Background: The long head of the biceps tendon (LHBT) is a major contributor to shoulder pain in patients with rotator cuff tears (RCT), which is why tenotomy or tenodesis is commonly performed during RCT surgical repair. However, recent evidence highlights the importance of preserving the LHBT due to its potential role as an augmentative structure and stabilizer. Currently, no clear consensus or objective criteria exist to guide decisions about whether the LHBT should be sacrificed or preserved during rotator cuff repair. In this study, we compare clinical outcomes among patients with similar degrees of LHBT degeneration who were treated either with tenotomy (±tenodesis) or with debridement and radiofrequency ablation.Methods: We performed a retrospective comparative study. Group I was composed of 75 patients (mean age, 64.90±4.60; female, 46; male, 29) with large RCTs who underwent arthroscopic cuff repair associated with LHBT debridement and radiofrequency ablation for a Biceps Inflammation Section Integrity (BISI) score <5. Group II was composed of 86 patients (mean age, 65.70±3.58; female, 48; male, 38) with large RCTs who underwent arthroscopic cuff repair associated with LHBT tenotomy/tenodesis for a BISI score <5. All RC repairs were performed using a single-row technique with titanium anchors. Clinical outcomes were evaluated 1 year postoperatively using the Constant-Murley Score, the visual analog scale (VAS) for pain, and patient satisfaction surveys. Group comparisons were conducted using standard tests for continuous and categorical variables.Results: At the 1-year follow-up, the mean Constant scores were 76 in the preservation group and 78 in the tenotomy group, with no statistically significant difference (P=0.16). Both groups reported low pain levels (mean VAS, 2). Similar strength deficits and partial limitations in shoulder rotations were observed in both groups. Patient satisfaction rates were 79% vs 81%, respectively.Conclusions: Routine sacrifice of the LHBT during rotator cuff repair may not be necessary for mild to moderate degeneration (BISI <5). Biceps preservation may help maintain shoulder biomechanics and offer advantages for future revision surgeries.Level of evidence: III.
Background: This study was conducted to analyze clinical outcomes after arthroscopic stabilization procedures in patients with shoulder instability and posttraumatic adhesive capsulitis. Methods: Patients who underwent arthroscopic Bankart repair between 2019 and 2022 with limitation of forward flexion <120°, external rotation <30°, and internal rotation below L3 were included. Demographic data, arthroscopic findings, visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were evaluated. Results: Nineteen (4.3%) of 442 patients were included in the study with a mean follow-up of 33.7±2.8 months. The mean age was 32.8±1.9 years, with a mean time of 6.6±1.8 months from the last episode of instability. At final follow-up, 17 of 19 patients (89.5%) recovered full ranges of motion. Forward flexion improved from 112.2°±9.4° to 170.8°±2.1° (P<0.001), internal rotation from 2.3±0.4 to 7.2±0.8 (P=0.001), and external rotation from 23.2°±1.3° to 61.6°±2.8° (P=0.019). The mean VAS score decreased from 3.5±0.5 to 0.4±0.2 (P<0.001). The ASES score improved from 71.7±2.4 to 92.7±2.2 (P<0.001), and the Rowe score increased from 71.5±3.2 to 97.4±1.0 (P<0.001). No complications or revision surgeries occurred. Conclusions: Arthroscopic stabilization provided satisfactory functional recovery and range of motion in patients with anterior instability and posttraumatic adhesive capsulitis. Level of evidence: IV.
Background:Degenerative shoulder disorders impose a significant clinical and economic burden. The critical shoulder angle (CSA) has been established as a predictor of rotator cuff tears and glenohumeral osteoarthritis, but the anatomical basis underlying those relationships remains incompletely characterized. This study investigates whether the CSA correlates with the size of the rotator cuff muscle insertional footprints. Methods:An anatomical study was performed on 28 shoulders from 14 formalin-fixed cadavers (mean age, 77.15 years; standard deviation, 9.94). Radiographs in the Grashey view were used to measure the CSA. The insertional footprints of the supraspinatus (SSP), infraspinatus (ISP), teres minor (TM), and subscapularis (SSC) were dissected and measured. A correlation analysis was conducted to assess relationships. Results:A moderate inverse correlation was found between the CSA and the footprint size of all examined muscles: ISP (r=-0.52, P<0.01), TM (r=-0.60, P<0.001), SSP (r=-0.51, P<0.01), and SSC (r=-0.42, P<0.05). Large CSA values were associated with small insertional areas. Conclusions:This study suggests that a large CSA is associated with significantly smaller-than-average insertional footprints. These findings provide an anatomical basis for biomechanical models that could help to refine risk assessment and preventive strategies for shoulder pathology. Level of evidence: Anatomical study.
Background:The optimization of implant positioning in reverse shoulder arthroplasty produces evolving and conflicting data. The distalization-lateralization index (DLI) has been introduced as a measurement that combines both lateralization and distalization. This study aimed to determine whether legacy and novel measurements correlate with patient reported outcomes. Methods:Patients who underwent primary reverse shoulder arthroplasty at a single institution between 2016 and 2022 and had a minimum of 2 years of follow up were screened by retrospective chart review. Radiographs were used to measure the lateralization shoulder angle, distalization shoulder angle, acromiohumeral interval (AHI), acromiohumeral offset (AHO), and glenohumeral offset (GHO). DLI and ΔDLI were calculated from the ΔAHI and ΔAHO. A linear regression analysis was performed to identify correlations between any measurements and the postoperative American Shoulder and Elbow Surgeons (ASES) score. Results:Data were analyzed from 140 patients with an average age of 71 years and average follow up of 3.3 years. AHO had an adjusted mean difference of -0.29 (P=0.009) between high and low ASES score groups. There was a weak, but statistically significant association between the ASES score and the DLI (r=0.181, P=0.032) in the simple linear regression, but no association was found in the multivariable linear regression, β=0.46 (95% CI, -0.04 to 0.95; P=0.072). Conclusions:Increased DLI was found to be weakly associated with higher ASES scores in the univariate analysis, but not after controlling for other variables. Although the correlation was not statistically significant, both the DLI and GHO were associated with higher ASES scores in the multivariate analysis, warranting further study with larger patient cohorts. Level of evidence:III.
Cardiac implantable electronic devices (CIEDs) are becoming increasingly common, and shoulder surgeons encounter patients with these devices with growing frequency. Despite this, practical guidance on managing CIEDs during shoulder surgery remains limited. This narrative review provides a consolidated framework for managing these patients across the perioperative period. We outline essential functions, indications, and structural components of modern devices, including transvenous pacemakers, transvenous implantable cardioverter-defibrillators, subcutaneous implantable cardioverter-defibrillators, and leadless pacemakers. CIED placement techniques and their anatomic relevance to the deltopectoral approach are reviewed. Associated risks, such as lead traction, pocket violation, and electromagnetic interference (EMI), are highlighted. Preoperative management focuses on structured screening: confirming device type and indication, assessing pacing dependency, and coordinating with electrophysiology. Practical guidance clarifies when magnet application is sufficient and when formal reprogramming is required. Intraoperative management centers on maintaining rhythm stability and protecting the device. Continuous electrocardiogram and pulse monitoring are recommended, with external pacing and defibrillation available. EMI risk is reduced by placing the dispersive (grounding) pad on the ipsilateral side, using bipolar cautery when possible, and limiting monopolar cautery to short, low-energy bursts. Mechanical injury is minimized through careful retractor placement. Postoperative care focuses on confirming that the device has returned to baseline function. By integrating device mechanics, anatomic considerations, and perioperative management principles, this review offers a unified, surgery-specific approach to caring for patients with CIEDs undergoing shoulder procedures. The accompanying algorithm provides a stepwise procedure for assessment and decision-making aimed at reducing cardiac risk.
Background: The American Shoulder and Elbow Surgeons (ASES) score is a patient-reported outcome measure for shoulder functionality that can be collected at baseline and postoperative time points. In total shoulder arthroplasty (TSA), its temporal relationship with other recovery metrics is unknown. This study evaluates the potential of early ASES changes after TSA to predict other outcomes, particularly active forward flexion (AFF), active external rotation (AER), and VAS pain scores at final follow-up.Methods: A retrospective chart review identified patients who underwent primary TSA between 2018 and 2023. Demographics, postoperative ASES scores, visual analog scale (VAS) pain scores, AFF, AER, and complication rates (revision, readmission, and mortality rates) were recorded. Percentage changes from baseline were calculated for each outcome. Linear regression analyses controlling for age, sex, race, body mass index, and Charlson Comorbidity Index scores were used to assess associations between ASES changes at 6 weeks, 3 months, 6 months, and 1 year and subsequent outcomes.Results: In total, 394 TSA patients were investigated, with a mean follow-up of 2.9 years. Percent changes in ASES scores at 3 months (P=0.023), 6 months (P=0.001) and 1 year (P=0.006) were significantly associated with AFF improvement at 1 year. ASES changes were also associated with VAS pain scores, with 6-week ASES changes correlating with 3-month VAS improvement (P=0.039). A 1% ASES increase at each interval predicted continued 1% gains postoperatively. No significant associations were observed for AER within 2 years postoperatively or any complication rate within 1 year postoperatively.Conclusions: Early improvements in the ASES score can predict later postoperative outcomes after TSA, supporting its use as an indicator of recovery trajectory.Level of evidence: IV.
Background: Anatomical total shoulder arthroplasty (aTSA) is typically reserved for end-stage glenohumeral arthritis with an intact rotator cuff and adequate glenoid bone stock. With the exponential increase in total shoulder arthroplasty surgeries, complications and the need for re-revision surgery have also increased. Typically, aTSA is revised to a reversed prosthesis, but in some cases the anatomic configuration is maintained. Revision surgery is associated with a higher risk of complications and re-revisions than primary surgery. However, the literature on re-revision surgery after aTSA is sparse.Methods: An observational cohort study was conducted using data from the Dutch National Registry. We report re-revision rates and reasons and analyze the implant survival of revised aTSA (anatomic-to-anatomic revision). Due to the small sample size, this study is strictly descriptive and is not suitable for identifying risk factors or predicting survival.Results: Overall, 5,547 primary aTSAs were registered between 2014 and 2023, and the 58 patients who underwent revision surgery with the implant remaining in an anatomic configuration were included in this study. Re-revision surgery was performed in 10 patients (17%). The most common indications for re-revision surgery were glenoid component loosening (n=4) and rotator cuff rupture (n=4). Implant survival at 3 years after the first revision was 80%. All re-revisions occurred within 3 years after revision surgery.Conclusions: We report a 3-year implant survival of 80% after an anatomic-to-anatomic revision of aTSA. Failure causes and the number of re-revision surgeries in aTSA indicate a high risk of early failure and provide a warning for surgeons considering the retention of an anatomic configuration.Level of evidence: IV.
Background: Rotator cuff repair (RCR) is one of the most common orthopedic procedures in the United States. Although arthroscopic and open RCR yield similar long-term outcomes, differences in reimbursement and short-term safety are less understood. This study aimed to evaluate differences between RCR techniques in work relative value units (wRVUs), operative times, Medicare reimbursement amounts, and 30-day complication rates.Methods: For data collection, the National Surgical Quality Improvement Program database was retrospectively analyzed (2006–2023). Patients undergoing arthroscopic or open RCR were identified by Current Procedural Terminology codes and matched 1:1 via propensity score matching according to demographics and comorbidities. Outcomes included operative time, wRVUs, Medicare reimbursement amount, and 30-day postoperative complications.Results: A total of 18,988 matched patients (9,494 with arthroscopic RCR, 9,494 with open RCR) were included. Arthroscopic RCR cases had significantly longer operative times than open RCR cases (91.82±43.71 minutes vs. 80.93±41.02 minutes, P<0.001) but generated 17.7% higher wRVUs per minute (0.20±0.09 vs. 0.17±0.07, P<0.001) and 36.0% more revenue per case ($485.20±$0.00 vs. $356.77±$7.54, P<0.001). Arthroscopic RCR patients had significantly lower overall 30-day complication rates (1.1% vs. 1.5%, P=0.010), including fewer superficial (0.2% vs. 0.4%, P=0.023) and deep surgical site infections (0.0% vs. 0.2%, P=0.004).Conclusions: Arthroscopic RCR is associated with lower short-term complication rates than open RCR, despite requiring longer operative times and more resources. This clinical trade-off suggests that the additional operative demands of arthroscopic surgery are justified by the associated improvements in patient safety, highlighting the value of reduced complications as a key advantage of the arthroscopic approach.Level of evidence: III.
Background: This study used Statcast-derived metrics to evaluate return to play (RTP) and performance outcomes in Major League Baseball (MLB) position players following ulnar collateral ligament (UCL) surgery.Methods: MLB position players undergoing UCL surgery between 2017 and 2024 were identified using the Tommy John List. A 1:1 age-matched control group of uninjured MLB position players was used for performance comparisons. Performance data from the two seasons before surgery and the two seasons following RTP were collected. The data included usage, offensive performance, batted ball metrics, and defensive performance.Results: Twenty-five MLB position players were confirmed to have undergone UCL surgery (UCL reconstruction=18; UCL repair=7). Twenty-one players (84%) returned to MLB competition with a mean time to RTP of 9.4±3.8 months. Players who underwent UCL repair returned significantly faster than those who underwent reconstruction (7.3±1.6 vs. 10.4±4.2 months, P=0.049). No statistically significant differences were observed between pre- and post-surgery performance across any metric for the full cohort. However, catchers demonstrated statistically significant improvements in average exit velocity and hard-hit percentage compared to both preoperative performance (exit velocity: P=0.04; hard-hit percentage: P=0.03) and matched controls (exit velocity: P=0.046; hard-hit percentage: P=0.04).Conclusions: MLB position players return to competition at a high rate following UCL surgery. Among those who return, Statcast-derived offensive and defensive metrics demonstrate that postoperative changes in performance are minimal and statistically insignificant. Interestingly, catchers demonstrated paradoxical improvements in both postoperative average exit velocity and hard-hit percentage.Level of evidence: III.
BACKGROUND:Patients with cardiac implantable electronic devices (CIEDs) increasingly present for elective orthopedic procedures. In this study we evaluate peri-operative complications associated with CIED presence using a large multicenter database. METHODS:Retrospective cohort analysis was performed using the TriNetX database. Adults undergoing primary total shoulder arthroplasty (TSA) between 2005 and 2025 were identified and stratified by CIED status. Four propensity score-matched (1:1) analyses were conducted: all TSA patients with versus without CIEDs, (2) patients with cardiac disease with CIED versus without CIEDs, and patients with recent device implantation (<6 months before TSA) versus patients with remote device implantation (>6 months before TSA). Matching balanced demographic factors and comorbidities. Outcomes included 90-day and 2-year complications. Relative risks, 95% CIs, and P-values were calculated using chi-square and t-tests; significance was set at P<0.05. RESULTS:After matching, 6,931 patients were included per cohort. CIED presence was associated with significantly higher 90-day rates of cardiac, renal, infectious, and neurologic complications, as well as increased mortality, readmissions, and emergency department visits. These associations persisted after controlling for underlying cardiac disease. Patients undergoing TSA within 6 months of device implantation experienced higher rates of complications. Revision rates were not significantly different between groups, and mechanical outcome associations were variable. CONCLUSIONS:CIED presence was associated with increased systemic complications following TSA, particularly when surgery occurred within 6 months of device implantation. Mechanical outcome differences were less consistent. These findings indicate the necessity of multidisciplinary perioperative planning, thoughtful surgical timing, and prospective studies to better define underlying risk pathways. Level of evidence: III.
BACKGROUND:Fixation of clavicular shaft fractures carries risks of nonunion, infection, and functional loss. Although superior and anteroinferior plating have widely been studied, the optimal approach remains debated. Previous literature has relied on indirect comparisons and been limited by early study cutoffs, high heterogeneity, and omission of key outcomes. This meta-analysis directly compared union, function, and complications between superior and anteroinferior plating. METHODS:This review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Eligible studies included randomized trials or prospective/retrospective cohort studies of adults. Outcomes of interest included the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; and complications (plate removal, infection, nonunion). Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions or Cochrane Risk of Bias 2.0 tool, and certainty of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Analyses were performed in Review Manager 5.4 (Cochrane). RESULTS:Twelve studies (n=980) were included. Constant-Murley scores did not differ significantly (mean difference [MD]=-1.19; 95% CI, -3.18 to 0.81; P=0.24). Beginning at 2 years, DASH scores showed no difference (MD=1.62; 95% CI, -0.46 to 3.70; P=0.13). Times-tounion (MD=0.41; 95% CI, -0.60 to 1.43; P=0.42) and rates of nonunion (odds ratio [OR]=2.42; 95% CI, 0.59-9.94; P=0.22) were comparable. Plate removal (OR=1.16; 95% CI, 0.82-1.65; P=0.41) and infection (OR=0.81; 95% CI, 0.32-2.06; P=0.66) also showed no significant differences. Heterogeneity was minimal (I2=0). CONCLUSIONS:Superior and anteroinferior plating of midshaft clavicle fractures provide comparable union rates, functional outcomes, and complication rates. Selection of the surgical approach should depend on fracture morphology, surgeon preference, and patient-specific factors. Level of evidence: III.
Background The incidence of ulnar collateral ligament (UCL) repair continues to increase, so evaluating the accuracy and readability of information about this procedure that is produced by artificial intelligence (AI) models is important. This study assesses AI-generated responses to common patient questions about UCL repair. Methods Twenty patient questions frequently encountered in clinical practice were submitted to ChatGPT, Gemini, and Grok. Three fellowship-trained orthopedic surgeons independently rated answer accuracy using the ChatGPT Response Rating System (CRRS) and AI Response Metric (AIRM), which assign scores from 1–5, with lower scores indicating better accuracy. Responses with CRRS >2 were classified as requiring more than minimal clarification. Readability was evaluated using the Flesch-Kincaid Reading Ease (FKRE) and Grade Level (FKGL) metrics. Responses with an FKGL >6 exceeded the American Medical Association (AMA) and National Institutes of Health (NIH) recommended 6th grade reading level for patient education materials. Results More than minimal clarification was required for 15% (3/20) of ChatGPT, 5% (1/20) of Gemini, and 40% (8/20) of Grok responses. Gemini (CRRS, 1.5±0.5; AIRM, 1.6±0.5) demonstrated significantly better accuracy than ChatGPT (CRRS, 2.0±0.4; P=0.0002; AIRM, 2.2±0.5; P=0.0001) and Grok (CRRS, 2.1±0.7; P=0.005; AIRM, 2.4±0.8; P=0.002). All responses exceeded the AMA/NIH 6th grade reading level threshold (FKGL >6). Gemini produced the highest FKGL (16.2±2.2), significantly higher than ChatGPT (14.4±1.6, P=0.005) and Grok (14.6±1.7, P=0.017). FKRE did not differ significantly among models (P=0.14). Conclusions AI models generated generally accurate information about UCL repair but at reading levels far above the AMA/NIH recommendations. In this study, Gemini was the most accurate model and produced the least readable content. Level of evidence III.
Background We aimed to determine whether increased vertical displacement on upright clavicle radiographs (UCR) compared with supine clavicle radiographs (SCR) influenced the decision to operate. Methods Adult patients with clavicle fractures identified on initial SCR or computed tomography scans during primary evaluation at a level 1 trauma center from July 2021 to November 2023 were included. The patients also underwent UCR. Exclusion criteria were patients with chronic or pathologic fractures, inadequate imaging, or incomplete documentation. Increases in vertical displacement from SCR to UCR were measured, and we recorded how often these increases on UCR prompted surgical management. Results Overall, 160 patients (average age 47.0 years; 70% male) met the inclusion criteria. Most of the study population was managed nonoperatively (90%), with only 16 patients (10%) managed surgically. Only two of the 160 patients (1.3%) underwent surgical intervention based primarily on increased vertical displacement on UCR. With an average change of 4.5 mm (95% CI, 3.5–6.6 mm) between SCR and UCR for patients managed nonoperatively, and 5.1 mm (95% CI, 2.7–7.5 mm) for those managed operatively. There was no significant difference in management based on UCR (P=0.71). Subgroup analysis, stratifying patients by either ≥1 cm or <1 cm of displacement, found there was still no statistically significant change in SCR and UCR (P=0.44). Conclusions Inpatient UCR rarely alters the management of clavicle fractures at our institution, indicating that its use is best reserved for case-by-case consideration. Level of evidence IV.
Background Total elbow arthroplasty (TEA) is increasingly performed for complex elbow pathology, yet revision procedures remain challenging due to high complication rates and limited bone stalk. While TEA may produce satisfactory functional outcomes for select patients, it is often burdened by high complication rates, necessitating revision TEA, often with extensive bone loss. Among available reconstructive strategies, allograft–prosthesis composite (APC) reconstruction has emerged as a possible technique; however, reported outcomes remain heterogeneous. This systematic review aims to characterize the use and outcomes of APC reconstruction in revision TEA for patients with significant bone loss. Methods We searched the PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify clinical studies of revision TEA performed with an APC published between inception of each database and 2023. Outcomes of interest were patient-reported outcome measures (PROMs), range of motion (ROM), radiographic outcomes, and complications. Results We included five studies that reported on 85 elbows with APC TEA revisions for extensive bone loss. PROMs and ROM were reported for 70 elbows, yielding a mean postoperative Mayo Elbow Performance Score of 64 points and an active elbow arc of 24°–120°. The complication rate across 85 elbows was 38.8% (33 elbows). The graft–host junction non-union rates of humeral and ulnar allografts were 40% (20 elbows) and 16% (5 elbows), respectively. Conclusions APC provides a salvage option in revision TEA with severe bone loss but is associated with high complication and non-union rates.
Background This study aimed to determine the effectiveness of electromyography (EMG) biofeedback training on scapular kinematics and/or muscle activation in patients with scapular dyskinesis (SD) associated with subacromial impingement syndrome (SIS). Methods An electronic search was conducted in the Medline, Embase, Scopus, Web of Science, CINAHL, SPORTDiscus, LILACS, CENTRAL, and PEDro databases. Eligibility criteria comprised randomized clinical trials investigating the effects of adding EMG biofeedback training to scapular-focused exercises on scapular kinematics and/or muscle activation in patients with SD associated with SIS. Data were pooled using a Hartung-Knapp-Sidik-Jonkman random-effects method or Mantel–Haenszel fixed-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Four trials met the eligibility criteria. The mean difference (MD) for upward rotation was 1.13° (P=0.07), and that for downward rotation was 1.2° (P=0.08). The MDs for muscle activation of the lower trapezius during scapular plane elevation and descending movements were 7.22% (P=0.010) and 2.26% (P<0.001), respectively. The MDs for the muscle balance ratios of the upper/lower trapezius and upper trapezius/serratus anterior were 0.11% (P=0.95) and 0.15% (P=0.04), respectively. All differences favored the EMG biofeedback plus scapular-focused exercises group. Conclusions In the short-term, adding EMG biofeedback training to scapular-focused exercises resulted in significant differences only in lower trapezius activity. Conversely, the results were inconclusive regarding improvements in scapular kinematics and changes in the activation of other scapular muscles. The quality of evidence ranged from very low to high according to GRADE rating, suggesting that the effect of EMG biofeedback might not be captured in this study. Level of evidence I.
Background We aimed to review all published evidence on the surgical management of internal impingement and associated conditions in athletes of overhead sports. Methods Our search included studies reporting outcomes of any surgical intervention on shoulder internal impingement and its sequelae in overhead athletes. The primary outcome was return to sport at pre-injury level or higher in the main text (RTS+). Secondary outcomes included return to sport at any level (RTS), shoulder function, and complications. No quantitative analyses were possible due to the nature of the evidence included. Results Forty-two observational studies were eligible. They included 1,420 overhead athletes with a mean age of 27.3 years. RTS+ across all surgical procedures ranged from 25% to 94%. In patients treated with debridement of articular-sided partial-thickness rotator cuff tears, the RTS+ ranged from 50% to 85%, and in those who underwent posterior glenoidplasty for glenoid spurs, it ranged from 55% to 63.6%. Comparative studies for superior labrum anterior to posterior (SLAP) tears demonstrated similar RTS+ after open subpectoral tenodesis and arthroscopic SLAP repair. RTS+ after the two procedures in all observational studies ranged from 35% to 100% and 54.2% to 100%, respectively. RTS+ after capsulorrhaphy, when performed concomitantly with other procedures, ranged from 25% to 93%. Conclusions Outcomes associated with the surgical management of internal impingement are variable. Surgical decision-making should prioritize patient-specific factors following unsuccessful conservative management. We provide surgical recommendations and considerations.
Parsonage-Turner syndrome (PTS) is an underdiagnosed condition that presents with debilitating symptoms in affected patients, with reported incidence rates varying between 1.64 and 3 per 100,000 individuals. Clinical presentation often includes acute shoulder pain associated with neurological deficits that do not follow a regular diagnostic pattern. The cause of this disease is not fully understood, but it is generally triggered by an upper respiratory infection a few weeks prior to presentation. Other associated risk factors include genetic predisposition, vaccines, and surgical intervention. Diagnosis often relies on clinical investigation, holistic physical exam, and appropriate diagnostic studies. Treatment is often conservative, in the form of physical rehabilitation and pain management to avoid muscular atrophy. The condition generally resolves over time, with a recovery rate of 65% at 10 months and a favorable prognosis for most cases. However, recurrences are noted, especially in patients with a genetic predisposition to the condition (75% in the hereditary form vs. 26% in the general form). Future research should explore the pathophysiological processes behind this disease to extrapolate strategies that can achieve an earlier diagnosis and more effective treatment.
Rotator cuff tears (RCTs) are a leading cause of shoulder pain. Magnetic resonance imaging (MRI) is the gold standard for diagnosis, but interpretation is limited by variable sensitivity, interobserver variability, and increasing workload. Recent advances in artificial intelligence (AI), including deep learning and large language models (LLMs), have been explored to enhance diagnostic accuracy and efficiency. A structured search of PubMed, Embase, Scopus, and Cochrane Central databases identified studies published from 2019 or later applying AI to shoulder MRI for RCT detection, classification, segmentation, or reporting. Eligible studies reported quantitative outcomes. Of 732 records, 584 were screened, 121 underwent full-text review, and 19 were included in this narrative review. Deep learning models demonstrated diagnostic accuracies ranging from 71% to 100%, with sensitivities of 73%-100% and specificities of 70%-100%. About 20% of included studies used external validation, with 5%-15% performance reductions, underscoring limited generalizability. Visual Geometry Group (VGG)-based architectures and convolutional neural networks (CNNs) using multiplanar inputs achieved higher performance for full-thickness tear detection, while radiomics contributed to assessment of tear severity and muscle quality. Regulatory-approved software remains limited, and no fully automated diagnostic system has received Food and Drug Administration (FDA) clearance. LLMs demonstrated potential in patient education and report drafting, though informational quality was variable (median DISCERN score, 40/80), requiring expert oversight. AI applications in shoulder MRI demonstrate promising diagnostic accuracy and potential workflow benefits, but current evidence is constrained by limited external validation, dataset heterogeneity, and lack of regulatory clearance. Future research should prioritize multicenter validation, clinical integration, and explainability to enable safe clinical use of AI.
Background Elbow dysfunction can impair daily activities and reduce health-related quality of life (HRQoL). This study used the EuroQol five dimensions instrument (EQ-5D) alongside functional scores and treatment priorities to assess HRQoL in patients awaiting elective elbow surgery. Methods In this prospective study, patients scheduled for elbow surgery from December 2024 onward were enrolled and categorized as having osteoarthritis, stiffness, or instability. HRQoL was measured using the EQ-5D. Multivariable regression was performed with EQ-5D as the dependent variable and waiting time, age, sex, and diagnosis as predictors. Functional outcomes were assessed with the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (qDASH). Patients also indicated whether they prioritized pain relief or improved mobility. Results Overall, 102 patients were included. The mean waiting time was 204±115 days, and the overall EQ-5D index was 0.67±0.06. Patients with osteoarthritis had the lowest EQ-5D index (0.60±0.29), highest pain levels (2.32±0.48), and greatest depression scores (1.97±0.75). They also showed the lowest MEPS and highest qDASH, with MEPS significantly lower than in patients with instability (P=0.016). The multivariable regression suggested non-significant trends toward lower EQ-5D with longer waiting times (β=–0.0001, P=0.663) and older age (β=0.002, P=0.306). Osteoarthritis patients prioritized pain relief (P=0.026), and stiffness patients prioritized mobility (P=0.021). Conclusions Although longer waiting times and older age showed non-significant trends toward lower HRQoL, osteoarthritis patients were most affected, with the lowest EQ-5D (0.60) and significantly worse MEPS (P=0.016) than in the other groups. Future studies should test whether preoperative pain or psychological support can mitigate HRQoL decline. Level of evidence II.
BACKGROUND:Concomitant repair of the subscapularis (SSC) tendon in reverse total shoulder arthroplasty (RTSA) with a lateralized design remains controversial. The present study aimed to evaluate the effect of SSC repair (repair at native insertion, repair at superiorly migrated position, and no repair) on the glenohumeral arc of motion following RTSA in a cadaveric biomechanical setting. METHODS:RTSA was performed on eight cadaveric shoulders under six testing conditions as follows: unrepaired SSC/intact teres minor (TM); intact SSC/intact TM; superiorly repaired SSC/intact TM; unrepaired SSC/deficient TM; intact SSC/deficient TM; and superiorly repaired SSC/deficient TM. Increasing load (2.5-N increments) was applied to the middle deltoid (anterior, posterior; 10 N each, middle; 10- 20 N). The resulting abduction and rotation positions were measured. RESULTS:Unrepaired SSC demonstrated greater abduction and reduced internal rotation (IR), whereas SSC repair increased IR, particularly in TM-deficient models. Superiorly repaired SSC had higher glenohumeral abduction and IR than original SSC repair. SSC repair caused excessive IR in the TM deficiency seen with massive rotator cuff tears. CONCLUSIONS:Concomitant SSC repair in lateralized RTSA decreased glenohumeral abduction and increased IR. Concomitant SSC repair at the original and superiorly migrated footprints should be carefully considered following lateralized RTSA. Level of evidence: V.
