Thursday, October 27, 2011

Shoulder arthritis papers at the 2011 closed meeting of the ASES - subscapularis, outcome, failure of resurfacing, nerve block complications

The ASES met this month in West Virginia for their annual meeting. Here is a short summary of some of the most interesting presentations.

Hsu et al: In a randomized study of subscapularis tenotomy vs. lesser tuberosity osteotomy during total shoulder arthroplasty, there were no significant differences noted in clinical outcome. They suggested that lesser tuberosity may improve exposure of the glenoid.

Bunting et al: A five year followup of total shoulder arthroplasty for primary degenerative joint disease showed improvement in the SST from an average of 4 preoperatively to an average of 10 postoperatively. 3% of the 231 cases required subsequent surgery for subscapularis tear (2), hematoma (1), glenoid component loosening (1), post-surgical fracture (2), and rotator cuff issues (1).

Strauss et al: Seven patients initially treated with biological resurfacing (such as meniscal allograft) had clinical failure and were revised to total shoulder arthroplasty at an average of 2 years after the initial surgery. The results were disappointing: the SST scores improved from 1 before surgery to only 4 after surgery.

Green et al: The authors reviewed complications after 226 total shoulder replacements with interscalene nerve blocks. 51 of these (22%) had complications, including 22 medical complications and 33 surgical complications with 2 deaths. 17 patients had neurologic complications, bringing into question the possible role of the nerve block.

Aboud et al: Intraoperative nerve monitoring during shoulder arthroplasty revealed that 59 of 136 shoulders showed evidence of intraoperative nerve dysfunction, most commonly with the axillary nerve, followed by the musculocutaneous nerve and the radial nerve. Only one patient had a clinically notable nerve injury after surgery.


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