JAAOS, Volume 17, No. 8

Glenoid bone deficiency in recurrent anterior shoulder instability: diagnosis and management.

Recurrent anterior shoulder instability may result from a spectrum of overlapping, often coexistent factors, one of which is glenoid bone loss. Untreated, glenoid bone loss may lead to recurrent instability and poor patient satisfaction. Recent studies suggest that the glenoid rim is altered in up to 90% of shoulders with recurrent instability, thus underscoring the need for careful diagnosis, quantification, and preoperative evaluation. Biomechanical and clinical studies offer criteria that may be used in both primary and revision settings to judge whether shoulder stability is compromised by a bony defect. Along with patient activity level, these criteria can help guide the surgeon in selecting treatment options, which range from nonsurgical care to isolated soft-tissue repair as well as various means of bony reconstitution.

    • Keywords:
    • Biomechanics|Bone Resorption|Humans|Joint Instability|Orthopedic Procedures|Recurrence|Reoperation|Shoulder Joint

    • Subspecialty:
    • Shoulder and Elbow

Pseudarthrosis of the spine.

Pseudarthrosis is the result of failed attempted spinal fusion. This condition typically manifests with axial or radicular pain months to years after the index operation. Diagnosis is based on clinical presentation and imaging studies, after other causes of persistent pain are ruled out. The degree of motion seen on flexion-extension radiographs that is indicative of solid or failed fusion remains a point of controversy. Thin-cut CT scans may be more reliable than radiographs in demonstrating fusion. Metabolic factors, patient factors, use and choice of instrumentation, fusion material, and surgical technique have all been shown to influence the rate of successful fusion. Treatment of the patient with symptomatic pseudarthrosis involves a second attempt at fusion and may require an approach different from that of the index surgery as well as the use of additional instrumentation, bone graft, and osteobiologic agents.

    • Keywords:
    • Bone Transplantation|Humans|Orthopedic Procedures|Pseudarthrosis|Reoperation|Risk Factors|Spinal Fusion|Tomography

    • X-Ray Computed

    • Subspecialty:
    • Pain Management

    • Spine

Exercise and pregnancy.

Exercise is an important component of a healthy lifestyle and, as such, is recommended during pregnancy. However, the response to exercise of both the expectant mother and fetus varies depending on the fitness level of the woman. The response to exercise is also affected by the known musculoskeletal and physiologic changes associated with pregnancy, such as increased ligament laxity, weight gain, change in the center of gravity, and carpal tunnel syndrome. Although the physiologic responses of the pregnant woman and fetus have been well studied, the literature contains comparatively few studies investigating response to exercise. When performed properly, activities such as aerobics, impact and nonimpact activities, resistance training, and swimming may be beneficial during pregnancy.

    • Keywords:
    • Breast Feeding|Diabetes

    • Gestational|Exercise|Exercise Tolerance|Female|Humans|Pre-Eclampsia|Pregnancy

    • Subspecialty:
    • General Orthopaedics

    • Sports Medicine


Osteosarcoma, the most common bone sarcoma, affects approximately 560 children and adolescents annually in the United States. The incidence of new diagnoses peaks in the second decade of life. Twenty percent of patients present with clinically detectable metastases, with micrometastases presumed to be present in many of the remaining patients. Treatment typically includes preoperative chemotherapy, surgical resection, and postoperative chemotherapy. Limb-salvage procedures with wide surgical margins are the mainstay of surgical intervention. Advances in chemotherapy protocols have led to a 5-year survival rate of 60% to 78%. Among the goals of future treatment regimens are improved chemotherapeutic agents with higher specificity and lower toxicity.

    • Keywords:
    • Adolescent|Bone Neoplasms|Child|Combined Modality Therapy|Drug Therapy|Humans|Neoplasm Staging|Orthopedic Procedures|Osteosarcoma|Survival Rate

    • Subspecialty:
    • Musculoskeletal Oncology

    • Pediatric Orthopaedics

Stress radiographs in orthopaedic surgery.

Stress radiographs are useful in determining the amount of ligamentous laxity present following trauma. The results may be helpful in determining diagnosis, surgical indications, and the type and timing of rehabilitation. Some techniques for obtaining stress radiographs involve specific patient positioning or manually applied force; others require use of a particular testing device. Stress radiographs may be obtained for a variety of anatomic areas and joints. The parameters that define abnormality on stress radiographs should be compared with those of clinical findings. The use of common and novel methods to obtain stress radiographs has led to improved identification and diagnosis of many orthopaedic pathologies. Some of these techniques have been developed with the aim of reducing patient discomfort or minimizing the clinician's exposure to radiation.

    • Keywords:
    • Arthrography|Humans|Joint Instability|Joints|Ligaments|Orthopedic Procedures|Wounds and Injuries

    • Subspecialty:
    • Trauma