Controversies in shoulder surgery and algorithmic approach to decision making

The field of shoulder surgery is constantly evolving and for all good reasons. A simple PubMed search with the term “shoulder” responds with over 110,000 results with the earliest article dating back to 1797 (1). The trend of shoulder-related articles in PubMed search results shows a consistent upward trend and in the last five years from 2019–2023, an approximate average of 7,000 articles per year appear to have been published (1). We have also seen an evolution of shoulder surgery as a recognized niche subspeciality within orthopedics with dedicated fellowship programs across the globe. The interest in field of shoulder surgery is evident from the rise in shoulder speciality journals to cater to the growing interest in this field. There is an undoubted rise in interest, research, and clinical practice related to shoulder surgery.

Despite the growing literature and interest in shoulder surgery, the treatment for common shoulder joint problems such as rotator cuff tear, arthritis, proximal humerus fracture, and glenohumeral instability lack consensus in standard algorithm of treatment (2-4). Year after year, we encounter several nuances in management protocols and surgical treatment for shoulder conditions. Furthermore, the rise of number of cases of and publications related to reverse shoulder arthroplasty as the mainstay treatment of end stage shoulder disease makes it imperative for surgeons to understand its indications, implant factors to optimize results, and manage complications (4). The plethora of information available could overwhelm orthopedic surgeons while deciding the difference between proven and experimental treatments and best possible line of management for common shoulder problems.

We are proud to present special series “Controversies in Shoulder Surgery and Algorithmic Approach to Decision Making” published in Annals of Joint. We have included the most controversial topics in shoulder surgery such as partial and massive rotator cuff tears, proximal humerus fractures, shoulder instability, and shoulder arthroplasty. The articles in this series are based on review of most recent available literature and insights by global leading experts in shoulder surgery. The aim of this series is focused on providing algorithmic approach for treatment of common shoulder conditions for use in clinical practice for orthopedic surgeons.

I would like to thank the authors of the articles for their time and effort with their remarkable manuscripts which would guide the readers on effective treatment algorithms for shoulder conditions. I also express my gratitude to the editorial board and staff of the journal Annals of Joint for the opportunity and platform of the special series on controversies in shoulder surgery.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Joint for the series “Controversies in Shoulder Surgery and Algorithmic Approach to Decision Making”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-24-39/coif). The series “Controversies in Shoulder Surgery and Algorithmic Approach to Decision Making” was commissioned by the editorial office without any funding or sponsorship. P.M. served as the unpaid Guest Editor of the series. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. PubMed search with term “shoulder”. Accessed 25th Aug 2024. Available online: https://pubmed.ncbi.nlm.nih.gov/?term=shoulder&timeline=expanded&sort=pubdate&sort_order=asc
2. Mbogori MJ, Ma J, Wong I. Surgical Management of Massive Irreparable Cuff Tears/Management of Rotator Cuff Disease: Interpositional Graft for Irreparable Posterosuperior Rotator Cuff Tears. Curr Rev Musculoskelet Med 2024;17:235-46. [Crossref] [PubMed]
3. Pasqualini I, Rossi LA, Pan X, et al. High Variability in Standardized Outcome Thresholds of Clinically Important Changes in Shoulder Instability Surgery: A Systematic Review. Arthroscopy 2024;S0749-8063(24)00576-0.
4. Jin H, Jiang S, Pavel V, et al. Global trends and research hotspots of reverse total shoulder arthroplasty: a bibliometric analysis from 1991 to 2022. EFORT Open Rev 2024;9:297-308. [Crossref] [PubMed]

Prashant Meshram