Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely un...Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.展开更多
Introduction: Analgesia following shoulder surgery commonly uses interscalene nerve blockade. When contraindicated (i.e. respiratory compromise), suprascapular nerve blockade can provide a viable alternative. Although...Introduction: Analgesia following shoulder surgery commonly uses interscalene nerve blockade. When contraindicated (i.e. respiratory compromise), suprascapular nerve blockade can provide a viable alternative. Although a number of techniques have been used, Barber in 2005 described a simple method using anatomical landmarks. While theoretically straightforward, substantive evidence supporting the advantages attributed to the technique has yet to be identified. The present study anatomically examines the technique proposed by Barber to critically assess its potential to benefit clinical practice. Materials and Methods: Using the technique proposed by Barber in 2005, the Nevaiser portal was used to introduce a K-wire into the supraspinous fossa in the region of the suprascapular nerve. A spinal needle was inserted in the same manner and left in position in the presumed region of the transverse scapular ligament. Tissue was dissected out around the wire and needle to visualize their proximity to the suprascapular nerve and transverse scapular ligament respectively. Results: The K-wire was consistently located close to the suprascapular nerve with all cases being within 5 mm. Spinal needle placement relative to the transverse scapular ligament was variable with 50% anterior, 25% posterior, and 25% displaced (likely due to dissection). Conclusions: The results illustrate that it is possible to reliably place a needle close to the suprascapular nerve using the technique described by Barber in 2005. This study provides anatomical confirmation of Barbers description of a simple technique and the basis for clinical study.展开更多
Purpose Posterior fracture-dislocation of shoulder is an infrequent traumatic event;however,most orthopaedic surgeons may face the challenge of treating it.The aim of this study is to review and summarise systematical...Purpose Posterior fracture-dislocation of shoulder is an infrequent traumatic event;however,most orthopaedic surgeons may face the challenge of treating it.The aim of this study is to review and summarise systematically the current principles of the management of this complex injury,and create a treatment algorithm.Methods Both PubMed and Scopus Databases were systematically searched for the terms“posterior shoulder fracture-dislocation”or“posterior glenohumeral fracture-dislocation”or“posterior glenoid fracture-dislocation”for articles written in English and published in the last decade.Results A total of 900 articles were identified,of which 13 were retained for analysis.A total of 153 patients(161 shoulders)were identified.These patients were treated either with open reduction and internal fixation,modified McLaughlin procedure,allograft/autograft humeral head reconstruction or shoulder arthroplasty.The mean age was 40.15 years.The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45,whereas by bone graft was 84.18.Further,the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure,respectively.Conclusion The management of posterior shoulder fracture-dislocation may be challenging,and the best surgical option depends on many variables such as the chronicity of the injury,the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any.A treatment algorithm is proposed,based on the current literature in an effort to create a consensus for these injuries.For the acute shoulder fracture-dislocations,an open reduction should be performed.For the chronic fracture/dislocations in the elderly low-demand patients,conservative treatment should be performed.For the rest of the patients,depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique,the use of an allograft,osteotomy or arthroplasty.展开更多
文摘Frozen shoulder is a common disease which causes significant morbidity. Despite over a hundred years of treating this condition the definition, diagnosis, pathology and most efficacious treatments are still largely unclear. This systematic review of current treatments for frozen shoulder reviews the evidence base behind physiotherapy, both oral and intra articular steroid, hydrodilatation, manipulation under anaesthesia and arthroscopic capsular release. Key areas in which future research could be directed are identified, in particular with regard to the increasing role of arthroscopic capsular release as a treatment.
文摘Introduction: Analgesia following shoulder surgery commonly uses interscalene nerve blockade. When contraindicated (i.e. respiratory compromise), suprascapular nerve blockade can provide a viable alternative. Although a number of techniques have been used, Barber in 2005 described a simple method using anatomical landmarks. While theoretically straightforward, substantive evidence supporting the advantages attributed to the technique has yet to be identified. The present study anatomically examines the technique proposed by Barber to critically assess its potential to benefit clinical practice. Materials and Methods: Using the technique proposed by Barber in 2005, the Nevaiser portal was used to introduce a K-wire into the supraspinous fossa in the region of the suprascapular nerve. A spinal needle was inserted in the same manner and left in position in the presumed region of the transverse scapular ligament. Tissue was dissected out around the wire and needle to visualize their proximity to the suprascapular nerve and transverse scapular ligament respectively. Results: The K-wire was consistently located close to the suprascapular nerve with all cases being within 5 mm. Spinal needle placement relative to the transverse scapular ligament was variable with 50% anterior, 25% posterior, and 25% displaced (likely due to dissection). Conclusions: The results illustrate that it is possible to reliably place a needle close to the suprascapular nerve using the technique described by Barber in 2005. This study provides anatomical confirmation of Barbers description of a simple technique and the basis for clinical study.
文摘Purpose Posterior fracture-dislocation of shoulder is an infrequent traumatic event;however,most orthopaedic surgeons may face the challenge of treating it.The aim of this study is to review and summarise systematically the current principles of the management of this complex injury,and create a treatment algorithm.Methods Both PubMed and Scopus Databases were systematically searched for the terms“posterior shoulder fracture-dislocation”or“posterior glenohumeral fracture-dislocation”or“posterior glenoid fracture-dislocation”for articles written in English and published in the last decade.Results A total of 900 articles were identified,of which 13 were retained for analysis.A total of 153 patients(161 shoulders)were identified.These patients were treated either with open reduction and internal fixation,modified McLaughlin procedure,allograft/autograft humeral head reconstruction or shoulder arthroplasty.The mean age was 40.15 years.The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45,whereas by bone graft was 84.18.Further,the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure,respectively.Conclusion The management of posterior shoulder fracture-dislocation may be challenging,and the best surgical option depends on many variables such as the chronicity of the injury,the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any.A treatment algorithm is proposed,based on the current literature in an effort to create a consensus for these injuries.For the acute shoulder fracture-dislocations,an open reduction should be performed.For the chronic fracture/dislocations in the elderly low-demand patients,conservative treatment should be performed.For the rest of the patients,depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique,the use of an allograft,osteotomy or arthroplasty.
