Background: Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines.

Methods are needed for identifying poorer quality cadaver proximal humeri to ensure that they are not disproportionately segregated into experimental groups for fracture studies. We hypothesized that measurements made from radiographs of cadaveric proximal humeri are stronger predictors of fracture strength than chronological age or bone density values derived from dual-energy x-ray absorptiometry (DXA) scans. Thirty-three proximal humeri (range: 39-78 years) were analyzed for: (1) bone mineral density (BMD, g/cm 2 ) using DXA, (2) bulk density (g/cm 3 ) using DXA and volume displacement, (3) regional bone density in millimeters of aluminum (mmAl) using radiographs, and (4) regional mean (medialþlateral) cortical thickness and cortical index (CI) using radiographs. The bones were then fractured simulating a fall. Strongest correlations with ultimate fracture load (UFL) were: mean cortical thickness at two diaphyseal locations (r ¼ 0.71; p < 0.001), and mean mmAl in the humeral head (r ¼ 0.70; p < 0.001). Weaker correlations were found between UFL and DXA-BMD (r ¼ 0.60), bulk density (r ¼ 0.43), CI (r ¼ 0.61), and age (r ¼ À0.65) (p values <0.01). Analyses between UFL and the product of any two characteristics showed six combinations with r-values >0.80, but none included DXA-derived density, CI, or age. Radiographic morphometric and densitometric measurements from radiographs are therefore stronger predictors of UFL than age, CI, or DXA-derived density measurements. ß

Double-row rotator cuff repairs are becoming popular because of their ability to improve initial ultimate failure load for full-thickness rotator cuff tears, especially in middle-aged to elderly patients. We hypothesized a quasi-double-row repair using a combination of transosseous sutures, anchors, and double knots (TOAK technique) would exceed the clinically relevant 250-N load threshold and the initial mean ultimate failure loads of anchor-only and transosseous suture-only fixation. In simulated full-thickness supraspinatus tears in cadavers (mean age, 62 years; range, 50-77 years), failure loads of two repair techniques were compared with a TOAK repair using sutures and bioabsorbable anchors. Radiographic densitometry was conducted on all humeral heads. Testing was performed at 6 mm per minute in 18 bones in the following three groups (n = 6 per group): (1) transosseous suture-only with weave-type stitch and single-knot fixation; (2) anchor-only with horizontal mattress stitch and single-knot fixation; and (3) TOAK. The mean ultimate failure load was 238 N for the transosseous suture-only group and 215 N for the anchor-only group. Although the bones had lower density, TOAK specimens failed at 55% to 67% higher loads (mean, 404 N) than the other groups. These data support further evaluation of the TOAK technique for full-thickness supraspinatus tears in middle-aged to elderly patients.

Although a majority of orthopaedic surgeons believe that they should expand their role in the medical treatment of patients with an osteoporotic fracture, many do not institute medical treatment and think that the patient's primary care providers should be responsible for medical care.