Rispoli, Damian M.

Purpose Our purpose was to evaluate the distance from the bony edge of the glenoid to the visible (or macroscopic) demarcation at the junction of the labrum and the articular cartilage. Methods Ten fresh‐frozen cadaveric upper extremity specimens were dissected. The shoulder was disarticulated and periarticular structures were removed, leaving the glenoid with the labrum attached. The macroscopic edge of the glenoid was then marked with a drill at the 3‐, 4‐, 5‐, 6‐, 7, 8‐, and 9‐o'clock positions, as defined by a clock face (right) and a reverse clock face (left). Soft tissue and cartilage were then removed, and the distance from the outer edge of the drill hole to the bony rim was measured. Results The mean distance from the bony edge in hourly intervals starting at the 3‐o'clock position anteriorly and extending to the 9‐o'clock position posteriorly was 4.03 mm (range, 2.1 to 5.21 mm; SD, 0.96 mm), 4.2 mm (range, 2.1 to 5.31 mm; SD, 0.97 mm), 4.51 mm (range, 3.1 to 5.2 mm; SD, 0.91 mm), 5.14 mm (range, 3.1 to 7 mm; SD, 1.38 mm), 3.24 mm (range, 1.1 to 5.2 mm; SD, 1.4 mm), 3.78 mm (range, 1 to 6 mm; SD, 1.6 mm), and 4.28 mm (range, 2.1 to 7.3 mm; SD, 1.51 mm), respectively. A trend was noted for significant differences between locations, but this did not reach statistical significance (analysis of variance, P = .086). Conclusions The macroscopic edge of the labrum on the glenoid face does not correspond to the bony edge of the glenoid. The labrum overlaps onto the bony surface of the glenoid from a minimum of 1.6 mm to a maximum of 7.3 mm. Clinical Relevance Our findings provide anatomic data that enhances the arthroscopist's ability to anatomically reconstruct the glenoid labrum.

Ulnar neuropathy presents as a complication in 5% to 10% of total elbow replacements, but subsequent ulnar neurolysis is rarely performed. Little information is available on the surgical management of persistent ulnar neuropathy after elbow replacement. We describe our experience with the surgical management of this problem. Of 1607 total elbow replacements performed at our institution between January 1969 and December 2004, eight patients (0.5%) had a further operation for persistent or progressive ulnar neuropathy. At a mean follow-up of 9.2 years (3.1 to 21.7) six were clinically improved and satisfied with their outcome, although, only four had complete recovery. When transposition was performed on a previously untransposed nerve the rate of recovery was 75%, but this was reduced to 25% if the nerve had been transposed at the time of the replacement.

We have examined the relief from pain and the functional outcome in 18 patients who underwent resection arthroplasty of the shoulder as a salvage operation between 1988 and 2002. The indications included failed shoulder replacement in 17, with infection in 13, and chronic septic arthritis in one. The mean follow-up was 8.3 years (2.5 to 16.6). Two intra-operative fractures of the humerus occurred, both of which healed. The level of pain was significantly decreased (t-test, p < 0.001) but five patients continued to have moderate to severe pain. The mean active elevation was 70° (0° to 150°) postoperatively and represented an improvement from 39° (0° to 140°) (t-test, p = 0.003), but internal and external rotation were hardly changed. The mean number of positive answers on the 12-question Simple Shoulder Test was 3.1 (0 to 12) but the shoulder was generally comfortable when the arm was positioned at rest by the side. The mean post-operative American Shoulder and Elbow Surgeon’s score was 36 (8 to 73). Despite applying this procedure principally to failed shoulder replacements, the results were similar to those reported in the literature for patients after severe fracture-dislocation. Reduction of pain is possible in one half to two-thirds of patients. The outcome of this operation in providing relief from pain cannot be guaranteed, but the shoulder is usually comfortable at rest, albeit with profound functional limitations.