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BackgroundThis study was designed to investigate the prevalence of rotator cuff tears in a population who had never sought for symptoms from their shoulders. The aim was to see whether there is a correlation between dysfunction and the presence of cuff tears seen with ultrasonography or radiology.Materials and methodsClinical assessment with constant score, ultrasound and radiographic examination was done on 106 voluntary subjects (212 shoulders). There were 52 men and 54 women with a median age of 66 years. The correlations between complaints, cuff tears, constant score, ultrasound and radiological findings were calculated.ResultsOf 106 subjects, 64 (60%) had shoulder problems. The prevalence of full-thickness cuff tears was 30% (21% of all the 212 shoulders). 61% of the shoulders with full-thickness tears had symptoms compared to 33% of the shoulders without tears. The constant score was lower in shoulders with full-thickness tears. Partial tears or acromioclavicular degeneration had no impact on shoulder complaints or constant score. The subacromial index was lower for shoulders with full-thickness tears. Patients with primary osteoarthritis had a lower acromion index than patients with full-thickness tears.ConclusionThe prevalence of shoulder complaints and/or cuff tears was high in this population, which had never sought medical care for shoulder problems. Only full-thickness tears had an impact on shoulder function and constant score. Partial-thickness tears and degenerative changes in the acromioclavicular joint may be considered as age-related changes. The subacromial index can be used as a predictor for full-thickness cuff tears.Level of evidenceLevel III, cross-sectional study, prevalence study.

Purpose: To develop and validate a two-stage system for automated quality assessment of shoulder true-AP radiographs by combining joint localization with quality classification. Materials and Methods: From the MURA “SHOULDER” subset, 2956 anteroposterior images were identified; 59 images with negative–positive inversion, excessive metallic implants, extreme exposure, or presumed fluoroscopy were excluded, yielding a class-balanced set of 2800 images (1400 OK/1400 NG). A YOLOX-based detector localized the glenohumeral joint, and classifiers operated on both whole images and detector-centered crops. To enhance interpretability, we integrated Grad-CAM into both whole-image and local classifiers and assessed attention patterns against radiographic criteria. Results: The detector achieved AP@0.5 = 1.00 and a mean Dice similarity coefficient of 0.967. The classifier attained AUC = 0.977 (F1 = 0.943) on a held-out test set. Heat map analyses indicated anatomically focused attention consistent with expert-defined regions, and coverage metrics favored local over whole-image models. Conclusions: The two-stage, XAI-integrated approach provides accurate and interpretable assessment of shoulder true-AP image quality, aligning model attention with radiographic criteria.

Now in its Second Edition, this resident-friendly reference explains the basics of MRI...then walks readers easily through the radiologic evaluation of shoulder disorders, particularly rotator cuff disease and shoulder instability. Written in an inviting, easy-to-follow style and illustrated with more than 600 scans, this long-awaited new edition will be a favorite practical reference for residents, practicing radiologists, and orthopaedic surgeons. The book features contributions from expert radiologists and orthopaedic surgeons. Chapters review MRI techniques and shoulder anatomy, describe and illustrate MRI findings for a wide variety of conditions, and explain how abnormalities seen on MR images relate to pathophysiology and clinical signs.

Eighteen consecutive patients who had recurrent, unidirectional, post‐traumatic shoulder instability were included. All these patients underwent surgery using an open Bankart technique involving absorbable suture anchors. The median age at the index operation was 27 (16–50) years. One subluxation and two re‐dislocations occurred during the follow‐up period of 90 (80–95) months. At the 90‐month control, the Rowe and Constant scores were 94 (63–100) points and 88.5 (65–100) points, respectively. The strength measurements on the index side in 90° abduction revealed 8.1 (3.7–17.2) kg compared with 7.6 (2.7–17.6) kg on the contra lateral side (n.s.). The external rotation in abduction was 80 (60–95)° compared with 100 (70–120)° for the contra lateral side ( p = 0.0015). Signs of minor or moderate degeneration were found in five of 18 patients (28%) on the preoperative radiographs. There was a significant continuous increase in degenerative changes during the follow‐up period as seen on the seven, 33 and 90‐month radiographs ( p = 0.01, 0.03 and 0.01, respectively). On the 90‐month radiographs, 12 of 18 patients (67%) had minor, moderate or severe degenerative changes ( p = 0.0004 preoperative vs. 90 months). On the 7‐month radiographs, two of 18 patients (11%) had invisible or hardly visible drill holes in conjunction with the absorbable implants. On the 90‐month radiographs, 12 of 18 patients (67%) had invisible or hardly visible drill holes ( p = 0.003 7 months vs. 90 months). In the long term, the method resulted in stable, well‐functioning shoulders in 15 of 18 patients (83%). The stabilisation was not, however, able to prevent further increases in radiographic degenerative changes during the 7–8‐year follow‐up. The drill holes used for the absorbable suture anchors appeared to heal in the majority of patients during the follow‐up period.

Das Impingementsyndrom ist ein klinisches Krankheitsbild multifaktorieller Genese, bei dem es primär oder sekundär zu einer schmerzhaften mechanischen Beeinträchtigung der Rotatorenmanschette kommt. Als primäre Faktoren gelten ein gebogener oder hakenförmiger Vorderrand des Akromions oder von diesem entspringende Osteophyten, was zu Läsionen der Supraspinatussehne führen kann. Zu den sekundären Faktoren zählt man v. a. eine Tendinitis calcarea, eine glenohumerale Instabilität, ein Os acromiale sowie degenerative Veränderungen im Bereich des Akromioklavikulargelenks. Bildgebend steht an erster Stelle ein Nativröntgen, mit dem sich die knöchernen Strukturen gut darstellen lassen. Falls vorhanden, kann in weiterer Folge die Sonographie Auskunft über den Zustand der Rotatorenmanschette geben. Mit der MRT schließlich lässt sich die Beziehung von Akromion und gelenkassoziierten Strukturen zur Rotatorenmanschette optimal evaluieren. Vielfach lässt sich jedoch keine makroskopisch sichtbare Ursache für das Impingement erkennen. Die Therapie ist initial meist konservativ, bei chronischer Symptomatik ist ein operativer Eingriff indiziert.

The aim of this study was to compare the clinical and radiographic results using either absorbable or non‐absorbable suture anchors in patients with recurrent unidirectional, post‐traumatic shoulder dislocations. All patients had a Bankart lesion. One surgeon operated on 33 consecutive patients, 27 males and six females. Group A comprised 15 shoulders and group B 18 shoulders, all of which underwent a standardised open Bankart reconstruction using 3.7‐mm TAG suture anchors. In group A, absorbable anchors were used, while in group B, non‐absorbable ones were used. There was one re‐dislocation in each group. In group A, the Rowe and Constant scores were 89 (69–98) and 89 (76–99) points, respectively. The corresponding values in group B were 87 (44–98) (not significant; NS) and 90 (71–100) points (NS). The strength measurements revealed 8.1 (3.8–12.3) kg in 90° abduction in group A and 10.0 (6.7–12.0) kg in group B. Healthy control shoulders revealed 10.2 (4.5–13.2) kg (NS A and B versus controls). The external rotation in abduction was 70° (40–90) in group A and 80° (40–100) in group B. The value for the controls was 90° (80–120) [P<0.001 (A versus controls),P<0.05 (A versus B) andP<0.001 (B versus controls)]. The radiographs revealed that 9/15 (60%) in group A and 10/15 (66%) in group B had visible drill holes or cystic formations in conjunction with the drill holes (NS). Furthermore, 11/15 (73%) in group A and 10/15 (66%) in group B had signs of minor degeneration (NS). We conclude that, in terms of stability and clinical results, no differences were found between the study groups. Both groups demonstrated a restriction in external rotation as compared with the healthy shoulders in the same cohort. On the radiographs, visible drill holes or cystic formations in conjunction with the drill holes were seen with equal frequency, regardless of whether absorbable or non‐absorbable suture anchors were used.

Background Four-part fractures of the proximal humerus account for 3% of all humeral fractures and are regarded as the most difficult fractures to treat in the elderly. Various authors recommend nonoperative treatment or hemiarthroplasty, but the literature is unclear regarding which provides better quality of life and function. Questions/purposes We therefore performed a randomized controlled trial to compare (1) function, (2) strength, and (3) pain and disability in patients 65 years and older with four-part humeral fractures treated either nonoperatively or with hemiarthroplasty. Methods We randomly allocated 50 patients to one of the two approaches. There were no differences in patient demographics between the two groups. The Constant-Murley score was the primary outcome measure. Secondary outcome measures were the Simple Shoulder Test, abduction strength test as measured by a myometer, and VAS scores for pain and disability. All patients were assessed at 12 months. Results We found no between-group differences in Constant-Murley and Simple Shoulder Test scores at 3- and 12-months followup. Abduction strength was better at 3 and 12 months in the nonoperatively treated group although the nonoperatively treated patients experienced more pain at 3 months; this difference could not be detected after 12 months. Conclusions We observed no clear benefits in treating patients 65 years or older with four-part fractures of the proximal humerus with either hemiarthroplasty or nonoperative treatment. Level of Evidence Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Background The purpose of this study was to assess the long-term results of the stemless onlay Comprehensive Nano reverse total shoulder arthroplasty (rTSA) system. Methods We evaluated 35 shoulders at an average follow-up of 106 ± 14.6 months (range, 80–135) (follow-up rate 66%). Patients were evaluated via the Constant–Murley scale, the DASH score (Disabilities of the Arm, Shoulder and Hand) and the subjective shoulder value (SSV). Furthermore, a visual analog scale (VAS) for pain intensity was used. The passive glenohumeral range of motion and active total range of motion were recorded. Radiographic assessment was performed on true antero-posterior and axillary views. Results The mean age at surgery was 72.8 ± 6.7 years (range, 47–82). Four patients were revised to a stemmed implant during the follow-up period and were excluded from further assessment. In the remaining group, the Constant score was 82.9 ± 13.1 (range, 40–97), the DASH score was 10.6 ± 17.3 (range, 0–77.5), the SSV was 85.0 ± 18.1 (range, 10–100), and the VAS score for pain was 0.9 ± 1.7/10 (range, 0–7). The mean active flexion and abduction values were 159.8 ± 13.8 and 155.9 ± 20.1, whereas the active external and internal rotation values averaged 34.8 ± 15.3 and 88.9 ± 7.9, respectively. Grade I radiolucency lines (RLLs) were found in 4 patients (14.3%). RLLs > 1 mm were not observed. Two patients experienced early varus displacement of the humeral tray with full reintegration without revision. Revisions to a stemmed implant were performed for atraumatic peg breakage of the humeral tray in 2 patients, early septic loosening in one patient and periprosthetic fracture in one patient. Grade 1 notching was found in 17.9%, and acromion stress fracture was found in 3.6%. Three patients experienced postoperative neurological deficits, with complete recovery in 2 patients. Conclusions Compared with published data on stemmed and stemless rTSA, the comprehensive Nano rTSA system in the present study has comparable or even superior clinical outcomes at long-term follow-up. The rates of implant-associated complications and revision, however, are high compared with those reported in the literature. Trial registration Retrospectively registered on 6th August 2025 German Clinical Trial Register, clinical trial number DRKS00037624, https//www.drks.de/DRKS00037624.

Background Acromial morphology has previously been defined as a risk factor for some shoulder pathologies. Yet, study results are inconclusive and not all major shoulder diseases have been sufficiently investigated. Thus, the aim of the present study was to analyze predictive value of three radiological parameters including the critical shoulder angle, acromion index, and lateral acromion angle in relationship to symptomatic patients with either cuff tear arthropathy, glenohumeral osteoarthritis, rotator cuff tear, impingement, and tendinitis calcarea. Methods A total of 1000 patients’ standardized true-anteroposterior radiographs were retrospectively assessed. Receiver-operating curve analyses and multinomial logistic regression were used to examine the association between shoulder pathologies and acromion morphology. The prediction model was derived from a development cohort and applied to a validation cohort. Prediction model’s performance was statistically evaluated. Results The majority of radiological measurements were significantly different between shoulder pathologies, but the critical shoulder angle was an overall better parameter to predict and distinguish between the different pathologies than the acromion index or lateral acromion angle. Typical critical shoulder angle-age patterns for the different shoulder pathologies could be detected. Patients diagnosed with rotator cuff tears had the highest, whereas patients with osteoarthritis had the lowest critical shoulder angle. The youngest patients were in the tendinitis calcarea and the oldest in the cuff tear arthropathy group. Conclusions The present study showed that critical shoulder angle and age, two easily assessable variables, adequately predict different shoulder pathologies in patients with shoulder complaints.