The use of reverse shoulder arthroplasty is becoming increasingly popular for the treatment of complex three- and four-part proximal humerus fractures in the elderly compared with the often unpredictable and poor outcomes provided by open reduction and internal fixation and by hemiarthroplasty. Inferior results with plate osteosynthesis are often a result of complications of humeral head osteonecrosis, loss of fixation, and screw penetration through the humeral head, whereas major concerns with hemiarthroplasty are tuberosity resorption, malunion, and nonunion resulting in pseudoparalysis. Comparative studies support the use of reverse shoulder arthroplasty in elderly patients with complex proximal humerus fractures because the functional outcomes and relief of pain are reliably improved. Repair and union of the greater tuberosity fragment during reverse shoulder arthroplasty demonstrates improved external rotation, clinical outcomes, and patient satisfaction compared with outcomes after tuberosity resection, nonunion, or resorption. Satisfactory results can be obtained with careful preoperative planning and attention to technical details.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

No abstract

After carpal tunnel syndrome, cubital tunnel syndrome is the second most common compression neuropathy in the upper extremity. Various sites of ulnar nerve compression at the elbow exist, with the most common being between the 2 heads of the flexor carpi ulnaris. Other potential sites include the arcade of Struthers, the space between Osborne's ligament and the medial ulnar collateral ligament, the medial epicondyle, the medial head of the triceps, and the medial intermuscular septum. The anconeus epitrochlearis, an anomalous muscle that runs between the medial aspect of the olecranon and the medial epicondyle, is found in up to 28% of cadavers. Although it is far less common, it must be considered when evaluating a patient with cubital tunnel syndrome. The authors report a 19-year-old man with a 2-month history of atraumatic left elbow pain accompanied by distal motor and sensory symptoms that significantly affected his activities of daily living and quality of life. After a short course of conservative management, surgical excision of the anomalous muscle, along with decompression of the ulnar nerve, was performed because of progression of symptoms. The patient had immediate improvement in subjective symptoms and strength on removal of the anconeus epitrochlearis. As shown in this case report, recovery of both motor and sensory nerve function can be achieved if the source of compression is an anomalous muscle and is treated with early surgical removal.

Osteoid osteoma is a rare occurrence in the hand, and only a small percentage affects the thumb and distal phalanges. An 18-year-old right-hand-dominant man presented to our office with an approximately 1-year history of left thumb pain without any history of trauma. He had seen several doctors previously and undergone multiple diagnostic tests with no definitive diagnosis. Plain radiographs and computed tomography at our institution were consistent with the diagnosis of osteoid osteoma. The patient was treated with surgical excision of the lesion without bone grafting. The diagnosis of osteoid osteoma was confirmed by pathology. At 6 months follow-up, the patient showed complete resolution of pain and full restoration of hand function. This case demonstrates that osteoid osteoma should not be forgotten as a differential diagnosis in patients with finger pain, especially in individuals who have not yet or just recently have reached skeletal maturity.