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The tendon of the long head of the biceps (LHB) is a common source of pain in the shoulder, and the surgical treatments proposed are tenotomy or tenodesis performed in different ways. The purpose of this study is to compare the clinical results (objective and subjective) of tenotomy versus soft tissue tenodesis. One-hundred and four patients with an isolated LHB pathology, arthroscopically treated between 2004 and 2007, were observed retrospectively. Forty-eight of these patients were treated with tenotomy and 56 with a soft tissue tenodesis technique. All the patients were evaluated by an independent observer with a minimum follow-up of 2 years which included VAS, DASH questionnaire, Constant score and ROM evaluation with a goniometer. All these evaluations were performed pre- and post-operatively. An independent expert radiologist then performed an ultrasound examination only in the post-operative evaluation of the tenodesis group looking to confirm the effectiveness of the procedure. In both groups, the scores were significantly improved. In the tenotomy group, 16.6 % of the patients had bicipital cramps for a mean post-operative time of 1 month. Constant score improved in both groups: 46.6 to 86.1 in tenotomy group and 48.9-84.9 in tenodesis group; VAS improved from 8.4 to 1.5 in tenotomy group and from 8.8 to 1.4 in tenodesis group; DASH scores changed from 42.5 to 13.6 in tenotomy group and from 55.8 to 11.4 in tenodesis group. Popeye sign was present in 37.5 % in the tenotomy group and in 5.3 % in tenodesis group. In 3 patients of the tenodesis group, ultrasound revealed complete failure of the tenodesis. In conclusion, both procedures are effective in terms of treatment of LHB pathologies. Tenotomy does not require specific post-operative treatment and is easy to perform, but cramp and Popeye sign may occur after surgery. The soft tissue tenodesis technique is an easy and cost-effective way to perform tenodesis with good results, especially in preventing the Popeye sign, but requires a longer rehabilitation time. Level of evidence IV.

Arthroscopic transtendon partial articular supraspinatus tendon avulsion-type rotator cuff repair was a reliable procedure that resulted in a good outcome in terms of pain relief and shoulder scores in 98% of the 54 patients. Better results could be expected in patients with less tendon retraction, a larger footprint exposure, of younger age, and with a clinical history of trauma.

Total shoulder replacement is a successful procedure for degenerative or some inflammatory diseases of the shoulder. However, fixation of the glenoid seems to be the main weakness with a high rate of loosening. The results using all-polyethylene components have been better than those using metal-backed components. We describe our experience with 35 consecutive total shoulder replacements using a new metal-backed glenoid component with a mean follow-up of 75.4 months (48 to 154). Our implant differs from others because of its mechanism of fixation. It has a convex metal-backed bone interface and the main stabilising factor is a large hollow central peg. The patients were evaluated with standard radiographs and with the Constant Score, the Simple Shoulder Test and a visual analogue scale. All the scores improved and there was no loosening, no polyethylene-glenoid disassembly and no other implant-related complications. We conclude that a metal-backed glenoid component is a good option in total shoulder replacement with no worse results than of those using a cemented all-polyethylene prosthesis.

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Purpose Revision of a shoulder arthroplasty to a reverse arthroplasty is a highly demanding procedure. The aim of this study is to report the clinical results of hemi and total shoulder prosthesis revisions to reverse implants without removal of the humeral stem, using a modular shoulder replacement system (SMR Lima LTD). We retrospectively reviewed 26 patients who underwent an operation from 2004 to 2009. Methods The patients were divided into two groups: in Group I, 18 patients underwent a revision of hemiarthroplasty implanted for fracture; in Group II, eight patients underwent a revision of anatomical total prosthesis. All patients were evaluated at a mean follow-up of 32.3 (±12.7) months using the Constant score rating scale and by range of motion evaluation, EQ-VAS, X-ray and CT scan. Results The Constant score of each patient was 47.88 (±5.88) after the revision. The EQ-VAS improved from 40 (±20) to 70 (±10). All patients improved in terms of range of motion.The radiographs and CT scans obtained after revision showed good integration and no signs of loosening of the implant. The mean time of surgery was recorded as 62′ (±8′), with a maximum blood loss of less than 300 ml in all cases. Conclusions Our study demonstrates that using a full modular system at the time of the first implant allows avoidance of the step to remove the humeral stem and metal back in cases of shoulder prosthesis revision to a reverse prosthesis, resulting in a short operative time, few intraoperative complications and a satisfactory clinical outcome at medium-term follow-up.