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S. Rymaruk and C. Peach

  • Frozen shoulder causes significant functional disability and pain in a population group constituted by patients who are often middle-aged and working.

  • Frozen shoulder remains poorly understood. The available literature is limited and often prone to bias.

  • A rapid, non-surgical and cost-effective treatment that reduces pain and restores function is an attractive option.

  • Hydrodilatation is a potential first-line treatment of frozen shoulder in secondary care.

Cite this article: EFORT Open Rev 2017;2:462–468. DOI: 10.1302/2058-5241.2.160061

Raul Barco and Samuel A. Antuña

  • Medial elbow pain is uncommon when compared with lateral elbow pain.

  • Medial epicondylitis is an uncommon diagnosis and can be confused with other sources of pain.

  • Overhead throwers and workers lifting heavy objects are at increased risk of medial elbow pain.

  • Differential diagnosis includes ulnar nerve disorders, cervical radiculopathy, injured ulnar collateral ligament, altered distal triceps anatomy or joint disorders.

  • Children with medial elbow pain have to be assessed for ‘Little League elbow’ and fractures of the medial epicondyle following a traumatic event.

  • This paper is primarily focused on the differential diagnosis of medial elbow pain with basic recommendations on treatment strategies.

Cite this article: EFORT Open Rev 2017;2:362-371. DOI: 10.1302/2058-5241.2.160006

E. Itoi

  • Shoulder stability depends on the position of the arm as well as activities of the muscles around the shoulder. The capsulo-ligamentous structures are the main stabilisers with the arm at the end-range of movement, whereas negative intra-articular pressure and concavity-compression effect are the main stabilisers with the arm in the mid-range of movement.

  • There are two types of glenoid bone loss: fragment type and erosion type. A bone loss of the humeral head, known as a Hill-Sachs lesion (HSL), is a compression fracture of the humeral head caused by the anterior rim of the glenoid when the humeral head is dislocated anteriorly in front of the glenoid. Four out of five patients with anterior instability have both Hill-Sachs and glenoid bone lesions, which is called a ‘bipolar lesion’.

  • With the arm moving along the posterior end-range of movement, or with the arm in various degrees of abduction, maximum external rotation and maximum horizontal extension, the glenoid moves along the posterior articular margin of the humeral head. This contact zone of the glenoid with the humeral head is called the ‘glenoid track’.

  • A HSL, which stays on the glenoid track (on-track lesion), cannot engage with the glenoid and cannot cause dislocation. On the other hand, a HSL, which is out of the glenoid track (off-track lesion), has a risk of engagement and dislocation. Clinical validation studies show that the ‘on-track/off-track’ concept is able to predict reliably the risk of a HSL being engaged with the glenoid. For off-track lesions, either remplissage or Latarjet procedure is indicated, depending upon the glenoid defect size and the risk of recurrence.

Cite this article: EFORT Open Rev 2017;2:343-351.

Richard W. Nyffeler and Dominik C. Meyer

  • The shape of the acromion differs between patients with degenerative rotator cuff tears and individuals without rotator cuff pathology.

  • It can be assessed in the sagittal plane (acromion type, acromion slope) and in the coronal plane (lateral acromion angle, acromion index, critical shoulder angle).

  • The inter-observer reliability is better for the measurements in the coronal plane.

  • A large lateral extension (high acromion index or high critical shoulder angle) and a lateral down-sloping of the acromion (low lateral acromion angle) are associated with full-thickness supraspinatus tears.

  • The significance of glenoid inclination for rotator cuff disease is less clear.

  • The postulated patho-mechanism is the compression of the supraspinatus tendon between the humeral head and the acromion. Bursal side tears might be caused by friction and abrasion of the tendon. Articular side tears could be due to impairment of the gliding mechanism between tendon fibrils leading to local stress concentration. Further research is needed to understand the exact pathomechanism of tendon degeneration and tear.

Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160076. Originally published online at

Nicolas Bonnevialle, Florence Dauzères, Julien Toulemonde, Fanny Elia, Jean-Michel Laffosse, and Pierre Mansat

  • Periprosthetic shoulder infection (PSI) is rare but potentially devastating. The rate of PSI is increased in cases of revision procedures, reverse shoulder implants and co-morbidities. One specific type of PSI is the occurrence of low-grade infections caused by non-suppurative bacteria such as Propionibacterium acnes or Staphylococcus epidemermidis.

  • Success of treatment depends on micro-organism identification, appropriate surgical procedures and antibiotic administration efficiency. Post-operative early PSI can be treated with simple debridement, while chronic PSI requires a one- or two-stage revision procedure. Indication for one-time exchange is based on pre-operative identification of a causative agent. Resection arthroplasty remains an option for low-demand patients or recalcitrant infection.

Cite this article: EFORT Open Rev 2017;2:104-109. DOI: 10.1302/2058-5241.2.160023

Daniel Bachman and Akin Cil

  • Distal humeral replacement and the total elbow are two commonly-used arthroplasties

  • Each prosthesis has evolving indications and surgical techniques

  • Recent changes in device design and implantation methods are due to biomechanical and clinical outcome-based research

  • New prostheses and methods provide: better elbow kinematics, more durable bearings and longer-lasting joint replacement potential

Cite this article: EFORT Open Rev 2017;2:83-88. DOI: 10.1302/2058-5241.2.160064

Michele Boffano, Stefano Mortera, and Raimondo Piana

  • Shoulder joint dislocation is the most common joint dislocation seen in the emergency department.

  • Traumatic dislocation may cause damage to the soft-tissues surrounding the shoulder joint and sometimes to the bone. The treatment, which aims at restoration of a fully functioning, pain-free and stable shoulder, includes either conservative or surgical management preceded by closed reduction of the acute dislocation.

  • Conservative management usually requires a period of rest, generally involving immobilisation of the arm in a sling, even though it is still debated whether to immobilise the shoulder in internal or external rotation.

  • Operative management, with no significant differences in term of re-dislocation rates between open and arthroscopic repair, incorporates soft-tissue reconstructions and/or bony procedures and is recommended in young male adults engaged in highly demanding physical activities.

  • At our institution, non-operative management is favoured particularly for patients with multi-directional instability or soft-tissue laxity. Conservative measures are often preferred in older patients or younger patients that are not actively engaged in overhead activities. Immediate surgery on all first-time dislocations may subject many patients to surgery who would not have had any future subluxation.

  • For these reasons, initially we will always try physical therapy and activity modification for the vast majority of our patients.

Cite this article: EFORT Open Rev 2017;2:35-40.DOI: 10.1302/2058-5241.2.160018.

Felix H. Savoie and Michael O’Brien

  • Damage to the medial collateral ligament of the elbow from an instability episode usually heals with non-operative treatment. In some cases, residual instability may occur, leading to functional impairment.

  • Non-operative management can be successful when bracing, taping and therapy are used to stabilise the elbow.

  • A recent report detailing the efficacy of platelet-rich plasma in effectively treating ulnar collateral ligament (UCL) injuries in throwers has shown promise. However, there remain specific groups that should be considered for repair or reconstruction. These may include throwing athletes, wrestlers and some individuals involved in highly active physical activity which demands stability of the elbow.

  • The results of surgical repair and reconstruction allowing a return to sports are quite good, ranging from 84% to 94%. Complications are generally low and mostly centred on ulnar nerve injuries.

  • This report represents a review of the literature concerning valgus instability over the past five years, supplemented by selective older articles where relevant.

Cite this article: EFORT Open Rev 2017;2:1-6. DOI:10.1302/2058-5241.2.160037.

Megan Conti Mica, Pieter Caekebeke, and Roger van Riet

  • Chronic posterolateral rotatory instability (PLRI) is the most common form of chronic elbow instability.

  • PLRI usually occurs from a fall on the outstretched hand. On impact, the radial head and ulna rotate externally coupled with valgus displacement of the forearm. This leads to posterior displacement of the radial head relative to the capitellum, thus causing disruption of some or all of the lateral-sided stabilisers.

  • PLRI is mainly a clinical diagnosis with a history of instability, clicking and lateral-sided pain, with a positive clinical examination including the pivot-shift test, push-up, chair and tabletop test.

  • MRI can often help guide diagnosis but more commonly assists in surgical planning.

  • Surgery is indicated in patients with persistent, symptomatic instability of the elbow causing pain or functional deficit. There are several surgical techniques to treat PLRI, often leading to good to excellent results.

  • An open or arthroscopic technique has been successfully used in patients with symptomatic PLRI following one or more episodes of dislocation or subluxation. At the pre-operative examination under general anaesthesia, all of our patients had a positive pivot-shift test but not a frank dislocation. We prefer to perform a lateral collateral ligament (LCL) reconstruction with an allograft tendon.

  • The outcomes after repair are good to excellent in the majority of patients. Results of acute repair are generally better compared with reconstruction. This is due to the fact that predictive factors for a poor outcome include the number of previous surgeries and the prevalence of degenerative changes at the elbow.

  • Recurrent instability is not uncommon following repair or reconstruction and has been reported in up to 25% of patients after medium- to longer-term follow-up.

Cite this article: EFORT Open Rev 2016;1:461-468. DOI: 10.1302/2058-5241.160033

Alexandre Lädermann, Stephen S. Burkhart, Pierre Hoffmeyer, Lionel Neyton, Philippe Collin, Evan Yates, and Patrick J. Denard

  • Rotator cuff lesions (RCL) have considerable variability in location, tear pattern, functional impairment, and repairability.

  • Historical classifications for differentiating these lesions have been based upon factors such as the size and shape of the tear, and the degree of atrophy and fatty infiltration. Additional recent descriptions include bipolar rotator cuff insufficiency, ‘Fosbury flop tears’, and musculotendinous lesions.

  • Recommended treatment is based on the location of the lesion, patient factors and associated pathology, and often includes personal experience and data from case series. Development of a more comprehensive classification which integrates historical and newer descriptions of RCLs may help to guide treatment further.

Cite this article: Lädermann A, Burkhart SS, Hoffmeyer P, et al. Classification of full thickness rotator cuff lesions: a review. EFORT Open Rev 2016;1:420-430. DOI: 10.1302/2058-5241.1.160005.