Purpose: This study was undertaken to evaluate the efficacy of a proximal humeral locking plate, and to specifically study the effect of patient age and fracture type on the outcome. Materials and Methods: Thirty-one cases of proximal humeral fractures fixed by using the proximal humeral interlocking (PHILOS) plate were reviewed. Results: Average functional scores (minimum 18 months post operation) per AO / ASIF fracture type were 25.3 for type A, 21.4 for type B, and 22.7 for type C. There was no statistically significant difference between the groups. The functional scores for patients over 65 years of age were significantly inferior (P = 0.03). At a final radiological review (mean 12 months post operation), 30 (96%) of the patients demonstrated fracture union. Seven patients (22.5%) required a second surgical procedure. Conclusion: We obtained both good functional results and bone healing with the PHILOS plate, irrespective of fracture type; the older patients had a poorer outcome. We caution the surgeons on the high potential for reoperations with its use.

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Background: The short head of biceps brachii has been the subject of little investigation when compared to the long head or distal biceps tendons. The aim of this study was to dissect and describe the origin and proximal portion of the short head of biceps brachii. Materials and Methods: Three left and two right (n = 5) fresh-frozen human cadaver shoulders were dissected and the proximal short head was measured and photographed. Results: The origin of the short head of biceps consisted of muscle fibres attaching directly to the tip of the coracoid process, with a thin, tendinous aponeurosis covering its anterior surface, rather than a true tendon as previously described. Conclusion: The short head of biceps does not attach to the coracoid process via a true tendon. These findings have implications for procedures that utilise the short head of biceps. Level of Evidence: Basic science study.

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Background: Rotator cuff problems are frequently seen by orthopedic surgeons and accurate diagnosis is essential for appropriate management. Value of the clinical assessment of a shoulder is often limited, therefore, imaging studies have important implications in the management of rotator cuff pathologies. Aim: The purpose of this retrospective study is to compare the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for detection of full-thickness rotator cuff tears. Materials and Methods: We reviewed 91 consecutive cases of shoulder arthroscopy and open rotator cuff repair, who had undergone preoperative investigation in the form of either an ultrasound or MRI. Thirty-six patients had an ultrasound and 55 had an MRI for their affected shoulders. We compared the accuracy of US and MRI for detection of full-thickness rotator cuff tears, using the operative findings as the 'gold standard'. Data regarding a supraspinatus tear was assessed for the purpose of this study. Results: Ultrasonography correctly diagnosed 15 out of 17 tears (sensitivity of 0.88). There were 17 true-negative and two false-positive ultrasounds (specificity of 0.89). MRI accurately identified 33 of the 36 tears (sensitivity of 0.91). There were 16 true-negative and three false-positive tears on MRI (specificity of 0.84). The positive predictive value (PPV) was 88% for US and 92% for MRI. The negative predictive value (NPV) was 89% for US and 84% for MRI. The overall accuracy of the ultrasound was 88.89% (95% confidence interval (CI) = 74.09 to 96.18) as compared to 89.09% (95% CI = 77.82% to 95.26%) for the MRI. Conclusion: Full-thickness rotator cuff tears can be identified using ultrasound and MRI with comparable accuracy. US being a dynamic study and better tolerated by the patient, can therefore be used as the first-line investigation for rotator cuff tear, where appropriate skills are available to reduce the waiting time and cost of investigation.

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Background: The hourglass biceps, an intra-articular entrapment of the long head of the biceps (LHB), is a possible diagnosis in cases of shoulder pain associated with loss of passive elevation. Purpose: The objective of this study is to investigate the role of dynamic ultrasound (U/S) in determining the diagnosis of the hourglass biceps lesion. Materials and Methods: A prospective cohort of 16 patients with the clinical suspicion of an hourglass lesion, a preoperative ultrasound, and a confirmed hourglass LHB at surgery, were included in the study. Eight patients had preoperative dynamic ultrasound assessment of the LHB, and eight had standard ultrasound investigations and served as a control group. Results: Dynamic ultrasound accurately diagnosed an hourglass biceps in three out of eight cases. LHB hypertrophy was demonstrated in five out of eight cases with U/S and three out of eight cases with standard U/S. All patients were treated by excision of the intra-articular portion of the LHB, 15 by bipolar tenotomy, and one by LHB tenodesis. Conclusions: Dynamic ultrasound shows promise in improving the accuracy in diagnosis of LHB hypertrophy and the Hourglass lesion. Level of Evidence : III (Consecutive case-control study investigating a diagnostic test).

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Background: Assessment of shoulder function is an essential part of clinical practice. Current scoring relies on multiple subjective and / or objective components. We present a single angular measurement, the coronal plane angle, which relates to the functional assessment of the shoulder. Materials and Methods: One hundred patients were prospectively enrolled and assessed using the Constant-Murley score and the Oxford shoulder questionnaire, and the coronal plane angle was measured for both symptomatic and asymptomatic shoulder. Results: Nine patients were excluded from the study: Four had apprehension and five were not able to get their hand to head. The mean coronal plane angle on the symptomatic side was +11.3 ^o and the asymptomatic side -1.5 ^o (P ≤ 0.01). Pearson's correlation of 0.9 and 0.84 was demonstrated for the Constant-Murley and Oxford shoulder scores, respectively, with the coronal plane angle. Conclusion: The coronal plane angle is a single objective assessment and provides a simple alternative to shoulder assessment for the majority of patients.

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