Journal of Shoulder and Elbow Surgery最新文献

{"title":"Glenohumeral arthritis impairs shoulder mobility and promotes dynamic compensatory strategies during overhead reach.","authors":"Nicholas Morriss, Patrick Castle, Dylan N Greif, Joshua Pezzullo, Matthew Ambalavanar, Jordan Manning, Ye Shu, Jacob Earnhart, Gabriel Ramirez, Gregg Nicandri, Sandeep Mannava, Ram Haddas, Ilya Voloshin","doi":"10.1016/j.jse.2026.02.019","DOIUrl":"10.1016/j.jse.2026.02.019","url":null,"abstract":"<p><strong>Background: </strong>Glenohumeral arthritis (GHA) decreases shoulder range of motion, yet the extent of glenohumeral motion loss and accompanying whole-body compensations are not well quantified.</p><p><strong>Methods: </strong>Eighty-six patients with GHA completed an overhead reach task using both symptomatic and asymptomatic shoulders in a motion-tracking laboratory. Range of motion and peak angles of symptomatic to asymptomatic contralateral shoulders were compared.</p><p><strong>Results: </strong>The symptomatic shoulder demonstrated 38° less flexion (84° symptomatic vs. 122° asymptomatic, P < .001), 4° less abduction (25° vs. 29°, P < .001), and 22° less internal rotation (21° vs. 43°, P < .001) compared to the asymptomatic shoulder. Patients compensated for these deficits via greater lumbar extension (6° vs. 5°, P < .01), greater lumbar rotation (9° vs. 3°, P < .001), contralateral pelvic rotation (6° vs. 2°, P < .001), reduced cervical flexion (9° vs. 18°, P < .001) with altered lateral bending (7° vs. 11°, P < .001), and greater elbow flexion (26° vs. 4°, P .001).</p><p><strong>Conclusions: </strong>GHA is associated with substantial loss of shoulder motion during an overhead reach task that mimics daily activities, which leads to compensatory increases in cervical, lumbar, pelvic, and elbow kinematics.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147370552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eccentric mechanical stimulation promotes rotator cuff healing by regulating macrophage polarization in a murine model","authors":"Yundong Peng PhD ,&nbsp;Luyu Diao PhD ,&nbsp;Fengxing Li PhD ,&nbsp;Jieping Wang PhD ,&nbsp;Yonghong Yu MSc ,&nbsp;Shaohui Jia PhD ,&nbsp;Cheng Zheng PhD, MD","doi":"10.1016/j.jse.2025.07.008","DOIUrl":"10.1016/j.jse.2025.07.008","url":null,"abstract":"<div><h3>Background</h3><div>Eccentric mechanical stimulation (EMS) has been proposed as a potential therapy for tendon-bone injuries. Macrophages, as key immune cells, may play a significant role in promoting tendon-bone injury healing through mechanical stimulation, because of their polarization. This study aims to investigate the role of macrophages in rotator cuff injury repair promoted by EMS.</div></div><div><h3>Methods</h3><div>A total of 96 male C57BL/6 mice were used to establish a rotator cuff injury repair model and were randomly divided into 4 groups: Control, EMS, control + clodronate liposomes, and EMS + clodronate liposomes. Specimens were collected at 2 and 4 weeks postoperatively for histologic, radiologic, immunohistochemical, and biomechanical analyses.</div></div><div><h3>Results</h3><div>At 2 weeks postoperatively, the EMS group exhibited a thicker fibrocartilage layer and increased expression of M2 macrophages compared with other groups. At 4 weeks, histologic analysis revealed higher fibrocartilage and proteoglycan content in the EMS group, with increased local expression of M2 macrophages and reduced expression of M1 macrophages. Micro–computed tomography results showed superior bone volume–total volume fraction, trabecular bone number, and trabecular bone thickness in the EMS group. Biomechanical testing indicated higher failure load and ultimate strength in the EMS group. The positive effects of mechanical stimulation were significantly diminished after macrophage depletion using clodronate liposomes.</div></div><div><h3>Conclusion</h3><div>Macrophages may play a crucial role in the repair of rotator cuff injuries promoted by EMS. The therapeutic benefits are partly attributed to the regulation of macrophage function, with EMS reducing M1 macrophage expression and enhancing M2 macrophage polarization. This promotes the healing of rotator cuff tendon–bone injuries and suggests that targeting macrophage polarization may have positive effects on tendon-bone interface injury recovery.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 832-840"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of time from injury to surgery on surgical technique and complication rate in distal biceps tendon repair","authors":"Laura J. Morrison MD, MSc ,&nbsp;Chloe Elliott BS ,&nbsp;Bayan Ghalimah MD ,&nbsp;Eric C. Sayre PhD ,&nbsp;Neil J. White MD","doi":"10.1016/j.jse.2025.07.027","DOIUrl":"10.1016/j.jse.2025.07.027","url":null,"abstract":"<div><h3>Background</h3><div>Surgical treatment options for distal biceps tendon ruptures vary based on time from injury to surgery. While direct repair (DR) is preferred for acute injuries, high flexion angle (HFA) repair and allograft reconstruction (AR) are alternatives for chronic cases. This study examines the relationship between time to surgery, surgical technique selection, and complication rates.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on patients treated surgically for distal biceps tendon ruptures at a single center from January 2012 to June 2023. Cases were identified through electronic medical records and included patients aged ≥ 18 years with unilateral ruptures. Demographics, time to surgery, surgical techniques (DR, HFA repair, and AR), and complications were recorded. Descriptive statistics and multinomial logistic regression were used to assess the association between time to surgery and surgical technique.</div></div><div><h3>Results</h3><div>A total of 373 patients were included, with 90% undergoing DR (n = 334), 6% HFA repair (n = 22), and 5% AR (n = 17). The mean (standard deviation) time from injury to surgery was 16 (± 30) days for DR, 82 (± 162) days for HFA repair, and 274 (± 455) days for AR. Surgical technique selection was significantly associated with time to surgery (Kruskal Wallis <em>P</em> &lt; .001), with DR favored in acute cases and HFA repair/AR in chronic presentations. The inflection point for equal probabilities of DR, HFA repair, and AR occurred at 25-27 weeks postinjury. The overall complication rate was 12% (n = 45), with nerve injuries being the most common (7%, n = 25).</div></div><div><h3>Conclusion</h3><div>Timing significantly impacts surgical technique selection in distal biceps tendon ruptures. DR remains the standard for acute injuries, while HFA repair and AR are viable options for chronic cases. The multinomial probability graphic can be used to educate and counsel patients on surgical decision-making for chronic distal biceps ruptures.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 826-831"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Return to sport after arthroscopic xenograft bone block associated with Bankart repair and subscapularis augmentation in competitive contact athletes with recurrent anterior shoulder instability’ [Journal of Shoulder and Elbow Surgery (2025) e954]","authors":"Raffaele Russo MD ,&nbsp;Alberto Fontanarosa MD ,&nbsp;Marco Montemagno MD ,&nbsp;Alfonso Fedele MD ,&nbsp;Angelo De Crescenzo MD ,&nbsp;Francesco Di Pietto MD ,&nbsp;Roberto Calbi MD ,&nbsp;Raffaele Garofalo MD","doi":"10.1016/j.jse.2025.10.001","DOIUrl":"10.1016/j.jse.2025.10.001","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Page e522"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Augmented 4-screw vs. nonaugmented 6-screw PHILOS plating in low-bone quality proximal humerus fractures: a biomechanical human cadaveric study","authors":"Fabian Pretz MD ,&nbsp;Frank J.P. Beeres MD, PhD (Prof) ,&nbsp;Björn-Christian Link MD, PD ,&nbsp;Yannic Lecoultre MD ,&nbsp;Reto Babst MD (Prof) ,&nbsp;Boyko Gueorguiev PhD (Prof) ,&nbsp;Peter Varga PhD, PD ,&nbsp;Bryan J.M. van de Wall MD, PhD, PD ,&nbsp;Ivan Zderic PhD ,&nbsp;Torsten Pastor MD, PhD, PD","doi":"10.1016/j.jse.2025.07.006","DOIUrl":"10.1016/j.jse.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus fractures are frequent in patients with low bone quality. PHILOS plates are widely used with either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF) techniques. However, it remains unclear whether plating with 4 cement-augmented proximal screws provides biomechanical stability comparable to using 4 nonaugmented proximal screws plus 2 additional calcar screws in unstable low bone quality proximal humerus fractures.</div></div><div><h3>Methods</h3><div>Fourteen paired human cadaveric humeri with low bone quality and simulated unstable 3-part proximal humerus fractures (AO 11-B1) were assigned to 2 groups – 4S+ and 6S – and stabilized using PHILOS plates with 4 proximal head screws in both groups. In the 6S group, 2 additional calcar (inferomedial support) screws were used, whereas in the 4S+ group, the 4 screw tips were augmented with bone cement. Cyclic axial loading tests were conducted until failure. Interfragmentary movements were monitored via motion tracking.</div></div><div><h3>Results</h3><div>Initial axial construct stiffness and cycles to failure showed no significant differences between groups (<em>P</em> = .171, <em>P</em> = .397). Although interfragmentary movements were slightly higher in the 4S+ group, this difference was not significant (<em>P</em> ≥ .071). Under cyclic loading, the 6S group exhibited a significant progressive increase over cycles for varus deformation (<em>P</em> = .029), humeral head displacement (<em>P</em> = .038), and screw bending in row A (<em>P</em> = .003), whereas no significant increase over cycles was observed in the 4S+ group and between the groups.</div></div><div><h3>Conclusion</h3><div>From a biomechanical perspective, PHILOS plating with 4 cement-augmented screws demonstrated comparable stability versus plating with 4 nonaugmented head screws plus 2 additional calcar screws, suggesting that the former fixation technique represents a valid alternative to the latter, particularly in case of low bone quality.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 765-774"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of tranexamic acid reduces opioid consumption after arthroscopic rotator cuff repair","authors":"Katherine A. Burns MD ,&nbsp;Lynn M. Robbins PA-C ,&nbsp;Laura A. Humphrey PA-C ,&nbsp;Angela R. LeMarr RN, BSN, ONC ,&nbsp;Diane J. Morton MS, MWC ,&nbsp;Melissa L. Wilson MPH, PhD","doi":"10.1016/j.jse.2025.07.023","DOIUrl":"10.1016/j.jse.2025.07.023","url":null,"abstract":"<div><h3>Background</h3><div>Tranexamic acid (TXA) is an antifibrinolytic agent that has effectively reduced transfusion risk and minimized blood loss after total joint arthroplasty. TXA use has had mixed results on postoperative pain after arthroscopic rotator cuff repair (ARCR). The purpose of this prospective, double-blind, randomized, controlled trial was to examine the impact of TXA on prescription opioid consumption for 3 postoperative days in an outpatient population after ARCR. Intraoperative visualization and postoperative pain scores also were collected.</div></div><div><h3>Methods</h3><div>Patients scheduled to have ARCR with one surgeon at one institution were eligible for inclusion in a prospective, double-blind, randomized, and placebo-controlled trial comparing a cohort receiving intravenous administration of TXA 1,000 mg with a cohort receiving an equivalent volume of intravenous saline. The primary outcome was opioid consumption as measured by morphine milligram equivalents for the first 3 days after surgery. The secondary outcome was subjective measurement of pain as measured by the visual analog scale for the first 3 days after surgery.</div></div><div><h3>Results</h3><div>A total of 165 patients were enrolled, with 82 patients in the TXA group and 81 in placebo after 2 exclusions. No significant differences between groups were found for age, race, sex, size of rotator cuff tear, number of anchors used, or modifiable risk factors including preoperative opioid use and smoking tobacco status. TXA use independently reduced opioid consumption significantly for the first 3 days after ARCR by 18 morphine milligram equivalents (<span><math><mrow><mi>β</mi></mrow></math></span> = −18.0 [−35.4, −0.5], <em>P</em> = .044). Age also affected opioid use, with older patients consuming slightly less opioid than younger patients per year of age (<span><math><mrow><mi>β</mi></mrow></math></span> = −1.5 [−2.5, −0.5], <em>P</em> = .003). Factors that significantly increased opioid use included prior opioid use (<span><math><mrow><mi>β</mi></mrow></math></span> = 64.2 [32.0, 96.3], <em>P</em> &lt; .001) and increasing number of anchors used (per anchor, <span><math><mrow><mi>β</mi></mrow></math></span> = 7.9 [4.0, 11.7], <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>TXA use significantly reduced opioid consumption after ARCR. Advancing age modulated postoperative opioid consumption, whereas preoperative opioid use and number of anchors used increased opioid consumption in the first 3 days after ARCR. No differences were found in subjective pain score as measured by visual analog scale for the first 3 days after ARCR.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 757-764"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does prophylactic antibiotic choice for total shoulder arthroplasty matter? A matched cohort analysis","authors":"Tej Joshi MD ,&nbsp;Akhil Katakam MD ,&nbsp;Daniel Calem MD ,&nbsp;Daniella Ogilvie MD ,&nbsp;Eitan M. Kohan MD ,&nbsp;Francis G. Alberta MD","doi":"10.1016/j.jse.2025.07.017","DOIUrl":"10.1016/j.jse.2025.07.017","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infection (PJI) of the shoulder is a devastating complication following total shoulder arthroplasty (TSA). The majority of literature regarding antibiotic choice for TSA is from accompanying literature in other orthopedic subspecialties. The purpose of this study was to delineate the relationship between various perioperative antibiotics, including local, topical vancomycin, and their potential protective effect on PJI following shoulder arthroplasty.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using the TriNetX database to identify 28,098 patients who underwent TSA. Patients were stratified into cohorts based on the type of prophylactic antibiotic received in the perioperative period–only cefazolin, noncefazolin prophylaxis, vancomycin only, cefazolin with any form of vancomycin, cefazolin with topical vancomycin, only clindamycin, and cefazolin with clindamycin. The later 6 cohorts were one-to-one propensity score matched with the cefazolin-only cohort for risk analysis. The 90-day and 2-year risk of PJI and revision was analyzed, in addition to other surgical, hospital readmission, or emergency department visit complications.</div></div><div><h3>Results</h3><div>At 2 years, cefazolin monotherapy was associated with a significantly lower incidence of prosthetic joint infection and overall infection than noncefazolin regimens. No significant differences were found when cefazolin was compared with vancomycin alone or clindamycin alone. Adding local vancomycin did not significantly reduce the risk of PJI at any time point. Secondary antibiotic prophylaxis in addition to cefazolin was not associated with a decreased risk of infection at any time point.</div></div><div><h3>Conclusion</h3><div>Antibiotic prophylaxis choice for TSA may vary based on the surgeon's preference. Noncefazolin prophylaxis may not provide the same protection against PJI and overall infection as cefazolin prophylaxis. Cefazolin monotherapy is associated with lower infection rates compared to other noncefazolin regimens, suggesting that cefazolin should be used preferentially. However, prospective trials are required to further elucidate this finding.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 704-712"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative testosterone replacement therapy is associated with increased rates of periprosthetic joint infection, acute kidney injury, and emergency department utilization after total shoulder arthroplasty: a propensity-score matched analysis","authors":"Alexander E. White MD ,&nbsp;Argen Omurzakov BA ,&nbsp;Arsen M. Omurzakov BA ,&nbsp;Christian E. Athanasian BA ,&nbsp;Christopher M. Brusalis MD ,&nbsp;Michelle E. Kew MD ,&nbsp;Michael C. Fu MD ,&nbsp;Lawrence V. Gulotta MD ,&nbsp;Samuel A. Taylor MD","doi":"10.1016/j.jse.2025.07.022","DOIUrl":"10.1016/j.jse.2025.07.022","url":null,"abstract":"<div><h3>Background</h3><div>The use of testosterone replacement therapy (TRT) has increased in recent years; however, its effect on surgical outcomes and long-term implant survival in total shoulder arthroplasty (TSA) remains unclear. This study aimed to assess the association between preoperative TRT and postoperative complications following TSA.</div></div><div><h3>Methods</h3><div>The TriNetX database was queried to identify patients undergoing TSA before 2020. Patients were then stratified based on preoperative TRT within 1 year before surgery. Propensity score matching was performed in a 1:1 ratio to balance demographic variables and comorbidities. Outcomes assessed included 90-day and 1-year medical and implant complications and 5-year implant complications. Statistical analyses were performed using TriNetX's built-in analytics platform.</div></div><div><h3>Results</h3><div>Following propensity score matching, 1,369 patients were included in each cohort and no baseline differences were detected. At 90 days postoperatively, TRT patients had significantly higher rates of emergency department (ED) visits (13.7% vs. 8.1%, risk ratio [RR]: 1.69, <em>P</em> &lt; .001). At 1 year, TRT patients demonstrated increased rates of ED utilization (26.6% vs. 16.9%, RR: 1.58, <em>P</em> &lt; .001), acute kidney injury (17.5% vs. 12.1%, RR: 1.45, <em>P</em> &lt; .001), and periprosthetic joint infection (PJI) (4.8% vs. 2.4%, RR: 2.00, <em>P</em> &lt; .001). At 5 years, TRT was associated with increased rates of PJI (7.9% vs. 4.5%, RR: 1.74, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Preoperative TRT is associated with an increased risk of PJI, acute kidney injury, and postoperative ED visits following TSA. These findings highlight the need for careful preoperative risk assessment and patient counseling when considering TSA in patients on TRT.</div></div>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 689-696"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Baek et al. regarding: “Machine learning models can define clinically relevant bone density subgroups based on patient-specific calibrated computed tomography scans in patients undergoing reverse shoulder arthroplasty”","authors":"Daniel Ritter MSc,&nbsp;Patrick J. Denard MD,&nbsp;Patric Raiss MD,&nbsp;Brian C. Werner MD,&nbsp;Asheesh Bedi MD,&nbsp;Samuel Bachmaier MSc","doi":"10.1016/j.jse.2025.07.034","DOIUrl":"10.1016/j.jse.2025.07.034","url":null,"abstract":"","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages e518-e520"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological and electrodiagnostic insights into suprascapular nerve dysfunction: a key predictor of poor functional outcomes in shoulder hemiarthroplasty","authors":"Ahmet Keskin MD ,&nbsp;Niyazi Iğde MD ,&nbsp;Bülent Karslıoğlu MD ,&nbsp;Fethi Mıhlayanlar MD ,&nbsp;Onur Akan MD ,&nbsp;Ahmet Akçay MD ,&nbsp;Yunus İmren MD ,&nbsp;Süleyman Semih Dedeoğlu MD","doi":"10.1016/j.jse.2025.07.001","DOIUrl":"10.1016/j.jse.2025.07.001","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Suprascapular nerve (SSN) dysfunction has emerged as an underexplored factor influencing functional outcomes after shoulder hemiarthroplasty (SHA) for proximal humerus fractures. Despite achieving optimal tuberosity healing and prosthesis alignment, some patients continue to experience poor functional recovery. This study investigates the role of SSN dysfunction as a key determinant of unfavorable outcomes following SHA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This retrospective study analyzed 38 patients who underwent SHA for Neer type III or IV proximal humerus fractures. Inclusion criteria included radiographic confirmation of tuberosity healing, absence of pre-existing rotator cuff tears, and sufficient follow-up. Patients were divided into 2 groups based on the Constant Shoulder Score (CSS) at 12 months postoperatively: group G (good outcomes, CSS difference between prosthetic and healthy shoulders &lt;30) and group P (poor outcomes, CSS difference ≥30). Electrophysiologicalassessments were performed bilaterally to evaluate SSN function. Compound muscle action potentials and needle electromyography were used to measure nerve conduction and detect chronic neurogenic changes. Bilateral ultrasound imaging quantified supraspinatus muscle thickness at medial, central, and lateral points. These measurements provided a detailed comparison of prosthetic and healthy shoulders, identifying patterns of nerve dysfunction and muscle atrophy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Group P exhibited significantly lower American Shoulder and Elbow Surgeons scores, higher visual analog scale scores, and reduced shoulder motion (&lt;em&gt;P&lt;/em&gt; &lt; .01 for all). Findings revealed significantly lower compound muscle action potential amplitudes in the prosthetic shoulder of group P (2.55 ± 0.42 mV) compared with the prosthetic shoulders of healthy side (4.82 ± 0.67 mV, &lt;em&gt;P&lt;/em&gt; &lt; .001) and group G (4.27 ± 0.55 mV, &lt;em&gt;P&lt;/em&gt; &lt; .001). Reductions in amplitude exceeded 50% on the prosthetic side for group P. Needle electromyography of prosthetic shoulders in group P demonstrated chronic neurogenic changes, including fibrillation potentials and polyphasic motor unit potentials, in the supraspinatus and infraspinatus muscles. Ultrasound measurements revealed significant supraspinatus muscle atrophy on the prosthetic side in group P, with medial thickness reduction identified as the strongest predictor of poor outcomes (odds ratio = 1.312, 95% confidence interval: 1.042-1.654, &lt;em&gt;P&lt;/em&gt; = .021). Healthy shoulders in group P exhibited no significant neurogenic abnormalities, highlighting localized dysfunction in the prosthetic side.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;SSN dysfunction, evidenced by reduced nerve amplitudes and supraspinatus muscle atrophy, significantly predicts poor functional outcomes following SHA, even when tuberosities are well healed. These findings highlight the importance of perioperative nerve preservation stra","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":"35 3","pages":"Pages 719-730"},"PeriodicalIF":2.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}