Clinics in Shoulder and Elbow最新文献

{"title":"Surgical management of recalcitrant lateral epicondylitis: indications, techniques, and outcomes.","authors":"Tae-Yeong Kim, Bong Kyu Kim, Jun-Beom Lee, Jung-Taek Hwang","doi":"10.5397/cise.2026.00388","DOIUrl":"10.5397/cise.2026.00388","url":null,"abstract":"<p><p>Lateral epicondylitis is a common cause of lateral elbow pain. Although most patients improve with nonoperative treatment, a subset develops persistent symptoms requiring surgical intervention. Various surgical techniques-including open and arthroscopic debridement, percutaneous tenotomy, and tendon repair-have been described; however, the optimal surgical strategy remains controversial. This review summarizes current evidence regarding surgical techniques and clinical outcomes, with particular emphasis on the role of tendon repair in patients with high-grade common extensor tendon tears. Overall, surgical treatment yields satisfactory outcomes, with success rates exceeding 80%-90%. Increasing evidence suggests that the severity of tendon tearing plays an important role in surgical decision-making. In particular, tears involving ≥50% of tendon thickness appear to represent a clinically meaningful threshold for considering tendon repair rather than debridement alone.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"264-271"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence revolution in shoulder magnetic resonance imaging: current evidence and future directions for rotator cuff diagnosis.","authors":"Jong-Ho Kim, Jangwhan Bai, Ban Seok Kim, Young-Min Noh","doi":"10.5397/cise.2025.00990","DOIUrl":"10.5397/cise.2025.00990","url":null,"abstract":"<p><p>Rotator cuff tears (RCTs) are a leading cause of shoulder pain. Magnetic resonance imaging (MRI) is the gold standard for diagnosis, but interpretation is limited by variable sensitivity, interobserver variability, and increasing workload. Recent advances in artificial intelligence (AI), including deep learning and large language models (LLMs), have been explored to enhance diagnostic accuracy and efficiency. A structured search of PubMed, Embase, Scopus, and Cochrane Central databases identified studies published from 2019 or later applying AI to shoulder MRI for RCT detection, classification, segmentation, or reporting. Eligible studies reported quantitative outcomes. Of 732 records, 584 were screened, 121 underwent full-text review, and 19 were included in this narrative review. Deep learning models demonstrated diagnostic accuracies ranging from 71% to 100%, with sensitivities of 73%-100% and specificities of 70%-100%. About 20% of included studies used external validation, with 5%-15% performance reductions, underscoring limited generalizability. Visual Geometry Group (VGG)-based architectures and convolutional neural networks (CNNs) using multiplanar inputs achieved higher performance for full-thickness tear detection, while radiomics contributed to assessment of tear severity and muscle quality. Regulatory-approved software remains limited, and no fully automated diagnostic system has received Food and Drug Administration (FDA) clearance. LLMs demonstrated potential in patient education and report drafting, though informational quality was variable (median DISCERN score, 40/80), requiring expert oversight. AI applications in shoulder MRI demonstrate promising diagnostic accuracy and potential workflow benefits, but current evidence is constrained by limited external validation, dataset heterogeneity, and lack of regulatory clearance. Future research should prioritize multicenter validation, clinical integration, and explainability to enable safe clinical use of AI.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":"29 2","pages":"272-283"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148220010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Keeled versus pegged glenoid components in total shoulder arthroplasty for primary osteoarthritis: a meta-analysis.","authors":"Marc Boutros, Guy Awad, Jean-Pierre Saad, Zina Smadi, Reina Al Khatib, Raphael Bou Rached, Bassem Elhassan","doi":"10.5397/cise.2025.01480","DOIUrl":"10.5397/cise.2025.01480","url":null,"abstract":"<p><strong>Background: </strong>Glenoid fixation strongly influences longevity and outcomes in anatomic total shoulder arthroplasty. Keeled and pegged designs are common, but comparative evidence for function, range of motion, and survivorship is inconsistent.</p><p><strong>Methods: </strong>A systematic search of PubMed, Scopus, the Cochrane Library, and Google Scholar was conducted from database inception through December 2025. Thirteen comparative studies (n=3,219) met the inclusion criteria. Evaluated outcomes included patient-reported outcome measures (American Shoulder and Elbow Surgeons [ASES], Constant-Murley score, Simple Shoulder Test [SST], visual analog scale [VAS] pain scores), shoulder range of motion (flexion, external rotation, internal rotation), and implant-related outcomes, including failure and revision. Follow-up ranged from short to long-term (up to 26 years).</p><p><strong>Results: </strong>Across pooled analyses, no significant differences were observed between pegged and keeled glenoid components in ASES (P=0.69), Constant-Murley (P=0.61), SST (P=0.74), or VAS pain scores (P=0.88). Postoperative flexion (P=0.61) and external rotation (P=0.35) were comparable between groups. Pegged glenoid components demonstrated a statistically significant but small improvement in internal rotation (mean difference, 1.60°; 95% CI, 0.54°-2.66°; P=0.003). Revision rates were significantly lower with pegged glenoid components compared with keeled designs (risk ratio, 0.49; 95% CI, 0.28-0.86; P=0.01), while overall failure rates did not differ significantly between groups (P=0.07).</p><p><strong>Conclusions: </strong>Both designs yield similar pain relief, functional gains, and shoulder motion across most patient-reported outcome measures. Pegged components show lower revision risk and slightly better internal rotation, although survivorship findings are primarily supported by observational evidence. Selection should be individualized to anatomy, bone quality, and surgical factors, not expectations of superior overall function. Level of evidence: II.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"220-235"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The limited diagnostic value of \"feeling a pop\" for identifying acute tendon rupture in workers' compensation shoulder claims.","authors":"Sina Ramtin, Prakash Jayakumar, David Ring, Melissa Tonn","doi":"10.5397/cise.2025.01438","DOIUrl":"10.5397/cise.2025.01438","url":null,"abstract":"<p><strong>Background: </strong>When an adult with rotator cuff tendinopathy reports feeling or hearing a pop along with new pain, both the clinician and the patient may inaccurately and unhelpfully expect (framing heuristic) an injury and consider it a compensable work claim.</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of 118 people that filed work claims for new shoulder pain where aspects of their care or recovery trajectory triggered a peer review. We collected data on age, sex, reports of hearing or feeling a pop (25%; 29 of 118 patients), and reports of new numbness or tingling (11%; 13 of 118 patients). Five (4%) patients had a possible acute rotator cuff rupture (relatively large defect with good muscle) and 11 (9%) had a long head of biceps rupture, age indeterminate.</p><p><strong>Results: </strong>Accounting for confounding variables using logistic regression, possibly acute rotator cuff defects and age-indeterminate long head of biceps ruptures were associated with older age (odds ratio [OR], 1.10; 95% CI, 1.02-1.18) and the presence of a degenerative rotator cuff defect (OR, 6.0; 95% CI, 1.5-24) but not with sensation of a \"pop.\"</p><p><strong>Conclusions: </strong>Based on this evidence, among people claiming injury at work, when a \"pop\" is reported the clinician should not expect new pathophysiology. Level of evidence: III.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"215-219"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-inflammatory use and rotator cuff repair outcomes: a prospective 5-year cohort follow-up of 2,533 patients.","authors":"William J Caughey, Anthony Maher, Warren B Leigh, Matthew J Brick, Simon W Young, Cameron G Walker, Michael A Caughey","doi":"10.5397/cise.2025.01396","DOIUrl":"10.5397/cise.2025.01396","url":null,"abstract":"<p><strong>Background: </strong>Non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of postoperative pain control following rotator cuff repair, despite a thorough understanding of their effects on clinical outcomes. This paper aims to assess the influence of NSAID use on pain and functional outcomes for 5 years postoperatively.</p><p><strong>Methods: </strong>Patients undergoing rotator cuff repair throughout New Zealand were enrolled in this prospective cohort study from March 1, 2009, to December 31, 2010, with 2,533 primary repairs included. Follow-up was 81% at 5 years. Demographic, preoperative, and intraoperative data as well as NSAID use duration were recorded, with follow-up at 6, 12, 24 months, and 5 years, measuring Flex Shoulder Function and visual analog scale pain score.</p><p><strong>Results: </strong>In total, 72% of the study population used NSAIDs postoperatively; 18% took NSAIDs for up to 2 weeks in duration, 21% 3-6 weeks, 12% 7 weeks to 3 months and 21% over 3 months. NSAID use for longer than 2 weeks was associated with poorer function at 6 and 12 months postoperatively, with use longer than 6 weeks associated with poorer function at 6, 12, 24 months, and 5 years. Improvement in function was significantly lower in those taking NSAIDs for more than 3 months (P=0.04). A higher rate of stiffness was seen in the NSAID group (P<0.001).</p><p><strong>Conclusions: </strong>Use of NSAIDs longer than 6 weeks following rotator cuff repair was associated with poorer functional outcomes, and higher pain with extended use. This data raises concern regarding potential detrimental effects of NSAIDs following rotator cuff repair, and further research is required to determine their safe duration of use. Level of evidence: II.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"208-214"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acromion to greater tuberosity distance: a simple radiographic key to unlocking optimal deltoid tension in reverse shoulder arthroplasty.","authors":"Jaemin Lee, Doo Sup Kim","doi":"10.5397/cise.2026.00402","DOIUrl":"10.5397/cise.2026.00402","url":null,"abstract":"","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"171-173"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of patients with cardiac implantable electronic devices in shoulder surgery.","authors":"Tarishi Parmar, Favian Su, Joseph A Abboud, Robert K Altman, Eric Black","doi":"10.5397/cise.2026.00066","DOIUrl":"10.5397/cise.2026.00066","url":null,"abstract":"<p><p>Cardiac implantable electronic devices (CIEDs) are becoming increasingly common, and shoulder surgeons encounter patients with these devices with growing frequency. Despite this, practical guidance on managing CIEDs during shoulder surgery remains limited. This narrative review provides a consolidated framework for managing these patients across the perioperative period. We outline essential functions, indications, and structural components of modern devices, including transvenous pacemakers, transvenous implantable cardioverter-defibrillators, subcutaneous implantable cardioverter-defibrillators, and leadless pacemakers. CIED placement techniques and their anatomic relevance to the deltopectoral approach are reviewed. Associated risks, such as lead traction, pocket violation, and electromagnetic interference (EMI), are highlighted. Preoperative management focuses on structured screening: confirming device type and indication, assessing pacing dependency, and coordinating with electrophysiology. Practical guidance clarifies when magnet application is sufficient and when formal reprogramming is required. Intraoperative management centers on maintaining rhythm stability and protecting the device. Continuous electrocardiogram and pulse monitoring are recommended, with external pacing and defibrillation available. EMI risk is reduced by placing the dispersive (grounding) pad on the ipsilateral side, using bipolar cautery when possible, and limiting monopolar cautery to short, low-energy bursts. Mechanical injury is minimized through careful retractor placement. Postoperative care focuses on confirming that the device has returned to baseline function. By integrating device mechanics, anatomic considerations, and perioperative management principles, this review offers a unified, surgery-specific approach to caring for patients with CIEDs undergoing shoulder procedures. The accompanying algorithm provides a stepwise procedure for assessment and decision-making aimed at reducing cardiac risk.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"291-301"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential of early American Shoulder and Elbow Surgeons score changes to predict postoperative outcomes after total shoulder arthroplasty.","authors":"Thomas Stanila, Samuel E Mircoff, Dane H Salazar, Nickolas G Garbis","doi":"10.5397/cise.2025.01270","DOIUrl":"10.5397/cise.2025.01270","url":null,"abstract":"<p><strong>Background: </strong>The American Shoulder and Elbow Surgeons (ASES) score is a patient-reported outcome measure for shoulder functionality that can be collected at baseline and postoperative time points. In total shoulder arthroplasty (TSA), its temporal relationship with other recovery metrics is unknown. This study evaluates the potential of early ASES changes after TSA to predict other outcomes, particularly active forward flexion (AFF), active external rotation (AER), and VAS pain scores at final follow-up.</p><p><strong>Methods: </strong>A retrospective chart review identified patients who underwent primary TSA between 2018 and 2023. Demographics, postoperative ASES scores, visual analog scale (VAS) pain scores, AFF, AER, and complication rates (revision, readmission, and mortality rates) were recorded. Percentage changes from baseline were calculated for each outcome. Linear regression analyses controlling for age, sex, race, body mass index, and Charlson Comorbidity Index scores were used to assess associations between ASES changes at 6 weeks, 3 months, 6 months, and 1 year and subsequent outcomes.</p><p><strong>Results: </strong>In total, 394 TSA patients were investigated, with a mean follow-up of 2.9 years. Percent changes in ASES scores at 3 months (P=0.023), 6 months (P=0.001) and 1 year (P=0.006) were significantly associated with AFF improvement at 1 year. ASES changes were also associated with VAS pain scores, with 6-week ASES changes correlating with 3-month VAS improvement (P=0.039). A 1% ASES increase at each interval predicted continued 1% gains postoperatively. No significant associations were observed for AER within 2 years postoperatively or any complication rate within 1 year postoperatively.</p><p><strong>Conclusions: </strong>Early improvements in the ASES score can predict later postoperative outcomes after TSA, supporting its use as an indicator of recovery trajectory. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"198-207"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-revision rate after anatomic-to-anatomic revision of total shoulder arthroplasty: a descriptive study of the Dutch national registry.","authors":"M Azad Naryapraği, Dries Boulidam, Anneke Spekenbrink-Spooren, Geert A Buijze, Oscar Dorrestijn, Michel P J van den Bekerom, Arno A Macken","doi":"10.5397/cise.2025.01312","DOIUrl":"10.5397/cise.2025.01312","url":null,"abstract":"<p><strong>Background: </strong>Anatomical total shoulder arthroplasty (aTSA) is typically reserved for end-stage glenohumeral arthritis with an intact rotator cuff and adequate glenoid bone stock. With the exponential increase in total shoulder arthroplasty surgeries, complications and the need for re-revision surgery have also increased. Typically, aTSA is revised to a reversed prosthesis, but in some cases the anatomic configuration is maintained. Revision surgery is associated with a higher risk of complications and re-revisions than primary surgery. However, the literature on re-revision surgery after aTSA is sparse.</p><p><strong>Methods: </strong>An observational cohort study was conducted using data from the Dutch National Registry. We report re-revision rates and reasons and analyze the implant survival of revised aTSA (anatomic-to-anatomic revision). Due to the small sample size, this study is strictly descriptive and is not suitable for identifying risk factors or predicting survival.</p><p><strong>Results: </strong>Overall, 5,547 primary aTSAs were registered between 2014 and 2023, and the 58 patients who underwent revision surgery with the implant remaining in an anatomic configuration were included in this study. Re-revision surgery was performed in 10 patients (17%). The most common indications for re-revision surgery were glenoid component loosening (n=4) and rotator cuff rupture (n=4). Implant survival at 3 years after the first revision was 80%. All re-revisions occurred within 3 years after revision surgery.</p><p><strong>Conclusions: </strong>We report a 3-year implant survival of 80% after an anatomic-to-anatomic revision of aTSA. Failure causes and the number of re-revision surgeries in aTSA indicate a high risk of early failure and provide a warning for surgeons considering the retention of an anatomic configuration. Level of evidence: IV.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"191-197"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Popeye sign: beyond the bulge-a proposal for a standardized definition and classification.","authors":"Igor J Shirinskiy, Lotte Fokker, Michel Pj van den Bekerom, Bart Muller, Derek Fp van Deurzen","doi":"10.5397/cise.2026.00038","DOIUrl":"10.5397/cise.2026.00038","url":null,"abstract":"<p><p>The Popeye sign is a classic eponym describing the cosmetic deformity following long head of the biceps tendon (LHBT) retraction. While frequently cited, its diagnosis remains subjective and standardized criteria are lacking. Muscle mass, body mass index, and surgical treatment of LHBT pathology as well as patient perceptions can all influence the prevalence and functional effect of the Popeye sign. This article reviews the historical origin of the eponym and its clinical relevance. Furthermore, we propose a novel, standardized diagnostic grading system to quantify the Popeye sign, facilitating more consistent reporting in future clinical research.</p>","PeriodicalId":33981,"journal":{"name":"Clinics in Shoulder and Elbow","volume":" ","pages":"284-290"},"PeriodicalIF":2.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13268773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147934151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}