44Background: Rotator cuff tears are the commonest tendon injury in the adult 45 population, resulting in substantial morbidity. The optimum management for these 46 patients is not known. The natural history of patients with rotator cuff tears included in RCTs is to improve 68 over time, whether treated operatively or non-operatively. 69 70What is known about the subject: Rotator cuff tears represent the commonest tendon 71 injury in the adult population, however the optimum management of these patients is 72 not known. In other chronic musculoskeletal conditions, it has been shown that there 73 is improvement in clinical outcome measures with all treatments over time. However, 74 it is not known if this is also true for rotator cuff tears. 75 76What this study adds to existing knowledge: This review found there is consistent 77 improvement in Constant score, irrespective of intervention given whether it is 78 operative, or non-operative treatments. Patient outcomes at 12 months are highly 79 predictive of outcomes at 24 months, suggesting that 12-month should be used as a 80 primary outcome time point for future randomised controlled trials in full-thickness 81 rotator cuff tears. 82 MAIN TEXT 83

Lateral elbow tendinopathy, commonly known as tennis elbow, is a condition that can cause significant functional impairment in working-age patients. The term tendinopathy is used to describe chronic overuse tendon disorders encompassing a group of pathologies, a spectrum of disease. This review details the pathophysiology of tendinopathy and tendon healing as an introduction for a system grading the severity of tendinopathy, with each of the 4 grades displaying distinct histopathological features. Currently, there are a large number of nonoperative treatments available for lateral elbow tendinopathy, with little guidance as to when and how to use them. In fact, an appraisal of the clinical trials, systematic reviews, and meta-analyses studying these treatment modalities reveals that no single treatment reliably achieves outstanding results. This may be due in part to the majority of clinical studies to date including all patients with chronic tendinopathy rather than attempting to categorize patients according to the severity of disease. We relate the pathophysiology of the different grades of tendinopathy to the basic science principles that underpin the mechanisms of action of the nonoperative treatments available to propose a treatment algorithm guiding the management of lateral elbow tendinopathy depending on severity. We believe that this system will be useful both in clinical practice and for the future investigation of the efficacy of treatments.

Arthroscopic capsular release for adhesive capsulitis of the shoulder is a treatment option. The present study aimed to investigate the clinical outcomes following arthroscopic capsular release among idiopathic, diabetic and secondary adhesive capsulitis. Hypothesis:Different aetiological groups yield variable outcomes following arthroscopic capsular release. Materials and Methods:A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Database in April 2017. Comparative studies that reported range of motion or functional outcomes following arthroscopic capsular release in patients with adhesive capsulitis were included. A systematic review of the studies was conducted following the PRISMA guidelines. Results:Six studies met the eligibility criteria. The overall population included 463 patients; 203 idiopathic, 61 diabetic and 199 secondary cases. Of four studies comparing idiopathic and diabetic patients, three reported significantly worse range of movement and function in the diabetic group at various follow up points. No significant difference in function and motion was reported between the idiopathic and secondary groups.Recurrent pain was highest in diabetic patients (26%) compared to idiopathic groups (0%) and the secondary group had a higher rate of revision surgery when compared to the idiopathic group (8.1% vs. 2.4%) Discussion:Arthroscopic capsular release has a high success rate regardless of the underlying aetiology. However, diabetic patients are reported to have more residual pain, reduced motion and inferior function compared to idiopathic cases. The rate of revision capsular release is higher among patients with post-surgical adhesive capsulitis when compared to idiopathic cases.

There are significant personal and health economic differences between the two methods of treatment which may influence local choice.

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