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Introduction: The purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients., Materials and Methods: We undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy., Results: Our results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists., Conclusion: We conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.

Purpose: To compare the clinical outcome between the use of knotless sutures versus knot-tying sutures in arthroscopic Bankart repairs., Methods: Between January 2007 and January 2011, 87 patients who underwent arthroscopic Bankart repair with the use of knot-tying suture anchors or knotless suture anchors were evaluated, with 45 patients in the knot-tying suture group and 42 patients in the knotless group. Patients were assigned to either group, with odd-numbered patients going to the knot-tying suture arm and even-numbered patients assigned to the knotless arm. Outcomes included the Constant score, the visual analog scale (VAS) score, patient satisfaction score, and range of motion in forward flexion and external rotation with the arm in adduction. Redislocations or subluxations with the 2 techniques was also studied., Results: Both groups showed a statistically significant improvement between the preoperative and postoperative VAS scores and Constant scores. In the knot-tying suture group, the VAS score improved from 2.5 ± 2.3 to 0.7 ± 0.5 (P < .05) and the Constant score improved from 64 ± 7 to 92 ± 10 (P < .05). In the knotless group, the VAS score improved from 2.8 ± 2.5 to 0.9 ± 0.6 (P < .05), and the Constant score improved from 62 ± 6 to 89 ± 9 (P < .05). The patient satisfaction scores were 6.9 and 7.1 for the knot tying and knotless groups, respectively. No statistically significant differences were found when comparing the outcomes between the 2 groups. The change in the range of forward flexion and external rotation was also similar in the 2 groups. There was also no difference in recurrence or redislocation rates., Conclusions: Both the knot-tying and knotless suture anchors groups showed statistically significant and similar improvement in VAS and Constant scores. Both anchors provided reasonable outcomes. The knotless suture anchor is a good alternative to knot-tying suture anchors so that arthroscopic Bankart repairs can be performed without knot tying., Level of Evidence: Level II, prospective comparative study., (Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Fluid extravasation is not uncommon after shoulder arthroscopy. We report a case of massive fluid extravasation that resulted in rhabdomyolysis and renal shutdown following routine shoulder arthroscopic surgery. Compartment pressures in the deltoid, supraspinatus, and infraspinatus were normal. Magnetic resonance imaging of the shoulder revealed extensive subcutaneous edema and high-signal changes in the entire deltoid muscle. The patient made an uneventful recovery with adequate supportive treatment and renal dialysis. Repeat imaging studies 3 months later revealed complete restoration to normal of the deltoid muscle. In addition to extensive fluid extravasation in this patient, the use of nonsteroidal anti-inflammatory medication, the development of a transient allergic reaction to a prescribed antibiotic, and the inclusion of epinephrine in the infusion fluid may have collectively contributed to rhabdomyolysis. We recommend that the use of infusion pumps should be limited to the shortest time possible, and that gravity inflow should be used as much as possible. Inflow should preferably occur through the arthroscope itself, rather than through a separate portal cannula, which may dislodge, inadvertently causing infusion of high-pressure fluid into the surrounding tissue.

The shoulder is a complex of 5 joints and disturbances at any of these joints are likely to interfere with the smooth rhythm observed in movements of this complex. The overall ratio of scapulothoracic to glenohumeral movement of 1:2 is made possible by a clockwork mechanism that involves movements at these 2 articulations with axial rotation of the clavicle that connects the shoulder girdle to the torso. Stability of the scapulothoracic, glenohumeral joints and acromio clavicular joints rely not only on the intrinsic capsular ligaments, bony architecture and musculature, but also on extrinsic ligaments that need to be addressed in management of instability at these joints. Of the soft tissues, premature degeneration and tears of the rotator cuff tendons pose special clinical problems by disturbance of the delicate balance between the cuff and the deltoid muscle.

Present methods of documenting internal rotation of the shoulder joint are based on the point reached over the back by the tip of the fully extended thumb. Disease or stiffness of the joints distal to the shoulder gives a false measure of internal rotation. Using the interepicondylar line of the humerus in the coronal plane as the neutral position, internal rotation can be documented accurately as the angle formed by this line with the coronal plane when the shoulder is rotated inwards.

10 patients with primary neoplasms of the shoulder girdle underwent limb salvage procedures involving resection of the proximal humerus and parts of the scapula and clavicle. The function of the ipsilateral limb was assessed in all patients, in 9 at least one and a half years after surgery. Function was good in 3 of the 6 patients in whom an interposition bone graft was used and a successful shoulder arthrodesis was achieved. In the remaining 3, proximal arthrodesis was unsuccessful and the result was fair in 2 and a failure in 1. All 3 patients in whom the extended Tikhoff Linberg type of reconstruction was undertaken had good function although unsatisfactory cosmetic results. The 10th patient, who had a temporary cement and wire interposition, died of distant metastases 8 months after surgery and was considered a failure.

The role of the tendon of the long head of the biceps in the stabilization of the head of the humerus was studied in 15 freely hanging anatomic specimen shoulders. Upward migration of the humeral head was measured by noting any reduction in the acromiohumeral distance in roentgenograms of the shoulder. There was a statistically significant decrease in the acromiohumeral interval on tensing the short head of biceps, but there was no significant change in the interval on tensing either the long head or both heads of the biceps brachii. Severing the tendon of the long head while both the heads were tensed caused a significant upward migration of the head of the humerus. One of the important functions of the long head of the biceps is to stabilize the humeral head in the glenoid during powerful elbow flexion and forearm supination by the main muscle. Sacrifice of the intraarticular segment of this tendon in surgical procedures of the shoulder may produce instability and dysfunction.

The role of atmospheric pressure in providing static stability of the shoulder was studied experimentally in 24 cadaveric shoulders. Atmospheric air was allowed to enter the joint after puncturing the capsule. Three types of experiment were performed: in the first, the capsule was punctured after sequential division of the muscles; in the second, atmospheric air was let in by percutaneous puncture of of the capsule without dividing the muscles; and in the third, air was first let into the joint by percutaneous puncture of the capsule and then the muscles of the shoulder were divided. It was found that the intact shoulder subluxated after percutaneous puncture even without division of the overlying muscles or the capsule. Our findings suggest that negative pressure and muscle tone are the main static stabilisers of the shoulder, rather than the joint capsule.