Nonoperative treatment of five common shoulder injuries

Pogorzelski, Jonas; Fritz, Erik M.; Godin, Jonathan A.; Imhoff, Andreas B.; Millett, Peter J.

doi:10.1007/s11678-018-0449-1

Cited by 12 publications

(3 citation statements)

References 74 publications

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“…Other authors reported even higher failure rates with a nonoperative approach, with recurrence rates up to 92% especially in patients younger than 30 years. 21 , 39 , 45 , 48 As such, there has been growing interest in the role of surgical stabilization after first-time shoulder dislocation (FSD). Studies from Great Britain and Germany have shown a significant increase of primary repair surgery in cases of FSD in the last 2 decades.…”

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confidence: 99%

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

et al. 2021

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Background: Treatment of first-time shoulder dislocation (FSD) is a topic of debate. After high rates of recurrent instability after nonoperative management were reported in the literature, primary repair of FSD significantly increased. At the same time, new concepts were proposed that had promising results for immobilization in external rotation (ER) and abduction (ABD). Purpose: The aim of this study was to evaluate the recurrence rates (primary outcome) and clinical outcomes (secondary outcome parameters) of immobilization in ER+ABD versus arthroscopic primary stabilization after FSD. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In a multicenter randomized controlled trial, patients with FSD were randomized to either treatment with immobilization in 60° of ER plus 30° of ABD (group 1) or surgical treatment with arthroscopic Bankart repair (group 2). Clinical evaluation was performed 1, 3, and 6 weeks as well as 6, 12, and 24 months postoperatively or after reduction, including range of motion, instability testing, subjective shoulder value, Constant-Murley score, Rowe score, and Western Ontario Shoulder Instability Index. Recurrent instability events were prospectively recorded. Results: Between 2011 and 2017, a total of 112 patients were included in this study. Of these, 60 patients were allocated to group 1 and 52 to group 2. At the 24-month follow-up, 91 patients (81.3%) were available for clinical examination. The recurrence rate was 19.1% in group 1 and 2.3% in group 2 ( P = .016). No significant differences were found between groups regarding clinical shoulder scores ( P > .05). Due to noncompliance with the immobilization treatment protocol, 4 patients (6.7%) were excluded. Conclusion: Immobilization in ER+ABD versus primary arthroscopic shoulder stabilization for the treatment of FSD showed no differences in clinical shoulder scores. However, recurrent instability was significantly higher after nonoperative treatment.

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confidence: 99%

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

et al. 2021

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“…Similar to our observations, a systematic review by Castro, Corrêa [ 259 ] reported low to very-low-quality evidence to support the conservative management of rotator cuff and biceps tendinopathy-related shoulder pain. Generic rehabilitation principles for tendinopathy typically include progressive muscle strengthening for tendon remodelling and adaption to load [ 260 , 261 ]. From the anecdotal research we found on biceps activity during common shoulder rehabilitation exercises, a potential LHB rehabilitation exercise program may include a progression of biceps curls into elevation, shoulder front raises in external rotation, elbow extension and supination, and a sport-specific program of overhead to underarm throwing drills.…”

Section: Discussionmentioning

confidence: 99%

The long head of biceps at the shoulder: a scoping review

Diplock

Hing

Marks

2023

BMC Musculoskelet Disord

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Background This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions. Methods PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English. Results 214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep’s role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy’s limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation. Conclusions The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required. Pre-registration OSF: https://osf.io/erh9m

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“…If an RCR is deemed impossible prior to surgery due to an irreparable situation, treatment options such as non-operative management, the debridement of the rotator cuff with or without the tenotomy or tenodesis of the long head of the biceps tendon (LHBT), partial repair, tendon transfers (TTs), the implantation of a subacromial biodegradable spacer (SBS), superior capsular reconstruction (SCR) and the implantation of a reverse total shoulder arthroplasty (RTSA) are considered viable alternatives [ 2 , 9 , 10 , 11 , 12 , 13 , 14 ]. Specific advantages and disadvantages have been reported for each of these procedures.…”

Section: Introductionmentioning

confidence: 99%

Management of Irreparable Posterosuperior Rotator Cuff Tears—A Current Concepts Review and Proposed Treatment Algorithm by the AGA Shoulder Committee

Pogorzelski

Rupp

Scheiderer

et al. 2023

JPM

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Posterosuperior rotator cuff tears range among the most common causes of shoulder complaints. While non-operative treatment is typically reserved for the elderly patient with low functional demands, surgical treatment is considered the gold standard for active patients. More precisely, an anatomic rotator cuff repair (RCR) is considered the most desirable treatment option and should be generally attempted during surgery. If an anatomic RCR is impossible, the adequate choice of treatment for irreparable rotator cuff tears remains a matter of debate among shoulder surgeons. Following a critical review of the contemporary literature, the authors suggest the following evidence- and experience-based treatment recommendation. In the non-functional, osteoarthritic shoulder, treatment strategies in the management of irreparable posterosuperior RCT include debridement-based procedures and reverse total shoulder arthroplasty as the treatment of choice. Joint-preserving procedures aimed at restoring glenohumeral biomechanics and function should be reserved for the non-osteoarthritic shoulder. Prior to these procedures, however, patients should be counseled about deteriorating results over time. Recent innovations such as the superior capsule reconstruction and the implantation of a subacromial spacer show promising short-term results, yet future studies with long-term follow-up are required to derive stronger recommendations.

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Nonoperative treatment of five common shoulder injuries

Cited by 12 publications

References 74 publications

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

Immobilization in External Rotation and Abduction Versus Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation: A Multicenter Randomized Controlled Trial

The long head of biceps at the shoulder: a scoping review

Management of Irreparable Posterosuperior Rotator Cuff Tears—A Current Concepts Review and Proposed Treatment Algorithm by the AGA Shoulder Committee

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