Tears of the rotator cuff, both partial, and less commonly, full thickness, are relatively common in the throwing athlete. The rotator cuff is subjected to enormous stresses during repetitive overhead activity. The supraphysiological strains, especially when combined with pathology elsewhere in the kinetic chain, can lead to compromise of the cuff fabric, most commonly on the undersurface where tensile overload occurs. Exacerbation by a tight posterior capsular, anterior instability, and internal impingement render the cuff progressively compromised, with intrinsic shear stresses and undersurface fiber failure. Advances in imaging technology, including contrast magnetic resonance imaging, dynamic ultrasound, and arthroscopic visualization have enhanced our understanding of cuff pathology in this athletic population. Unfortunately, this has not yet translated into how to best approach these athletes to return them to their previous level of activity. Nonoperative management remains the mainstay for most throwers, with arthroscopic debridement an effective surgical option for those with refractory symptoms. Despite technological advances in cuff repair in the general population, comparable outcomes have not been achieved in high-level throwers. Widespread appreciation that securing the cuff operatively will likely end an athletes' throwing career has led to adopting a surgical approach that emphasizes debridement over repair for nearly all partial and full-thickness tears. Whether advances in surgical technique will ultimately permit definitive and lasting repairs that allow overhead throwers to return to their previous level of sports remains unknown at this time.

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This study explored the radiographic and anatomical differences in normal shoulders between men and women, as well as factors such as race, height, weight, and age. A total of 205 patients with documented normal anatomical radiographs comprised the study population. Five fellowship-trained orthopedic surgeon reviewers measured head diameter, humeral head size, head to tuberosity distance, greater tuberosity width, neck-shaft angle, surface-arc angle, glenoid neck length, and distance from the lateral acromion process to the greater tuberosity on anteroposterior radiographs with the shoulder in external rotation. After the reviewers identified and marked defined anatomical landmarks, a comprehensive automated calculator was used to compute all parameters. Between men and women, head diameter (P<.001), humeral head size (P<.001), greater tuberosity width (P<.001), distance from the lateral acromion process to the greater tuberosity (P<.001), and glenoid neck length (P<.001) were significantly different, whereas race was not significantly different for any anatomical parameter. Using Spearman's rho, there was a strong correlation between head diameter/humeral head height and height (r=0.77/r=0.68), weight (r =0.62), and greater tuberosity width (r=0.66/r= 0.61); there also was a strong negative correlation between head to tuberosity distance and neck-shaft angle (r=-0.80). This study demonstrated precisely defined proximal humeral anatomical relationships and sizes using an advanced standardized imaging software program. With these data, orthopedic surgeons and implant designers can better understand the anatomy and glenohumeral relationships to re-create when performing total shoulder arthroplasty. [Orthopedics. 2017; 40(3):155-160.].

Background No consensus exists among orthopedic surgeons regarding the optimal intervention for adhesive capsulitis. The purpose of this study was to determine which treatment provides the best objective outcome following manipulation under anesthesia (MUA), MUA + arthroscopic capsular release (CR), or CR alone. Methods Between 2011 and 2015, 97 shoulders were treated for adhesive capsulitis (MUA, MUA+CR, CR) and followed for three months or until achieving full range of motion (ROM). Patients' charts were reviewed for demographic information, diabetes, pre/post-operative ROM, and complications. Results The average age at surgery was 57 years (range: 31-80 years) with a mean follow-up of 6.2 months (range: 2-43 months). ROM improved significantly regardless of treatment modality (p < 0.001). MUA had significantly more external rotation at follow-up than MUA+CR and CR alone (62 vs 49 vs 48, p = 0.02). Groups were similar in regards to post-operative elevation and internal rotation. Loss of external rotation following surgery was significantly more common in the MUA+CR group (p = 0.03). In diabetics, no treatment option was superior to another in regards to final ROM. Conclusion Operative treatment of idiopathic adhesive capsulitis is efficacious and safe for improving shoulder ROM across treatment modalities. Surgeon preference may effectively guide treatment independent of diabetic status.