scholarly journals Failed shoulder stabilization procedure in the elderly: reverse shoulder replacement is the treatment ultimum

2019 ◽  
Vol 5 (5) ◽  
pp. 982
Author(s):  
Subramanian Kanthalu Narayanan ◽  
Navaladi Muthusamy ◽  
Vanaj Kumar Pauldhurai
Keyword(s):  
Rotator Cuff ◽  
Shoulder Instability ◽  
The Elderly ◽  
Bone Defects ◽  
Anterior Dislocation ◽  
Glenoid Component ◽  
Shoulder Replacement ◽  
Active Flexion ◽  
Reverse Shoulder Replacement

<p class="abstract">Shoulder instability, though often seen in younger individuals it can also occur in the elderly. Shoulder instability in the elderly is often missed and definitive management gets delayed. Treatment delay has a significant influence on the choice of surgical procedure and its functional outcome. We report a 77 year old female who presented with a missed anterior dislocation of the glenohumeral joint. She had undergone an open Latarjet procedure for shoulder instability eight months before her presentation. Considering her age, humeral head bone defects, rotator cuff tear and degenerative changes in the joint we opted for a Reverse Shoulder Replacement in her. The patient now has a pain free, stable and mobile shoulder joint. Her pre-operative Constant score was 11 which improved to 67 at 6 months follow up. Now after 12 months follow up, she has active flexion up to 150°, abduction- 90°, external rotation- 10°, internal rotation- 30<sup>0</sup> and extension- 50°. Reverse shoulder replacement is a viable treatment option for chronic locked shoulder dislocations with concomitant rotator cuff lesions. Though there is a concern about failure of the glenoid component due to bone defects, RSA is still preferable in elderly patients with low functional demand.</p>

scholarly journals Surgical Outcomes In The Frequency, Etiology, Direction, Severity (feds) Classification System For Shoulder Instability

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0012
Author(s):  
Justin A. Magnuson ◽  
Brian R. Wolf ◽  
Kevin J. Cronin ◽  
Cale A. Jacobs ◽  
Shannon Ortiz ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Surgical Outcomes ◽  
Anterior Dislocation ◽  
Failure Rates ◽  
Glenohumeral Instability ◽  
Initial Event ◽  
Common Category ◽  
Patient Reported ◽  
Type Of Failure

Objectives: The Frequency, Etiology, Direction, Severity (FEDS) system is a reliable and reproducible classification of glenohumeral instability. Frequency is defined as Solitary (1), Occasional (2-5), or Frequent (>5) episodes per year; etiology as Traumatic or Atraumatic; direction as Anterior, Posterior, or Inferior; and severity as a Subluxation or Dislocation. 36 total combinations are possible, named by the first letter of each variable in order. The purpose of this descriptive study was to investigate epidemiology, surgical outcomes, and failure using FEDS in patients undergoing surgery in a large multicenter cohort of prospectively enrolled patients. Methods: 1204 patients undergoing surgery were assigned to FEDS categories. Two-year follow-up at time of analysis was available for 629 patients (85.7% of those eligible based on date of surgery). Those categories consisting of at least 5% of patients were further analyzed by patient reported outcomes (PROs) and failure rates for a total of 466 patients. PROs included American Shoulder and Elbow Surgeons score (ASES), Western Ontario Shoulder Instability index (WOSI), and Single Assessment Numeric Evaluation (SANE). Failure benchmarks included rates of recurrent subluxation, dislocation, and revision surgery. Results: Sixteen categories represented at least one percent of patients. Occasional Traumatic Anterior Dislocation (OTAD) was the most common category with 16.4% of patients. Five other anterior categories (STAS, OTAS, FTAS, STAD, FTAD) and one posterior category (STPS) represented at least 5%. PROs and failure rates for anterior categories are summarized in Figure 1. PROs improved significantly for each category. A downward trend in WOSI and ASES was noted in particular with increasing frequency of the dislocation groups. The highest rates of each type of failure occurred in the occasional and frequent groups for both dislocation and subluxation. Low rates of failure occurred in STPS, with 17.9% reporting subluxation, 3.6% dislocation, and no revisions. Conclusion: While overall success was good, different FEDS categories showed varying degrees of improvement and failure rates, indicating that the system can be used to provide prognostic insight for presurgical education. Overall, outcomes for traumatic anterior instability decreased with higher initial frequency, showing worse PROs and higher failure. Frequency appeared to have the greatest effect on outcomes. Early surgical intervention may be beneficial in preventing progression to more severe FEDS categories, with higher frequency having previously been associated with both higher rates of bone loss and greater time between initial event and surgical stabilization.

scholarly journals Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients?

2020 ◽  
Vol 23 (2) ◽  
pp. 62-70 ◽  
Author(s):  
Sae Hoon Kim ◽  
Whanik Jung ◽  
Sung-Min Rhee ◽  
Ji Un Kim ◽  
Joo Han Oh
Keyword(s):  
Bone Defect ◽  
Shoulder Instability ◽  
Bone Defects ◽  
Defect Size ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Anterior Instability ◽  
Recurrent Instability ◽  
Capsulolabral Reconstruction

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

E-REHABILITATION SOLUTION FOR ROTATOR CUFF SYNDROME IN COVID-19 PANDEMIC ERA

2021 ◽  
pp. 2150002
Author(s):  
Amit Lakhani ◽  
Ena Sharma ◽  
Sarita Khadayat
Keyword(s):  
Rotator Cuff ◽  
External Rotation ◽  
Mobile Apps ◽  
Health Sector ◽  
The Elderly ◽  
Cross Infection ◽  
Main Mode ◽  
Forward Flexion ◽  
Rehabilitation Centers

Objectives: COVID-19 pandemic has severely affected the health sector in the whole world. Routine OPDs including rehabilitation centers are partially functional to minimize the risk of cross-infection. In elderly patients, rotator cuff syndrome is a common cause of shoulder pain and daily physiotherapy is the main mode of management. To minimize the risk of cross-infection (COVID-19), we introduced E-rehabilitation services via various mobile apps to our patients. In developing countries like India, E-rehabilitation is still a new concept. Methods: This study evaluated 70 patients who had been enrolled for E-rehabilitation with a minimum of 4 weeks follow-up. Every patient was asked to use the rehabilitation App as per their requirement. Results were assessed with Disabilities of the Arm, Shoulder and Hand (DASH), visual analogue scale (VAS) and active ranges of movement (forward flexion and external rotation). Results: The average age of enrolled patients at the time of surgery was 55.0 years (range, 40–65 years). In 2 and 4 weeks, the range of forward flexion and external rotation has improved significantly. DASH and VAS Score has also been decreased significantly at an average of 2 and 4 weeks with [Formula: see text]. Conclusion: In this paper, we summarized the management of rotator cuff syndrome by using various mobile apps and also the various challenges faced in the elderly population with the newer concept of E-rehabilitation in this pandemic.

scholarly journals The influence of fatty infiltration and muscle atrophy of the rotator cuff muscles on midterm functional outcomes in total shoulder resurfacing at six years’ follow-up

2018 ◽  
Vol 12 (2) ◽  
pp. 91-98
Author(s):  
Gray AD Edwards ◽  
Philip A McCann ◽  
Michael R Whitehouse ◽  
Charles J Wakeley ◽  
Partha P Sarangi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Rotator Cuff ◽  
Muscle Atrophy ◽  
Functional Outcomes ◽  
Fatty Infiltration ◽  
Resonance Imaging ◽  
Shoulder Replacement ◽  
Total Shoulder Replacement

Background We report functional outcomes at six years in patients with varying degrees of fatty infiltration and atrophy of the rotator cuff muscles who have undergone anatomic total shoulder replacement. Methods A retrospective analysis of case notes and magnetic resonance imaging scans of patients undergoing total shoulder replacement for primary glenohumeral arthritis was performed. Patients were grouped based upon their pre-operative magnetic resonance imaging findings for fatty infiltration, muscle area and tendinopathy. Post-operative functional outcomes were assessed using the Oxford Shoulder Score and Quick Disabilities of the Arm, Shoulder and Hand score. Post-operative measurements were made for active shoulder movements. Results Thirty-two patients were reviewed at a mean of 67 months following surgery. All patients demonstrated fatty infiltration on their pre-operative magnetic resonance imaging scan. Muscle atrophy was shown in 22 patients and 12 had tendinopathy. Multiple regression analysis showed no correlation between the Oxford Shoulder Score (p = 0.443), the Quick Disabilities of the Arm, Shoulder and Hand score (p = 0.419), forward flexion (p = 0.170), external rotation (p = 0.755) and any of the pre-operative independent variables. Discussion The degree of fatty infiltration, muscle atrophy and tendinopathy of the rotator cuff muscle on pre-operative magnetic resonance imaging scanning is not associated with functional outcome score or functional movement at medium-term follow-up following total shoulder replacement. Level of evidence IV

scholarly journals Rotator cuff tears: functional outcomes of open surgery

2020 ◽  
Author(s):  
Zafer Volkan Gokce
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Tendon Healing ◽  
The Elderly ◽  
Rotator Cuff Tears ◽  
Functional Assessments ◽  
Before And After ◽  
Correlation Tests ◽  
Cuff Repair

Abstract Background: The aim of the present study was to evaluate the clinical and radiological outcomes of the patients who underwent open surgical repair with the diagnosis of rotator cuff rupture. Methods: Twenty-eight rotator cuff tear patients refractory to conservative treatment and underwent open rotator cuff repair between April 2012 and April 2017 were retrospectively included in the study. Patients were assessed radiologically and clinically before and after surgery. Patients' age, gender, duration of complaints, the type of the rupture, the data obtained during operation (rupture size, shape, affected tendon, the presence of retraction if any), postoperative complications were recorded. Functional assessments of the patients were performed at 6th and 12th months preoperatively and postoperatively with objective assessments using Constant and UCLA scoring. All patients' operated shoulders were evaluated with MRI during their recent follow-up. Results: The mean postoperative follow-up period of the patients was 30.4 (range: 13-72) months. Preoperative and postoperative mean UCLA scores of the patients were 10.85±1.89, and 28.8±3.34, respectively (p < 0.001). Pre-, and postoperative average Constant scores were 38.1 (range, 7.0 to 56.0), and 72.4 (range, 52.0 to 98.0), respectively (p < 0.001). Rotator cuff continuity was assessed in shoulder MRIs obtained during recent follow-ups of patients, and four recurrent tears were observed. Correlation tests revealed that tear size observed during surgery showed a significant (p = 0.002) and a weakly negative (r = -0.468) correlation with preoperative Constant scores, and a significant (p = 0.0001) and moderately negative (r = -0.645) relationship with postoperative Constant scores. UCLA and Constant functional outcomes were worse in patients over 60 years of age, than younger patients and recurrent tears were more often observed in the elderly population. A significant relationship was revealed between the age of the patients and tendon healing (p < 0.05). Conclusion: The results of this study suggest that open repair is a reasonable and successful treatment option in patients with rotator cuff tears. Overall satisfactory clinical outcomes could be achieved.

scholarly journals Outcomes After Arthroscopic Bankart Repair in Adolescent Athletes Participating in Collision and Contact Sports

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769795 ◽  
Author(s):  
Michael G. Saper ◽  
Charles Milchteim ◽  
Robert L. Zondervan ◽  
James R. Andrews ◽  
Roger V. Ostrander
Keyword(s):  
Shoulder Instability ◽  
Functional Outcomes ◽  
Case Series ◽  
Bankart Repair ◽  
Anterior Dislocation ◽  
Contact Sports ◽  
Time To Surgery ◽  
Arthroscopic Bankart Repair ◽  
The Mean

Background: Literature on arthroscopic stabilization in adolescent patients participating in collision and contact sports is limited, as most studies include adolescents within a larger sample group comprised primarily of adults. Purpose: To review the outcomes of arthroscopic Bankart repair for anterior shoulder instability in an adolescent population participating in collision and contact sports. Study Design: Case series; Level of evidence, 4. Methods: This retrospective review included 39 shoulders in 37 adolescent (≤19 years) athletes who underwent primary arthroscopic Bankart repair using suture anchors with at least 2-year follow-up. All patients had a history of trauma to their shoulder resulting in an anterior dislocation. Outcome measures included patient satisfaction, the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score. Recurrence of dislocation and return to sporting activity were also assessed. Results: The mean age at the time of surgery was 16.9 years (range, 15-19 years), and the mean follow-up was 6.3 years (range, 4.3-10.0 years); 58.6% of patients participated in collision sports. Time to surgery after the initial dislocation episode was 9.2 months (range, 0.5-36.2 months). Four shoulders (10.3%) had dislocation events postoperatively. The majority (78.1%) of patients returned to sports at the same level of competition. Mean VAS was 0.49 ± 1.0, and the mean ASES and Rowe scores were 92.8 ± 12.6 and 85.0 ± 24.2, respectively. Univariate analyses demonstrated that subjective functional outcomes were negatively correlated with recurrence (ASES, P = .005; Rowe, P = .001) and failure to return to sport (ASES, P = .016; Rowe, P = .004). Independent variables shown to have no significant relationship to functional outcomes included age, follow-up, number of preoperative dislocations, time to surgery, sport classification, competition level, tear extent, number of anchors, concurrent Hill-Sachs lesion, and repair of a superior labral anterior-posterior (SLAP) lesion. Conclusion: Arthroscopic Bankart repair is an effective surgical option for traumatic shoulder instability in adolescents participating in collision and contact sports. At a minimum 4-year follow-up, arthroscopic Bankart repair effectively restored stability in 90% of cases; 80% returned to their preinjury level of sport.

Reverse the Trend for Proximal Humeral Fractures: A Review of the Evidence for the Use of Reverse Shoulder Replacement in Acute Trauma

2012 ◽  
Vol 4 (4) ◽  
pp. 237-243
Author(s):  
Clare Taylor ◽  
Thomas Cosker ◽  
Christopher Smith
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Complication Rates ◽  
Shoulder Replacement ◽  
Acute Trauma ◽  
Outcome Scores ◽  
Reverse Shoulder Replacement

Background Proximal humeral fractures in the elderly population represent a particularly demanding subset of fractures. These have been traditionally treated with Hemi-arthroplasty (HA). Recently there has been a trend towards using a Reverse shoulder replacement (RSR) in some of these patients. The primary aim of the study was to systematically review the literature on the functional outcome scores for RSR in proximal humeral fractures and compare it with the best quality literature available for HA. Secondarily to compare range of movement, complication rates, re-operation rates and x-ray changes. Methods A systematic review of the literature was performed using the keywords: Delta, inverse, shoulder, trauma, and fracture. Only studies with 10 patients or more, presenting new data on the functional outcome scores of RSR for acute trauma were included. Studies reporting the use of RSR for fracture sequalae were excluded. These results were compared to the most comprehensive and up to date literature available for HA for proximal humeral fractures. Results Eight papers met the full inclusion and exclusion criteria. Data was available for 178 patients with a minimum follow-up of only 3 months. The mean absolute constant score for RSR patients was 54% and 57% for HA patients. RSR had an infection rate of 3%, a dislocation rate of 4% and an overall re-operation rate of 5.6%. Conclusion Functional outcomes and range of movements achieved by RSR seem to be similar to those achieved by HA and may eventually be proven to have better outcomes in a certain sub-group of patients. However, there is currently less than 200 patients reported in the literature with a very short term follow-up. RSR is more expensive than HA, and there is a definite learning curve associated with this prosthesis. Although RSR may be valuable in patients where a traditional HA is deemed not suitable, caution must be used until better quality research is available. Level of evidence: Level III systematic review of Level III studies

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