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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.

This study aimed to determine the effectiveness of electromyography (EMG) biofeedback training on scapular kinematics and/or muscle activation in patients with scapular dyskinesis (SD) associated with subacromial impingement syndrome (SIS). An electronic search was conducted in the Medline, Embase, Scopus, Web of Science, CINAHL, SPORTDiscus, LILACS, CENTRAL, and PEDro databases. Eligibility criteria comprised randomized clinical trials investigating the effects of adding EMG biofeedback training to scapular-focused exercises on scapular kinematics and/or muscle activation in patients with SD associated with SIS. Data were pooled using a Hartung-Knapp-Sidik-Jonkman random-effects method or Mantel-Haenszel fixed-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Four trials met the eligibility criteria. The mean difference (MD) for upward rotation was 1.13&#xb0; (P=0.07), and that for downward rotation was 1.2&#xb0; (P=0.08). The MDs for muscle activation of the lower trapezius during scapular plane elevation and descending movements were 7.22% (P=0.010) and 2.26% (P<0.001), respectively. The MDs for the muscle balance ratios of the upper/lower trapezius and upper trapezius/serratus anterior were 0.11% (P=0.95) and 0.15% (P=0.04), respectively. All differences favored the EMG biofeedback plus scapular-focused exercises group. In the short-term, adding EMG biofeedback training to scapular-focused exercises resulted in significant differences only in lower trapezius activity. Conversely, the results were inconclusive regarding improvements in scapular kinematics and changes in the activation of other scapular muscles. The quality of evidence ranged from very low to high according to GRADE rating, suggesting that the effect of EMG biofeedback might not be captured in this study. Level of evidence: I.

Fixation of clavicular shaft fractures carries risks of nonunion, infection, and functional loss. Although superior and anteroinferior plating have widely been studied, the optimal approach remains debated. Previous literature has relied on indirect comparisons and been limited by early study cutoffs, high heterogeneity, and omission of key outcomes. This meta-analysis directly compared union, function, and complications between superior and anteroinferior plating. This review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Eligible studies included randomized trials or prospective/retrospective cohort studies of adults. Outcomes of interest included the Disabilities of the Arm, Shoulder, and Hand (DASH) score; Constant-Murley score; and complications (plate removal, infection, nonunion). Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions or Cochrane Risk of Bias 2.0 tool, and certainty of evidence was determined with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Analyses were performed in Review Manager 5.4 (Cochrane). Twelve studies (n=980) were included. Constant-Murley scores did not differ significantly (mean difference [MD]=-1.19; 95% CI, -3.18 to 0.81; P=0.24). Beginning at 2 years, DASH scores showed no difference (MD=1.62; 95% CI, -0.46 to 3.70; P=0.13). Times-tounion (MD=0.41; 95% CI, -0.60 to 1.43; P=0.42) and rates of nonunion (odds ratio [OR]=2.42; 95% CI, 0.59-9.94; P=0.22) were comparable. Plate removal (OR=1.16; 95% CI, 0.82-1.65; P=0.41) and infection (OR=0.81; 95% CI, 0.32-2.06; P=0.66) also showed no significant differences. Heterogeneity was minimal (I2=0). Superior and anteroinferior plating of midshaft clavicle fractures provide comparable union rates, functional outcomes, and complication rates. Selection of the surgical approach should depend on fracture morphology, surgeon preference, and patient-specific factors. Level of evidence: III.

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. 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. 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. 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.

Existing research on the influence of symptom duration on the outcomes of ultrasound-guided shoulder hydrodilatation for frozen shoulder remains limited. This prospective analytical study aims to investigate the associations between symptom duration and other potential factors and shoulder function following ultrasound-guided shoulder hydrodilatation. This study was conducted at the Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, and involved patients with frozen shoulder who underwent ultrasound-guided shoulder hydrodilatation. Using convenience sampling, 72 participants were recruited, and 36 were classified into the early hydrodilatation group and 36 into the late hydrodilatation group. Outcome measures were the Oxford Shoulder Score (OSS), visual analog scale (VAS), and shoulder range of motion (ROM), which were assessed both before and 6 weeks after the hydrodilatation procedure. Duration of symptoms, age, sex, history of diabetes mellitus, physiotherapy, and baseline shoulder ROM did not exhibit any association with OSS changes. However, a high VAS score at baseline was associated significantly with improved shoulder function following ultrasound- guided shoulder hydrodilatation (P=0.006). There was no association between the duration of symptoms and enhanced shoulder function after ultrasound-guided shoulder hydrodilatation in short-term assessments. Patients with higher baseline shoulder pain severity tended to experience greater improvements in shoulder function compared to those with milder pain levels. Level of evidence: III.

Elbow dysfunction can impair daily activities and reduce health-related quality of life (HRQoL). This study used the EuroQol five dimensions instrument (EQ-5D) alongside functional scores and treatment priorities to assess HRQoL in patients awaiting elective elbow surgery. In this prospective study, patients scheduled for elbow surgery from December 2024 onward were enrolled and categorized as having osteoarthritis, stiffness, or instability. HRQoL was measured using the EQ-5D. Multivariable regression was performed with EQ-5D as the dependent variable and waiting time, age, sex, and diagnosis as predictors. Functional outcomes were assessed with the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (qDASH). Patients also indicated whether they prioritized pain relief or improved mobility. Overall, 102 patients were included. The mean waiting time was 204&#xb1;115 days, and the overall EQ-5D index was 0.67&#xb1;0.06. Patients with osteoarthritis had the lowest EQ-5D index (0.60&#xb1;0.29), highest pain levels (2.32&#xb1;0.48), and greatest depression scores (1.97&#xb1;0.75). They also showed the lowest MEPS and highest qDASH, with MEPS significantly lower than in patients with instability (P=0.016). The multivariable regression suggested non-significant trends toward lower EQ-5D with longer waiting times (&#x3b2;=-0.0001, P=0.663) and older age (&#x3b2;=0.002, P=0.306). Osteoarthritis patients prioritized pain relief (P=0.026), and stiffness patients prioritized mobility (P=0.021). Although longer waiting times and older age showed non-significant trends toward lower HRQoL, osteoarthritis patients were most affected, with the lowest EQ-5D (0.60) and significantly worse MEPS (P=0.016) than in the other groups. Future studies should test whether preoperative pain or psychological support can mitigate HRQoL decline. Level of evidence: II.

Concomitant repair of the subscapularis (SSC) tendon in reverse total shoulder arthroplasty (RTSA) with a lateralized design remains controversial. The present study aimed to evaluate the effect of SSC repair (repair at native insertion, repair at superiorly migrated position, and no repair) on the glenohumeral arc of motion following RTSA in a cadaveric biomechanical setting. RTSA was performed on eight cadaveric shoulders under six testing conditions as follows: unrepaired SSC/intact teres minor (TM); intact SSC/intact TM; superiorly repaired SSC/intact TM; unrepaired SSC/deficient TM; intact SSC/deficient TM; and superiorly repaired SSC/deficient TM. Increasing load (2.5-N increments) was applied to the middle deltoid (anterior, posterior; 10 N each, middle; 10- 20 N). The resulting abduction and rotation positions were measured. Unrepaired SSC demonstrated greater abduction and reduced internal rotation (IR), whereas SSC repair increased IR, particularly in TM-deficient models. Superiorly repaired SSC had higher glenohumeral abduction and IR than original SSC repair. SSC repair caused excessive IR in the TM deficiency seen with massive rotator cuff tears. Concomitant SSC repair in lateralized RTSA decreased glenohumeral abduction and increased IR. Concomitant SSC repair at the original and superiorly migrated footprints should be carefully considered following lateralized RTSA. Level of evidence: V.

Isolated infraspinatus tears are rare and traditional arthroscopic repairs often result in unsatisfactory outcomes. This study evaluates the clinical and radiological outcomes of arthroscopically-assisted lower trapezius tendon (aLTT) transfer in patients with isolated irreparable infraspinatus tears. This single-center retrospective study reviewed patients who underwent aLTT transfer for irreparable infraspinatus tears with no advanced glenohumeral arthritis. Clinical assessment included visual analog scale (VAS), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Single Assessment Numeric Evaluation (SANE). Shoulder range of motion was also evaluated. Radiographic evaluation included postoperative magnetic resonance imaging used to evaluate tendon integrity at final follow-up. Two patients were excluded due to loss to follow-up or incomplete data. Six patients were included, with a mean age of 60.7&#xb1;4.1 years and a mean follow-up duration of 36.7&#xb1;19.8 months (range, 24-75 months). At the final follow-up, VAS pain scores had improved from 6.0&#xb1;1.4 to 1.7&#xb1;0.8 (P<0.05). Functional scores had also improved: Constant score, from 51.5&#xb1;5.6 to 72.0&#xb1;6.4; ASES, from 60.5&#xb1;4.5 to 82.0&#xb1;6.3; and SANE, from 48.0&#xb1;6.7 to 79.1&#xb1;8.0 (P<0.05). Range of motion (ROM) improved in forward elevation (115&#xb0;&#xb1;12&#xb0; to 170&#xb0;&#xb1;9&#xb0;), abduction (95&#xb0;&#xb1;15&#xb0; to 143&#xb0;&#xb1;16&#xb0;), and external rotation at side (22&#xb0;&#xb1;11&#xb0; to 51&#xb0;&#xb1;11&#xb0;) (P<0.05). No progression of glenohumeral arthritis or tendon retears were seen on final follow-up. aLTT transfer significantly reduces pain, improves shoulder function, and restores ROM in patients with isolated irreparable infraspinatus tears. These findings suggest that aLTT transfer is an effective treatment option for this challenging condition. Level of evidence: IV.

Distal humerus fractures (DHFs) are challenging orthopedic injuries requiring tailored management. Surgical options primarily include open reduction and internal fixation (ORIF) and total elbow arthroplasty (TEA) for non-reconstructable fractures. While clinical considerations typically guide treatment, recent studies have shown better surgical incentives for arthroplasty compared to ORIF. This study aims to investigate compensation differences across treatment options for DHFs and to evaluate the potential association of financial incentives with clinical decisions in orthopedic surgical care. A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database was conducted for DHF cases from 2006 to 2022. Patients undergoing ORIF or TEA were matched 1:1 using propensity score matching, controlling for demographics and comorbidities. Work relative value units (wRVUs), operative times, Medicare reimbursement rates, and 30- day postoperative complications were compared. Among the 506 matched patients (253 ORIF, 253 TEA), mean operative time was similar (P=0.903), while TEA procedures had significantly higher wRVUs per minute (0.15&#xb1;0.06 vs. 0.11&#xb1;0.05, P<0.001) and revenue per case ($684.05&#xb1;$89.73 vs. $469.48&#xb1;$36.04, P<0.001). No significant differences in 30-day postoperative complication rates, including bleeding requiring transfusion, surgical site infections, or major complications, were observed. This study demonstrates that ORIF generates lower surgeon reimbursement than TEA for DHFs despite similar short-term outcomes, suggesting that financial incentives do not favor TEA when surgically indicated. These findings underscore the need to evaluate RVU assignment to procedures, aligning physician incentives with patient care priorities. Level of evidence: IV.

Acromioclavicular (AC) joint (ACJ) dislocation can lead to superior clavicular instability when the AC and coracoclavicular (CC) ligaments are torn. No previous study has assessed the effects of combined AC-CC ligament resections in fresh-frozen cadavers with preserved soft tissues around the thorax and shoulder girdle. This study aimed to develop such an ACJ dislocation model and evaluate stability following ligament resections. Nine fresh-frozen cadaver shoulders (mean age, 86.6 years) without clavicular fractures or ACJ osteoarthritis were used. Each specimen included the thoracic spine, scapula, clavicle, and shoulder. Biomechanical testing was performed with a customized system to assess displacement and evaluate superior and posterior stability. Three conditions were compared: intact ligaments, AC ligament resection, and AC-CC ligament resection. Superior translations were 0.0 mm (intact), 1.1 mm (AC resection), and 9.6 mm (AC-CC resection). Posterior translations were 0.0 mm, 3.2 mm, and 9.0 mm, respectively. The AC-CC resection group showed significantly increased translations compared to the intact and AC resection groups. No significant difference was observed between the intact and AC resection groups in superior translation. Posterior translation increased progressively from intact to AC and then AC-CC resection. This is the first study to assess both superior and posterior ACJ stability using cadavers with preserved soft tissues. Our findings demonstrate the importance of the AC and CC ligaments in maintaining ACJ stability. Notably, the AC ligament contributes to posterior stability, indicating the need for reconstruction to achieve overall joint stability. Level of evidence: Controlled laboratory study.

Total elbow arthroplasty (TEA) is increasingly performed for complex elbow pathology, yet revision procedures remain challenging due to high complication rates and limited bone stalk. While TEA may produce satisfactory functional outcomes for select patients, it is often burdened by high complication rates, necessitating revision TEA, often with extensive bone loss. Among available reconstructive strategies, allograft-prosthesis composite (APC) reconstruction has emerged as a possible technique; however, reported outcomes remain heterogeneous. This systematic review aims to characterize the use and outcomes of APC reconstruction in revision TEA for patients with significant bone loss. We searched the PubMed/Medline, Embase, Web of Science, and Cochrane databases to identify clinical studies of revision TEA performed with an APC published between inception of each database and 2023. Outcomes of interest were patient-reported outcome measures (PROMs), range of motion (ROM), radiographic outcomes, and complications. We included five studies that reported on 85 elbows with APC TEA revisions for extensive bone loss. PROMs and ROM were reported for 70 elbows, yielding a mean postoperative Mayo Elbow Performance Score of 64 points and an active elbow arc of 24&#xb0;-120&#xb0;. The complication rate across 85 elbows was 38.8% (33 elbows). The graft-host junction non-union rates of humeral and ulnar allografts were 40% (20 elbows) and 16% (5 elbows), respectively. APC provides a salvage option in revision TEA with severe bone loss but is associated with high complication and non-union rates.

Acromioplasty is frequently performed during arthroscopic rotator cuff repair (ARCR) to address subacromial impingement, though its clinical value remains debated. This meta-analysis examines whether acromioplasty improves functional outcomes, pain relief, or re-tear rates in patients undergoing ARCR for full-thickness rotator cuff tears. A systematic search of PubMed, Embase, Cochrane Library, and Scopus was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify randomized controlled trials (RCTs) from 2011 to 2023. Six RCTs comparing ARCR with and without acromioplasty were included. Primary outcomes included functional scores of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff Index, University of California, Los Angeles scores, pain levels (visual analog scale [VAS]), and re-tear rates. Data were pooled using a random-effects model. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Across 574 patients, both groups demonstrated improvement in functional outcomes. The acromioplasty group showed a modest advantage (e.g., ASES score: mean difference, 2.93), but these gains did not exceed the minimal clinically important difference. There were no significant differences in pain relief (as measured by VAS) or re-tear rates between groups. The risk of bias was moderate in some trials due to a lack of blinding. GRADE assessment rated evidence as high for ASES scores and moderate for other outcomes. Acromioplasty offers statistically modest improvements in shoulder function but does not meaningfully enhance pain relief or reduce re-tear rates. Given these findings, the routine use of acromioplasty in ARCR is not supported; however, select patients may benefit based on individual anatomical or clinical factors. Level of evidence: I.

Patients with cardiac implantable electronic devices (CIEDs) increasingly present for elective orthopedic procedures. In this study we evaluate peri-operative complications associated with CIED presence using a large multicenter database. Retrospective cohort analysis was performed using the TriNetX database. Adults undergoing primary total shoulder arthroplasty (TSA) between 2005 and 2025 were identified and stratified by CIED status. Four propensity score-matched (1:1) analyses were conducted: all TSA patients with versus without CIEDs, (2) patients with cardiac disease with CIED versus without CIEDs, and patients with recent device implantation (<6 months before TSA) versus patients with remote device implantation (>6 months before TSA). Matching balanced demographic factors and comorbidities. Outcomes included 90-day and 2-year complications. Relative risks, 95% CIs, and P-values were calculated using chi-square and t-tests; significance was set at P<0.05. After matching, 6,931 patients were included per cohort. CIED presence was associated with significantly higher 90-day rates of cardiac, renal, infectious, and neurologic complications, as well as increased mortality, readmissions, and emergency department visits. These associations persisted after controlling for underlying cardiac disease. Patients undergoing TSA within 6 months of device implantation experienced higher rates of complications. Revision rates were not significantly different between groups, and mechanical outcome associations were variable. CIED presence was associated with increased systemic complications following TSA, particularly when surgery occurred within 6 months of device implantation. Mechanical outcome differences were less consistent. These findings indicate the necessity of multidisciplinary perioperative planning, thoughtful surgical timing, and prospective studies to better define underlying risk pathways. Level of evidence: III.

This prospective randomized study aimed to compare the clinical effectiveness of ultrasound-guided dry needling and platelet-rich plasma injections in patients with refractory lateral epicondyle tendinopathy. Fifty patients (25 in each group) diagnosed with refractory lateral epicondyle tendinopathy were randomized to receive either ultrasound-guided dry needling or platelet-rich plasma injection. Patients were evaluated before treatment and at 1, 3, and 6 months after the intervention using the visual analog scale, the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, the Patient-Rated Tennis Elbow Evaluation, and grip strength measurements. All procedures were performed under continuous ultrasound guidance. Both groups showed significant improvements in pain, function, and grip strength over time. There were no significant differences in grip strength between the groups at any time point. However, patients treated with platelet-rich plasma showed superior outcomes in pain and functional scores, particularly at the 6-month follow-up. No complications were observed in any of the patients. Both ultrasound-guided dry needling and platelet-rich plasma injections are effective options for refractory lateral epicondyle tendinopathy. Platelet-rich plasma may offer greater clinical benefit, particularly in pain reduction and functional improvement. Further research with larger cohorts is required to establish optimal treatment protocols. I.

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. 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). 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&#xb0;; 95% CI, 0.54&#xb0;-2.66&#xb0;; 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). 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. IV.

A variety of agents are used during rotator cuff repair (RCR) to establish biophysical barriers against adhesion formation, including sodium hyaluronate and poloxamer. The aim of this study was to determine the role played by injection location and analyze the effects on shoulder function after cuff repair. We retrospectively reviewed data from 187 consecutive patients with rotator cuff tears who were treated with a thermosensitive medical chitosan-based anti-adhesive agent. The 45 patients in the glenohumeral joint (GH) group were matched 1:1 with patients in the subacromial space (SA) group based on propensity scores. Clinical outcomes and range of motion (ROM) were evaluated using a visual analog scale (VAS) score for pain and functional assessments conducted preoperatively, 6 months postoperatively, and at the final follow-up (minimum 12 months). After excluding patients without 1 year of postoperative follow-up, 28 patients in each group were chosen for this study. The preoperative VAS score for pain, functional scores, and ROM did not differ significantly between the groups. At the final visit, the VAS score for pain was statistically significantly lower in the SA group (1.04&#xb1;0.69 for GH group vs. 0.78&#xb1;1.21 for SA group, P=0.038), but the difference did not meet the criteria for the minimal clinically important difference (MCID). Furthermore, none of the functional scores or ROMs differed significantly between the groups at the final visit. There were two retears in the GH group (7.1%) and three retears in the SA group (10.7%). Neither ROM nor the retear rate differed between glenohumeral and subacromial injection of a thermosensitive medical chitosan-based anti-adhesive agent after RCR. Although the SA group had a slightly lower VAS score for pain at the last follow-up, the difference did not reach the MCID criteria. Overall, the injection site did not appear to alter postoperative ROM recovery. III.

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. 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. 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). 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. II.

AIM: Despite the lateral epicondylitis or tennis elbow is a common cause of pain in orthopaedic and sports medicine, the results of the different modalities of conservative treatment are still contradictory. The pourpose of this study was to evaluate the efficacy of radial shock wave therapy (RSWT) in the treatment of tennis elbow. METHODS: In a prospective randomized controlled single-blind study, of 75 eligible patients, 62 with tennis elbow were randomly assigned to study group and control group. There were 31 patients in the study group and 31 patients in the control group. Both groups had received a treatment a week for 4 weeks; the study group had received 2000 impulses of RSWT and the control group 20 impulses of RSWT. All patients were evaluated 3 times: before treatment, at the end of treatment and to 6 months follow-up. The evaluation consisted of assessments of pain, pain-free grip strength test, and functional impairment. RESULTS: Statistical analysis of visual analogue scale (VAS), disabilities of the arm, shoulder, and hand (DASH) questionnaire and pain-free grip strength test scores has shown, both after treatment and to the follow-up at 6 months, significant difference comparing study group versus control group (P <0.001). Statistical analysis within the groups, showed always statistically significant values for the study group. Also the control group showed statistically significant differences for some analyzed parameters. Nevertheless such differences resulted to be more statistics that not clinics as it showed the percentage of satisfied patients in the study group (87% post-treatment; 84% follow-up) in comparison with that of the control group (10% post-treatment; 3% follow-up), and the number needed to treat (NNT) that is of 1.15 at post-treatment and of 1.25 to the 6 months follow-up. CONCLUSION: The use of RSWT allowed a decrease of pain, and functional impairment, and an increase of the pain-free grip strength test, in patients with tennis elbow. The RSWT is safe and effective and must be considered as possible therapy for the treatment of patients with tennis elbow.

Avascular necrosis (AVN) of the humeral head can progress to joint collapse and marked functional limitation, often requiring surgical treatment. Total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) are the main surgical treatment options, but their comparative clinical value remains a topic of debate. In particular, uncertainty persists regarding how functional benefit, complication risk, and implant durability should be balanced in contemporary practice. In this meta-analysis, we compared functional outcomes, complication rates, and revision risk between TSA and HA in patients with humeral head AVN. We performed a systematic search of PubMed, Scopus, Cochrane Library, Embase, and Google Scholar from database inception through November 2025. Nine comparative studies were included. Pooled mean difference (MD) and risk ratio (RR) were calculated using fixed- or random-effects models. HA was associated with significantly higher patient-reported function as measured by American Shoulder and Elbow Surgeons (ASES) scores compared with TSA (MD, 17.12; P<0.00001), whereas TSA resulted in greater external rotation (MD, -10.23&#xb0;; P=0.02). HA was also associated with a significantly lower overall complication rate compared with TSA (RR, 0.33; P<0.0001). Reported complications included suture abscess, periprosthetic fracture, rotator cuff pathology, postoperative stiffness, and dislocation. Visual analog scale pain score, Simple Shoulder Test score, internal rotation, and revision rates did not differ significantly between procedures (all P>0.05). In humeral head AVN, HA yields higher ASES scores and fewer complications, whereas TSA results in greater external rotation. Pain and revision rates are comparable, supporting the choice of individualized procedure selection based on glenoid status and patient goals. III.