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Background: Determining the presence of bacteria in the shoulder prior to shoulder arthroplasty can be challenging especially in the case of revision arthroplasty. An open biopsy provides an opportunity to obtain tissue samples with minimal patient morbidity. The purpose of this study was to characterize the diagnostic utility of an open shoulder biopsy. Methods: A retrospective cohort study was performed at an academic medical center. All patients that underwent an open shoulder biopsy using a small proximal deltopectoral incision between 2008 and 2021 were included. Demographics, surgical history, culture results, and development of subsequent infection were recorded. Subsequent infection was defined as the development of a sinus tract, purulent drainage, or revision surgery with greater than or equal to two tissues specimens with growth of the same bacterial species. Sensitivity and negative predictive value (NPV) of an open biopsy were calculated based on the development of subsequent infection. As culture positive patients were treated for their infection, positive predictive value and specificity could not be determined. Results: We identified 55 patients that underwent 75 open biopsies. Most patients had a shoulder arthroplasty in place at the time of biopsy (69.1%), while 23.6% had an antibiotic spacer, and 7.3% had a native shoulder. Patients with a history of infection were more likely to have a spacer in place at the time of biopsy (65% vs. 0%; P

The pathogenesis of primary glenohumeral arthritis (GHOA) is mediated by a complex interaction between osseous anatomy and the surrounding soft tissues. Recently, there has been growing interest in characterizing the association between the anterior shoulder joint capsule and primary GHOA because of the potential for targeted treatment interventions. Emerging evidence has shown substantial synovitis, fibrosis, and mixed inflammatory cell infiltrate in the anterior capsule of osteoarthritic shoulders. In addition, increased thickening of the anterior shoulder joint capsule has been associated with greater posterior glenoid wear and humeral head subluxation. While these findings suggest that anterior capsular disease may play a causative role in the etiology and progression of eccentric GHOA, further studies are needed to support this association. The purpose of this article is to review the pathogenesis of primary GHOA, contextualize current hypotheses regarding the role of the anterior capsule in the disease process, and provide directions for future research.

Background: Distal humerus fractures (DHFs) pose a treatment challenge in elderly patients. We sought to systematically review and report the clinical outcomes of the nonoperative approach (eg, “bag of bones”) for the treatment of these injuries and the rate of conversion to delayed surgery. Methods: A comprehensive review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Studies involving outcomes after nonoperative treatment of DHF in patients >65 years of age were included from 1985 to present. Data regarding patient age, DHF type, nonoperative treatment method, complications, conversion to delayed surgery, range of motion, union rate, and surgeon- and patient-reported outcome measures were extracted. Results: A total of five studies met inclusion criteria (all level IV evidence), yielding a total of 143 patients (mean age: 73.5 years to 87.4 years) with 7.1 months to 55 months of follow-up. The mean Mayo Elbow Performance Index scores were good to excellent across several studies (range 83-93.1). Multiple studies reported good range of motion (mean arc of motion: 81 to 106 degrees) and low levels of upper extremity disability (mean Quick Disability of the Arm-Shoulder-Hand scores: 31.3 to 38.5) at the final follow-up. The rate of conversion to total elbow arthroplasty and operative fixation ranged from 0% to 7.5% and 0% to 5%, respectively. Conclusion: Nonoperative management of distal humerus fractures in the elderly seems to be associated with acceptable functional outcomes and low rates of delayed surgery. This information is important for patient counseling and treatment decision-making.