
| | - Arthur van Noort
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, Netherlands
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13
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Pajolli LJR, Carlini MC, Ferrari I, Matsunaga FT, Archetti Netto N, Tamaoki MJS. Intra and Interobserver Agreement Regarding the Walch Classification System for Shoulder Joint Arthritis. Rev Bras Ortop 2019; 54:644-648. [PMID: 31875062 PMCID: PMC6923637 DOI: 10.1016/j.rbo.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 04/03/2018] [Indexed: 11/20/2022] Open
Abstract
Objective
To evaluate the inter- and intraobserver agreement regarding the Walch classification system for shoulder arthritis.
Methods
Computed tomography scans of the shoulder joint of adult patients were selected between 2012 and 2016, and they were classified by physicians with different levels of expertise in orthopedics. The images were examined at three different times, and the analyses were evaluated by the Fleiss Kappa index to verify the intra- and interobserver agreement.
Results
The Kappa index for the intraobserver agreement ranged from 0.305 to 0.545. The inter-observer agreement was very low at the end of the three evaluations (κ = 0.132).
Conclusion
The intraobserver agreement regarding the modified Walch classification varied from moderate to poor. The interobserver agreement was low.
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Affiliation(s)
- Lauro José Rocchetti Pajolli
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
- Endereço para correspondência Lauro José Rocchetti Pajolli, MD Departamento de Ortopedia e Traumatologia, Escola Paulista de MedicinaUniversidade Federal de São Paulo (Unifesp), São Paulo, SPBrasil
| | - Marcelo Casciato Carlini
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Isabella Ferrari
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Fábio Teruo Matsunaga
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Nicola Archetti Netto
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Marcel Jun Sugawara Tamaoki
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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14
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Hasler A, Fornaciari P, Jungwirth-Weinberger A, Jentzsch T, Wieser K, Gerber C. Reverse shoulder arthroplasty in the treatment of glenohumeral instability. J Shoulder Elbow Surg 2019; 28:1587-1594. [PMID: 31000425 DOI: 10.1016/j.jse.2019.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenohumeral instability is a rare indication for primary reverse total shoulder arthroplasty (RTSA), accounting for fewer than 1% of the indications in the literature. The aim of this study was to analyze the clinical and radiographic outcomes of RTSA for recurrent instability after failed operative repair or instability associated with major bone loss in elderly patients. METHODS A retrospective matched case-control study was performed. We compared 11 shoulders treated with RTSA for instability (cases) with 22 matched shoulders treated with RTSA for rotator cuff insufficiency (controls). Clinical and radiographic outcomes were compared. RESULTS The median follow-up period was 74 months (interquartile range [IQR], 18 months; range, 22-171 months) in cases and 70 months (IQR, 13 months; range, 23-172 months) in controls. The median age was 74 years (IQR, 18 years) in the case group and 70 years (IQR, 13 years) in the control group. No significant differences were found between the 2 groups in satisfaction scores, preoperative and postoperative absolute and relative Constant scores, and complication rates. Active range of motion tended to be superior in the controls for mean flexion (130° vs. 110°, P = .15), abduction (143° vs. 100°, P = .16), and external rotation (28° vs. 20°, P = .86) without the differences reaching statistical significance, possibly because of the small sample size. Postoperative dislocation was not recorded in cases or controls, but subjective insecurity regarding stability was reported once in each group. CONCLUSION RTSA seems to represent a valuable treatment option for glenohumeral instability in an elderly population with large bone loss or as a salvage procedure after failed operative glenohumeral stabilization. Postoperative instability was not observed in the case and control groups.
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Affiliation(s)
- Anita Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Paolo Fornaciari
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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15
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Kamineni S, Unger RZ, Desai R. Shoulder Arthrodesis in the Management of Glenohumeral Pathologies. J Shoulder Elb Arthroplast 2019. [DOI: 10.1177/2471549219850655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In an era of advanced shoulder stabilization procedures, arthroplasty implants and techniques, shoulder arthrodesis is considered an end-stage salvage procedure with negative connotations. However, in correctly selected patients, arthrodesis can alleviate pain, provide acceptable and stable motion, with a resultant functional shoulder. Methods The current literature on shoulder arthrodesis was reviewed to determine the indications, surgical technique, post-operative rehabilitation, complications and outcomes. Results Indications for shoulder arthrodesis include brachial plexus injuries, paralytic disorders, pseudo paralysis from combined severe/irreparable rotator cuff and deltoid injuries, inflammatory arthritis with severe rotator cuff pathology, persistent refractory instability, and tumor resection. Shoulder arthrodesis generally involves compression screws with or without plate fixation and bone graft. The arthrodesis is positioned to optimize the function of the extremity, primarily for activities of daily living. Postoperatively, most patients are immobilized for 8 to 10 weeks, dependent on the completeness of radiological fusion. Complications include nonunion, shoulder girdle muscle atrophy, painful hardware, periprosthetic fractures, and infection. Discussion With the use of recent biological innovations, the nonunion rate has declined, and rehabilitation technologies have allowed maintenance of muscle mass for future conversion to shoulder arthroplasty. Hence, in carefully selected patients, shoulder arthrodesis provides a valuable option for a stable, functional, and pain-free shoulder and should be retained as part of the treatment algorithm for complex shoulder pathology.
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Affiliation(s)
- Srinath Kamineni
- Department of Orthopaedic Surgery and Sports Medicine, Elbow Shoulder Research Centre University of Kentucky, Lexington, Kentucky
| | - R Zackary Unger
- Department of Orthopaedic Surgery and Sports Medicine, Elbow Shoulder Research Centre University of Kentucky, Lexington, Kentucky
| | - Rasesh Desai
- Department of Orthopaedic Surgery and Sports Medicine, Elbow Shoulder Research Centre University of Kentucky, Lexington, Kentucky
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16
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Belkheyar Z, Belkacem Djeffel A, Cambon-Binder A. Glenohumeral fusion in adults with sequelae of obstetrical brachial plexus injury: a report of eight cases. J Hand Surg Eur Vol 2019; 44:248-255. [PMID: 30466377 DOI: 10.1177/1753193418812639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess the outcomes of glenohumeral fusion performed in adulthood in patients with poor recovery after obstetric brachial plexus injury. We reviewed eight patients with obstetrical brachial plexus injury who had undergone shoulder arthrodesis. The mean age was 28 years (range 16 to 55). All of the patients had active periscapular and elbow flexor muscles. At an average follow-up of 20 months, the active range of abduction and external rotation of the affected shoulder was 67° (range 50° to 85°) and 21° (range 0° to 40°), respectively. All of the patients were satisfied with the outcome of the intervention. Fusion was obtained between 3 and 6 months, and none of the patients experienced residual pain. Shoulder fusion improved the active shoulder abduction and external rotation in adults with residual obstetrical brachial plexus paralysis. Level of evidence: IV.
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Affiliation(s)
| | | | - Adeline Cambon-Binder
- 3 Department of Orthopaedic and Hand Surgery, Saint-Antoine Hospital, Paris, France.,4 Sorbonne Université, Paris, France
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17
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Abstract
Articular cartilage injuries in the glenohumeral joint present a unique and difficult problem for the patient and surgeon alike. Various etiologies exist for the development of these cartilage lesions; therefore, treatment options are vast and must be chosen thoughtfully, especially in the young, active patient. Across all treatment modalities, the goal is for the patient to regain lasting function and mobility while decreasing pain.
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18
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Toney CB, Thompson MJ, Barnes BJ, Boardman ND. Conversion of Glenohumeral Fusion to Reverse Total Shoulder Arthroplasty: A Case Report. JBJS Case Connect 2018; 7:e20. [PMID: 29244700 DOI: 10.2106/jbjs.cc.16.00029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CASE A 41-year-old woman presented 5 years after glenohumeral arthrodesis. She experienced symptomatic relief following conversion to reverse total shoulder arthroplasty, regaining nearly full passive range of motion and >50% of normal active forward flexion, abduction, internal rotation, and external rotation. CONCLUSION Conversion from glenohumeral arthrodesis to reverse total shoulder arthroplasty in a patient with a functioning deltoid and adequate bone stock may provide symptomatic relief and improved function in the setting of symptomatic glenohumeral arthrodesis refractory to conservative measures.
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Affiliation(s)
- C Brian Toney
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
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19
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Wagner ER, McLaughlin R, Sarfani S, Cofield RH, Sperling JW, Sanchez-Sotelo J, Elhassan BT. Long-Term Outcomes of Glenohumeral Arthrodesis. J Bone Joint Surg Am 2018; 100:598-604. [PMID: 29613929 DOI: 10.2106/jbjs.17.00428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenohumeral arthrodesis is associated with a high rate of complications. Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function. The purpose of this study was to examine the clinical outcomes of glenohumeral arthrodesis. METHODS Twenty-nine patients with 29 affected shoulders underwent primary glenohumeral arthrodesis between 1992 and 2009. Surgical indications included rotator cuff arthropathy and pseudoparalysis (n = 7), neurologic injuries (n = 12), chronic infection (n = 3), recurrent dislocations (n = 3), and proximal humeral or shoulder girdle tumors (n = 4). Surgical fixation techniques included plates and screws in 18 patients and screws only in 11 patients. RESULTS All patients were examined, with a mean follow-up of 12 years (range, 2 to 22 years). Twelve patients (41%) had postoperative complications, including 6 periprosthetic fractures, 7 nonunions, and 3 infections. Eleven patients (38%) required additional surgical procedures after arthrodesis, including revision internal fixation to achieve glenohumeral fusion after nonunions (n = 7), irrigation and debridement with antibiotic treatment for deep infections (n = 2), open reduction and internal fixation to treat fracture (n = 2), and implant removal to treat symptomatic patients (n = 3). Patients experienced reasonable overall pain relief. The mean postoperative scores were 35 points for the Subjective Shoulder Value, 58 points for the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and 54 points for the Short Form-36. Eighty-seven percent of patients reported postoperative limitations. Patients with neurologic injuries had worse functional outcomes, and an arthrodesis position of ≥25° yielded better functional outcomes. CONCLUSIONS Glenohumeral arthrodesis is associated with a high rate of patients with complications (41%). Although patients experience reasonable pain relief and shoulder stability, they experience marked limitations in their upper-extremity function. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Shumaila Sarfani
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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20
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Wall KC, Toth AP, Garrigues GE. How to Use a Graft in Irreparable Rotator Cuff Tears: A Literature Review Update of Interposition and Superior Capsule Reconstruction Techniques. Curr Rev Musculoskelet Med 2018; 11:122-130. [PMID: 29327176 DOI: 10.1007/s12178-018-9466-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE OF REVIEW To introduce the challenges in addressing irreparable rotator cuff tears and examine the surgical options, specifically interposition grafting and superior capsule reconstruction. RECENT FINDINGS Interposition grafting of rotator cuff tears shows promising results in reducing pain and improving function postoperatively and one study demonstrated that it performs significantly better than partial repair alone. Superior capsule reconstruction has become popular rapidly, but given the novelty of the procedure, there is currently a paucity of outcomes data to review. Irreparable rotator cuff tears are a challenging condition with a variety of surgical options available. Two such options-interposition and superior capsule reconstruction-both employ grafts in an attempt to restore joint stability and function. In the past 3 years, literature discussing interposition grafting has explored the different types of grafts, and mostly employed pre-post analysis. The recent superior capsule reconstruction articles strictly used human dermal allograft and offer a variety of surgical techniques without quantitative data.
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Affiliation(s)
- Kevin C Wall
- Duke University School of Medicine, Duke University Health System, Durham, NC, USA
| | - Alison P Toth
- Section for Shoulder Reconstruction, Department of Orthopaedic Surgery, Duke University Medical Center, Box 3639, Durham, NC, 27710, USA
| | - Grant E Garrigues
- Section for Shoulder Reconstruction, Department of Orthopaedic Surgery, Duke University Medical Center, Box 3639, Durham, NC, 27710, USA.
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21
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Elhassan BT, Wagner ER, Werthel JD, Lehanneur M, Lee J. Outcome of reverse shoulder arthroplasty with pedicled pectoralis transfer in patients with deltoid paralysis. J Shoulder Elbow Surg 2018; 27:96-103. [PMID: 28941970 DOI: 10.1016/j.jse.2017.07.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/12/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of shoulder arthritis associated with deltoid paralysis can be very challenging. The purpose of this study was to report the outcome of reverse shoulder arthroplasty with pedicled pectoralis transfer to reconstruct the anterior deltoid in patients with symptomatic shoulder arthritis and a paralyzed deltoid. METHODS This study included 31 patients with an average age of 51 years (range, 27-73 years). All patients had chronic deltoid paralysis with significant loss of function due to progressive arthritis associated with rotator cuff deficiency. All patients underwent reverse shoulder arthroplasty with pedicled pectoralis muscle transfer. Additional transfers were performed in patients with no preoperative external rotation: 5 underwent latissimus transfer, and 3 underwent direct lower trapezius transfer to the infraspinatus. RESULTS At an average follow-up of 37 months, 29 patients had significant improvements in pain; the shoulder subjective value; the Disabilities of the Arm, Shoulder and Hand score; and shoulder range of motion, mainly flexion of 83° and external rotation of 15°. Two patients sustained postoperative acromial fractures and had persistent pain after surgery with minimal improvement in shoulder flexion and external rotation. One of them had a failed attempt at open reduction-internal fixation of the acromion. CONCLUSION Reverse shoulder arthroplasty with pedicled pectoralis transfer is a promising procedure that may lead to improved pain and function in patients with shoulder arthritis associated with deltoid paralysis.
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Affiliation(s)
| | - Eric R Wagner
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Malo Lehanneur
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Julia Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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22
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Puskas GJ, Lädermann A, Hirsiger S, Hoffmeyer P, Gerber C. Revision rate after screw or plate arthrodesis of the glenohumeral joint. Orthop Traumatol Surg Res 2017; 103:875-884. [PMID: 28669920 DOI: 10.1016/j.otsr.2017.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Glenohumeral arthrodesis is a rare salvage procedure for selected patients with different shoulder pathologies. Among a variety of surgical techniques, compression screws or plate fixation are most widely used. Minimally invasive screw fixation has become more popular, although it has been shown to be biomechanically inferior to plate arthrodesis. HYPOTHESIS Screw arthrodesis would lead to a higher revision rate than plate arthrodesis. MATERIAL AND METHODS Twenty-seven plate and 7 screw arthrodesis of the glenohumeral joint in 19 male and 15 female patients of a mean age of 50years (range, 16-85years) were reviewed in a retrospective multicenter study with at a follow-up of 43months (range, 11-152months) to compare their clinical and radiographic outcome with special focus on revision rate. RESULTS Constant score did not change, but its subscore for pain significantly improved from 4.5 points (range, 0-15 points) to 11 points (range, 6-15 points). The subjective shoulder value increased significantly from 19% (range, 0-70%) to 41% (range, 10-80%) and 81% of the patients were satisfied. In 14 patients (41%), the arthrodesis had to be revised either for non-union (11) or malunion (3) at a mean of 12months (range, 0-47months). The 2 groups did not differ in terms of demographic data, nor of preoperative and postoperative clinical data. There were more revisions after screw than plate fixation. If revision was performed for non-union, this difference was significant. DISCUSSION/CONCLUSION In selected patients, glenohumeral arthrodesis can significantly reduce pain and achieve at best a reasonable function and subjective satisfaction rate. Revision rates favor plate over isolated screw fixation. LEVEL OF EVIDENCE IV retrospective series.
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Affiliation(s)
- G J Puskas
- Orthopedic Department University, Balgrist University Hospital, Zurich, Switzerland.
| | - A Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - S Hirsiger
- Orthopedic Department University, Balgrist University Hospital, Zurich, Switzerland
| | - P Hoffmeyer
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - C Gerber
- Orthopedic Department University, Balgrist University Hospital, Zurich, Switzerland
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23
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Thangarajah T, Higgs D, Bayley JIL, Lambert SM. Glenohumeral arthrodesis for recurrent types II and III shoulder instability. J Shoulder Elbow Surg 2017; 26:687-691. [PMID: 27856264 DOI: 10.1016/j.jse.2016.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study reports the clinical outcome after glenohumeral arthrodesis for recurrent type II (atraumatic structural) and type III (muscle patterning nonstructural disorder) shoulder instability. METHODS A retrospective review was conducted at a single facility. Eight consecutive patients (7 women and 1 man) with recurrent shoulder instability underwent arthrodesis and were monitored for a mean of 57 months (range, 24-123 months). Mean age at the time of surgery was 47 years (range, 21-73 years). RESULTS Bony union was achieved in all patients at a mean time to fusion of 3 months (range, 1-11 months). No complications, such as routine removal of the metalwork or loosening, were noted. No residual perceived glenohumeral instability was reported, and no patient developed scapulothoracic instability or painful scapular dyskinesis. The mean Oxford Shoulder Instability Score improved from 8 preoperatively (range, 0-19) to 32 postoperatively (range, 16-41; P = .001). This was accompanied by an increase in the mean subjective shoulder value, which improved from 22 (range, 0-50) preoperatively to 73 (range, 50-100) postoperatively (P = .004). CONCLUSION In our series, glenohumeral arthrodesis was associated with no complications and was able to reduce pain, eliminate instability, and improve functional outcome. It should therefore be considered in this patient population.
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Affiliation(s)
- Tanujan Thangarajah
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Deborah Higgs
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - J Ian L Bayley
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Simon M Lambert
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, UK
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24
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Kendall J, McNally M. Septic Arthritis of the Shoulder with Proximal Humerus Osteomyelitis, Treated by Ilizarov Shoulder Arthrodesis. J Bone Jt Infect 2017; 2:90-95. [PMID: 28529869 PMCID: PMC5423580 DOI: 10.7150/jbji.17083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Septic arthritis of the shoulder can destroy the glenohumeral joint resulting in significant pain, instability and poor function. Surgical treatment is notoriously difficult with significant risk of complications. Shoulder arthrodesis has been performed using both internal and external fixation but has high complication rates in the presence of infection. We present our experience of managing a patient with significant pain and loss of function as a result of septic arthritis of the shoulder following infected proximal humeral fracture fixation with associated proximal humeral osteomyelitis. We discuss patient presentation, appropriate investigations, decision-making, pre-operative planning and the principles of managing of bone and joint infection. Wide excision with Ilizarov stabilisation and implantation of an absorbable antibiotic carrier, allowed successful fusion with eradication of the infection. The benefits of using this arthrodesis technique include reduced risk of infection recurrence and excellent stability of construct, therefore reducing time to fusion and minimising soft tissue trauma with the opportunity for early rehabilitation and return to optimal level of function.
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Affiliation(s)
- John Kendall
- Department of Limb Reconstruction, Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University, Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE
| | - Martin McNally
- Department of Limb Reconstruction, Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University, Hospitals NHS Foundation Trust, Windmill Road, Oxford, OX3 7HE
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25
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Fischer C, Krammer D, Hug A, Weber MA, Kauczor HU, Krix M, Bruckner T, Kunz P, Schmidmaier G, Zeifang F. Dynamic contrast-enhanced ultrasound and elastography assess deltoid muscle integrity after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:108-117. [PMID: 27374234 DOI: 10.1016/j.jse.2016.04.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 03/16/2016] [Accepted: 04/05/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The outcome after reverse shoulder arthroplasty (RSA) depends on the condition of the deltoid muscle, which we assessed with new ultrasound modalities and electromyography (EMG). Contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) were applied to assess perfusion and elasticity of the deltoid muscle compared with the clinical and functional outcome. METHODS The study recruited 64 patients (mean age, 72.9 years) treated with RSA between 2004 and 2013. The deltoid muscle was examined with EMG and ultrasound imaging. Functional scores such as Constant score and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score were assessed. Among other CEUS parameters, the wash-in perfusion index, time to peak, and rise time were compared between the operated-on and contralateral shoulders as well as between patients with above-average and below-average outcome. The stiffness of the deltoid muscle was analyzed with ARFI. RESULTS After RSA, deltoid perfusion (wash-in perfusion index, Δ = -12% ± 22%, P = .0001) and shoulder function (Constant score, Δ = -14 ± 24, P < .0001) were both inferior compared with the contralateral side. This perfusion deficit was associated with a limited range of motion (time to peak and anteversion: r = -0.290, P = .022). Deltoid perfusion was higher in patients with above-average outcome (rise time, Δ = 33% ± 13%, P = .038). The operated-on deltoid muscles showed higher stiffness than the contralateral muscles (ARFI, Δ = 0.2 ± 0.9 m/s, P = .0545). EMG excluded functionally relevant axillary nerve injuries in the study population. CONCLUSIONS CEUS revealed reduced mean perfusion of the deltoid muscle after RSA. Reduced perfusion was associated with limited range of motion and below-average outcome. Functional shoulder impairment after RSA might be predicted by noninvasive CEUS as a surrogate parameter for the integrity of the deltoid muscle.
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Affiliation(s)
- Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
| | - Daniel Krammer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Hug
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Krix
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Pierre Kunz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Zeifang
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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26
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Thangarajah T, Lambert SM. Management of recurrent shoulder instability in patients with epilepsy. J Shoulder Elbow Surg 2016; 25:1376-84. [PMID: 27288273 DOI: 10.1016/j.jse.2016.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/13/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
Epileptic seizures can cause dislocation of the shoulder. Recurrent instability is common and occurs soon after the first dislocation. Significant bone loss from the humeral head and glenoid is thought to be responsible for this, and therefore the majority of surgical approaches focus on bone augmentation of the glenohumeral joint. Understanding of the current management strategies and the anatomic lesions associated with seizure-related shoulder instability will guide clinical decision-making. The purpose of this article was to review the pathoanatomy, treatment options, and clinical outcomes of seizure-related shoulder instability.
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Affiliation(s)
- Tanujan Thangarajah
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK.
| | - Simon M Lambert
- The Shoulder and Elbow Service, The Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Abstract
Restoration of shoulder function in patients with brachial plexus injury can be challenging. Initial reported efforts were focused on stabilizing the shoulder, improving inferior subluxation and restoring abduction and flexion of the joint. Recent advancements and improved understanding of coordinated shoulder motion and the biomechanical properties of the muscles around the shoulder applicable to tendon transfer have expanded available surgical options to improve shoulder function, specifically external rotation. Despite the advances in reconstructive options, brachial plexus injury remains a serious problem that requires complex surgical solutions, prolonged recovery, and acceptance of functional loss.
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Affiliation(s)
- Chelsea C Boe
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Bassem T Elhassan
- Department of Orthopedic Surgery, College of Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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28
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Rotator Cuff Tear Arthropathy: Pathophysiology, Imaging Characteristics, and Treatment Options. AJR Am J Roentgenol 2015; 205:W502-11. [DOI: 10.2214/ajr.14.13815] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Fávaro RC, Abdulahad M, Filho SM, Valério R, Superti MJ. Artropatia de manguito: o que esperar do resultado funcional da artroplastia reversa? Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fávaro RC, Abdulahad M, Filho SM, Valério R, Superti MJ. Rotator cuff arthropathy: what functional results can be expected from reverse arthroplasty? Rev Bras Ortop 2015; 50:523-9. [PMID: 26535197 PMCID: PMC4610983 DOI: 10.1016/j.rboe.2015.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/10/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the functional results from reverse arthroplasty and its complications and relationships with types of injury. METHODS Twenty-seven shoulders (26 women and one man) were treated. The patients were assessed using the UCLA functional scale. The implant used was the Delta Xtend Depuy(®) model. The injuries were classified using the Seebauer method for the degree of arthroplasty and the Nerot method for notching. RESULT The mean age was 77.4 years (range: 67-89) and the follow-up was 25.8 months (range: 6-51). The preoperative UCLA score was 10.1 (range: 6-15) and the postoperative UCLA score was 29.8 (range: 22-35), which was a statistically significant improvement (p < 0.001). According to the Seebauer classification, five patients were 1B, 19 were 2A and three were 2B. Fifteen cases presented complications (55.5%) and notching was the commonest of these, occurring in 14 patients (nine with grade 1 and five with grade 2), but this did not cause instability in any of them. Only one patient (3.7%) had a major complication, consisting of dislocation in the immediate postoperative period. Two patients (7.4%) said that they would undergo the procedure again. One patient (3.7%) underwent a revision procedure. CONCLUSION Reverse arthroplasty was shown to be an excellent option for treating patients with rotator cuff arthropathy, with a low rate of major complications. Notching was a frequent complication, but in the majority of the cases, it did not present clinical repercussions.
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Thangarajah T, Alexander S, Bayley I, Lambert SM. Glenohumeral arthrodesis for the treatment of recurrent shoulder instability in epileptic patients. Bone Joint J 2015; 96-B:1525-9. [PMID: 25371468 DOI: 10.1302/0301-620x.96b11.33754] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report our experience with glenohumeral arthrodesis as a salvage procedure for epilepsy-related recurrent shoulder instability. A total of six patients with epilepsy underwent shoulder fusion for recurrent instability and were followed up for a mean of 39 months (12 to 79). The mean age at the time of surgery was 31 years (22 to 38). Arthrodesis was performed after a mean of four previous stabilisation attempts (0 to 11) in all but one patient in whom the procedure was used as a primary treatment. All patients achieved bony union, with a mean time to fusion of 2.8 months (2 to 7). There were no cases of re-dislocation. One revision was undertaken for loosening of the metalwork, and then healed satisfactorily. An increase was noted in the mean subjective shoulder value, which improved from 37 (5 to 50) pre-operatively to 42 (20 to 70) post-operatively although it decreased in two patients. The mean Oxford shoulder instability score improved from 13 pre-operatively (7 to 21) to 24 post-operatively (13 to 36). In our series, glenohumeral arthrodesis eliminated recurrent instability and improved functional outcome. Fusion surgery should therefore be considered in this patient population. However, since the majority of patients are young and active, they should be comprehensively counselled pre-operatively given the functional deficit that results from the procedure.
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Affiliation(s)
- T Thangarajah
- Royal National Orthopaedic Hospital Stanmore, The John Scales Centre for Biomedical Engineering, IOMS, Division of Surgery and Interventional Science, University College London, HA7 4LP, UK
| | - S Alexander
- The Royal National Orthopaedic Hospital, The Shoulder and Elbow Service, Stanmore, HA7 4LP, UK
| | - I Bayley
- The Royal National Orthopaedic Hospital, The Shoulder and Elbow Service, Stanmore, HA7 4LP, UK
| | - S M Lambert
- The Royal National Orthopaedic Hospital, The Shoulder and Elbow Service, Stanmore, HA7 4LP, UK
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Valenti P, Kilinc AS, Sauzières P, Katz D. Results of 30 reverse shoulder prostheses for revision of failed hemi- or total shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2014; 24:1375-82. [PMID: 24136494 PMCID: PMC4242974 DOI: 10.1007/s00590-013-1332-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/29/2013] [Indexed: 11/01/2022]
Abstract
PURPOSE Revision surgery for shoulder prosthesis remains a difficult task in shoulder surgery. The purpose of this retrospective study was to evaluate the clinical and radiological outcomes of a series of 30 reverse shoulder prostheses performed as revision of failed hemi- or total shoulder arthroplasty. The most relevant technical points in surgery are described, as are other surgical options; a rational strategy for the treatment of these patients is proposed. MATERIALS AND METHODS Thirty patients (average age 69.5) were included. Mean follow-up was 36.4 months (range 24-100 months). There were 14 patients in group 1 (Delta III) and 16 in group 2 (Reverse Arrow). RESULTS A total of 83% were satisfied (16 cases) or very satisfied (9 cases), and 17% were disappointed (5 patients). The mean Constant score increased from a mean of 25-52. The mean score for pain improved from 5 (range 0-15) to 13 (range 5-15) (p < 0.001). The mean score of strength improved from 1 (range 0-6) to 5 (range 0-10) (p < 0.001). The forward elevation changed from a mean of 55° (range 0-120) to 108° (range 40-160) (p < 0.001). There was no significant improvement of external rotation at 0° abduction (range 14°-18°) or internal rotation (range 5-4.63). There were 4 scapular notching. We could not find the influence of scapular notching on Constant Score. Complication rate was 26.6%. CONCLUSION Reverse total shoulder arthroplasty prosthesis represents an available option in difficult cases of failed hemiarthroplasty or total shoulder arthroplasty when the rotator cuff is irreparable and the glenoid bone stock is sufficient. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Philippe Valenti
- Institut de la Main, Clinique Jouvenet, 6 Square Jouvenet, 75016 Paris, France
| | | | - Philippe Sauzières
- Institut de la Main, Clinique Jouvenet, 6 Square Jouvenet, 75016 Paris, France
| | - Denis Katz
- Clinique du Ter, BP 71, 56275 Ploemeur, Morbihan, France
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Arthroscopic glenohumeral arthrodesis with o-arm navigation. Arthrosc Tech 2014; 3:e205-9. [PMID: 24904761 PMCID: PMC4044498 DOI: 10.1016/j.eats.2013.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/24/2013] [Indexed: 02/03/2023] Open
Abstract
Glenohumeral arthrodesis is an end-stage salvage operation that has traditionally been performed in an open fashion. In recent years an arthroscopic approach has been described. The purpose of this report was to present an arthroscopic glenohumeral arthrodesis technique with the assistance of O-arm-based navigation. An illustrative case example is presented. This technique allows not only a minimally invasive glenohumeral arthrodesis but also precise screw fixation by navigation, which may be particularly useful in cases of limited bone stock and/or bony deformity.
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Biomechanical analysis for primary stability of shoulder arthrodesis in different resection situations. Clin Biomech (Bristol, Avon) 2013; 28:618-25. [PMID: 23809612 DOI: 10.1016/j.clinbiomech.2013.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 05/13/2013] [Accepted: 05/29/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Only very few publications dealing with shoulder arthrodesis after bone resection procedures and no biomechanical studies are available. The presented biomechanical analysis should ascertain the type of arthrodesis with the highest primary stability in different bone loss situations. METHODS On 24 fresh cadaveric shoulder specimens three different bone loss situations were investigated under the stress of abduction, adduction, anteversion and retroversion without destruction by the use of a material testing machine. In each of the testings a 16-hole reconstruction plate was used and compared to arthrodesis with an additional dorsal 6-hole plate. FINDINGS The primary stability of shoulder arthrodesis with a 16-hole reconstruction plate after humeral head resection could be increased significantly if an additional dorsal plate was used. However, no significant improvement with the additional plate was detected after resection of the acromion. Of all investigated forms, arthrodesis after humeral head resection with additional plate showed the highest and arthrodesis after humeral head resection without additional plate showed the lowest force values. The mean values for forces achieved in abduction and adduction were considerably higher than those in anteversion and retroversion. INTERPRETATION There are no consistent specifications of arthrodesis techniques after resection situation available, thus the presented biomechanical testings give important information about the most stable form of arthrodesis in different types of bone loss. These findings provide an opportunity to minimize complications such as pseudarthrosis for a satisfying clinical outcome.
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Ghosh S, Singh VK, Jeyaseelan L, Sinisi M, Fox M. Isolated latissimus dorsi transfer to restore shoulder external rotation in adults with brachial plexus injury. Bone Joint J 2013; 95-B:660-3. [PMID: 23632677 DOI: 10.1302/0301-620x.95b5.29776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In adults with brachial plexus injuries, lack of active external rotation at the shoulder is one of the most common residual deficits, significantly compromising upper limb function. There is a paucity of evidence to address this complex issue. We present our experience of isolated latissimus dorsi (LD) muscle transfer to achieve active external rotation. This is a retrospective review of 24 adult post-traumatic plexopathy patients who underwent isolated latissimus dorsi muscle transfer to restore external rotation of the shoulder between 1997 and 2010. All patients were male with a mean age of 34 years (21 to 57). All the patients underwent isolated LD muscle transfer using a standard technique to correct external rotational deficit. Outcome was assessed for improvement in active external rotation, arc of movement, muscle strength and return to work. The mean improvement in active external rotation from neutral was 24° (10° to 50°). The mean increase in arc of rotation was 52° (38° to 55°). Mean power of the external rotators was 3.5 Medical Research Council (MRC) grades (2 to 5). A total of 21 patients (88%) were back in work by the time of last follow up. Of these, 13 had returned to their pre-injury occupation. Isolated latissimus dorsi muscle transfer provides a simple and reliable method of restoring useful active external rotation in adults with brachial plexus injuries with internal rotational deformity.
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Affiliation(s)
- S Ghosh
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, United Kingdom
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Elhassan B, Bishop AT, Hartzler RU, Shin AY, Spinner RJ. Tendon transfer options about the shoulder in patients with brachial plexus injury. J Bone Joint Surg Am 2012; 94:1391-8. [PMID: 22854992 DOI: 10.2106/jbjs.j.01913] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with brachial plexus injury and to determine the factors associated with favorable outcomes. METHODS Fifty-two patients with traumatic brachial plexus injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 injury, twenty-two had a C5-7 injury, five had a C5-8 injury, and thirteen had a C5-T1 injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. RESULTS All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). CONCLUSIONS Tendon transfers about the shoulder can improve shoulder function in patients with brachial plexus injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder abduction and flexion can be achieved. The outcome can be expected to be better in patients with less severe nerve injury.
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Affiliation(s)
- Bassem Elhassan
- Departments of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
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Bhandari P, Bhatoe H, Mukherjee M, Deb P. Management strategy in post traumatic brachial plexus injuries. INDIAN JOURNAL OF NEUROTRAUMA 2012. [DOI: 10.1016/j.ijnt.2012.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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[Screw arthrodesis of the shoulder]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2012; 23:215-26. [PMID: 21751092 DOI: 10.1007/s00064-011-0035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the procedure is arthrodesis of the shoulder by osteosynthesis of the glenohumeral and the acromiohumeral joint each with three screws, which results in preservation of scapulothoracic motion and pain relief. INDICATIONS Traumatic brachial plexus lesions, palsy in infancy, poliomyelitis with preserved or restorable function of the elbow and the hand. Paralysis of the deltoid muscle and the rotator cuff. Nonrestorable vast defect of the rotator cuff with pseudoparalysis. Chronic infectious arthritis resistant to therapy. Unsuccessful attempts to treat glenohumeral instability. Alternative procedure to shoulder arthroplasty in young patients with omarthrosis, who perform hard physical work. CONTRAINDICATIONS Insufficient strength of the scapular muscles (< grade 4, <75% of normal strength). Insufficient scapulothoracic passive motion. Inadequate soft tissue coverage after burns, excessive previous surgery or radiotherapy. Incomplete rehabilitation (<3 years) after neurosurgical interventions (neurolysis, nerve transplantation). Cases of resection of the proximal humerus. SURGICAL TECHNIQUE Acampsia of the shoulder joint in 20° of abduction, 30° of anteversion, and 40° of internal rotation using three glenohumeral and three acromiohumeral spongiosa screws as a compression arthrodesis. POSTOPERATIVE MANAGEMENT Thorax-arm-abduction splint (20° of abduction, 30° of anteversion, and 40° of internal rotation) until the week 6 postoperatively with removal for physiotherapy and personal hygiene. Assisted active and passive motion exercises for the elbow, hand, and fingers after the postoperative day 1. Weaning from the splint after the end of the week 6 postoperatively, full range of motion allowed. RESULTS In a prospective study from January 2007 to September 2008, 4 patients with a medium age of 35.7 years underwent screw arthrodesis of the shoulder with a follow-up of 1.0 (0.6-1.5) year. Primary fusion of all arthrodesis surfaces was achieved in all patients; no revision surgery was necessary. All patients improved in shoulder function with an average range of motion of 60° abduction and 40° anteversion.
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Nam D, Maak TG, Raphael BS, Kepler CK, Cross MB, Warren RF. Rotator cuff tear arthropathy: evaluation, diagnosis, and treatment: AAOS exhibit selection. J Bone Joint Surg Am 2012; 94:e34. [PMID: 22438007 DOI: 10.2106/jbjs.k.00746] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Rotator cuff tear arthropathy encompasses a broad spectrum of pathology, but it involves at least three critical features: rotator cuff insufficiency, degenerative changes of the glenohumeral joint, and superior migration of the humeral head. Although many patients possess altered biomechanics of the glenohumeral joint secondary to rotator cuff pathology, not all patients develop rotator cuff tear arthropathy, and thus the exact etiology of rotator cuff tear arthropathy remains unclear. The objectives of this manuscript are to (1) review the biomechanical properties of the rotator cuff and the glenohumeral joint, (2) discuss the proposed causes of rotator cuff tear arthropathy, (3) provide a brief review of the historically used surgical options to treat rotator cuff tear arthropathy, and (4) present a treatment algorithm for rotator cuff tear arthropathy based on a patient's clinical presentation, functional goals, and anatomic integrity.
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Affiliation(s)
- Denis Nam
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Longo UG, Lamberti A, Khan WS, Maffulli N, Denaro V. Synthetic augmentation for massive rotator cuff tears. Sports Med Arthrosc Rev 2011; 19:360-365. [PMID: 22089286 DOI: 10.1097/jsa.0b013e318224e359] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The management of massive, irreparable rotator cuff tears is challenging. They are associated with persistent defects, weakness, and poor outcomes, and can cause an uncoupling of forces across the glenohumeral joint, with unstable shoulder kinematics. There has been much interest in the development of scaffolds to bridge massive rotator cuff tears. As allograft materials may produce inflammatory responses in the host, there is notable interest in developing synthetic grafts for surgical use. Benefits and limitations of the available synthetic scaffolds for augmentation of rotator cuff tears are reported in the present review.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, Trigoria Rome, Italy
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Sousa R, Pereira A, Massada M, Trigueiros M, Lemos R, Silva C. Shoulder arthrodesis in adult brachial plexus injury: what is the optimal position? J Hand Surg Eur Vol 2011; 36:541-7. [PMID: 21490031 DOI: 10.1177/1753193411405742] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Brachial plexus injuries are a major indication for shoulder arthrodesis. However, there is no consensus concerning the optimal position of the glenohumeral joint for fusion. Between 1997 and 2008, 19 shoulder arthrodeses were performed using pelvic reconstruction plates. The radiographic and functional characteristics of 13 patients of mean age 46 years were examined at a mean of 101 months after arthrodesis. Arthrodeses showed 30° mean angle of abduction, 32° forward flexion and 44° internal rotation of the humerus with respect to the scapula. Abduction >35° and forward flexion ≥30° seem to offer slightly better functional results. Internal rotation ≤45° significantly relates to better ability of the hand to reach the face (p = 0.012). Neither abduction >35° nor forward flexion ≥30° showed a higher prevalence of periscapular pain. Abduction around 35° and forward flexion around 30° are needed for good functional results. Internal rotation should not exceed 45°.
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Affiliation(s)
- R Sousa
- Orthopaedics Department, Hospital de Santo António, Centro Hospitalar do Porto, Portugal.
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Abstract
BACKGROUND Poliomyelitis in children can cause paralysis of shoulder girdle muscles leading to a flail shoulder. Shoulder arthrodesis is indicated as a possible treatment for these children in order to stabilize the shoulder. This retrospective study reviewed all shoulder arthrodesis surgeries owing to complications of polio performed at a major medical institution between 1981 and 1996 to assess position of fusion, radiographic evidence of fusion, complications, and patient satisfaction. METHODS A review of medical records identified 11 patients undergoing 13 shoulder arthrodesis procedures, with a mean age of 14.7 years at the time of the procedure. Internal fixation was achieved with large cancellous screws in 8 patients and a Dynamic Compression Plate (DCP) plate in 5 procedures. Average follow-up period was 41 months. Eight patients were placed into a spica cast and 5 used a sling postoperatively. RESULTS Shoulder arthrodesis surgery in this cohort resulted in an average position of fusion with 42.3 degrees of abduction, 23.8 degrees of flexion, and 26.2 degrees of internal rotation. Twelve of the 13 procedures assessed for radiographic union demonstrated fusion. The most common complications were malrotation and nonunion. Of the 13 procedures, 2 underwent humeral osteotomies for malrotation, and 1 with 6.5 mm cancellous screws required revision with a DCP plate owing to nonunion. Six patients underwent hardware removal, 3 of which were specifically owing to complaints of painful hardware. At final follow-up, no patient reported pain and all expressed satisfaction with their results and improved shoulder function after repair. CONCLUSION This study is the largest series of shoulder arthrodesis surgeries for treatment of patients with a flail shoulder from polio to date, providing a more thorough analysis of its efficacy as an indicated treatment. LEVEL OF EVIDENCE Level III-Retrospective Comparative Study.
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Savarese E, Postacchini R, Tudisco C. Sequelae of an undiagnosed unilateral congenital fixed anterior shoulder dislocation in a 40-year-old female. Musculoskelet Surg 2011; 95:163-9. [PMID: 21671099 DOI: 10.1007/s12306-011-0146-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 05/31/2011] [Indexed: 11/28/2022]
Abstract
Congenital shoulder dislocation is a rare condition. A review of the literature showed that 0.018-0.07% of newborns suffer from shoulder dislocations. There have been only few reports about this entity, clinic and radiologic features, treatment, and etiology of this condition remains unclear. We report a case of undiagnosed unilateral congenital fixed anterior shoulder dislocation in a 40-year-old female, which affected the day quality of life. Pediatrists and orthopaedic surgeons should know this rare condition and the importance of a proper diagnosis in the early childhood when an appropriate treatment could be performed.
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Affiliation(s)
- Eugenio Savarese
- San Carlo Hospital, Potito Petrone Street, 85100 Potenza, Italy.
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Kappe T, Cakir B, Reichel H, Elsharkawi M. Reliability of radiologic classification for cuff tear arthropathy. J Shoulder Elbow Surg 2011; 20:543-7. [PMID: 21454101 DOI: 10.1016/j.jse.2011.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 12/15/2010] [Accepted: 01/01/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several classification schemes have been proposed for cuff tear arthropathy and used for scientific and clinical purposes, even though their reliability has not been established and compared as of yet. MATERIALS AND METHODS Two observers (O1 and O2) twice independently classified 52 shoulder radiographs into the cuff arthropathy schemes of Favard, Visotsky-Seebauer, Hamada, and Sirveaux. The schemes of Samilson and Prieto as well as Kellgren and Lawrence, commonly used for osteoarthritis of the shoulder, were also used for comparison. Reliability was tested with the κ coefficient. RESULTS The intraobserver and interobserver reliabilities were 0.812 for O1, 0.710 for O2, and 0.305 for O1 versus O2 for the Favard classification; 0.868, 0.583, and 0.551, respectively, for the Visotsky-Seebauer classification; 1.000, 0.491, and 0.407, respectively, for the Hamada classification; and 0.852, 0.602, and 0.598, respectively, for the Sirveaux classification. For comparison, the Samilson-Prieto classification reached 0.815, 0.710, and 0.507, respectively, and the Kellgren-Lawrence scheme reached 0.815, 0.713, and 0.430, respectively. DISCUSSION Of the classification schemes tested, the Sirveaux classification displayed the best reliability overall. The Sirveaux classification only respects alterations of the glenoid, however. Among the schemes respecting both the glenoid and the humerus, the Hamada and Visotsky-Seebauer schemes showed similar reliability compared with the Samilson-Prieto and Kellgren-Lawrence systems, whereas the Favard classification was not as reliable. We therefore recommend the Visotsky-Seebauer or Hamada classification scheme.
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Affiliation(s)
- Thomas Kappe
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany.
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Wang J, Shen J, Dickinson IC. Functional outcome of arthrodesis with a vascularized fibular graft and a rotational latissimus dorsi flap after proximal humerus sarcoma resection. Ann Surg Oncol 2011; 18:1852-9. [PMID: 21331810 DOI: 10.1245/s10434-010-1443-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prognosis of humeral sarcomas has improved greatly in the past 20 years. As a result, the challenges for orthopedic oncologists include long-term handicap and local morbidity. METHODS Shoulder reconstruction after the resection of sarcomas with the proximal humerus was evaluated for 55 patients from 1990 to 2007 at two universities. After S34(5)B resections (intra-articular resection of the proximal humerus and the abductor mechanism), the shoulders were reconstructed with arthrodesis, prosthesis, or allograft-prosthesis composites (APC). RESULTS At the time of the latest follow-up examination, the average duration of follow-up was 86.73 months for the 39 patients who were still alive and whose limbs were salvaged. The local recurrence rate was 7.27% (4 of 55). Functional evaluation was conducted on the 39 patients who had the postreconstructions: 12 arthrodeses, 17 prostheses, and 10 APC. Statistical analysis showed that the functional score of shoulder reconstruction significantly varied among the three groups by the test of homogeneity of variances with P = 0.222, by analysis of variance with P < 0.01, and by post hoc test (Student-Newman-Keuls) with α = 0.05. Primary arthrodesis resulted in better function and increased strength than the prostheses and the APC. Insertion of an allograft, a vascularized fibular graft, a rotational latissimus dorsi flap, and cancellous autograft bone were the preferred arthrodesis techniques used to achieve fusion and reduce complications. CONCLUSIONS After resection of the sarcoma with the proximal humerus with the abductor apparatus, shoulder arthrodesis is recommended above other reconstructions for better functional outcome as well as increased strength and capacity to position the hand.
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Affiliation(s)
- Jin Wang
- Muskulaskeletal Oncology Department, First Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong, China.
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Abstract
Microsurgical restoration of shoulder abduction with free muscle transfers is one of the most challenging reconstructions. The purpose of this study was to analyze retrospectively the outcomes of free muscle transfer for shoulder abduction. Since 1981, 22 muscles have been transferred for shoulder abduction in posttraumatic brachial plexopathy. Two techniques have been used: a double muscle transfer of adductor longus and gracilis was used for shoulder abduction and elbow flexion, respectively (n = 18), and latissimus dorsi transfer for shoulder abduction (n = 4). For the double muscle transfer, the mean range of motion of shoulder abduction was found postoperatively to be 30 +/- 24 degrees and the mean muscle grade was to be 2.61 +/- 0.76 (P < 0.001). For latissimus transfer, the mean postoperative muscle grade of the transferred muscle was 3.25 +/- 0.73, and the shoulder abduction was 40 +/- 32 degrees. Free muscle transfer can enhance shoulder abduction after inadequate results from primary reconstruction or in late cases. In this study, all patients achieved a stable shoulder, 53% yielded shoulder abduction against gravity, and 9% achieved abduction to the horizontal level.
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47
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Nam D, Kepler CK, Neviaser AS, Jones KJ, Wright TM, Craig EV, Warren RF. Reverse total shoulder arthroplasty: current concepts, results, and component wear analysis. J Bone Joint Surg Am 2010; 92 Suppl 2:23-35. [PMID: 21189245 DOI: 10.2106/jbjs.j.00769] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- D Nam
- Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
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48
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Elhassan B, Bishop A, Shin A, Spinner R. Shoulder tendon transfer options for adult patients with brachial plexus injury. J Hand Surg Am 2010; 35:1211-9. [PMID: 20610066 DOI: 10.1016/j.jhsa.2010.05.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Accepted: 05/01/2010] [Indexed: 02/02/2023]
Abstract
Enhancement of upper-extremity function, specifically shoulder function, after brachial plexus injury requires a good understanding of nerve repair and transfer, with their expected outcome, as well as shoulder anatomy and biomechanics enabling the treating surgeon to use available functioning muscles around the shoulder for transfer, to improve shoulder function. Surgical treatment should address painful shoulder subluxation in addition to improvement of function. The literature focuses on improving shoulder abduction, but improving shoulder external rotation should take priority because this function, even if isolated, will allow patients to position their hand in front of their body. With a functional elbow and hand, patients will be able to do most activities of daily living. The lower trapezius has been shown to be a good transfer to restore external rotation of the shoulder. Other parts of the trapezius, levator scapulae, rhomboids, and, when available, the latissimus dorsi, pectoralis major, teres major, biceps, triceps, and serratus anterior muscles can all be used to replace the rotator cuff and deltoid muscle function. To optimize the results, a close working relationship is required between surgeons reconstructing brachial plexus injury and shoulder specialists.
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Degenerative changes of the deltoid muscle have impact on clinical outcome after reversed total shoulder arthroplasty. Arch Orthop Trauma Surg 2010; 130:177-83. [PMID: 19898856 DOI: 10.1007/s00402-009-1001-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Despite a high complication rate, subjective and objective results of reversed shoulder arthroplasty for severe rotator cuff lesions associated with osteoarthritis, fracture sequelae, or revision of hemiarthroplasty are favorable. However, whether the changes in biomechanics of the joint may lead to structural changes in the remaining rotator cuff and the deltoid muscle, and may thereby alter the clinical result, has rarely been described. This study investigates the context between postoperative fatty infiltration of the remaining rotator cuff and the deltoid muscle, and the clinical outcome after reversed shoulder arthroplasty. METHODS Twenty-three patients with an average age of 73.1 +/- 5.6 years were evaluated at an average of 26 +/- 16.8 months. Evaluation included assessment of Constant Score, disabilities of the arm, shoulder and hand score, radiographic evaluation with measurement of the humeral lengthening and medialization of the center of rotation, and magnetic resonance imaging or computed tomography to classify changes in the rotator cuff and the deltoid muscle. Results There was a significant correlation between fatty infiltration of the deltoid muscle and the clinical score results. Patients with a longer follow-up showed a higher amount of degenerative changes of the deltoid than patients with a shorter follow-up. Degenerative changes of the rotator cuff showed no significant correlation to clinical results. The amount of arm lengthening, medialization of the center of rotation, and scapula notching showed no correlation to clinical results or degenerative changes of the deltoid and the rotator cuff. CONCLUSIONS These data show that degeneration of the deltoid muscle is of impact for clinical outcome. Although other factors like disuse or pain as a reason for muscular changes cannot be fully excluded, this degeneration might occur after time due to biomechanical changes after reversed arthroplasty. However, prospective studies with longer follow-up periods and repetitive assessment of muscle quality are necessary to further support these results.
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Lower Trapezius Transfer to Improve External Shoulder Rotation in Patients With Brachial Plexus Injury. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2009. [DOI: 10.1097/bte.0b013e3181b2b0bc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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