Faculty Bibliography

The rotator cable is an extension of the coracohumeral ligament coursing along the undersurface of the supraspinatus and infraspinatus tendons. The rotator cable is thought to play a role in the biomechanical function of the intact and torn rotator cuff. It can be seen on all the imaging planes used for the conventional magnetic resonance imaging of the shoulder. Clinically, the integrity of the rotator cable can play a role in the treatment selection for patients with a rotator cuff tear.

BACKGROUND: Shoulder arthroplasty has become more prevalent, and patients undergoing shoulder arthroplasty are becoming more active. Recommendations for return to athletic activity have not recently been updated and do not consider the newest arthroplasty options. METHODS: A survey was distributed to 310 members of the American Shoulder and Elbow Surgeons, inquiring about allowed participation in 28 different athletic activities after 5 types of shoulder arthroplasty options (total shoulder arthroplasty, hemiarthroplasty, humeral resurfacing, total shoulder resurfacing, and reverse shoulder arthroplasty). RESULTS: The response rate to the survey was 30.3%, with 74.1% of respondents allowing some return to athletic activity after shoulder arthroplasty. The 28 athletic activities were grouped into 4 categories based on the load and possible impact to the shoulder. Only 51% of respondents allowed any participation in contact sports, whereas 90% allowed some participation in noncontact low-load sports. Return to sports after humeral resurfacing was highest, at 92.0% of the respondents, whereas the least percentage of surgeons allowed sports after reverse total shoulder arthroplasty, at 45.2%. CONCLUSION: The majority of surveyed surgeons allowed some return to sports after shoulder arthroplasty. Surgeons were more likely to recommend return to sports if the activities did not involve significant contact, risk of fall or collision, or application of high loads to the shoulder joint. Surgeons were also more likely to recommend return to sports if the arthroplasty did not involve the glenoid. CLINICAL RELEVANCE: The results of this survey may help surgeons counsel patients regarding return to specific athletic activities after various types of shoulder arthroplasty.

BACKGROUND: Locking plates have become a commonly used fixation device in the operative treatment of three- and four-part proximal humerus fractures. Examining function in patients treated nonoperatively and operatively should help determine whether and when surgery is appropriate in these difficult-to-treat fractures. QUESTIONS/PURPOSES: We compared functional scores, ROM, and radiographs in patients with one-part proximal humerus fractures treated nonoperatively to those in patients with displaced three- and four-part proximal humerus fractures treated with open reduction and internal fixation using locking plates. PATIENTS AND METHODS: We retrospectively reviewed 142 patients with proximal humerus fractures treated with a standardized treatment algorithm over a 6-year period. Three- and four-part fractures were treated surgically while one-part fractures were treated nonoperatively. Functional scores, ROM, and radiographs were used to evaluate outcomes. American Shoulder and Elbow Surgeons and SF-36 scores were obtained at 12 months. Of the 142 patients, 101 (51 with three- or four-part fractures and 50 with one-part fractures) had a minimum followup of 12 months (average, 19 months; range, 12-64 months). RESULTS: The fractures united in all patients. At 1 year, the patients with one-part fractures had better SF-36 physical and mental scores and American Shoulder and Elbow Surgeons scores than the three- and four-part fractures. Both groups had similar shoulder ROM. Nine patients treated operatively had complications, four of which were related to screw penetration into the joint. CONCLUSIONS: Patients with three- and four-part fractures should be advised of the likelihood of persistent functional impairment and a relatively higher risk of complications when treated operatively with locked plates. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence

We reviewed 11 cases of luxatio erecta (inferior shoulder dislocation) managed acutely at our institutions to gain insight into the diagnostic and management principles of this condition. We then compared our findings with those in the current literature. Luxatio erecta requires careful clinical and radiographic evaluation and a high index of suspicion for associated injuries, as they occur frequently and can be significant given their tendency to be associated with higher energy trauma. Our results indicate that the majority of patients return to preinjury level of shoulder function, despite associated injuries. Closed reduction constituted definitive management in 100% of the cases in our series, and there was no recurrent instability at follow-up

INTRODUCTION: Frozen shoulder (FS) is a common diagnosis treated by orthopaedic surgeons and other physicians caring for musculoskeletal problems. However, there is no standard definition and classification for this common condition. MATERIALS AND METHODS: We asked 211 clinician members of the American Shoulder and Elbow Surgeons to review our proposed definition of FS and its classification into primary and secondary types. Secondary FS was further divided into intrinsic, extrinsic, and systemic types. The survey required responses to 5 specific questions via an analog scale (1, strongly disagree; 5, strongly agree). Agreement was defined as a 4 or 5 on the analog scale. RESULTS: We received 190 responses (90%). Eighty-two percent agreed with the proposed definition of FS. Eighty-five percent agreed that FS should be divided into primary and secondary types. Sixty-six percent agreed with subdivision of secondary FS into intrinsic, extrinsic, and systemic types. Eighty-four percent agreed that there was a clinical entity of primary or idiopathic FS. Eighty-five percent agreed that obtaining a consensus definition and classification of FS was a worthwhile endeavor. DISCUSSION: Significant benefits can be gained from the development of a standard definition and classification of FS, achieved through a consensus of shoulder specialists, that provides a strong foundation for potential acceptance by all musculoskeletal specialists who treat this condition