Shoulder surgery recent articles on

Samer Hasan and I wrote the first What’s New in Shoulder and Elbow Surgery for the JBJS. Actually, it was the first What’s New JBJS review article. I have always felt that there should be a location for this type of information that came out more than once a year. Dr. Hasan has undertaken this project and we will evaluate the interest level and then determine if it should continue. A surgeon can go to each of the meetings or use PubMed or one of the many excellent search tools to review recent articles by keywords but there are two fundamental issues. First, how does the surgeon (or medical industry professional) select which of the hundreds (or thousands) of articles to read and second, how relevant (truthful, useful etc) are each of these articles. We think there is a place for some sort of expert-refereed summary of recent articles.

Here is a sample of what he wrote.

G9-MD What’s New in Shoulder Surgery 2011

Samer S. Hasan, MD, PhD

  1. Rotator Cuff

Several studies explored the demographics of partial thickness and full thickness rotator cuff tears.

  1. Asymptomatic Rotator Cuff Tears: Patient Demographics and Baseline Shoulder Function

Keener and colleagues reported on the demographic features and physical function of subjects with asymptomatic rotator cuff tears. The study included 196 subjects with an asymptomatic rotator cuff tear as well as a control group of 54 subjects with an intact rotator cuff tear presenting with a symptomatic contralateral rotator cuff tear. The authors found similar demographic features for both study and control groups. Subjects with an intact rotator cuff had greater American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores than those with an asymptomatic tear, but these differences were felt to be clinically insignificant. Hand dominance was associated with the presence of shoulder pain. The authors found no differences in functional scores, range of motion, or strength between partial-thickness tears and full-thickness tears, or in functional scores among full-thickness tears of various sizes. The authors concluded that the asymptomatic rotator cuff tear is associated with a clinically insignificant loss of shoulder function compared with an intact rotator cuff. Consequently, a clinically detectable decline in shoulder function may signal an “at-risk” asymptomatic tear. The onset of pain may be important for creating a measurable loss of shoulder function in cuff-deficient shoulders.2.

2.       Symptomatic Progression of Asymptomatic Rotator Cuff Tears

In a complementary study by the same group (Mall et al.), the authors found that pain development was associated with progression of the tear. Specifically 18% of full-thickness tears increased > 5 mm in size and 40% of partial-thickness tears had progressed to a full-thickness tear.  The onset of pain was associated with a decline in range of motion and ASES score. Furthermore, subjects who developed pain were found to have larger tears at initial evaluation compared with subjects who remained asymptomatic. The authors suggested that further research into prophylactic treatment of asymptomatic shoulders to maintain comfort and function is needed.

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