Chapter 38 The Upper Limb

The shoulder girdle is controlled and supported by muscles crossing between the spine, thorax, scapula and humerus. The sternoclavicular joint is the only synovial joint between the upper limb and the axial skeleton. The commonest congenital abnormality is due to abnormal scapular descent from its embryonic midcervical position. Radiographs are often of limited value because most shoulder pain arises, from soft-tissue structures. Both ultrasound and magnetic resonance imaging allow the integrity and health of the rotator cuff to be checked whereas magnetic resonance arthrography also gives information on the integrity of the labrum of the glenohumeral joint. The rotator cuff has a relatively poor blood supply in the segment that glides between the humeral head and acromion, as described in Rotator cuff degeneration and impingement. The glenohumeral joint is commonly involved in rheumatoid arthritis. As is typical of this condition, there is osteoporosis, destruction of the articular cartilage and synovial proliferation with pannus formation.

Multiple Choice Questions
Weblinks

Journal articles

https://www.journalslibrary.nihr.ac.uk/hta/hta19800/#/s1/ (free)

The UK Rotator Cuff Surgery (UKUFF) trial assessing the clinical effectiveness and cost-effectiveness of arthroscopic compared with open rotator cuff repair.

https://link.springer.com/article/10.1007%2Fs00402-007-0549-7/ (paid)

The Oxford shoulder score and its current use.

https://journals.lww.com/jbjsjournal/Abstract/1998/09000/The_Coonrad_Morrey_Total_Elbow_Arthroplasty_in.12.aspx/ (paid)

Long-term follow-up of the Coonrad–Morrey elbow replacement in rheumatoid arthritis.

https://www.sciencedirect.com/science/article/abs/pii/S1058274614001542?via%3Dihub/ (paid)

Long-term follow-up of the Latarjet procedure for shoulder instability.

https://journals.lww.com/jbjsjournal/Abstract/1972/54010/Anterior_Acromioplasty_for_the_Chronic_Impingement.3.aspx/ (paid)

Neer’s description of the open acromioplasty for subacromial impingement.

https://journals.lww.com/jbjsjournal/Abstract/1991/73030/Posterolateral_rotatory_instability_of_the_elbow_.15.aspx/ (paid)

Review of posterolateral rotatory instability of the elbow.

https://journals.lww.com/jbjsjournal/Abstract/1976/58020/Normal_and_abnormal_motion_of_the_shoulder.6.aspx/ (paid)

Paper discussing both normal and abnormal movements of the shoulder.

https://journals.lww.com/jbjsjournal/Abstract/1978/60010/The_Bankart_procedure__a_long_term_end_result.1.aspx/ (paid)

Long-term results of the original Bankart procedure.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586318/ (free)

Perspectives on deep infection within shoulder replacements over a 33-year career.

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