Rotator cuff disorders are considered to be among the most common causes of shoulder pain and disability encountered in both primary and secondary care.The general pathology of subacromial impingment generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch. However acute traumatic injuries may also lead to this condition.Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process. Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingment, with MRI scans being reserved for more complex cases.A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice. However, in young patients or following any traumatic injury to the rotator cuff, surgery should be considered early. If surgery is to be performed this should be done arthroscopically and in the case of complete rotator cuff rupture the tendon should be repaired where possible.
Frozen shoulder is a common, disabling but self-limiting condition, which typically presents in three stages and ends in resolution. Frozen shoulder is classified as primary (idiopathic) or secondary cases. The aetiology for primary frozen shoulder remains unknown. It is frequently associated with other systemic conditions, most commonly diabetes mellitus, or following periods of immobilisation e.g. stroke disease. Frozen shoulder is usually diagnosed clinically requiring little investigation. Management is controversial and depends on the phase of the condition. Non-operative treatment options for frozen shoulder include analgesia, physiotherapy, oral or intra-articular corticosteroids, and intra-articular distension injections. Operative options include manipulation under anaesthesia and arthroscopic release and are generally reserved for refractory cases.
Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management.A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted.The majority of recent data suggests that operative treatment may be more appropriate as it improves functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.
Aim: The SuperPATH approach has been in practice for almost a decade. There is no systematic review to date comparing the novel SuperPATH approach with conventional approaches. Therefore, it is important to conduct an up-to-date review to evaluate the benefits and drawbacks of the SuperPATH approach in comparison to widely accepted traditional approaches. Our primary aim was to compare the newer SuperPATH approach with the traditional approaches to the hip in terms of functional outcome and radiological parameters. We also aimed to identify any potential complications of the SuperPATH approach as it is a new surgical technique lacking any published sytematic reviews. Materials and methods: The review was conducted in accordance with the steps detailed in the Cochrane Handbook for Systematic reviews of intervention and will be reported bearing in mind the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PICO terms were independently searched in multiple databases. Studies that compared SuperPATH with traditional approaches were included in the analysis. Results: 7 studies including a total of 730 patients were available for final analysis. 3 studies were randomised control trials, 2 were prospective cohort studies and 2 were non-randomised case control studies. Patients in the SuperPATH group were discharged earlier (2 days difference in weighted mean). The operative time was 5 minutes longer (84.46 vs. 78.99) and there was a marginal decrease in blood loss (38 ml lesser) in the SuperPATH approach. VAS Score and HHS at the end of 1 year was comparable in both study groups. Cup abduction angle and anteversion angles were acceptable and comparable in both groups. Conclusions: The SuperPATH approach shows minimal improvement in length of hospital stay and blood loss with no significant improvement in pain or functional outcome score. There are no major complications reported and the radiological parameters are comparable.
A 68-year-old woman with osteoarthritis had a ceramic-on-ceramic left total hip arthroplasty, including ceramic femoral head and acetabular liner. At 5 years after surgery, the patient developed onset of a very loud squeaking noise, which could be heard 25 m from her, associated with limited hip movement. Findings at revision surgery included a broken ceramic femoral head component, complete wear of the ceramic acetabular component, and black wear debris. Squeaking hip after ceramic-on-ceramic total hip arthroplasty may be associated with catastrophic failure of the arthroplasty components.
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