Faculty Bibliography

BACKGROUND: Injection to the acromioclavicular (AC) joint can be both diagnostic and therapeutic. PURPOSE: The purpose of this study was to evaluate the accuracy of in vivo AC joint injections. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Thirty patients with pain localized to the AC joint were injected with 1 mL of 1% lidocaine and 0.5 mL of radiographic contrast material (Isovue). Radiographs of the AC joint were taken after the injection. Each radiograph was reviewed by a musculoskeletal radiologist and graded as intra-articular, extra-articular, or partially intra-articular. RESULTS: Of the 30 injections performed, 13 (43.3%) were intra-articular, 7 (23.3%) were partially articular, and 10 (33.3%) were extra-articular. When the intra-articular and the partially articular groups were combined, 20 patients (66.7%) had some contrast dye in the AC joint. CONCLUSION: This study demonstrates that despite the relatively superficial location of the AC joint, the clinical accuracy of AC joint injections remains relatively low.

BACKGROUND: Superior labrum anterior-posterior (SLAP) lesions of the shoulder that require surgical repair are relatively uncommon. However, recent observations suggest that there may be a rise in the incidence of SLAP lesion repair. MATERIALS AND METHODS: The Statewide Planning and Research Cooperative Systems (SPARCS) database from the New York State Department of Health was used to acquire data for all outpatient ambulatory surgery procedures that were performed in New York State from 2002 to 2010. The data were reviewed and analyzed to compare the incidence of arthroscopic SLAP lesion repairs relative to other outpatient surgical procedures. RESULTS: Within New York State, from 2002 to 2010, the number of all ambulatory surgical procedures increased 55%, from 1,411,633 to 2,189,991. Correspondingly, the number of ambulatory orthopedic procedures increased 135%, from 118,126 to 278,136. In comparison, the number of arthroscopic SLAP repairs increased 464%, from 765 to 4,313 (P < .0001). This represented a population-based incidence of 4.0/100,000 in 2002 and 22.3/100,000 in 2010. The mean age of patients undergoing arthroscopic SLAP repair in 2002 was 37 +/- 14 years. The mean age in 2010 was 40 +/- 14 years (P < .0001). CONCLUSIONS: The data suggest a substantial increase in the number of arthroscopic SLAP repairs that is significantly more rapid than the rising rate of outpatient orthopedic surgical procedures. In addition, there is a significant increase in the age of patients who are being treated with arthroscopic SLAP repairs.

Most patients experience pain relief and functional improvement following arthroscopic rotator cuff repair, but some continue to experience symptoms postoperatively. Patients with so-called failed rotator cuff syndrome, that is, with continued pain, weakness, and limited active range of motion following arthroscopic rotator cuff repair, present a diagnostic and therapeutic challenge. A thorough patient history, physical examination, and imaging studies (eg, plain radiography, MRI, magnetic resonance arthrography, ultrasonography) are required for diagnosis. Management is determined based on patient age, functional demands, rotator cuff competence, and the presence or absence of glenohumeral arthritis. Treatment options include revision repair, nonanatomic repair with or without biologic or synthetic augmentation, tendon transfer, and arthroplasty.

Magnetic resonance (MR) imaging is the primary diagnostic imaging modality for the evaluation of patients with suspected internal derangement of the shoulder joint. Awareness and understanding of the complex anatomy of the shoulder articulation and the ability to recognize normal anatomic variants and potential imaging pitfalls are critical to accurate interpretation of conventional and arthrographic MR imaging studies. This review discusses the normal anatomy and anatomic variants of the glenoid labrum, articular cartilage, and glenohumeral ligaments. An improved understanding of normal anatomy, biomechanics, and variants will help to avoid potential pitfalls in the interpretation of noncontrast and arthrographic shoulder MR imaging examinations.

The glenohumeral joint is the most commonly dislocated joint in the body. The prevalence of this condition and the instability that may result from it has been a focus of diagnosis and treatment since the original description of the Bankart lesion in 1923. Now, with the introduction of MRI, lesions causing anterior shoulder instability can be diagnosed more accurately. This has led to improved understanding of the pathoanatomy that must be addressed and corrected during surgical repair. Initial attempts at arthroscopic treatment, including staple repair, transosseus suture repair, rivets, and thermal capsulorraphy were fraught with complications and unacceptably high recurrence rates. The development of arthroscopic suture anchors have revolutionized the treatment of anterior shoulder instability, such that arthroscopic management is now the standard of care. In the hands of experienced surgeons, outcomes for arthroscopic treatment of shoulder instability now approaches the success of open treatment

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

BACKGROUND: Previous studies have documented a decrease in proprioceptive capacity in the unstable shoulder. The degree to which surgical approach affects recovery of strength and proprioception is unknown. MATERIALS AND METHODS: The recovery of strength and proprioception after open surgery for recurrent anterior glenohumeral instability was compared for 2 surgical procedures. A prospective analysis of 55 consecutive patients with posttraumatic unilateral recurrent anterior glenohumeral instability was performed. Thirty patients (group 1) underwent an open inferior capsular shift with detachment of the subscapularis, and 25 (group 2) underwent an anterior capsulolabral reconstruction. RESULTS: Mean preoperative proprioception and strength values were significantly lower for the affected shoulders in both groups. At 6 months after surgery, there were no significant differences for mean strength and proprioception values between the unaffected and operative sides for group 2 patients. In group 1 patients, however, there were still significant deficits in mean position sense and strength values. Complete restoration of proprioception and strength, however, was evident by 12 months in group 1. CONCLUSION: This study demonstrates that there are significant deficits in both strength and proprioception in patients with posttraumatic, recurrent anterior glenohumeral instability. Although both are completely restored by 1 year after surgery, a subscapularis-splitting approach allows for complete recovery of strength and position sense as early as 6 months postoperatively. Detachment of the subscapularis delays recovery of strength and position sense for up to 12 months after surgery

The use of arthroscopic techniques for excision of the pre-patellar bursa has become more common in recent years for the treatment of prepatellar bursitis. The current literature includes several case series that report few complications with this technique. We report the case of a 73-year-old male who sustained a low-energy patella tendon rupture 2 months after arthroscopic resection of the prepatellar bursa. We hypothesize that during arthroscopic excision of the prepatellar bursa there was an iatrogenic injury to the patellar tendon, which contributed to the subsequent rupture. Surgical repair was successfully performed using an open technique with a 1-year follow-up. To our knowledge, this is the first case report of patella tendon rupture following arthroscopic excision of the prepatellar bursa