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We report the short- to medium-term outcomes for patients with Kienböck’s disease and ulnar positive or neutral wrists treated by capitate shortening osteotomy combined with a 4 + 5 extensor compartmental artery vascularized bone graft placed in the lunate. This is a retrospective study of seven consecutive patients with Lichtman Stage 2 to 3B. Radiological and clinical outcomes were evaluated. Six patients maintained their Lichtman stage, one progressed. Mean time to union of the capitate was 10 weeks. Five of six lunates were completely revascularized on MRI scans, with one partial revascularization. Mean follow-up for functional scores was 40 months (range 15 to 62). Mean pain score improved significantly from 7.4/10 preoperatively to 1.9/10 postoperatively, and patient satisfaction was 9.2/10. Mean postoperative Quick Disabilities of Arm, Shoulder and Hand, Patient Evaluation Measure and Patient-Rated Wrist Evaluation scores were improved. All patients returned to their previous work. We conclude that this procedure has good short- to medium-term outcomes. Level of evidence: IV

Background We report on the medium- to long-term results of a randomized controlled trial (RCT) aiming to determine whether rotator cuff repair confers any advantage over arthroscopic sub-acromial decompression (ASAD) alone in the management of medium-sized rotator cuff tears. Methods Ethical approval was sought to follow-up patients previously enrolled in a completed and previously published RCT comparing the outcome of ASAD with mini-open cuff repair for the treatment of rotator cuff tear. Forty-two patients were enrolled in the original study, with a mean of 64 years (range 54 years to 77 years). Results Fifteen of the original 17 patients randomized to ASAD alone and 18 of the original 25 patients randomized to cuff repair were available for follow-up. Each patient underwent American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scoring, and clinical and ultrasound examination. Mean duration of follow-up was 7 years (range 5 years to 11 years). There was no statistically significant difference in terms of ASES, DASH and Constant scores at follow-up between the two groups. Some 33% of patients in the cuff-repair group had a proven re-rupture on ultrasound. This patient subgroup had significantly worse Constant scores compared to patients where the repair remained intact. None of the patients from either group developed cuff-tear arthropathy requiring arthroplasty surgery. Conclusions In this medium- to longer-term study, there is no demonstrable significant benefit of cuff repair over decompression alone for the treatment of medium-sized rotator cuff tears, in terms of ASES, DASH and Constant scores for pain, function and strength modules. The presence of cuff tear does not necessitate surgical repair. This conclusion should drive surgical strategies and shared decision-making between patients and surgeons.

Background Management of degenerate rotator cuff tears associated with subacromial impingement is debatable. Methods We performed a prospective, randomised controlled trial to assess the efficacy of arthroscopic subacromial decompression (ASD) with or without repair of the rotator cuff using a mini-open technique. Results 42 patients (29 males and 13 females) with a mean age of 64 years (range 54–77 years) were recruited. 25 patients underwent ASD and cuff repair using mini-open technique whereas 17 patients had only ASD alone. All the patients were followed for a minimal of 1 year post-operatively. At final follow-up the mean Constant scores and patient satisfaction scores were not different between the groups (p value 0.06 and 0.44 respectively). The mean DASH scores were marginally significant (p value 0.05) and mean ASES scores were significant (p value 0.03). A 38% cuff rerupture rate was noted in the cuff repair group. Conclusions Our study demonstrates that in short-term the results of ASD with or without rotator cuff repair are not significantly different, however positive trends were noted in the cuff repair group. Although a significant rerupture rate was noted (38%) this had little effect on the outcome.

This paper explores the application of Bayesian probabilistic modeling to issues of music cognition and music theory. The main concern is with the problem of key-finding: the process of inferring the key from a pattern of notes. The Bayesian perspective leads to a simple, elegant, and highly effective model of this process; the same approach can also be extended to other aspects of music perception, such as metrical structure and melodic structure. Bayesian modeling also relates in interesting ways to a number of other musical issues, including musical tension, ambiguity, expectation, and the quantitative description of styles and stylistic differences.