Aim: To demonstrate that inappropriate sequencing of activation of shoulder muscles can cause shoulder instability.

Methods. The records of 933 cases of recurrent shoulder instability referred to a specialist shoulder service between 1993 and 2003 were reviewed. All patients were assessed clinically. Muscle patterning abnormality (Bayley 1986) was identified in 428 patients (46%). Confirmatory functional electromyography was performed in 166 (36%). Inappropriate pectoralis major activation was identified in 73% of anterior instability. In posterior instability, inappropriate activation of latissimus dorsi and anterior deltoid was present in 72% and infra-spinatus was suppressed in 19%. Arthroscopic assessment was performed in 141 (33%), identifying structural lesions of instability in 86 (20%).

All patients diagnosed with muscle patterning disorder received specilalist physical therapy using biofeedback. Symptomatic improvement or stability was achieved in 76% of patients with anterior instability but with no previous surgery, and in 53% of patients with previous surgery. Posterior instability was eliminated in 85% of cases.

Conclusion. Muscle patterning abnormalities contribute to recurrent instability of the shoulder in 46% of cases. The success of physical therapy in these patients is high.

We describe a patient with a painful sciatic neuropathy after total hip arthroplasty. Treatment was confined to neuroleptic and analgesic agents until neurolysis at seven years abolished pain and restored function.

Introduction: Many specialists believe that neuromuscular blockade is most effective if the injection is placed close to the major motor points of the muscle. This study aimed to produce a ‘user-friendly’ map of injection sites by combining data from existing literature, recent anatomical dissections and information obtained clinically at the time of botulinum toxin injection.

Methods: A literature search collected all clinically relevant anatomical data regarding the identification of motor points in various muscles. Where data was lacking, anatomical dissections were performed on cadaveric specimens. These specimens were also used to ‘confirm’ the existing published data. All motor points measurements were then related to a series of surface anatomy lines that were easily identifiable in a patient with neuromuscular disability. Over the last year, 150 ‘motor points’ have been identified in patients undergoing neuromuscular blockade using a nerve stimulator and related to the same surface markings used in the cadaveric studies. Good correlation between existing literature and our cadaveric studies was found. New data was collected for forearm flexors, adductors and shoulder muscles. The correlation between clinical and anatomical motor points was good with errors averaging 5% of the measured distance.

Conclusion: A ‘Body Map’ is being produced that can be displayed in clinical areas to facilitate the use and improve the efficacy of neuromuscular blockade and encourage its use in the outpatient setting.

This study assesses the clinical performance of the Souter-Strathclyde elbow arthroplasty with a standardised index and long-term survivorship analysis.

We undertook assessment of 68 primary Souter-Strathclyde total elbow replacements. Of 53 patients assessed with pre-operative Souter-Strathclyde charts, nine died and one was lost to follow-up, 43 had radiographic and telephone review, and 38 (88%) had clinical examination according to the Mayo Elbow Performance Index.

Survival of the 43 elbows was to a mean of 72 months (range 8 to 187). A cohort of 25 elbows available for review with > 5-year follow up had improvement in pain, motion, stability and function. Eight of ten elbows in deceased patients had satisfactory scores at the last assessment. Ulnar neuropraxia occurred in eight elbows (12%), persistent sensory deficit in two (3%) and motor deficit in one. Two triceps abscesses required local skin flap cover. Revision was undertaken in 14 elbows (20%) for instability (6) bony injury (3), loosening (3) and intraoperative problems (2).

The survivorship at 13 years was 74% with 62 (91%) of all elbows achieving a satisfactory Mayo score.

This study assesses the clinical performance of the Souter-Strathclyde elbow arthroplasty with a standardised index and long term survivorship analysis.

We undertook assessment of 68 primary Souter-Strathclyde total elbow replacements. Of 53 patients assessed with pre-operative Souter-Strathclyde charts, nine died and one was lost to follow-up, 43 had radiographic and telephone review, and 38 (88%) had clinical examination according to the Mayo Elbow Performance Index.

Survival of the 43 elbows was to a mean of 72 months (range: eight to 187 months) with improvement in pain, motion, stability and function. Eight of 10 elbows in deceased patients had satisfactory scores at the last assessment. Ulnar neuropraxia occurred in eight elbows (12%), persistent sensory deficit in two (3%) and motor deficit in one. Two triceps abscesses required local skin flap cover. Revision was undertaken in 14 elbows (20%) for instability (six) bony injury (three), loosening (three) and intraoperative problems (two).

The survivorship at 13 years was 74% with 62 (91%) of all elbows achieving a satisfactory Mayo score.