Faculty Bibliography

Intrinsic disorders that can cause shoulder pain include arthritis, gout, pseudogout and osteonecrosis. In its mildest form, impingement syndrome may cause only minimal discomfort. At its worst, impingement syndrome may lead to rotator cuff tear. Bicipital tendinitis and rupture of the biceps tendon may also be associated with impingement. Early rehabilitative intervention is important. Physical therapy is directed toward restoring range of motion and muscle strength

Shoulder disorders are most commonly manifested by pain and limited function. Careful history and examination help the physician localize the problem to the shoulder joint, the surrounding tissues or adjacent sites that can cause referred pain to the shoulder. Common extrinsic causes of shoulder pain include postural problems and cervical spine disorders

We present a case of suppurative arthritis occurring in a patient with bilateral osteonecrosis of the femoral head. Predisposing factors were chronic alcoholism (osteonecrosis) and septicemia due to intravenous drug abuse (suppurative arthritis). Although the association of suppurative arthritis and osteonecrosis is rarely reported in the literature, the prevalence of osteonecrosis and of various factors predisposing to the development of suppurative arthritis should remind us of the possibility that a patient with osteonecrosis who develops sudden worsening of joint pain or fever may have developed suppurative arthritis of the affected joint, particularly when there is evidence of bone destruction

Hardware failure of the sliding screw system used in hip fracture fixation is rare. The fatigue failure of the sliding screw is always related clinically to nonunion or refracture along the path of the screw. In both situations, cyclic loading of the implant exceeds its endurance limit, and failure can ensue. Three cases of failure of the sliding screw are presented: a nonunion of a basicervical fracture, a nonunion secondary to stress fracture at the plate-barrel junction, and a refracture through the femoral neck after healing of an intertrochanteric fracture. A biomechanical analysis of the stresses on the sliding screw focuses on design features such as the internal threaded region used for the compression screw or the barrel length that creates increased stresses in the screw, thus lowering the number of cycles to failure. Based on this analysis, recommendations are made concerning implant design and surgical technique

Two cases of polyethylene bearing failure in the Triaxial elbow are presented. Although these were low-demand patients with the prostheses properly aligned, the severity of the wear suggests inadequate prosthesis design

Joint and soft tissue injections may be the only way to differentiate various arthritic disorders, accurately identify a septic joint, and apply focused treatment. Certain considerations can make these injections safer and more effective. This article reviews the principles of diagnostic and therapeutic use of joint and soft tissue injections and makes specific recommendations for common injection sites. Also described are appropriate aseptic techniques for aspirating and injecting joints, bursae, and soft tissue, as well as the judicious use of corticosteroid injections in this age group