This study, titled, “Two-Year Outcomes of Open Shoulder Anterior Capsular Reconstruction for Instability from Severe Capsular Deficiency”, documents outcomes after anterior capsulolabral reconstruction for recurrent shoulder instability in 15 patients (20 shoulders) who have had multiple failed stabilizations or collagen disorders.

Clavicle fractures are common in adults and children. Most commonly, these fractures occur within the middle third of the clavicle and exhibit some degree of displacement. Whereas many midshaft clavicle fractures can be treated nonsurgically, recent evidence suggests that more severe fracture types exhibit higher rates of symptomatic nonunion or malunion. Although the indications for surgical fixation of midshaft clavicle fractures remain controversial, they appear to be broadening. Most fractures of the medial or lateral end of the clavicle can be treated nonsurgically if fracture fragments remain stable. Surgical intervention may be required in cases of neurovascular compromise or significant fracture displacement. In children and adolescents, these injuries mostly consist of physeal separations, which have a large healing potential and can therefore be managed conservatively. In this study, “Treatment of Clavicle Fractures: Current Concepts and Review”, procedures and concepts of clavicle fracture management
are discussed including surgical indications, techniques, and results.

The rotator interval describes the anatomic space bounded by the subscapularis, supraspinatus, and coracoid. This space contains the coracohumeral and superior glenohumeral ligament, the biceps tendon, and anterior joint capsule. Although a definitive role of the rotator interval structures has not been established, it is apparent that they contribute to shoulder dysfunction. In this article, “The Rotator Interval: Pathology and Management”, a review of the anatomy and function of the rotator interval is analyzed. The presentation, physical examination, imaging characteristics, and management strategies are discussed for various diagnoses attributable to the rotator interval. Preferred methods for treatment of each lesion are also discussed.

Arthroscopy of the shoulder is not routinely preformed during reconstruction of the acromioclavicular joint. During an open AC joint reconstructive procedure, failure to recognize and address glenohumeral joint (GHJ) pathology can adversely affect outcomes. There is no consensus in the literature regarding the need for a narrowing of the subcoracoid space may lead to mechanical conflicts that result in injury to the rotator cuff, biceps, and biceps pulley. The coracohumeral interval (CHI) is associated with age and gender but has not been standardized to size and anatomic location. The purpose of this study: “Subcoracoid Impingement: Factors Associated with the Size and Location of the Coracohumeral Interval”, was to determine clinical and anatomic factors associated with the size and location of the CHI.

Shoulder pain accounts for approximately three million visits to physicians each year in the United States; of these visits, rotator cuff disease is the most common cause of shoulder pain. Rotator cuff disease is a prevalent cause of shoulder pain and shoulder weakness and often leaves patients with limited range of motion and functional use of their arm. This article, “Rotator Cuff Disease: Basics of Diagnosis and Treatment”, discusses the various types of rotator tears, diagnostic tests, and preferred treatment options that yield the most positive outcomes.

Posterior glenohumeral joint instability makes up approximately 2% to 10% of all shoulder instability reports in the literature and pathologic findings in patients, which often involve a spectrum of pathology rather than a single pathoanatomic finding. A combined posterior Bankart lesion and posterior humeral avulsion of the glenohumeral ligament has been defined as the floating posterior inferior glenohumeral ligament. This combination of pathology may result in severe posterior-inferior instability and the need to address both lesions during attempted surgical repair has therefore been stressed. In this study, “Repair of Floating Posterior Inferior Glenohumeral Ligament Lesions: Surgical Technique”, suggested techniques for repairing the various subtypes of floating posterior inferior glenohumeral ligament lesions is discussed. Repair of both the humeral and glenoid-sided injuries are addressed.

In the world of orthopedic medicine, no other joint is as prone and susceptible to dislocations as the shoulder joint with more than one third of all shoulder injuries being shoulder dislocations. Trauma is the primary cause of a shoulder dislocation. Multiple etiologic aspects need to be considered when determining the best approach to treating recurrent shoulder instability. This article, “Open Reconstruction of the Anterior Glenohumeral Capsulolabral Structures with Tendon Allograft in Chronic Shoulder instability”, offers insight on the open reconstruction technique using a tendon allograft. Other approaches are discussed in the article and advantages to the technique highlighted.

Multidirectional shoulder instability is defined as symptomatic instability in two or more directions. Instability occurs when static and dynamic shoulder stabilizers become incompetent due to congenital or acquired means. Nonspecific activity-related pain and decreased athletic performance are common complaints.  This article study discusses “Management of Multidirectional Instability of the Shoulder”. Clinical suspicion for instability is essential for timely diagnosis. Several examination techniques can be used to identify increased glenohumeral translation and are offered in this article. It is critical to distinguish increased laxity from instability. Initial management begins with therapeutic rehabilitation. If surgical management is required, advanced arthroscopic techniques offer several advantages over traditional open approaches and may have similar outcomes. The role of rotator interval capsular plication is controversial, but it may be used to augment capsular plication in patients with specific patterns of instability. Despite encouraging results, outcomes remain inferior to those associated with traumatic unidirectional instability.

Rotator cuff injuries are commonly diagnosed orthopaedic conditions. The purpose of this study, “Long-Term Survivorship and Outcomes After Surgical Repair of Full-Thickness Rotator Cuff Tears”, was to determine survivorship of primary open cuff repairs, with survivorship defined as a shoulder not requiring additional surgery. The study is fully discussed in this document. The conclusion at the end states that overall survivorship was 94% at 5 years after open rotator cuff surgery and 83% at 10 years. Among those patients who survived at 6.3 years, there was a mean 32-point increase in the ASES score and a rating for patient satisfaction with surgical outcomes of 8 of 10. As a consequence, most failures occurred in the first 2 years and if the cuff repairs survived the initial years, they were highly likely to survive over the 10-year period.

Osteoarthritis is a painful, debilitating condition that often will result in total shoulder arthroplasty (joint replacement) for patients. While this is an acceptable and effective procedure for elderly patients, younger, active patients are not viable candidates. This study: “Glenohumeral Joint Preservation: Current Options for Managing Articular Cartilage Lesions in Young, Active Patients”, is a review of joint-preservation techniques for the shoulder that refine successful operative techniques to repair symptomatic glenohumeral cartilage lesions in the shoulders of young, active patients. As new approaches to glenohumeral cartilage repair and shoulder joint preservation evolve, there continues to be a heightened need for collaborative research and well-designed outcomes analysis to facilitate successful patient care.