Purpose

Our understanding of the spectrum of pathological lesions of the shoulder anterior capsular-labral complex in anterior instability continues to evolve. In a previous study using magnetic resonance arthrography we have showed three variants of the essential lesion of the anterior capsular-labral complex. This is the first large arthroscopic study to finely evaluate the nature and relative proportions of these three lesions in anterior instability.

The aim of this prospective study was to report the mid-term results of arthroscopic repair of full thickness rotator cuff tears. Arthroscopic cuff repair, under regional interscalene block and balanced anaesthesia, was performed in 104 shoulders (102 patients). There were 52 female and 50 male patients with a mean age of 64 years (range 41 to 79). The mean size of the cuff tear was 3cm (range 1cm to 6 cm). Patients were discharged within 24 hours and followed a specific rehabilitation protocol. An assessment was performed pre-operatively and at a mean follow-up of 7 months (range 3 to 24 months). Outcome measures included pain, activities of daily living, shoulder function and level of patient satisfaction. Satisfactory pain relief was achieved in 98 patients (94%) with significant pain relief in 87 patients (83.6 %) and good in 12 patients (11.5 %). Ninety -six patients (92.3%) reported a satisfactory improvement in activities of daily living, with significant improvement in 89 (85.6%) and good in seven (6.7%). High levels of patient satisfaction were noted in 93 patients. Seven patients were moderately satisfied and two patients were not satisfied. The mean shoulder score improved from 29 pre-op to 82 post-op, and the shoulder function score from 32 pre-op to 84 post-op. No difference in outcome was found when the subgroup of 65 patients over the age of sixty was compared to the group of 37 patients under the age of sixty. We believe that this study has shown that the arthroscopic repair of the rotator cuff can consistently achieve a satisfactory outcome. It may therefore be considered as an alternative to the traditional open techniques.

The aim of this prospective study was to report the mid-term results of arthroscopic repair of full thickness rotator cuff tears.

One hundred and four shoulders in 102 consecutive patients were operated within a two-year period. There were 52 female and 50 male patients with a mean age of 64 years (range 41 to 79). Standard arthroscopic techniques of cuff repair were used, under regional inter-scalene block and balanced anaesthesia. The mean size of the cuff tear was 3 cm (range 1 to 6 cm). Patients were discharged within 24 hours and followed a specific rehabilitation protocol. An assessment was performed pre-operatively and at a mean follow-up of 7 months (range 3 to 24 months). Outcome measures included pain, activities of daily living, shoulder power and function and level of patient satisfaction.

Satisfactory pain relief was achieved in 98 patients (94%) with significant pain relief in 87 patients (83.6 %) and good in 12 patients (11.5 %). Ninety -six patients (92.3%) reported a satisfactory improvement in activities of daily living, with significant improvement in 89 (85.6%) and good in 7 (6.7%). Shoulder power was markedly improved in 95 patients (93%). High levels of patient satisfaction were noted in 93 patients. Seven patients were moderately satisfied and two patients were not satisfied.

The mean shoulder score improved from 29 pre-op to 82 post-op, and the shoulder function score from 32 pre-op to 84 post–op. Similar results were found when the subgroup of 65 patients over the age of sixty was compared to the group of 37 patients under the age of sixty. No difference in outcome was also noted in relation to the size of the tear, length of follow –up or sex of the patient.

We believe that this study has shown that the arthroscopic repair of the rotator cuff can consistently achieve a satisfactory outcome. It may therefore be considered as an alternative to the traditional open techniques.

The aim of this study was to assess the accuracy of Magnetic Resonance Arthrography (MRA) in symptomatic shoulder joint instability. Data were collected prospectively from MR Arthrograms performed in 40 consecutive patients with recurrent symptomatic instability. MR Arthrograms included views in the stress ABER position of the shoulder. Subsequently all patients underwent an arthroscopic shoulder stabilisation and the arthroscopic and MR Arthrographic findings were correlated. In case of discrepancy the films and operative findings were reviewed.

There were thirty three male and seven female patients with a mean age of 28 years (range 18–40). MR Arthrography showed 37 anterior-inferior tears (22 displaced Bankart tears, 8 nondisplaced Bankart tears, 5 chronic ALPSA lesions and 2 AGL lesions) and 3 posterior lesions. There were 3 discrepancies of which 2 were cases of missed Bankart lesion on MRArthrogram and one case of reverse Perthes lesion present on MRArthrogram but not seen on arthroscopy. Despite a review of the films, the missed Bankart’s lesions were not visualised. In the present study, MR arthrography had a 95% sensitivity in detecting ligamentolabral pathology and a positive predictive value of 0.975 in diagnosing a lesion in recurrent shoulder instability.

The results show that MR Arthrogram is a highly useful tool for investigating recurrent shoulder instability with very high sensitivity and positive predictive value. Of the 40 patients who underwent arthroscopy there were only 2 cases where MR Arthrography did not demonstrate an arthroscopically detected abnormality.

This study was performed to evaluate the efficacy of interscalene block combined with general anaesthetic for common surgical procedures of shoulder and the potential of this procedure for providing day case shoulder surgery.

114 consecutive patients undergoing shoulder surgery were audited using a questionnaire immediately after operation and at 6, 12 and 48 hours after operation. Pain scores were recorded based on visual analogue scale, type of operation, duration of operation, postoperative stay and complications. At 48 hours overall pain control was assessed and patients were asked about having their operation done as a day case.

104 patientswho responded to the questionnaire were included in the study. There were 52 males and 52 females with overall mean age of 49 years (range 18–85). 75 patients underwent arthroscopic decompression, 15 patients underwent arthroscopy assisted mini open cuff repair, 9 underwent open glenohumeral stabilisation and the rest five underwent open Mumford procedure. Mean operation time was 47 minutes (range 25–90). 97 (93%) patients had no pain immediately postoperatively, 76 (73%) patients were pain free at 6 hours and 39 (38%) were pain free at 12 hours. Mean pain scores art 6 hours was 3 and at 12 hours were 4. 101 patients said their pain was well controlled throughout the first 48 hours by simple oral analgesics. 84 (83%) patients expressed an opinion that they could have been managed as day case provided they were adequately counselled about the procedure. 6(5.7 %)patients showed signs of Horner’s syndrome that resolved by 12 hours. No other complications related to inter scalene block occurred.

This study has shown that interscalene block is a safe procedure providing sustained adequate pain relief after shoulder surgery. It could allow a high percentage of patients undergoing shoulder surgery to be discharged home on the day of surgery.

Aim. This study was performed to evaluate the efficacy of a balanced interscalene and general anaesthetic and its potential for use in increasing the provision of day case shoulder surgery.

Patients and Methods. 104 patients undergoing shoulder surgery were audited using a questionnaire immediately postoperatively, and at 6, 12 and 48 hours. Pain scores were recorded using a visual analogue scale. Operative details including operation time, postoperative stay and complications have also been recorded. At 48 hours patients were asked about having their operation as a day case and their pain control was assessed.

Results. 52 males and 52 females mean age 49 years (range 18–85) completed the questionnaire. 90 responded to a 48-hour interview. 75 arthroscopic decompressions, 15 arthroscopically assisted mini open cuff repairs, 9 open glenohumeral stabilisations and 5 open Mumford procedures were performed. Mean operation time was 47 minutes (range 25–90) and 101 patients were discharged after one (86 patients) or two (15 patients) postoperative nights. 97 patients had no pain immediately postoperatively, 76 were pain free at 6 hours and 39 were pain free at 12 hours. Mean pain scores at 6 and 12 hours were 3 and 4. 101 patients said that their pain was well controlled throughout the first 48 hours with simple oral analgesics. 83% of patients expressing an opinion on day case treatment (69 out of 83) could have been managed as day cases provided that they were adequately counseled about the procedure. 6 patients showed signs of Horner’s syndrome that resolved fully by 12 hours. No other complications related to the inter-scalene block occurred.

Conclusion. This study has shown that interscalene anaesthesia is a safe procedure providing sustained and adequate pain relief. In association with oral analgesia and patient counselling it allows a high percentage of patients undergoing shoulder surgery to be discharged home on the day of surgery.

Aim: A prospective study designed to assess and evaluate the results of arthroscopic acromioclavicular joint (ACJ) minimal excision arthroplasty.

Patients and Methods: Twenty-two patients with ACJ arthropathy underwent an arthroscopic limited excision of the ACJ preserving the superior ligamentous complex. The patients were assessed pre and post operatively using the Constant score. The average time from surgery to review was five months (three to nineteen months). A self assessment questionnaire was also used, evaluating outcome measures such as activities of daily living, shoulder function and patients satisfaction.

Results: The mean preoperative Constant score was 28 and postoperative score was 71 with an improvement in pain from 15% to 80% and the range of motion from 37% to 84%. The preoperative self assessment score was 25.9 and postoperative score was 83 with an improvement in activities of daily living from 28% to 79%, and shoulder function from 34% to 87%.Twenty patients were very satisfied, one was moderately satisfied and one patient was dissatisfied although his shoulder function increased from 20 to 60%.

Discussion: This study suggests that this technique is well accepted by the patients and results in a good improvement in shoulder function. The results are comparable with those reported in the literature concerning the standard ACJ arthroplasty. We therefore believe that a limited excision of the ACJ is adequate and a reliable alternative to conventional techniques.

Aim. The purpose of this study was to assess the outcome of arthroscopic shoulder surgery by evaluating the pre- and postoperative shoulder function using a simple self-assessment questionnaire filled in by the patient.

Patients and Methods. In this study 89 patients were studied who underwent arthroscopic subacromial decompression. Shoulder function was assessed preoperatively and at 3 to 6 months following surgery according to a self-assessment questionnaire, which was developed in our Shoulder Unit. It allows for a maximum score of hundred, with 30 points for pain, 20 for power and 50 points for work, recreation and 8 activities of daily living.

Results. All patients reported improvement in shoulder function with an average total shoulder score increase from 33.4% preoperatively to 87.8% post-surgery. The pain score increased from 21% to 83%, power from 30% to 89% and activities of daily living from 42% to 90%. Detailed analysis of ADL’s showed substantial improvement in all functions.

Conclusion. This study has shown that minimal invasive surgery to the shoulder in the form of arthroscopic procedure, results in satisfactory improvement of all outcome measures in the majority of the patients. Together with low morbidity and early functional recovery, shoulder arthroscopy appears to be the procedure of choice in current surgical practice.

We believe that the self-assessment questionnaire represents a useful outcome measure and reflects the improvement in shoulder function as perceived by the patient.

This study is designed to assess and evaluate the results of arthroscopic acromioclavicular joint (ACJ) minimal excision arthroplasty.

Twenty-two patients with ACJ arthropathy underwent an arthroscopic limited excision of the ACJ preserving the superior ligamentous complex. The patients were assessed pre and post operatively using the Constant score. The average time from surgery to review was five months (three to nineteen months). A self assessment questionnaire was also used, evaluating outcome measures such as activities of daily living, shoulder function and patients satisfaction.

The mean preoperative Constant score was 28 and postoperative score was 71 with an improvement in pain from 15% to 80%, the subjective score from 22% to 45%, and the range of motion from 37% to 84%. The preoperative self assessment score was 25.9 and postoperative score was 83 with an improvement in activities of daily living from 28% to 78%, and shoulder function from 34% to 87%. Twenty patients were very satisfied, one was moderately satisfied and one patient was dissatisfied although his shoulder function increased from 20 to 60%.

This study suggests that this technique is well accepted by the patients and results in a good improvement in shoulder function. The results are comparable with those reported in the literature concerning the standard ACJ arthroplasty. We therefore believe that a limited excision of the ACJ is adequate and a reliable alternative to conventional techniques.