This month selected the 5 most clinically compelling findings from among the studies highlighted in the most recent “What’s New in Shoulder Surgery.”
Rotator Cuff Repair
In a multicenter study of patients undergoing treatment of rotator cuff tears, investigator compared operative and nonoperative treatment with respect to the time to achieve clinically meaningful improvement in pain and function. The nonoperative group had a significantly greater probability of achieving the minimum clinically important difference in the Shoulder Pain and Disability Index (SPADI) scores at 3.3 months. But the operative group had significantly greater probability of achieving a >50% improvement in SPADI scores at 15.5 months and American Shoulder and Elbow Surgeons (ASES) scores at 24.7 months.
A prospective, randomized observational trial evaluated the efficacy of concomitant suprascapular nerve decompression at the time of rotator cuff repair. Shoulder function, MRI, and EMG and nerve conduction studies were assessed for 19 patients randomized to repair with or without nerve decompression. No clinically relevant difference between the 2 groups was found for any clinical parameter. The study was terminated because of safety concerns, with a 33% rate of electrophysiologic complications with no obvious clinical benefits of suprascapular nerve decompression.
Reverse Total Shoulder Arthroplasty
A prospective, randomized study evaluated the utility of tendon transfers at the time of reverse shoulder arthroplasty (RSA) in treating combined loss of elevation and external rotation. Both RSA treatment groups (16 patients who underwent a latissimus dorsi and teres major tendon transfer and 12 patients who did not) demonstrated significant improvements in the ability to perform ADLs requiring active external rotation postoperatively. Hornblower sign resolution occurred postoperatively in 73.3% and 58.3% of those with and without tendon transfer, respectively. The authors concluded that functional improvement in activities requiring external rotation could be achieved in RSA regardless of a concomitant tendon transfer.
In an investigation of risk factors for acromial and scapular fractures in RSA, researchers found that such fractures occurred in 1.5% of 4,125 shoulders that underwent primary RSA with 1 prosthesis. Female sex, rheumatoid arthritis, a diagnosis of cuff tear arthropathy, and the use of more baseplate screws were identified as significant risk factors on multivariate analysis.
Shoulder Instability
In a multicenter study of patients with first-time shoulder dislocation, patients were randomized to nonoperative management using an external rotation abduction brace (60 patients) or arthroscopic Bankart repair (52 patients). No significant differences were found between the groups at 2 years with respect to patient-reported outcomes. However, the nonoperatively treated group had a significantly higher rate of instability (19.1%) compared with the operatively treated group (2.3%).