Shoulder & Elbow

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Heri Suroto Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

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Benedictus Anindita Satmoko Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia

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Tabita Prajasari Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

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Brigita De Vega Division of Surgery and Interventional Science, University College London, Royal Free Hospital Campus, United Kingdom

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Teddy Heri Wardhana Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

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Steven K Samijo Department of Orthopedic and Traumatology, Zuyderland Medisch Centrum, Heerlen, Netherlands

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Purpose

  • The use of non-biodegradable suture anchors (NBSA) in arthroscopic rotator cuff repair (RCR) has increased significantly. However, several complications such as migration, chondral damage, revision, and imaging difficulties have been reported. Meanwhile, the effectiveness of biodegradable suture anchors (BSA) in overcoming such complications and achieving functional outcomes requires further study. Thus, we aim to compare the clinical outcomes and complications of RCR using BSA and NBSA using direct comparison studies.

Methods

  • Two independent reviewers conducted systematic searches in PubMed, Embase, Cochrane Library, and Web of Science from conception to September 2022. Using the RoB 2 and ROBINS-I tools, we assessed the included studies for bias. We applied GRADE to appraise our evidence. Our PROSPERO registration number is CRD42022354347.

Results

  • Six studies (two randomized controlled trials, one retrospective cohort, and three case–control studies) involving 423 patients were included (211 patients received BSA and 212 patients received NBSA). BSA was comparable to NBSA in forward flexion, abduction, external rotation, Constant–Murley score, and perianchor cyst formation (P = 0.97, 0.81, 0.56, 0.29, and 0.56, respectively). Retear rates were slightly higher while tendon healing was reduced in BSA compared to NBSA, but the differences were not significant (P = 0.35 and 0.35, respectively).

Conclusion

  • BSA and NBSA appear to yield similar shoulder functions and complications in rotator cuff repairs.

Open access
Pududu Archie Rachuene Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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Roopam Dey Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa

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Sudesh Sivarasu Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, South Africa

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Jean-Pierre du Plessis Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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Stephen Roche Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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Basil Vrettos Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa

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  • Structural glenoid defects are common during primary reverse shoulder arthroplasty (RSA) and are often associated with poor outcomes.

  • The lack of pre-operative imaging protocols for determining the depth and degree of glenoid wear hinders our ability to accurately plan and correct these defects.

  • Although bone grafting has been reported to be effective in reducing glenoid wear during RSA, there is limited information on when to utilise it and how to prepare the graft.

  • We conducted this review to assess the evidence for the management of glenoid defects, with an emphasis on bone grafts to treat structural glenoid bone loss in primary RSA patients.

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Maciej Otworowski Idea Ortopedia, Warsaw, Poland

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Dariusz Grzelecki Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Otwock, Poland

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Krzysztof Starszak Department of Human Anatomy, Medical University of Silesia, Katowice, Poland

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Andrzej Boszczyk Trauma and Orthopedics Department, Centre of Posgraduate Medical Education, Otwock, Poland

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Mateusz Piorunek Medical University of Warsaw, Warsaw, Poland

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Bartłomiej Kordasiewicz Idea Ortopedia, Warsaw, Poland
Trauma and Orthopedics Department, Centre of Posgraduate Medical Education, Otwock, Poland

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Purpose

  • The goal of this study was to review available literature on periprosthetic shoulder fractures to evaluate epidemiology, risk factors and support clinical decision-making regarding diagnostics, preoperative planning, and treatment options.

Methods

  • Two authors cross-checked the PubMed and Web of Science medical databases. The inclusion criteria were as follows: original human studies published in English, with the timeframe not limited, and the following keywords were used: ‘periprosthetic shoulder fracture,’ ‘total shoulder arthroplasty periprosthetic fractures,’ ‘total shoulder arthroplasty fracture,’ and ‘total shoulder replacement periprosthetic fracture.’ Seventy articles were included in the review. All articles were retrieved using the aforementioned criteria.

Results

  • The fracture rate associated with total shoulder arthroplasty varied between 0 and 47.6%. Risk factors for periprosthetic fractures were female gender, body mass index < 25 kg/m2, smoking, rheumatoid arthritis, and Parkinson’s disease. The most commonly used classification is the Wright and Coefield classification. Periprosthetic fractures can be treated both, conservatively and operatively.

Conclusion

  • Periprosthetic fracture frequency after shoulder arthroplasty ranges from 0 to 47.6%. The most common location of the fracture is the humerus and most commonly occurs intraoperatively. The most important factor influencing treatment is stem stability. Fractures with stem instability require revision arthroplasty with stem replacement. Fractures with a stable stem depending on the location, displacement and bone stock quality can be treated both conservatively and operatively. For internal fixation plates with cables and screws are most commonly used.

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Johannes Barth Clinique des Cèdres, 21 Avenue Albert Londres, 38130 Échirolles, France

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Jerôme Garret Clinique du parc, 155, Boulevard Stalingrad, Lyon, France

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Luca Nover ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Floris van Rooij ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Philippe Clavert Service de Chirurgie du Membre Supérieur, Haut Pierre 2, CHRU Strasbourg, avenue Molière, Strasbourg, France

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The Société Francophone d'Arthroscopie *
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The Société Francophone d'Arthroscopie

  • The aim of this study is to determine whether adjuvant Distal Clavicle Resection (DCR) improves outcomes of Rotator Cuff Repair (RCR) in terms of ROM, clinical scores as well as reducing complications and/or reoperations.

  • This systematic review conforms to the PRISMA guidelines. Studies were included if they compared outcomes of RCR with and without adjuvant DCR and reported on postoperative ROM, clinical scores, complications, and/or reoperations.

  • Seven studies that comprised 1572 shoulders which underwent RCR at a follow-up ranged 8-54 months: 398 with adjuvant DCR and 1174 without DCR. No significant differences were found between patients that had DCR versus those that did not have DCR, in terms of postoperative clinical scores (ASES, Constant, pVAS), postoperative ROM (AFE, external and internal rotation), retear rate and reoperation rate.

  • There were no significant differences in ROM, clinical scores, or rates of retears and reoperations between patients that underwent RCR with or without adjuvant DCR.

  • There is insufficient evidence to support routine DCR during RCR; the incidence of new or residual acromioclavicular joint (ACJ) pain after RCR with adjuvant DCR is higher than following isolated RCR, which could in fact induce iatrogenic morbidity and therefore does not justify the additional surgery time and costs of routine adjuvant DCR.

Open access
Stefan Bauer Ensemble hospitalier de la Côte, Chirurgie de l’épaule, Chemin du Crêt 2, Morges, Vaud, Switzerland
The University of Western Australia, Perth, Australia

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Phillipe Collin CHP Saint-Gregoire, 6 Boulevard de la Boutière 35760 Saint-Grégoire, France
Clinique Victor Hugo, 5 Bis rue du Dôme 75016 Paris, France
American Hospital of Paris, 55 Boulevard du Château, 92200 Neuilly-sur-Seine, France

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Matthias A Zumstein Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland
Shoulder, Elbow Unit, Sportsclinicnumber1, Papiermuehlestrasse 73, 3014 Bern, Switzerland
Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, Bern, Switzerland

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Lionel Neyton Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France

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William G Blakeney The University of Western Australia, Perth, Australia
Royal Perth Hospital, Perth, Australia

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  • Chronic traumatic anterior shoulder instability can be defined as recurrent trauma-associated shoulder instability requiring the assessment of three anatomic lesions: a capsuloligamentous and/or labral lesion; anterior glenoid bone loss and a Hill–Sachs lesion.

  • Surgical treatment is generally indicated. It remains controversial how risk factors should be evaluated to decide between a soft-tissue, free bone-block or Latarjet-type procedure.

  • Patient risk factors for recurrence are age; hyperlaxity; competitive, contact and overhead sports. Trauma-related factors are soft tissue lesions and most importantly bone loss with implications for treatment.

  • Different treatment options are discussed and compared for complications, return to sports parameters, short- and long-term outcomes and osteoarthritis.

  • Arthroscopic Bankart and open Latarjet procedures have a serious learning curve. Osteoarthritis is associated with the number of previous dislocations as well as surgical techniques.

  • Latarjet-type procedures have the lowest rate of dislocation recurrence and if performed correctly, do not seem to increase the risk of osteoarthritis.

Open access
Mark F Siemensma Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, 3000 CA, Rotterdam, The Netherlands

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Anna E van der Windt Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, 3000 CA, Rotterdam, The Netherlands

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Eline M van Es Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, 3000 CA, Rotterdam, The Netherlands

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Joost W Colaris Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, 3000 CA, Rotterdam, The Netherlands

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Denise Eygendaal Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, 3000 CA, Rotterdam, The Netherlands

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  • The elbow is prone to stiffness due to its unique anatomy and profound capsular reaction to inflammation. The resulting movement impairment may significantly interfere with a patient’s activities of daily living.

  • Trauma (including surgery for trauma), posttraumatic arthritis, and heterotopic ossification (HO) are the most common causes of elbow stiffness.

  • In stiffness caused by soft tissue contractures, initial conservative treatment with physiotherapy (PT) and splinting is advised. In cases in which osseous deformities limit range of motion (e.g. malunion, osseous impingement, or HO), early surgical intervention is recommended.

  • Open and arthroscopic arthrolysis are the primary surgical options. Arthroscopic arthrolysis has a lower complication and revision rate but has narrower indications.

  • Early active mobilization using PT after surgery is recommended in postoperative rehabilitation and may be complemented by splinting or continuous passive motion therapy. Most results are gained within the first few months but can continue to improve until 12 months.

  • This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness.

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Rui Claro Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Hospital de Santo António, Porto, Portugal
Shoulder Unit, Department of Orthopaedics, Centro Hospitalar Universitário de Santo António, Hospital de Santo António, Porto, Portugal
Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto, Portugal
Department of Orthopaedics, Hospital Lusíadas, Porto, Portugal
Shoulder and Elbow Unit, Hospital Lusíadas, Porto, Portugal

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Hélder Fonte Department of Orthopaedics, Hospital das Forças Armadas – Pólo Porto, Porto, Portugal
Department of Orthopaedics, Hospital Lusíadas, Porto, Portugal
Shoulder and Elbow Unit, Hospital Lusíadas, Porto, Portugal
Department of Orthopaedics, Hospital da Luz Arrábida, Portugal

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  • The treatment of rotator cuff tears (RCTs) has evolved. Nonsurgical treatment is adequate for many patients; however, for those for whom surgical treatment is indicated, rotator cuff repair provides reliable pain relief and good functional results. However, massive and irreparable RCTs are a significant challenge for both patients and surgeons.

  • Superior capsular reconstruction (SCR) has become increasingly popular in recent years. It works by passively restoring the superior restriction of the humeral head, thus restoring the pair of forces and improving the kinematics of the glenohumeral joint. Early clinical results using fascia lata (FL) autograft were promising in terms of pain relief and function.

  • The procedure has evolved, and some authors have suggested that FL autografts could be replaced by other methods. However, surgical techniques for SCR are highly variable, and patient indications remain undefined. There are concerns that the available scientific evidence does not support the popularity of the procedure.

  • This review aimed to critically evaluate the biomechanics, indications, procedural considerations, and clinical outcomes associated with the SCR procedure.

Open access
Claudio Rosso ARTHRO Medics, Shoulder and Elbow Center, Basel, Switzerland
University of Basel, Basel, Switzerland
Swiss Orthopaedics, Grandvaux, Switzerland

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Mark E Morrey Swiss Orthopaedics, Grandvaux, Switzerland

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Michael O Schär Swiss Orthopaedics, Grandvaux, Switzerland

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Kushtrim Grezda ARTHRO Medics, Shoulder and Elbow Center, Basel, Switzerland
University of Basel, Basel, Switzerland
Department of Orthopedic Surgery, Division of Shoulder and Elbow, Mayo Clinic, Rochester, Minnesota

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the Swiss Orthopaedics Shoulder Elbow and Expert Group †
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the Swiss Orthopaedics Shoulder Elbow and Expert Group

  • Platelet-rich plasma (PRP) is a revolutionary treatment that harnesses the regenerative power of the body's own platelets to promote healing and tissue regeneration.

  • While PRP therapy has emerged as a promising option for augmenting biologic healing in the shoulder, the complexity of shoulder disorders makes it difficult to draw definitive conclusions about the efficacy of PRP across different conditions and stages of disease.

  • Our comprehensive review of twenty-four studies highlights the current state of PRP therapy in shoulder pathologies, revealing a wide variety of number of patients, control groups and results. Despite these challenges, the regenerative potential of PRP therapy is moderate in some conditions, with numerous studies demonstrating the positive effects.

  • In conclusion, the authors of this study recommend the use of PRP therapy for adhesive capsulitis and rotator cuff repair of medium to large tears. However, they do not recommend the use of PRP for subacromial impingement or rotator cuff tears. It is up to the clinician's discretion to decide whether PRP therapy is appropriate for individual cases. However, there is still insufficient evidence to support the inclusion of PRP therapy in treatment protocols for other shoulder disorders. Therefore, further research is needed to fully explore the potential of PRP therapy in the treatment of various shoulder conditions.

Open access
A Prkić Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands
Amsterdam UMC Location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands

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N P Vermeulen Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands

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B W Kooistra Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands
Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, The Netherlands
Department of Orthopedic Surgery, Medische Kliniek Velsen, Velsen-Noord, The Netherlands

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B The Department of Orthopedic Surgery, Upper Limb Section, Amphia Hospital, Breda, The Netherlands

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M P J van den Bekerom Department of Orthopedic Surgery, Medische Kliniek Velsen, Velsen-Noord, The Netherlands
Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands

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D Eygendaal Department of Orthopedic Surgery and Sports Medicine, ErasmusMC, Rotterdam, The Netherlands

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  • Purpose: Total elbow arthroplasty (TEA) is rarely performed compared to other arthroplasties. For many surgical procedures, literature shows better outcomes when they are performed by experienced surgeons and in so-called ‘high-volume’ hospitals. We systematically reviewed the literature on the relationship between surgical volume and outcomes following TEA.

  • Methods: A literature search was performed using the MEDLINE, EMBASE and CINAHL databases. The literature was systematically reviewed for original studies comparing TEA outcomes among hospitals or surgeons with different annual or career volumes. For each study, data were collected on study design, indications for TEA, number of included patients, implant types, cut-off values for volume, number and types of complications, revision rate and functional outcome measures. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale.

  • Results: Two studies, which included a combined 2301 TEAs, found that higher surgeon volumes were associated with lower revision rates. The examined complication rates did not differ between high- and low-volume surgeons. In one study, low-hospital volume is associated with an increased risk of revision compared to high-volume hospitals, but for other complication types, no difference was found.

  • Conclusions: Based on the results, the evidence suggests that high-volume centers have a lower revision rate in the long term. No minimum amount of procedures per year can be advised, as the included studies have different cut-off values between groups. As higher surgeon- and center-volume, (therefore presumably experience) appear to yield better outcomes, centralization of total elbow arthroplasty should be encouraged.

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Anna Wawrzyniak Rehasport Clinic, Poznań, Poland

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Przemysław Lubiatowski Rehasport Clinic, Poznań, Poland
Sport Traumatology and Biomechanics Unit Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Science, Poznań, Poland

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Purpose

  • The purpose of this study was to collect and evaluate clinical and radiological evidence on shoulder neuroarthropathy (NA) in syringomyelia (SM) that may support the management and treatment of patients with this condition.

Materials and methods

  • This systematic review is based on the analysis of reports available in PubMed, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials using the following keywords: syringomyelia, neuroarthropathy, Charcot joint and shoulder degeneration. Thirty-nine publications were found presenting case reports or case series meeting our criteria. Pooled data included a group of 65 patients and 71 shoulders with NA secondary to SM.

Results

  • The most commonly reported symptoms were range of motion (ROM) limitation, weakness, swelling, pain and dissociated sensory loss. NA is usually monolateral and concerns only the shoulder. The average active shoulder ROM was flexion −59.2° (s.d. 37.9), internal rotation −29.8° (s.d. 22.6) and external rotation −21.1° (s.d. 23.6). Most of the patients (75%) presented with complete or nearly complete proximal humerus degeneration, while the degree of glenoid preservation varied. Fifty-two neuroarthropathic shoulders were treated conservatively with physiotherapy, anti-inflammatory medication and splinting. Eighteen patients were treated by surgical intervention.

Conclusion

  • Shoulder NA due to SM is a devastating and progressive condition, and its course is often unpredictable. Patients with unexplained shoulder degeneration should be evaluated for SM, especially if there are additional neurological symptoms. Conservative treatment usually reduces shoulder pain without improving ROM. For select patients, shoulder arthroplasty may be a better option for restoring function.

Open access