• N Wülker.
• Orthopädische Klinik, Medizinische Hochschule, Heimchenstrasse 1-7, 30601 Hannover. wuelker@dvse.org
• Orthopade. 2001 Oct 1;30(10):789-97.

AbstractWithin the past 100 years, shoulder and elbow surgery has developed into a highly sophisticated specialty. Technical advancements now allow operative treatment of most shoulder and elbow disorders. Shoulder arthroplasty is able to accurately reproduce normal anatomy and function. It is used in degenerative omarthrosis, humeral head fractures, rheumatoid arthritis, and rotator cuff arthropathy. After 10 years, survival of 93% can be expected and in omarthrosis an outcome score of 85 of 100 points. In recurrent shoulder instability, open surgery is still the gold standard. It allows to accurately adjust capsular tension. Modern arthroscopic techniques shorten the capsule with sutures or by capsular shrinkage, but sufficient follow-up is not yet available. Arthroscopic subacromial decompression is the standard procedure for subacromial disorders. The indication for operative rotator cuff closure must be adjusted to the age and functional expectations of the patient. Smaller defects can be closed arthroscopically. The operative technique in proximal humerus fractures is particularly demanding, due to osteoporosis and the risk of avascular necrosis. Magnetic resonance imaging is the preferred imaging technique at the shoulder, often combined with intravenous or intra-articular contrast injection. Elbow joint replacement is mostly used in rheumatoid arthritis and has achieved a high technical standard.

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