Background The role of postoperative pain in incidence of shoulder stiffness (SS) after shoulder arthroscopy has not been thoroughly investigated. The present study was conducted to assess the effects of early postoperative pain (EPOP) on onset of SS after arthroscopic rotator cuff (RC) repair. Materials and methods In a retrospective analysis of a prospectively collected database, 335 patients who underwent arthroscopic RC repair were evaluated. RC tendons were sutured to the bone using the double-row technique. EPOP was evaluated 1 week after surgery using the visual analog scale (VAS). SS was assessed 3 months after surgery and was categorized into moderate or severe based on shoulder range of motion (ROM). Each type of complication including SS was identified and recorded. Results Postoperative shoulder stiffness (POSS) was identified in 121 patients (36.2%) that was moderate in 86 patients (70.1%) and severe in 35 patients (28.9%). After 1 week, VAS pain score was equal to 7.7 ± 3.1 and 4.5 ± 2.1 in the patients with and without stiffness, respectively (p < 0.001). Diabetes and traumatic tear were found to be associated with postoperative stiffness (p = 0.046 and p < 0.001, respectively). Similar associations were found on multivariate analysis of data. VAS pain score was higher in the patients with severe stiffness compared with those with moderate stiffness (p < 0.001). Conclusions Our findings revealed that EPOP is associated with shoulder stiffness after arthroscopic RC repair. Therefore, strategies to ameliorate EPOP could be opted to decrease rate of POSS. Level of evidence Level IV

Background:The goal of this study was to evaluate the outcome of the open repair of rotator cuff tears via the deltopectoral approach in patients unable to afford arthroscopic repair costs.Methods:We evaluated 80 consecutive patients who were treated for full-thickness rotator cuff tears by open repair through the deltopectoral approach. There were 48 men and 32 women at a mean age of 60.1 years (range, 35-80 years). Preoperative and postoperative clinical assessments were performed with the Constant score, American Shoulder and Elbow Surgeons (ASES) score, modified University of California Los Angeles (UCLA) score, and pain visual analog scale.Results:The mean follow-up period was 30.6 months (range, 18-48 months). At final follow-up visits, the ASES, Constant score, and modified UCLA score were found to have improved significantly from 33.56, 39.24, and 13.0 to 85.64, 81.46, and 32.2, respectively (P <0.01). Pain, as measured on a visual analog scale, was improved significantly (P <0.01). The mean time for recovering the full range of motion was 2.5 months. Postoperative pain at 48 hours and at 6 weeks was relatively low. There were no cases of intractable stiffness.Conclusion:The deltopectoral approach for open rotator cuff repair produced satisfactory results and reduces rate of shoulder stiffness and postoperative pain.

Background Floating metacarpal is a rare concurrent bipolar dislocation of metacarpal at both ends. Isolated dislocations of Carpo-metacarpal (CMC) or Metacarpo-phalangeal (MCP) have been previously reported, simultaneous dislocations of both joints is scarcely reported in literature and bares high chance of diagnosis being missed on presentation. Patient A 29-year-old male presented with pain, swelling in left hand and loss of movement in fifth and fourth finger following a motorcycle fall injury. Radiography showed floating metacarpal of fifth ray along with fracture dislocation of at base of fourth metacarpal. Diagnosis The patient was diagnosed with floating fifth metacarpal along with fracture dislocation at base of fourth metacarpal. Intervention Open reduction and K-wire fixation was performed across CMC for fifth and fourth metacarpal along with MCP fixation for fifth metacarpal joint. Outcomes The patient had excellent outcome after one year with normal Range of motion and grip. Lessons Early recognition and prompt management of these injuries are considered as hallmark of prognosis. Ideal treatment for such dislocation is controversial. However, we have noted from earlier case reports that with acute dislocation and minimal swelling closed reduction and cast immobilization could be sufficient. In case of delayed presentation or swelling along with fracture, open reduction is favorable choice of treatment.

Background: Rotator cuff tears present in about 20% of the population. This has prompted surgeons to look for techniques to augment the rotator cuff tear repair. This study aimed to assess the results of Ultrapro mesh augmentation in patients with massive and large rotator cuff tears as a clinical trial. Methods: The study was a single-blind randomized controlled trial in which patients were randomly divided into two groups. Both groups underwent surgery. In one, Ultrapro mesh was used to augment the repair. Therapeutic outcome was assessed by using a joint range of motion, Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), and visual analogue scale (VAS). Results: 60 patients were included, of whom 47 were men. Forward flexion (FF), abduction, external rotation (ER), and internal rotation (IR) degree increased significantly in both groups (P < 0.01), but no significant difference was found between the two groups in terms of changes in these angles (P > 0.05). During the study period and in both groups, the OSS score decreased, and the SST score increased. The pain in both groups decreased until the sixth month and increased after that up to the twelfth month. Conclusion: Although the use of Ultrapro mesh augmentation in the rotator cuff tear has been associated with better long-term results in the abduction and ER of patients, the effect on the patients’ clinical results is not significant. Further studies are needed to make a more accurate judgment.