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Background Frozen shoulder has not previously been shown to be associated with infection. The present study set out to confirm the null hypothesis that there is no relationship between infection and frozen shoulder using two modern scientific methods, extended culture and polymerase chain reaction (PCR) for bacterial nucleic acids. Methods A prospective cohort of 10 patients undergoing arthroscopic release for stage II idiopathic frozen shoulder had two biopsies of tissue taken from the affected shoulder joint capsule at the time of surgery, along with control biopsies of subdermal fat. The biopsies and controls were examined with extended culture and PCR for microbial nucleic acid. Results Eight of the 10 patients had positive findings on extended culture in their shoulder capsule and, in six of these, Propionibacterium acnes was present. Conclusions The findings mean that we must reject the null hypothesis that there is no relationship between infection and frozen shoulder. More studies are urgently needed to confirm or refute these findings. If they are confirmed, this could potentially lead to new and effective treatments for this common, painful and disabling condition. Could P. acnes be the Helicobacter of frozen shoulder?

Two decades of rapid advances in basic knowledge, industrial technology and surgical skill have made shoulder replacement a predictable, safe and successful operation. This article looks to pass on some of these advances in our understanding of anatomy, pathology, surgical approaches and releases. It looks at contentious issues such as the hemi versus total shoulder debate, the stemmed, surface and stemless debate, the issues of DVT prophylaxis and prophylaxis against infection. Finally the article makes the plea that shoulders are different from hips and knees and that long term results depend more upon cuff function than prosthetic failure.

Background The present study examined the strength of fixation of a knotless anchor system that relies on trapping the suture between an interference fit screw and its bone tunnel, a method familiar to orthopaedic surgeons during anterior cruciate ligament reconstruction. Type of study In vitro biomechanical single-pull load to failure study of fixation achieved by interference fit screws in porcine bone. A standard suture anchor with eyelet was used as a control. Methods A single-pull to failure test was carried out on a Hounsfield H20K digital tensiometer (Tinius Olsen, Hersham, PA, USA). Two suture materials were compared [braided polyester (Ethibond; Ethicon Ltd, Edinburgh, UK) and a new suture (Fibrewire; Arthrex Inc., Naples, FL, USA) that has a high molecular weight polyethylene core]. Two interference fit screws were compared: one metal and the other plastic (PEEK; Parkus Medical, Sturgeon Bay, WI, USA). Results The average values were between 262 N and 584 N. The average failure value for a standard anchor was 206 N. Clinical Relevance Interference fit fixation provides an elegant strong knotless method for securing multiple sutures to a single point.

Background Frozen shoulder is a chronic fibrosing condition affecting the capsule of the joint. The predominant cells involved are fibroblasts and myofibroblasts that lay down a dense matrix of type I and type III collagen within the capsule. This subsequently contracts leading to the typical features of pain and stiffness. The histology is very similar to Dupuytren's contracture [1] – [5] . Chromosomal abnormalities, particularly Trisomy 7 and 8, have been found in Dupuytren's disease. Methods The aim of this study was to see if there are chromosomal changes in frozen shoulder. The anterosuperior shoulder joint capsule was excised in 16 patients with resistant primary frozen shoulder according to the method of Ozaki et al. [4] . The tissue was examined for chromosomal abnormalities using standard cytogenetic methods. Results Ten of the 16 showed chromosomal abnormalities, of which 7 had clonal chromosomal abnormalities; 4 had trisomy 7, 2 had trisomy 8, and 1 both trisomy 7 and 8. Conclusion This is approximately the same percentage and numerical type of change to the same chromosomes as previously reported in Dupuytren's disease.

Contracted (Frozen) Shoulder is an enigmatic common, disabling and painful condition. The last two decades have seen advances made in our understanding of the pathology, natural history and associations of this condition. This understanding has allowed led to the development of new and effective methods of treating the disease. Despite these advances there is still a long way to go before we have a full understanding of this condition.

BackgroundFrozen shoulder is considered to be associated with diabetes, thyroid disease, heart disease, high cholesterol and Dupuytren's disease. However, these associations have been made without arthroscopic confirmation of frozen shoulder or comparison with a control group. The present study aimed to compare the incidence of co-morbidities in a group of arthroscopically proven frozen shoulder patients and an age-and sex-matched control group.MethodsOne hundred and one patients with clinical and arthroscopically proven primary frozen shoulder and no other intra-articular pathology were identified. One hundred and one patients were recruited from a fracture clinic as an age- and sex-matched control group. Each patient was sent a questionnaire to document co-morbidities and frozen shoulder in siblings.ResultsOnly diabetes ( p = 0.002) and a sibling with frozen shoulder ( p < 0.02) were found to be risk factors for frozen shoulder.DiscussionThis is the first large study to use a precise diagnosis and a well-matched control group to quantify the associations of frozen shoulder. It confirms the link of frozen shoulder with diabetes and adds to the argument for a genetic link in patients requiring an arthroscopic capsular release. It questions the association of heart disease, high cholesterol and thyroid disease with frozen shoulder.

Background High re-tear rates and the cost of anchor repair have led some arthroscopic surgeons to consider going ‘back to the future’ and using Neer type transosseous sutures arthroscopically. Methods We examined the strength of suture repair in the laboratory using a Monsanto tensiometer (Monsanto, Swindon, UK) using a single pull to failure loading programme. Results This shows that, in transosseous repair, the bone tunnels can fail at between 16 N and 115 N compared to anchors that fail at 168 N to 712 N. Discussion This cautionary tale means that going back to ‘the good old days’ might not be such a good idea.

We present a case report of a total elbow replacement that survived 31 years in a young female patient with, early onset rheumatoid arthritis. Professor Michael Devas inserted this self-designed, unlinked elbow prosthesis in 1973. The ulnar component loosened after 17 years and was revised using impaction grafting to restore bone stock. The original prosthesis demonstrated minimal wear and it was therefore reinserted. It functioned for a further 14 years, allowing the patient to continue working virtually pain free as a secretary, mother and housewife. To our knowledge, this is the longest surviving unlinked elbow replacement reported in the literature.

We present two cases of primary glenoid dysplasia occurring in a father and son. The father presented at age 18 years and the son 7 years later at the age of 3 years. Both presented with recurrent shoulder pain and radiographs showed primary glenoid dysplasia. Our cases would strongly suggest autosomal dominant inheritance in this condition. Very few cases of familial occurrence of the disease have been reported. Since shoulder surgeons are the most likely physicians to encounter this condition knowledge of the pattern of inheritance may allow effective counselling.