What’s New in Shoulder and Elbow Surgery?

Every month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Here is a summary of key findings from Level-I, II, and III studies cited in the October 15, 2014 Specialty Update on shoulder and elbow surgery:

Shoulder

  • Using regional anesthesia rather than general anesthesia may reduce the risk of cerebral injury in surgical patients placed in the beach chair position.
  • Patients with less-than-massive rotator cuff injuries who received a ketorolac injection into the subacromial space experienced greater improvements in pain, function, range, and strength than those receiving a corticosteroid injection.
  • There was no significant difference in outcomes between platelet-rich plasma (PRP) injections and placebo injections in patients with either rotator-cuff tendinopathy or a tear involving less than 50% thickness.
  • Barbotage was more effective than isolated subacromial injections in people with calcific tendinitis.
  • In 83 patients followed for a mean of 10 months, 93% of double-row rotator-cuff repairs healed, compared with 75% of single-row repairs.
  • PRP matrix insertion provided little or no clinical/functional improvement in rotator-cuff healing after arthroscopic repair.
  • There was no apparent difference in rotator-cuff tear healing between those who were immobilized following arthroscopic repair and those exposed to early passive motion.
  • After 26 weeks, there were no significant differences between two groups of patients with glenohumeral arthritis who received either thrice-weekly hyaluronic acid or placebo injections.
  • A study comparing pegged versus keeled glenoid components in total shoulder arthroplasty revealed a risk ratio for revision that slightly favored pegged components.
  • The complication rate was 37.5% among young (< 65 years old) reverse total shoulder arthroplasty patients five to fifteen years following surgery.

Elbow

  • At 24-weeks of follow up, patients with lateral epicondylitis (tennis elbow) who received a PRP injection had pain-score improvement of 5%, compared to 56.1% in the control group. No significant difference was observed at 12 weeks post injection.
  • Another PRP study of 60 patients who were given a saline, PRP, or glucocorticoid injection for tennis elbow showed no significant difference in pain outcomes after three months, but the glucocorticoid group had a greater pain relief at the one-month follow up.
  • Among 130 elbows treated for fractures or fracture-dislocation, 37% demonstrated heterotopic bone; among those 37%, 54% demonstrated decreased range of motion due to impingement of heterotopic bone. Risk factors for heterotopic bone included elbow subluxation or dislocation, severe chest injury, open fractures, and surgical-treatment delay.

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