News Category: Shoulder

Pain on top of the shoulder where the collarbone meets the shoulder blade bone is a common finding with acromioclavicular (AC) joint problems. Many patients injure the AC joint during physical activity. Weight lifting, push-ups, or dips are the most common activities known to cause AC injury.

Healthcare providers use many tests to isolate the cause of shoulder pain. But some shoulder tests turn out positive for other problems when the real problem is AC joint injury. Finding a test that will always be positive with an AC joint injury is the goal of this study.

Doctors in Korea used three specific shoulder tests with two groups of patients. The tests were checked to see how good they were. Reliability shows if the test gives the same result when it’s repeated. Sensitivity reflects the test’s ability to give a true positive when there is a problem. Specificity means that the test gives a true negative when there isn’t a problem.

All patients had a shoulder problem. The first group had chronic AC joint pain and got relief of symptoms with a steroid injection. The second group had surgery for a shoulder joint problem other than an AC injury. The authors found that two tests were reliable, sensitive, and specific. The first was the cross body adduction stress test. The second was the AC resisted extension test. The third test (active compression) had high specificity but low sensitivity.

<p.The authors conclude that using all three tests together is best. Results of shoulder tests must be used with caution. In this study there were many tests for other shoulder problems that also caused AC joint pain. This can mislead the examiner. The authors suggest using these tests as only one part of the diagnostic process.

The results of this study will help doctors diagnose shoulder problems. Many patients with shoulder pain really have a problem with the acromioclavicular (AC) joint. The AC joint is where the outer edge of the collarbone (the clavicle) meets the acromion. The acromion is a bony projection off the shoulder blade. It forms a roof or shelf over the shoulder joint.

Researchers at the Sports Medicine and Shoulder Service in Sydney, Australia, carried out 20 tests on patients with shoulder pain. Muscles were examined, and X-rays and other imaging studies were done. Range of motion was measured, and some special tests just for AC problems were done.

Then each patient had a steroid injection with a numbing agent into the AC joint. Patients who got more than 50 percent relief from pain had a true AC joint problem. The researchers compared the results of the tests with the results from the successful injections.

They found that two tests were very accurate when used together. The Paxinos test and a positive bone scan gave the best information. The Paxinos test is done by applying front-to-back pressure through the AC joint. If these tests are both positive, then there’s a 99 percent chance the patient has an AC joint problem.

A pain diagram is also a good screening tool for AC joint pain. The most common pattern with AC joint pain starts in the middle of the clavicle and goes out over the shoulder to the middle of the upper arm. The authors suggest more testing is needed if one test is positive and one is negative.

Special metal sutures that look like screws are used in some types of shoulder surgery. This is a report of five cases where the screws were not placed properly. Each patient ended up with severe pain and damage to the shoulder joint.

Screws can come loose or break and move in the shoulder joint. The tip of the screw can also scrape and damage the joint when it’s not buried deep enough under the bone. The patient may feel severe pain and a “clunk” or catching sensation during motion. If not corrected early, the results can be poor.

The authors of this report describe proper placement and the best angle for anchoring the screws. They use photos taken of the inside of the joint to show how to screw the anchor in and how deep to go. They advise doctors to place the tip of the lowest anchor in the five o’clock or seven o’clock position. The tip must be under the first layer of bone, not just under the cartilage.

Each of the five men in this study had a second operation. The results weren’t too good. All five men were unhappy with the final results. Their severe pain continued, and their shoulders weren’t stable.

These researchers suggest looking for problems after shoulder repair using metal screws. Sharp pain and a catching sensation early in rehab should be reported and examined. Treatment to revise screw placement must be done as soon as possible. These steps are needed to help prevent severe damage to the joint.

Slowly but surely researchers are finding out what works and what doesn’t for soft tissue problems in the shoulder. So far studies show little benefit from taking nonsteroidal anti-inflammatory drugs or from steroid injections into the joint.

In this study the effect of ultrasound is measured. Ultrasound is a form of deep heat. It is thought to improve blood flow to healing tissue and to reduce pain. The result is increased motion and improved function.

Forty patients with a soft tissue disorder of the shoulder were divided into two groups. One group of 20 patients had ultrasound to the shoulder. The other group had “sham” ultrasound, meaning the ultrasound machine was used but not turned on. Both groups also had other physical therapy treatment.

Everyone was treated five days each week for three weeks, for a total of 15 sessions. Measures used to assess the differences in treatment results included pain at rest, pain with motion, range of motion, and function.

The authors reported changes within each group. There were no big differences between groups. The ultrasound didn’t add anything more to the results from physical therapy without ultrasound. They conclude that ultrasound isn’t needed or helpful in treating soft tissue disorders of the shoulder.

Ultrasound and MRIs are both used to find and measure rotator cuff tears in the shoulder. But which method is better? The results of this study show these two imaging methods are equally accurate. The doctor may choose one over the other based on other factors besides accuracy.

All patients in this study had an ultrasound and MRI of the same shoulder on the same day. Radiologists with more than 10 years of experience viewed the images. Rotator cuff tears were measured and labeled as either partial- or full-thickness tears.

Arthroscopic surgery was then done to check the findings. The torn tendon was also repaired. The imaging measure was correct if it was within five millimeters of what was found with arthroscopy. The researchers report that ultrasound found 98 percent of the full-thickness rotator cuff tears diagnosed by arthroscopy. MRI found 100 percent of the full-thickness tears.

Both imaging methods were less accurate at finding partial-thickness tears. Ultrasound found 68 percent and MRI found 63 percent of the partial tears.

The authors conclude that ultrasound and MRI are equally good ways to assess rotator cuff tears. It’s up to the doctor to choose which method to use. The choice may be based on cost, patient concerns, and imaging experience at the hospital or clinic.

We know that obesity is linked to all sorts of health problems. These authors tested whether there was a link between obesity and problems in the rotator cuff. The rotator cuff is a large, powerful band of tendons that surrounds the shoulder joint. Baseball pitchers often injure the rotator cuff. Swelling and inflammation of the rotator cuff tendons is common for the rest of us, too.

Problems with the rotator cuff can be disabling. Obesity seems to affect blood supply to the tissues. Could this lead to inflammation in the rotator cuff?

To check their theory, the authors looked at records for 311 patients who had rotator cuff surgery over eight years. They were compared to 933 people in the same age range who did not have rotator cuff problems. Results showed that the group with rotator cuff problems weighed more. The more overweight a person was, the more at risk a person was for rotator cuff problems.

More research is needed to fully understand this link. However, it seems like there is one more health risk related to obesity.

Patients usually have better outcomes when they go to surgeons and hospitals with more experience doing a certain procedure. This has been studied in hip and knee replacement surgeries. Does the theory hold true for shoulder joint replacement? Shoulder replacement is a fairly rare surgery. It is also very complex. In shoulder replacement surgery, either the whole joint or half of the joint may be replaced. Replacing half of the joint is called a hemiarthroplasty.

These researchers collected data on shoulder replacements done throughout the United States over a period of 13 years. The data came from 1,000 hospitals of all types: urban and rural, large and small, public and private. Numbers were studied for complications after surgery. Complications included infections, blood clots, and poor wound healing.

The results showed that complications from shoulder replacement surgery were low overall (just over one percent). However, surgeons and hospitals with more experience had better outcomes. Surgeons who did four or fewer shoulder replacements per year, and hospitals that did 10 or fewer per year, had higher rates of problems. Patients in hospitals that did fewer shoulder replacements also stayed in the hospital up to a day longer, on average.

The differences were more significant for hemiarthroplasties. The overall rate of complications was still less than two percent in every category. But the surgeons and hospitals with less experience had over 1.5 times more complications.

This information can be important for patients. But complication rates are fairly low in all cases. It may not make that much of a difference in choosing a surgeon.

However, studies like this are of special interest to insurance companies and hospitals. Their major interest is in keeping costs down. In the big picture, making hospital stays even slightly shorter and keeping complication rates as low as possible can save a lot of money.

Two muscles are most important in moving the scapula (shoulder blade) as the arm is reached overhead. These are the upper trapezius (UT) muscle and the serratus anterior (SA) muscle. The UT goes across the top of the shoulder. You use the UT to shrug your shoulders. The SA comes from the scapula under the armpit around the side of the trunk. The SA attaches along the upper eight or nine ribs on the front of the body. The SA helps move the scapula.

Shoulder problems can occur if these two muscles don’t contract and work together. There has to be just the right action between the UT and the SA. When the SA contraction is weak or the UT contraction is too strong, the scapula moves abnormally. It can even start to wing out instead of lying flat against the rib cage in the back.

The patient may end up with a problem where the shoulder joint pinches, called impingement. In this case the scapula moves up when it shouldn’t. There are exercises to help with this problem.

In this study, physical therapists from the University of Minnesota measured the force of contraction between the UT and SA. Two groups of patients completed four different exercises. One group had normal healthy shoulders with no problems. The second group had shoulder pain or abnormal shoulder movement.

The exercises used a special push-up with scapular protraction. This means at the end of each exercise, the patient actively moved the scapulae forward on the rib cage as far as possible. The therapists helped patients practice the movement until the right motion and timing were present. Each of the four exercises was done five times with a two-minute rest period between sets.

The authors found the SA was most active during the military type push-up with scapular protraction. It was least active when performing the same push-up activity in the standing position against the wall. Two other positions (on hands and knees, and on toes and forearms) had SA levels between the two extremes. Overall results were the same in both groups.

This study showed that special exercises can be done to strengthen the SA without making the UT any stronger. This keeps the UT from overpowering the SA. Patients with scapular winging or shoulder impingement can benefit the most from these exercises. The patient can start with the easiest exercise (wall push up with scapular protraction) and progress to the hardest (full push-up with scapular protraction).

Have you ever wondered how it is that you can move each arm together in exactly the same arc of motion? And how is it that you can do it with the same speed, and end up in the same position every time? The joints have a function called proprioception that makes this all possible.

Part of proprioception is joint position sense. The joint can actually tell where it is in relation to the body and other joints. The nerves in the muscles and ligaments around the shoulder send messages to the nervous system about the joint’s location.

In this study, shoulder joint proprioception was measured before and after an operation to repair an unstable shoulder. Fourteen patients were followed for at least five years. Results were measured using a test called the active angle reproduction test. This test shows the patient’s ability to put the shoulder in a set position using joint position sense.

Results were compared for the injured shoulder and the uninjured arm in the study patients. Results were also compared to subjects with normal shoulders. At first everyone was allowed to see his or her own movement. Then everyone was blindfolded. This takes away visual control. Patients and control subjects had to move the shoulder into one of 36 different joint positions.

The authors found a big improvement in joint proprioception in the operated shoulder. This result was present after an average of almost six years of follow-up. Shoulder movements away from the body and shoulder rotation improved. Before the operation, patients had worse results compared to the healthy control group. Five years after the operation, the patients had better joint position sense in both shoulders compared to the control group.

Researchers aren’t sure why patients get better proprioception than normal subjects after an operation to repair the shoulder. Only a few studies of this topic have been done. It may be that the soft tissues and ligaments around the shoulder regain their tension, or “spring.”

There were only 14 patients in this study, and the normal subjects weren’t measured five years later. For these reasons, the authors advise a larger study in the future to repeat this test. For now, we know joint position sense can be recovered in some patients after surgery to repair an unstable shoulder.

Even though orthopedic surgeons like to do surgery, they still prefer that patients get better without an operation. In the case of an unstable shoulder without a traumatic injury, physical therapy works about 80 percent of the time. Up to 20 percent of patients still need surgery after trying therapy.

In this study doctors looked at the 20 percent who didn’t get better without surgery. They used arthroscopic surgery to look inside the shoulder joint and find out what was wrong. Most often damage or tears of the joint capsule and labrum were found. The joint capsule is a fibrous envelope of tissue that goes around the shoulder joint. The labrum is a rim of cartilage on the joint itself.

This study shows that shoulder instability involving the capsule and labrum can occur without a traumatic injury. Doctors should suspect a problem in the joint when patients don’t get better with physical therapy. Another sign is that the shoulder dislocates but goes back in by itself, and there’s little or no pain when this happens.

Here’s a study that looks at the effect of diseases on patients with a chronic rotator cuff tear. All 206 shoulder patients were ready for surgery to repair the tear.

The focus of this research is comorbidities. A comorbidity occurs when one patient has more than one problem. For example a patient with a torn rotator cuff who also has diabetes, high blood pressure, and a thyroid problem is said to have comorbidities.

What’s the effect of comorbidities on the patient’s pain, function, and general health? That’s what researchers at Brown Medical School in Rhode Island set out to find. They used several surveys and asked patients many questions before surgery.

They found that when two or more comorbidities are present, the patient had worse pain, less function, and lower overall health. The most common problems were low back pain, high blood pressure, and arthritis. Several other factors had a negative effect on patient pain and function. These factors included older age, patient hopes, and smoking.

The authors report a good result for most rotator cuff repair operations. Those patients who don’t do well after surgery often have an increased number of comorbidities. This same group of patients has worse pain before the operation and poor overall health. It’s unclear what effect the comorbidities may have on the long-term results of the operation. Future studies are needed to look at this.

Less than 30 years ago, a single computer filled an entire room. Today the same device can be held in your hand. Technology has also changed medical diagnostic imaging. Equipment size and cost has changed. For example, an ultrasound machine used to weigh more than 100 pounds and cost up to 200,000 dollars. Today the same unit weighs about five pounds and costs under 20,000 dollars.

Ultrasound can be used to look at soft tissues around joints, including the shoulder. The doctor can examine the patient in the office and look for rotator cuff tears in the same visit. The patient isn’t exposed to radiation or dyes. The patient with claustrophobia isn’t put inside a machine. It’s fast and economical. Ultrasound can be used with patients who have metal implants or heart pacemakers. Are there any disadvantages with this testing? Only one: it doesn’t show tears of the cartilage in or around the joint.

In this report, doctors tell what kind of training is needed to begin using ultrasound for shoulder injuries. The exam for each of the muscles and tendons around the joint is also described. The results are compared with outcomes from other imaging studies such as magnetic resonance imaging (MRI) scans. Ultrasound is more accurate and more reliable. It’s also less costly than MRIs.

Doctors are pleased that in-office ultrasound helps them teach their patients. Patients are able to see for themselves exactly what’s wrong. The doctor can show normal anatomy and motion by using the machine on the uninjured side. When a patient can actually see a tear in the tendon, they get a first-hand view of why surgery may be recommended.

Just because something is popular doesn’t mean it’s good. This idea is true in the medical world, too. Doctors from the Shoulder and Elbow Center point out that thermal shrinkage of the shoulder joint capsule is a very popular operation. But there isn’t much research to back it up.

The purpose of this study was to see how well thermal shrinkage works for shoulder problems. Thermal shrinkage involves applying heat to the capsule around the shoulder to tighten it up. The procedure is called electrothermal capsulorrhaphy. Laser light or radiofrequency (RF) electrical current is used. The tissue is heated up then cooled down. This shrinks the tissue and forms scarring or thickening.

After shoulder dislocation, the capsule gets stretched out and doesn’t go back to its normal shape. When the shoulder dislocates over and over, the joint becomes even more unstable. That’s the most common reason to try thermal shrinkage. Doctors like the idea of thermal shrinkage because it can be done using an arthroscope without opening up the entire joint.

In this study, 84 patients were put into three groups: those whose shoulders popped out forward; those with a partial dislocation either forward or downward; and those with dislocation that occurred in more than one direction. After treatment with thermal shrinkage, each patient was examined using four measures. These measures included patient satisfaction, return to work or sport, shoulder function, and signs of instability.

Patients were followed for an average of three years. About two-thirds of the patients had an excellent or good outcome. However, almost 40 percent of the patients rated an unsatisfactory result. At first these patients reported good results. After a year things started to change. Painful symptoms came back, and shoulder dislocations occurred again. Some patients ended up needing another operation.

The authors say the goal of thermal shrinkage for an unstable shoulder is to get the same result as with open surgery. The poor long-term results for over one-third of the patients in this study are a big concern. These doctors conclude that the operation shouldn’t be used routinely until more studies are done. When it is used, patients should be followed long term.

The first operation to repair a torn rotator cuff tendon in the shoulder was reported in 1911. It is called an “open repair” since it involves an incision. Since then, treatment for this problem has improved. So have the results for patients. In 1992, almost 80 years later, the first arthroscopic repair of the rotator cuff took place.

An arthroscope is a tool that allows doctors to see and work inside a joint. No incision is needed. Only a very small opening is made. The operation is called a mini-open technique. In this study, one surgeon reports results of 96 arthroscopic rotator cuff repairs.

Men and women of all ages were included. They all had shoulder pain and weakness that didn’t get better with conservative care. The doctor describes step-by-step how the operation was done. There were slight differences from patient to patient based on problems inside the joint.

Pain, muscle strength, and function were the results measured. Ninety patients had a good to excellent result. That’s 94 percent of the group. Follow-up showed they still had good results up to 10 years after surgery.

Three patients had the other shoulder repaired earlier using the open method. They reported much better results with the arthroscopic method. They had a faster recovery and quicker return to normal function than with the open repair.

The authors report that their results compare favorably with other studies of this type. Arthroscopy allows surgeons to see the rotator cuff tear from all angles. This type of view isn’t possible with the open method. Being able to see where each suture goes and how it affects the rotator cuff is another big plus. Time will tell the final results another 10 to 20 years down the road.

Everyone and everything has a history. Keeping track of how things change over time is an important part of medical history. This is true for every disease, illness, and condition. This study reviews the history of treatment for shoulder instability. The authors also report the results of a new treatment.

Nineteen patients with multidirectional instability were treated and followed for at least two years. Multidirectional instability means the shoulder joint is too loose and moves too much. The extra motion is called joint laxity. This laxity occurs in one or more directions (down, forward, or back).

Treatment was with thermal shrinkage, which uses heat to tighten up the shoulder capsule that surrounds the shoulder joint. The capsule normally helps the joint stay stable. Thermal shrinkage can be done with lasers or with radiofrequency waves. Laser devices are expensive. Doctors must have special training to use this method. Radiofrequency is more popular now because it’s easier to use and cheaper.

One doctor treated all 19 shoulders. Each patient’s capsule was viewed with a videoscope. This tool allows the doctor to look inside the joint and see it on a TV screen. The radiofrequency probe was passed over the tissue section by section until all sides of the capsule were heated. Radiofrequency was set at 40 watts. This raised the tissue temperature to 152 degrees F.

All 19 patients were young and active. Nine had a recurrence of the same problem within the first nine months. Four patients had some nerve damage under the armpit, and one had muscle weakness. The authors report this high failure rate is not acceptable.

They suggest failure may be more likely when the patient has mostly posterior (backward) instability. Patients who can pop the shoulder in and out are also less likely to have a good result. It may be better to repair the shoulder in these patients using the usual methods of open or arthroscopic surgery with stitches to tighten the capsule.

You’re young and carefree, and suddenly you’re in a world of hurt. You’ve dislocated your shoulder. The Cincinnati Children’s Hospital Medical Center say there’s a 75 percent chance you’ll do it again.

This study looks at children and teens between the ages of 11 and 18 years. The results of anterior (forward) shoulder dislocation are reported. In the short term, painful symptoms kept adolescents from work and play. In the long run, an unstable shoulder that dislocates more than once can damage the shoulder joint.

Sometimes it doesn’t take much to dislocate a second time. Just reaching overhead or moving too quickly can do it. According to these authors, even patients who have surgery to repair a dislocated shoulder were at risk for another dislocation.

Researchers did find that a second dislocation is more likely after sports injuries. Even so, shoulder dislocations from sports injuries in this study had the same final outcome as other types of injuries. Motion and function for both groups weren’t any different four years after the injury.

The authors of this study aren’t sure why the results turned out the way they did. They think athletes may return to sports too soon after the first dislocation. Without good tissue healing, the shoulder dislocates again. Or perhaps the force of an athletic injury causes more tissue damage and easier dislocation afterwards.

It seems clear that, once damaged, a dislocated shoulder can easily pop out again in patients 18 years old or younger. Doctors caution that long-term results aren’t always good. A full recovery of shoulder function may not happen even with treatment.

We know athletes who throw overhead have more torn shoulder tendons than the average Joe. MRI results have shown this in many studies. But it may not be fair to compare athletes to non-athletes. The dominant arm of an athlete performs many overhead motions. Unathletic volunteers just don’t have the same stresses and loads.

Researchers at the North Carolina Sports Performance Center compared the dominant arm in athletes to the athlete’s other (nondominant) arm. MRI was used to show any injuries that were present but not causing symptoms. Five years later, the researchers contacted the athletes again to see if anything ever came of their asymptomatic injuries.

The MRI findings showed that 40 percent of the athletes had a torn rotator cuff in the dominant arm. The other arm was injury-free for all subjects. Another 25 percent had a different injury called Bennett’s lesion, which is a tear in the cartilage. Despite these injuries, no one had any loss of motion or strength. None of the other tests were positive for tendon or cartilage tears.

And five years later, no one had any symptoms or shoulder problems. This left the researchers wondering if the abnormal MRI signals are a sign of a developing problem or just a false positive test. (False positive means the test shows something’s wrong when there isn’t really anything there.)

The authors drew the following conclusions:

Iontophoresis is a treatment used by physical therapists for various conditions. An electric current pushes ions through the skin and into the tissues underneath. One use of iontophoresis is for calcium deposits in the tendons around the shoulder. This condition is called calcific tendonitis.

Pain and loss of motion are the main symptoms of calcific tendonitis. Sometimes the calcium deposits go away without treatment. When they don’t, patients often seek help. The usual treatment is with anti-inflammatory drugs. The drugs are taken by mouth or injected into the painful area. Other treatment includes physical therapy and, less often, surgery.

Doctors and physical therapists in Canada did a study on using iontophoresis to treat calcific tendonitis. They divided patients with this condition into two groups. One group had iontophoresis and physical therapy exercises for the shoulder. The second group had a placebo iontophoresis and the same exercises. Placebo means that the patients thought they were getting iontophoresis, but they really weren’t.

The researchers report no difference in results between the two groups. Both got better. They also note that there’s no way to know if the ion transfer really occurs across the skin into the tendons. Animal and human studies of this treatment haven’t been able to show that it really happens.

The authors point out that many patients get better on their own without treatment. There’s no way to know if those who improved would have gotten better without treatment anyway. They conclude the improvement in both groups was likely the result of physical therapy treatments, not the iontophoresis.

You don’t realize how often you raise your arms overhead during everyday activities until you can’t do it anymore. Pain and loss of function are no strangers to people with arthritis. One place this arthritis occurs is the acromioclavicular (AC) joint.

The AC joint is located at the end of the collarbone (clavicle) in front of the shoulder. The AC joint is formed by the clavicle and acromion. The acromion is a piece of bone that starts in the back as part of the shoulder blade and curves to form a bony roof over the shoulder.

When the arm is raised overhead, the top (head) of the humerus bone in the arm slides and glides in the socket to allow smooth motion. The humeral head normally drops down as the arm is raised up to avoid hitting the acromion. Changes from arthritis, pain, and muscle weakness may keep the humerus from dropping. If the head of the humerus doesn’t drop down in the socket, the bone comes up against the acromion, pinching the tissues in between. This condition is called subacromial impingement.

In this study, patients with both AC arthritis and subacromial impingement had surgery to repair the problem. The doctor removed about one-quarter of an inch (1 cm) from the clavicle at the AC joint. A special tool was used to burr away the bone from the front on the underside. This approach avoids damage to the nearby cartilage and soft tissues. The authors think this is the key to good results.

Patients in this study did have good results. They had pain relief and increased motion and function. They also reported improved work function that lasted for years after the operation. Patients who were involved in sports said that their athletic performance was improved, too.

The authors conclude that patients who are held back by a combination of AC arthritis and subacromial impingement can get help. Resecting the end of the clavicle takes the pressure off the AC joint to help avoid the pain of impingement.

Joint replacements may be for the young at heart, but they usually are done in the over-65 crowd. They aren’t usually given to the young in age. Joint implants have a limited life span and wear out. Saving them for older adults who are less active and put lower physical demands on their joints is the standard.

The shoulder joint may be a bit different. It doesn’t take the daily pounding and weight-bearing that a hip or knee gets. It’s easier to shield the shoulder from the physical stress of daily activities. But how well do shoulder joint replacements hold up in younger adults?

Researchers at the University of Florida followed 22 patients who had a shoulder replacement. All were younger than 50 at the time of the surgery. Some had rheumatoid arthritis (RA); others had joint damage from trauma or loss of blood supply. A lack of blood to the shoulder is called avascular necrosis. Several had joint damage from hemophilia, a bleeding disorder.

The researchers used telephone interviews and written surveys along with X-rays to follow the results. Patients were tracked for an average of five years. Questions were used to measure difficulty with activities in extremes of motion. For example, patients were asked, “Can you reach into your back pocket?” or “Can you use your arm overhead?”

The best shoulder function was seen in patients with hemophilia who had a partial joint replacement (hemi-arthroplasty). The next highest group had hemi-arthroplasty for trauma or avascular necrosis. These two groups had similar results.

Patients with the lowest score for function were seen in patients with RA. But patients with RA who got a total joint replacement did better than those with RA who had a hemi-arthroplasty.

The authors of this study think shoulder joint replacement is a good treatment option in younger patients. Compared with joint fusion or removing part of the joint, getting a new joint is worth thinking about, even for the young.