Frozen shoulder is a painful debilitating condition which can be diagnosed clinically. It is a condition of chronic inflammation and proliferative fibrosis resulting in painful limitation of shoulder movements with classical clinical signs. Diabetic patients are more likely to develop the disease and more likely to require operative management. Diabetic frozen shoulder is a difficult condition to manage, and the clinician must strike a balance between improving range of movement and treating pain, but not over-treating what is an essentially self-resolving condition. Treatment options principally include physiotherapy and intra-articular injections, and progression to hydrodilatation, manipulation under anaesthetic, or arthroscopic capsular release as required. In this article, we review the available literature to assess best management, and correlate with practice at our unit, proposing a management strategy for treating patients with diabetic frozen shoulder. Management decisions should be agreed upon jointly with the patient and be based upon comorbidities, severity and the natural history of the condition.

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Background Reliable, valid, feasible and objective assessment is desirable in all aspects of medical training to allow monitoring of progress and to ensure high standards. At present, no assessment model for shoulder arthroscopy exists that indisputably meets these criteria. The global rating scale (GRS) has been validated as a measure of technical performance in various surgical procedures. We have developed and aim to validate a GRS for shoulder arthroscopy (GRSSA). Materials and methods Using the GRSSA, 13 shoulder surgeons, rated 10 videos of diagnostic shoulder arthroscopy showing different levels of proficiency. Assessments were performed remotely using an online system developed for the study; assessors were blinded to the experience of the surgeon who was performing the arthroscopy. Construct validity was assessed via Cronbach's α and inter‐rater reliability was assessed via two‐way analysis of variance (ANOVA). Results The results suggest good construct validity (high internal consistency of GRSSA categories: Cronbach's α = 0.89 to 0.96). Two‐way ANOVA demonstrated a good discriminatory ability of the GRSSA but variability between raters (p = 0.0002 to 0.01), suggesting a current lack of inter‐rater reliability. Discussion The GRSSA appears to be a useful tool for the assessment of diagnostic arthroscopic skills and, using our online system, the assessor can be remote to the surgeon who is performing the procedure.

If a patient with a thin or porous mandibular cortex is identified by a chance radiographic finding, additional clinical risk factors need to be considered and the patient referred for further investigation with DXA where necessary.

Introduction Controversy exists surrounding the efficacy of the UK screening programme for developmental dysplasia of the hip (DDH). Method Clinical records were reviewed in children who were treated surgically for DDH. Demographic data, age and mode of presentation, and surgical treatments were analysed, as well as outcomes, re-operation rate and AVN incidence. Late diagnosis was defined as greater than 4 months. Results 106 children (16 male, 90 female) underwent surgery from 1997 to 2018. 95 hips were operated for dislocation and 22 were operated for dysplasia. 13 patients had bilateral dislocations. Of the dislocated hips, the median age at diagnosis was 9 months (IQR 2-19). 56% were diagnosed late. In the late diagnosis group the median age for diagnosis was 19 months (IQR 15-21). We have identified an increasing trend in late presentation in recent years. This has been matched with an increasing trend in operation rates for dislocation per 1000 births. Conclusions This study demonstrates that DDH is being diagnosed increasingly late, which correlates with an increased need for surgical management. This suggests that the current UK screening programme is failing to identify children with DDH in a timely fashion, which necessitates more aggressive surgical treatment and less favourable outcomes.