Faculty Bibliography

Total shoulder arthroplasty is a common treatment for glenohumeral arthritis. One of the most common failure modes of total shoulder arthroplasty is glenoid loosening, causing postoperative pain, limitation of function, and potentially, the need for revision surgery. The literature has devoted considerable attention to the design of the glenoid component; efforts to better understand the biomechanics of the reconstructed glenohumeral joint and identify factors that contribute to glenoid component loosening are ongoing. This article reviews the current state of knowledge about the glenoid in total shoulder arthroplasty, summarizing the anatomic parameters of the intact glenoid, variations in component design and fixation, the mechanisms of glenoid loosening, the outcomes of revision surgery in the treatment of glenoid component failure, and alternative treatments for younger patients

The aim of this study was to identify the magnitude and characteristics of work-related musculoskeletal complaints among perioperative nurses and technicians (PNT) and determine the associated ergonomic risk factors in the operating room (OR) environment based on self-report and focus group discussion. The 50 PNTs who participated in the study completed a self-report survey for musculoskeletal symptoms, Job Description Questionnaire, and Psychometric Evaluation Questionnaire, and participated in focus groups to discuss potential OR ergonomic risk factors. The results of the study demonstrated a high prevalence of work-related musculoskeletal disorders (WMSD) among PNTs, with lower back pain the most prevalent (84%) complaint, followed by ankle/foot (74%) and shoulder (74%) pain. In addition, lower back pain (31%), followed by ankle/knee (24%) pain were found to be the main causes of absenteeism from work. Participants suggested simple ergonomic and engineering solutions can be adopted to improve the work environment of PNTs

SUMMARY: The purpose of this study was to evaluate the role of reverse shoulder design parameters on performance. A computer analysis was conducted on the Grammont reverse shoulder to quantify the effect of varying design parameters on functional measurements during humeral abduction/adduction. The Grammont reverse shoulder impinged inferiorly and superiorly on the glenoid at 30.75 degrees and 95 degrees of humeral abduction, with an average jump distance of 10 mm. Several linear relationships were identified. To demonstrate the application of these relationships, a novel prosthesis was designed. The proposed 38-, 42-, and 46-mm reverse shoulder designs impinged inferiorly and superiorly on the glenoid at 7.25 degrees /87.5 degrees , 1 degrees /87.5 degrees , and 0 degrees /89.25 degrees of humeral abduction with an average jump distance of 11.7, 13.5, and 14.1 mm, respectively. The results of this study demonstrate that subtle changes in design parameters can minimize inferior glenoid impingement and offer the potential for dramatic functional improvements in range of motion (39%) and jump distance (36%)

The use of subacromial injections to treat shoulder pain has remained one of the most common procedures for the practicing orthopedist, rheumatologist, and general practitioner. Despite this, many prospective studies have questioned the efficacy of corticosteroid injections compared with nonsteroidal anti-inflammatory drugs or injections of local anesthetics alone, or both, when used for the treatment of symptomatic rotator cuff disease. Accurate diagnosis of the etiology of a patient's shoulder pain and proper injection technique are important in achieving satisfactory clinical outcomes. Both extrinsic as well as intrinsic etiologies for rotator cuff disease should be considered and must be elucidated with appropriate physical examination techniques. Although subacromial injections appear straightforward, more recent cadaveric, radiographic, and clinical studies have demonstrated variable accuracy rates using the two common techniques. In addition, absolute sterile technique must be used because infections of the subacromial space after injections, although uncommon, have generally led to debilitating conditions. This article reviews the etiology and pathophysiology of rotator cuff disease and the indications and techniques for subacromial corticosteroid injections

A prospective study was undertaken to determine if patients recover pre-injury level of shoulder function 1 year after 1 part proximal humeral fractures. Of the 67 patients enrolled, 43 were female and 24 male with an average age of 64.8 years (range, 25-90 years). All patients underwent a similar treatment protocol consisting of early therapy for range of shoulder motion and strengthening. Baseline demographics and functional assessment, including the American Shoulder and Elbow Surgeons (ASES) evaluation form and the SF-36, were obtained at the time of injury. Functional and demographic data were evaluated with a Student's t test. Fifty-four patients (80%) completed a 1-year follow-up. By 3 months, all patients attained radiographic and clinical evidence of union and no loss of reduction. At 1 year, the ASES score was similar to pre-injury status (93.7 vs 99.1; P = .12). The range of shoulder motion of the affected side was diminished compared to the unaffected extremity in internal rotation (P < .001) and external rotation (P < .001) but not forward flexion. Patients, who sustain minimally displaced proximal humeral fractures treated nonoperatively, largely returned to preoperative functional status at 1-year follow-up. Patients should be counseled and made aware of the decreased range of shoulder motion following this fracture

BACKGROUND: The implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting. METHODS: We analyzed the operative logs of 109 consecutive orthopaedic surgery residents (postgraduate years 2 through 5) from 2000 through 2006, representing a consecutive interval of years before and after the adoption of the work-hour restrictions. RESULTS: Following the implementation of the new work-hour policies, there was no significant difference in the operative volume for postgraduate year-2, 3, or 4 residents. However, the average operative volume for a postgraduate year-5 resident increased from 274.8 to 348.4 cases (p = 0.001). In addition, on analysis of all residents as two cohorts (before 2002 and after 2002), the operative volume for residents increased by an average of 46.6 cases per year (p = 0.02). CONCLUSIONS: On the basis of the findings of this study, concerns over the potential adverse effects of the resident work-hour polices on operative volume for orthopaedic surgery residents appear to be unfounded