Faculty Bibliography

Rheumatoid arthritis of the glenohumeral joint can produce significant pain and disability that interferes with the ability to perform even the basic activities of daily living. In this article the authors discuss the epidemiologic aspects of rheumatoid arthritis, the pathologic condition as it affects the shoulder complex (consisting of the glenohumeral, acromioclavicular, and sternoclavicular joints), the differential diagnosis, clinical and radiographic manifestations, and treatment approaches designed to maintain or regain function

The operative management (open versus arthroscopic) of subacromial impingement was investigated through a search of the English-language literature from 1970 to 1996. Thirty-four clinical studies comprising 1,935 patients met the following selection criteria: a study published in a peer reviewed journal, a valid materials and methods section (describing age, gender, number of subjects, follow-up period, treatment modality, and impingement stage), and acromioplasty without rotator cuff repair. Six hundred and ninety-eight patients had an open decompression (OD) and 1,237 had an arthroscopic subacromial decompression (ASD) for Stage II and III impingement. When possible, only Stage II patients were reviewed. A few studies combined Stage II and III patients in their results; thus, the patients were placed into two groups (OD and ASD) composed of four categories: OD of Stage II impingement (494 patients), OD of Stage II and III impingement (204 patients), ASD of Stage II impingement (727 patients), and ASD of Stage II and III impingement (510 patients). The average duration of symptoms before surgery ranged from 6 months to 43 months in the OD group and 6 months to 61 months in the ASD group. The average age was 41.8 and 42.1 years, clinical follow-up 6 months to 62 months and 12 months to 41 months in the OD and ASD groups, respectively. The objective success rates were 83.3% versus 81.4% and the subjective success rates were 90.0% versus 89.3% for OD versus ASD, respectively. Return to work ranged from 43% to 100% in the OD group and 74% to 100% in the ASD group. Based on our review, the outcome from ASD is similar to OD. For persistent stage II primary impingement, we recommend starting with ASD and reserve OD for surgical failures. ASD allows earlier rehabilitation than OD because complete detachment of the deltoid is not performed, yet ASD is technically more demanding and has a long learning curve

Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result