Neurogenic thoracic outlet syndrome (NTOS) is an oft-overlooked and obscure cause of shoulder pain, which regularly presents to the office of shoulder surgeons and pain specialist. With this paper we present an otherwise healthy young female patient with typical NTOS. She first received repeated conservative treatments with 60 units of botulinium toxin injected into the anterior scalene muscle at three-month intervals, which providing excellent results of symptom-free periods. Later a trans-axillary first rib resection provided semi-permanent relief. The patient was followed for 10 years after which time the symptoms reappeared. We review the literature and elaborate on the anatomy, sonoanatomy, etiology and characteristics, symptoms, diagnostic criteria and treatment modalities of NTOS. Patients with NTOS often get operated upon - even if just a diagnostic arthroscopy, and an interscalene or other brachial plexus block may be performed. This might put the patient in jeopardy of permanent nerve injury, and the purpose of this review is to minimize or prevent this.

Purpose: Traumatic anterior dislocation of the shoulder is a common occurrence increasingly being treated arthroscopically. This study aims to determine the outcome of arthroscopic anterior stabilization using bioknotless anchors and analyze the motion in a subset of these patients. Materials and Methods: The outcome of 20 patients who underwent arthroscopic anterior stabilization using the bioknotless system was studied (average follow-up 26 months). Four of these patients underwent motion analysis of their shoulder pre- and post-operatively. Results: 15% were dissatisfied following surgery and the recurrence of instability was also 15%. Those who were dissatisfied or suffered recurrent symptoms had statistically significant lower constant scores at the final follow up. Pre-operative motion analysis showed a disordered rhythm of shoulder rotation which was corrected following surgery with minimal loss of range of motion. Conclusions: Our success rate was comparable to similar arthroscopic techniques and results published in the literature. Patient satisfaction depended more on return to usual activities than recurrence of symptoms. There was very little reduction in range of movement following surgery and the rhythm of shoulder motion, particularly external rotation in abduction was improved. Level of Evidence: Four retrospective series.

Purpose: The most reliable clinical investigations to diagnose rotator cuff tears reported in the literature is a triad of weakness on resisted external rotation, pain on impingement, and weakness on supraspinatus testing, or a combination of two of the above in a patient over 60 years of age. We present a simple new clinical test "The lateral Jobe Test" and compare it to these combined tests. The lateral Jobe test is performed with the patient's shoulder abducted 90΀ in the coronal plane and internally rotated so that with the elbows flexed 90΀ the fingers point inferiorly and thumbs medially. A positive test is pain or weakness on resisting an inferiorly directed force applied to the distal arms or an inability to perform the test. Materials and Methods : A consecutive series of 175 patients undergoing shoulder arthroscopy were reviewed prospectively and examined by two independent orthopedic surgeons blinded to the diagnosis. The results of the clinical tests were validated against arthroscopic findings. Results : The lateral Jobe test had a significantly higher sensitivity (81 vs. 58%) than the combined tests. The specificity of both was similar at 89 and 88%, respectively. Conslusion : The lateral Jobe test is a simple single test which can help in the clinical diagnosis of rotator cuff tears. Level of Evidence : Level IIb

Separation of the acromioclavicular joint in conjunction with a coracoid fracture is a rare injury. Treatment decisions are traditionally based on the level of the fracture, the status of the coracoclavicular ligament and the activity level of the patient. We present a novel coracoid fracture pattern treated nonoperatively in a young, active patient and a thorough review of the literature regarding this topic.

Neuropraxia of the greater auricular nerve is an uncommon complication of shoulder surgery, with the patient in the beach chair position. The greater auricular nerve, a superficial branch of the cervical plexus, is vulnerable to neuropraxia due to its superficial anatomical location. In this case series, we present three cases of neuropraxia associated with direct compression by a horseshoe headrest, used in routine positioning for uncomplicated shoulder surgery. We outline the risk of using devices of this nature and discourage the use of similar headrest devices due to the potential complications in headrest devices that exert pressure on the posterior auricular area to maintain head position during surgery.