Winter 2020 - Joint management

Contents

Massive rotator cuff tears: new and evolving treatments

Massive rotator cuff tears (MRCTs) are tears over 5cm in size and often are not directly reparable, or have high failure rates with direct repair. They can present with pain, functional disability or both. Treatment is often multimodal and focused on the patient’s specific functional requirements. Improvements in function can often be obtained with patientspecific deltoid rehabilitation regimens, as long as pain is controlled. A large variety of novel surgical reconstructive options are now available and their indications are still being defined. In this article we will review the current new technologies and advancements in the management of MRCTs, while describing our approach to these often complex patients.

Lennard Funk, Micheal Walton and Julia Walton

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What's new in Tennis Elbow?

Tennis elbow (TE) is a common diagnosis for patients presenting with lateral elbow pain. While many patients improve quickly with therapy, some can be more resistant. Over the years, a huge variety of further therapeutic options have become available for these patients. This article aims to review the evidence behind some of the newer treatments on offer, as well as refreshing the principles behind making sure the diagnosis is right.

Andrew C Wright and Adam C Watts

 

Modern technologies in hand and wrist surgery

Over the past decade, there have been numerous advances within the field of hand and wrist surgery and surgeons have been able to adopt these new technologies to improve the accuracy of surgery with the goal to optimise functional outcomes for patients. This article provides an up-to-date overview of some of these developments, such as advanced imaging techniques, three-dimensional printing and new materials, and the advantages these new technologies offer to both patients and healthcare professionals.

Matthew Ricks and David James Murray

 

Is it more than just a torn ACL?

A large proportion of individuals who undergo anterior cruciate ligament (ACL) reconstruction surgery will describe, through their rehabilitation period, that they continue to experience a degree of rotational instability. This may contribute to a decision for them not to return to their previous level of sport, and may be in spite of excellent rehabilitation. This article highlights factors related to the original injury of an ACL tear that, until recent times, have not been considered surgically. Given that physiotherapists tend to have more contact time with patients in their rehabilitation than do surgeons, the ability of the physiotherapist to recognise, during compliant rehabilitation, a post-operative rotational instability may mean it will prompt a surgical referral where it can be addressed and improved.

Neil Jain

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