Purpose:The most reliable clinical investigations to diagnose rotator cuff tears reported in the literature is a triad of weakness on resisted external rotation, pain on impingement, and weakness on supraspinatus testing, or a combination of two of the above in a patient over 60 years of age. We present a simple new clinical test “The lateral Jobe Test” and compare it to these combined tests. The lateral Jobe test is performed with the patient’s shoulder abducted 90° in the coronal plane and internally rotated so that with the elbows flexed 90° the fingers point inferiorly and thumbs medially. A positive test is pain or weakness on resisting an inferiorly directed force applied to the distal arms or an inability to perform the test.Materials and Methods:A consecutive series of 175 patients undergoing shoulder arthroscopy were reviewed prospectively and examined by two independent orthopedic surgeons blinded to the diagnosis. The results of the clinical tests were validated against arthroscopic findings.Results:The lateral Jobe test had a significantly higher sensitivity (81 vs. 58%) than the combined tests. The specificity of both was similar at 89 and 88%, respectively.Conslusion:The lateral Jobe test is a simple single test which can help in the clinical diagnosis of rotator cuff tears.Level of Evidence:Level IIb

Unstable mallet fractures of the digit pose a challenge when treated surgically. We present the results of a technique, not earlier described, for the fixation of these uncommon injuries. The technique involves anatomical reduction and stable fixation of the distal articular fragment combined with stabilization of the distal interphalangeal joint with buried Kirschner wires allowing early mobilization of the digit. Twenty patients with an average follow-up of 12.7 months (10 mo to 21 mo) are presented. Results were good/excellent (Crawford's criteria) in 16 patients, fair in 3, and poor in 1 with those operated upon within 2 weeks postinjury achieving the best results. There were no incidences of fixation failure, loss of reduction, or posttraumatic osteoarthritis. One patient had a minor infection, but there were no cases of nail deformity or wound breakdown. There was high patient satisfaction and all patients returned to work after treatment. We conclude that this is a reliable technique with minimal complications and is comparable with other published operative and nonoperative treatment modalities.

Background Operative stabilisation of long segment periarticular, periprosthetic and pathological fractures in humerus is a challenging problem. Methods A total of 18 patients were treated by open reduction and internal fixation using the long proximal humeral internal locking system (PHILOS) plate. The types of fractures treated were long segment periarticular fractures extending into the diaphysis (11 of 18), periprosthetic fractures around humeral resurfacing (five of 18) and pathological fractures (two of 18).This study is a retrospective case series review of these cases with a final follow‐up observation.The mean follow‐up was for 13 months (range 4 months to 48 months). There were 11 women and seven men with a mean age of 52 years (range 19 years to 86 years). Outcomes were assessed using the Constant and Visual Analogue Score. Results There was no incidence of loss of fixation, malunion or avascular necrosis. The mean time to radiological union was 15 weeks (range 9 weeks to 22 weeks). The mean Constant score for posttraumatic fractures at final review was 76/100 (range 64 to 100). The mean Visual Analogue Score was 0.8 (range 0 to 3).The patients with pathological fractures survived for a mean 5 months (4 to 6 months). Conclusion The long PHILOS plate fixation provides reliable secure fixation for the treatment of complex humeral fractures, especially long segment periarticular fractures, segmental fractures involving proximal humerus and shaft, periprosthetic fractures around well‐fixed humeral resurfacing prosthesis and pathological fractures.

Background: The management of frozen shoulder (FS) differs depending on experience level and variation between scientific guidelines and actual practice. Purpose: To determine the current trends and practices in the management of FS among shoulder specialists and compare them with senior shoulder specialists. Study Design: Consensus statement. Methods: A team of 15 senior shoulder specialists (faculty group) prepared a questionnaire comprising 26 questions regarding the definition, terminology, clinical signs, investigations, management, and prognosis of FS. The questionnaire was mailed to all the registered shoulder specialists of Shoulder and Elbow Society, India (SESI) (specialist group; n = 230), as well as to the faculty group (n = 15). The responses of the 2 groups were compared, and levels of consensus were determined: strong (>75%), broad (60%-74.9%), inconclusive (40%-59.9%), or disagreement (<40%). Result: Overall, 142 of the 230 participants in the specialist group and all 15 participants in the faculty group responded to the survey. Both groups strongly agreed that plain radiographs are required to rule out a secondary cause of FS, routine magnetic resonance imaging is not indicated to confirm FS, nonsteroidal anti-inflammatory drugs should be administered at bedtime, steroid injection (triamcinolone or methylprednisolone) is the next best option if analgesics fail to provide pain relief, passive physical therapy should be avoided in the freezing phase, <10% of patients would require any surgical intervention, and patients with diabetes and thyroid dysfunction tend to fare poorly. There was broad agreement that routine thyroid dysfunction screening is unnecessary for women, a single 40-mg steroid injection via intra-articular route is preferred, and arthroscopic capsular release (ACR) results in a better outcome than manipulation under anesthesia (MUA). Agreement was inconclusive regarding the use of combined random blood sugar (RBS) and glycosylated hemoglobin versus lone RBS to screen for diabetes in patients with FS, preference of ACR versus MUA to treat resistant FS, and the timing of surgical intervention. There was disagreement over the most appropriate term for FS, the preferred physical therapy modality for pain relief, the most important movement restriction for early diagnosis of FS, and complications seen after MUA. Conclusion: This survey summarized the trend in prevalent practices regarding FS among the shoulder specialists and senior shoulder surgeons of SESI.