Shoulder/Elbow News

Massive rotator cuff tears are typically defined as rupture of at least two of the four rotator cuff tendons and/or retraction away from the attachment site of 5 cm or greater. Thus, these are generally accepted as more challenging repairs with a longer recovery. Tendon healing to bone biologically takes 3 months. Strengthening typically will not start until after this time, and therefore maximal recovery of strength can take up to 1 year. We must proceed with caution when rehabbing massive repairs as these repairs are at the highest risk for either re-rupture or not healing. Meta-analyses show the overall re-tear rate of all rotator cuff repairs is around 26%; however, when massive repairs are isolated, some studies report up to a 91% non-healing rate. Although many factors are important in predicting which rotator cuff tears will not heal, the size of the tear is paramount. Several studies have shown that despite many repairs not healing, clinical outcomes are still good. However, it has been shown shoulder strength is better if the repair heals and, therefore, every attempt should be made to ensure healing. Several well-done studies have shown rotator cuff repairs are most vulnerable to re-tear or non-healing in the first 6 months after repair. Therefore, when considering all these factors, it would be wise to delay return to demanding activity until at least the 6-month mark. However, it is even wiser to begin to ease into full activity at the 6-month mark with a goal of full return between 6 months and 1 year postoperatively.

A 70-year-old right-hand-dominant man presented to the orthopedic clinic with 3 months of worsening left shoulder pain after having undergone total shoulder arthroplasty for primary glenohumeral arthritis 1.5 years earlier at an outside hospital. The patient denied any history of trauma but noted new areas of redness and skin discoloration over his left shoulder. He denied any systemic signs of illness including fevers, chills or night sweats, but did note increasing difficulty with range of motion secondary to pain. The patient attempted 3 months to 6 months of organized physical therapy, but experienced worsening disability and pain with his activities of daily living. The patient was a non-smoker with no significant medical history. On exam, the patient’s left shoulder showed a well-healed deltopectoral incision with small areas of blotchy erythema surrounding the incision. Range of motion (ROM) was 90° forward elevation (FE), 45° external rotation (ER) and internal rotation (IR) to S1. The motor exam demonstrated weakness in FE and IR, but neurologic examination was normal.

NEW ORLEANS— At the American Academy of Orthopaedic Surgeons Annual Meeting, Jon J.P. Warner, MD, discussed how he used virtual planning to perform a shoulder replacement in a patient with severe deformity of the glenoid socket.

NEW ORLEANS — Use of the nonoperative instability severity index showed high school athletes with anterior shoulder instability and specific factors were more likely to experience successful outcomes with nonoperative treatment, according to results presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

NEW ORLEANS — Compared to patients who took a placebo after rotator cuff surgery, patients who took NSAIDs for 2 weeks after rotator cuff surgery had less pain and took fewer pills overall, said a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.

NEW ORLEANS — Telehealth is safe, satisfactory and cost-effective for treatment of non-displaced pediatric elbow fractures, according to a presenter here.

NEW ORLEANS — Reimbursement for orthopedic procedures has decreased from 2000 to 2016, with adult reconstruction reimbursement decreasing at a greater rate than other subspecialties, according to data presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

Patients who used long-term inhaled corticosteroids to treat their COPD were at moderately higher risk for upper extremity and hip fractures, according to findings published in Chest.

EFORT Open Reviews is the new open access journal from EFORT and Bone & Joint Publishing. All articles are free to read online with no subscription required.

A prevention program that improves physical function was effective in the prevention of medial elbow injury in youth baseball players, according to a recently published study.