Richard J. Hawkins

Background Ulnar collateral ligament (UCL) reconstruction (UCLR) of the elbow has received much attention given the rise in incidence among baseball pitchers. Stress ultrasonography has been demonstrated to be a critical evaluation tool of the UCL. No study has dynamically evaluated the ability of UCLR to restore normal kinematics. Purpose/Hypothe...

Background In a reverse total shoulder arthroplasty, the altered glenohumeral joint center of rotation subjects the glenoid baseplate to increased shear forces and potential loosening. Methods This study examined glenoid baseplate micromotion and initial fixation strength with the application of direct shear force in a Sawbone model. The reverse t...

Purpose To create a viable, mechanically expanded autograft long head biceps tendon (LHBT) scaffold for biologically augmenting the repair of torn rotator cuffs. Methods The proximal aspect of the tenotomized LHBTs were harvested from patients during rotator cuff repair surgery and were mechanically formed into porous scaffolds using a surgical gr...

Arthroscopic rotator cuff repair has become one of the most common and successful surgeries done in orthopedics. It represents the culmination of advances in many diverse fields such as optics, fluid dynamics, mechanical engineering, and most recently, orthobiologics. This article reviews the current state of the art of arthroscopic rotator cuff re...

Introduction Previous studies show that reverse shoulder arthroplasty (RSA) may improve forward elevation (FE) but external rotation (ER) may remain impaired with substantial teres minor fatty infiltration. The purpose of this study was to examine the influence of fatty infiltration on postoperative range of motion (ROM) and patient reported outcom...

Background Functional bracing is often used as an adjunct to nonoperative treatment of anterior shoulder instability, but no study has evaluated the effectiveness of in-season bracing. The purpose of this study was to examine successful return to play in a nonoperative cohort of adolescent athletes with in-season shoulder instability and compare th...

Background The management of the adolescent athlete after initial shoulder instability remains controversial. Hypothesis Individual risk factors in athletes with shoulder instability who are managed nonoperatively can be integrated into a scoring system that can predict successful return to sport. Study Design Retrospective cohort study. Level o...

Background Multiple factors including muscle atrophy, fatty infiltration, smoking, advanced patient age, and increasing tear size have been identified as risk factors for retear after rotator cuff repair. However, little is known about what effect the length of the residual rotator cuff tendon has on the success of repair and patient outcomes. Met...

Background Young age and contact sports have been postulated as risk factors for anterior shoulder instability. Management after shoulder instability is controversial, with studies suggesting that nonoperative management increases the risk of recurrence. Several studies examined return to play after an in-season instability episode, and few followe...

Background Controversy exists in reverse total shoulder arthroplasty in regard to variability in the center of rotation (COR), which modifies the superior-inferior position of the humerus to affect the acromiohumeral interval (AHI), and its effect on the deltoid lever arm (DLA), acromial index (AI), and critical shoulder angle (CSA). The purpose of...

The management of three- and four-part proximal humerus fractures remains controversial because the literature has supported all forms of management, including nonsurgical management, open reduction and internal fixation (ORIF), and shoulder arthroplasty. Specific patient factors ultimately influence the decision of which treatment best fits the pa...

Background: Movement toward a value-based health-care system necessitates the development of performance measures to compare physicians, hospitals, and health-care systems. Patient-reported outcomes (PROs) are a potential metric. However, valid use of PROs hinges on the ability to risk-adjust for baseline patient differences across a surgeon's pan...

Background There is an ever-increasing demand for widespread implementation of patient-reported outcomes. However, adoption is slow owing to limitations in clinical infrastructure and resources within busy orthopaedic practices. Prior studies showed the single alpha-numeric evaluation (SANE) score to correlate at a single point in time with the Ame...

Background Controversy exists as to whether the subscapularis should be repaired after reverse shoulder arthroplasty. The purpose of the present study was to evaluate the utility of repairing the subscapularis after reverse shoulder arthroplasty with regard to complications, objective findings, and patient-reported outcome measures. Methods We ret...

Objectives Early results following arthroscopic superior capsular reconstruction(SCR) in patients with massive, irreparable rotator cuff tears are promising. However, no studies have compared patient reported outcomes between SCR or reverse total shoulder(rTSA) and rotator cuff debridement for these patients. Therefore, the purpose of this study wa...

Background: Total shoulder arthroplasty remains an effective procedure for shoulder pain relief. Despite the negative effect of abnormal glenoid morphology and specifically retroverted and posteriorly subluxated glenoids, there is no consensus for management of B2 glenoids in total shoulder arthroplasty. The purpose of this study was to compare th...

Objectives The management of the adolescent athlete who presents for initial treatment after shoulder instability remains controversial. Risk factors such as age, gender, athletic status, and patient goals have all been demonstrated to result in a higher risk of recurrence with nonoperative management, but little work has been done to determine a t...

Background The objective of this study was to describe patients receiving each shoulder arthroplasty procedure and to assess surgical complications, hospital admissions for surgical complications, and surgical revisions among Medicare beneficiaries undergoing shoulder arthroplasty. Methods Medicare patients receiving shoulder arthroplasty in the U...

Although rare, infection after shoulder surgery can represent a devastating complication. Infection can negatively affect clinical outcomes, and eradication often requires a protracted treatment course. Staphylococcus aureus, Staphylococcus epidermidis, and Propionibacterium acnes are among the most frequently isolated pathogens. Perioperative meas...

Background Suprascapular neuropathy is an uncommon clinical diagnosis. Although there have been a number of case series reporting on this pathologic process, to date there has been no systematic review of these studies. This study aimed to synthesize the literature on suprascapular neuropathy with regard to clinical outcomes. The secondary objectiv...

The movement toward a value-based health care market requires comparison of physicians, hospitals, and health systems. Traditionally, process-based measures such as infection and readmission rates have been used. However, these events are uncommon in shoulder and elbow surgery, thus limiting their utility. Patient-reported outcomes (PROs) are a pro...

Background: This systematic review aims to synthesize published data for the most common subscapularis takedown and repair to compare outcomes in the setting of shoulder arthroplasty. Methods: Searches of MEDLINE and Cochrane Library databases identified studies that reported clinical or radiologic outcomes for subscapularis management in the se...

Background: Treatment choices for total shoulder arthroplasty (TSA) in the absence of full-thickness rotator cuff tears (RCTs) are not clearly defined in current literature. This study investigated the prevalence and effect of preoperative partial-thickness RCTs and muscular degenerative changes on postoperative outcomes after TSA. Methods: Medi...

Objectives The is an ever-increasing demand within the emerging health care arena to demonstrate the efficacy of orthopedic interventions. Widespread implementation of patient reported outcomes are limited in part due to the barriers of clinical infrastructure and resources in a busy orthopedic practice. Prior studies have shown the single alpha-nu...

Objectives However, the optimal treatment of biceps pathology is unclear as few studies have compared tenotomy versus tenodesis in the setting of RCTs. Therefore, the purpose of this study is to compare the outcomes of biceps tenodesis versus tenotomy in the setting of RCTs in order to determine if and when an advantage exists for one technique ove...

Objectives Generalized joint hypermobility is theorized as a risk factor for joint injury in sport. However, there are no studies demonstrating generalized joint hypermobility and upper extremity overuse injury. Therefore the purpose of this study was to prospectively examine generalized joint hypermobility using the Beighton Scale and upper extrem...

Background Pseudoparalysis remains one of the most challenging conditions in shoulder surgery. Long thought of as an unsolvable problem, recent advances in surgical techniques offer potential return of overhead motion in the setting of massive irreparable rotator cuff tears. This article summarizes the available literature including existing defini...

Background: Therapeutic efficacy of various mesenchymal stromal cell (MSC) types for orthopaedic applications is currently being investigated. While the concept of MSC therapy is well grounded in the basic science of healing and regeneration, little is known about individual MSC populations in terms of their propensity to promote the repair and/or...

Background Pain management strategies following shoulder arthroplasty vary significantly. Liposomal bupivacaine (LB) is an extended-release delivery of a phospholipid bilayer encapsulating bupivacaine that can result in drug delivery up to 72 hours. Prior studies in lower extremity surgery demonstrated efficacy of LB in comparison to a single-shot...

Glenoid component loosening is a common cause of failed total shoulder arthroplasty. Many different treatment options exist for the management of a symptomatic loose polyethylene glenoid component, ranging from component removal to revision arthroplasty. Arthroscopic removal and conversion to hemiarthroplasty provides a minimally invasive managemen...

Background: Pain management strategies following shoulder arthroplasty vary significantly. Liposomal bupivacaine (LB) is an extended-release delivery of a phospholipid bilayer encapsulating bupivacaine that can result in drug delivery up to 72 hours. Prior studies in lower extremity surgery demonstrated efficacy of LB in comparison to a single-sho...

Background: Baseball players displaying deficits in shoulder range of motion (ROM) are at increased risk of arm injury. Currently, there is a lack of consensus regarding the best available treatment options to restore shoulder ROM. Hypothesis: Instrumented manual therapy with self-stretching will result in clinically significant deficit reductio...

Background: Glenoid component loosening is common in total shoulder arthroplasty (TSA), often resulting from the mechanical interaction of glenohumeral components. This cadaveric study was performed to evaluate and to compare commercially available onlay and inlay glenoid prosthetic designs with respect to loading characteristics and loosening. M...

Background The processing of allograft tissues in anterior cruciate ligament (ACL) reconstruction continues to be controversial. While high-dose irradiation of grafts has received scrutiny for high failure rates, lower dose irradiation and “proprietary-based” nonirradiated sterilization techniques have become increasingly popular, with little in th...

Background: Resilience, characterized by an ability to bounce back or recover from stress, is increasingly recognized as a psychometric property affecting many outcomes' domains including quality of life, suicide risk in active-duty military personnel, and recovery in cancer patients. This study examines the correlation between resilience, as meas...

Background: Despite concerns about the longevity of total shoulder arthroplasty (TSA) in young patients, it remains an attractive option because of the absence of superior options. Methods: A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. English-language studies were identified with search terms "total...

Background Reports of return to play(8–80%) and subsequent injury(15–30%) are variable following arm injuries in baseball players with no known risk factors. Objective We aimed to prospectively examine the influence of injury history, return to sport criteria, and baseball participation as risk factors in youth and adolescent baseball players retu...

Background: The treatment of 3- and 4-part proximal humeral fractures in the older adult is controversial. No study has directly compared reverse shoulder arthroplasty (RSA) with nonoperative treatment for these fractures. The purpose of this study was to compare clinical and patient-reported outcomes between RSA and nonoperative treatment groups....

The incidence of complications continues to be a concern for reverse total shoulder arthroplasties (RSAs). Complication rates have been reported in various ranges, but are generally around about 20 % total with a reoperation rate of 12 %. Common complications include infection, dislocation, scapular notching, periprosthetic fracture, baseplate loos...

Objectives The teres minor has received increased attention in its role as a rotator cuff muscle, particularly in the setting of large infraspinatus tears. Studies have shown that it plays an important beneficial role after total (TSA) and reverse (RSA) shoulder arthroplasty, as well as in maintenance of function in the setting of infraspinatus was...

Background: Numerous studies have demonstrated that humeral retrotorsion is increased in the dominant arms of throwing athletes. No study has clearly defined the relationship between humeral retrotorsion and shoulder and elbow injury. Hypothesis: Uninjured professional pitchers will display more dominant humeral torsion (HT) than professional pi...

Objectives: Deficits in posterior shoulder flexibility and strength have been identified as modifiable risk factors for pitching injuries. There are no studies showing the effect of a prevention program on arm injuries and associated risk factors such as strength and ROM. The purpose of this study was to assess the effectiveness of a preseason prev...

Postsurgical pain, like that associated with major upper extremity surgery, can be significant and usually require the use of opioid analgesics. However, opioids are associated with significant adverse effects, including respiratory depression, which often drive the use of multimodal therapy with nonopioid analgesics, including local and regional a...

Background: Shoulder range of motion (ROM) deficits have been identified as injury risk factors among baseball athletes. Despite the knowledge surrounding these risk factors, there is a lack of consensus regarding the specific tissues responsible for these deficits in ROM. Purpose/hypothesis: The purpose of this study was to elucidate the primar...

Objectives Ulnar collateral ligament reconstruction(UCLR) of the elbow has received much attention given the rise in incidence among all pitchers. Recent studies have demonstrated stress ultrasonography is a critical tool in the evaluation of the UCL. . No study, has dynamically evaluated the UCL in uninjured professional pitchers under stress, nor...

Objectives Participation in baseball causes increased mechanical stress to the throwing arm and has been linked to alterations in shoulder range of motion (ROM) and bony morphology. Range of motion changes, specifically GIRD, has been associated with increased shoulder injury. However, the role of humeral torsion is unclear in shoulder injury. The...

Objectives: Ulnar collateral ligament (UCL) injury of the elbow is a common and debilitating problem seen frequently in elite baseball pitchers. Ultrasound has been shown to be a useful diagnostic tool in evaluating UCL injuries. We hypothesized that the evaluation using stress ultrasound (US) of the elbow to measure both the morphology of the UCL...

Approximately 6 million youngsters play organized baseball yearly, and injuries are common. Defining of risk factors for injuries in the throwing shoulder has largely been confined to the professional thrower. Unfortunately, these risk factors apply to only 1% of pitchers at risk for injury. Risk factors for injury in youth pitchers have received f...

Dominant shoulder glenohumeral internal rotation deficit (GIRD) has been associated with pitching arm injuries. The relationship of humeral torsion on development of GIRD is not clear. Pitchers displaying GIRD will display greater humeral retrotorsion when compared with those without GIRD. Cross-sectional study; Level of evidence, 3. Humeral torsio...

Objectives: High school pitchers are at three times greater risk of an upper extremity (UE) injury compared to position players, with most (69%) injuries occurring during the first month of the season. Therefore, a prevention program for pitchers targeting known risk factors may reduce their injury risk, particularly early in the season. The purpos...

Hypothesis: We hypothesize that patients with a positive tangent sign will have rotator cuff tears that are not able to be repaired primarily. Methods: We performed a retrospective review of the charts of patients who had undergone surgery for repair of a rotator cuff tear. The operative note was reviewed to determine whether the cuff tear was p...

The shoulder is subject to tremendous stress during the throwing motion, which creates the opportunity for injury and disability. Understanding the potential causes of injury in the overhead athlete can be challenging in and of itself; however, placing those diagnoses in the clinical context of an injured athlete can be even more challenging. In a...

Multidirectional instability is symptomatic inferior instability with instability in at least one other direction. Patients presenting with recurrent multidirectional instability despite prior surgical stabilization present a difficult challenge for shoulder surgeons. Patients who have had multiple failed stabilizations with continued symptomatic i...

Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central ner...

Objectives: Glenohumeral internal rotation deficit (GIRD) in the dominant shoulder of a throwing athlete is a previously recognized phenomenon which has been associated with upper extremity injury. The relationship between GIRD and humeral torsion has not clearly been elucidated. The purpose of this study was to compare humeral torsion between prof...

A wider spectrum of complications associated with shoulder arthroplasty is expected because of the substantial increase in the prevalence of this procedure over the past decade. It is helpful to review the management and methods needed to prevent the most common complications associated with shoulder arthroplasty.

Total shoulder arthroplasty provides reliable pain relief of osteoarthritic shoulder pain. The keys to success with shoulder arthroplasty are adhering to appropriate indications, understanding the surgical implications of various pathologies, and applying good surgical technique. Many complications of total shoulder arthroplasty may be avoided with...

Hypothesis: We hypothesize that the degree of supraspinatus atrophy, as assessed with the tangent sign will significantly correlate with increasing rotator cuff tear size. Methods: A retrospective review was performed assessing presence of muscle atrophy using the tangent sign, fatty atrophy based on Goutallier classification, and size of rotato...

Background: Fixation of the baseplate to the glenoid for the Reverse Shoulder Prosthesis (DJO Surgical, Austin, TX, USA) requires secure screw purchase to avoid excessive micromotion and baseplate failure. The best screw length for fixation is unknown. In addition, excessively long screws or a plunge of the drill bit during baseplate insertion cou...

Background: The biceps labral complex has received much interest in recent years as a source of shoulder pain. Magnetic resonance imaging (MRI) is the imaging modality of choice for those patients with a suspected superior labrum anterior-posterior (SLAP) tear. The goal of this study was to look at the accuracy of MRI without arthrography to corre...

Pitching causes increased mechanical stress to the arm and is thought to result in alterations in range of motion (ROM) as a result of osseous and soft tissue adaptations. Understanding the factors that contribute to alterations in ROM will allow for improved understanding of the pitching shoulder. This study examined humeral torsion (HT) and shoul...

Elite throwing athletes have increased proximal humeral retrotorsion (HRT) and glenoid retroversion (GRV) in their throwing shoulders compared with their nonthrowing shoulders. These adaptive morphologic changes are thought to be independently protective against shoulder injury; however, their relationship to each other is poorly understood. To det...

We sought to examine the relation among glenoid morphology, glenohumeral range of motion (ROM), and history of shoulder injury in professional baseball pitchers. We studied 58 professional baseball pitchers. Internal rotation (IR) and external rotation (ER) ROM was measured at 90° of abduction. Horizontal adduction (HAdd) ROM was also measured. Gle...

Background: Reverse total shoulder arthroplasty has shown promising early and midterm results; however, complication rates remain a concern. Glenoid loosening and notching, for example, can be deleterious to the long-term success. A 15° inferior inclination angle has been shown to offer the most uniform compressive forces across the base plate and...

The clinical diagnosis of a superior labral anterior posterior (SLAP) tear is extremely challenging. Most studies that advocate selected tests have errors in study design or significant bias, or both. The purpose of this study was to identify the diagnostic utility of the Active Compression/O'Brien's test, Biceps Load II test, Dynamic Labral Shear...

Although many definitions have been used to define massive rotator cuff tears, a tear is generally considered massive if it is greater than 5 cm in diameter. Most massive rotator cuff tears are chronic, and patients commonly present with an insidious onset of gradually worsening pain and weakness in the involved shoulder. In rare situations, patien...

Tendinopathy of the long head of the biceps (LHB) tendon commonly occurs in patients with rotator cuff tears, and the inflammation of one head tends to lead to inflammation of the other. Many theories have been proposed regarding the function of the LHB tendon; however, its exact purpose is poorly understood. It has been described as an important s...

Reverse total shoulder arthroplasty (RSA) is being increasingly used in the treatment of disabling shoulder conditions. This study reports the management of deep infections after RSA. Eight of 138 patients were treated for deep infection after the index procedure. A retrospective review was performed to identify risk factors, methods of management,...

Despite improved results with reverse shoulder arthroplasty (RSA), questions still remain regarding certain technical aspects of the operation. One particular area of question is the effect of subscapularis repair on complication rates, dislocation, pain, and overall range of motion. Some authors suggest that when a deltopectoral approach is used,...

Current etiologic theories concerning healing rates in rotator cuff repair have focused on the blood supply in the tendinous portion of the cuff. We currently have little information regarding the effect of our repair techniques on this critical variable. We hypothesize that intratendinous blood flow is changed during transosseus equivalent tendon...

Numerous outcomes measures can be used to capture and differentiate change in different constructs comprising recovery. Consequently, patients are often burdened by completing a number of measures which involves considerable time and effort. The purpose of this longitudinal, observational study was to identify the number of dimensions in a battery...

The purpose of this study was to prospectively evaluate the accuracy of three different approaches used for glenohumeral injections. In addition, the accuracy of the injection was compared to the experience and confidence of the provider. One-hundred six consecutive patients with shoulder pain underwent attempted intra-articular injection either po...

Rotator cuff injuries are commonly diagnosed orthopaedic conditions. The purpose of this study was to determine survivorship of primary open cuff repairs, with survivorship defined as a shoulder not requiring additional surgery. Between 1993 and 2004, open cuff repairs were performed in 254 patients (263 shoulders). All had a complete tear of the s...

To investigate the diagnostic accuracy and association to disability of selected functional findings or physical examination tests for patellofemoral pain syndrome (PFPS) in patients with anterior knee pain. A sample of 76 consecutive patients with anterior knee pain was further subdivided into PFPS and other diagnoses. Routine physical examination...

Recent studies have demonstrated better outcomes with operative fixation of displaced midshaft clavicle fractures. We hypothesize that the risk of major complication with intramedullary fixation for clavicle fractures will be low. Clavicle fractures in 58 patients were treated with intramedullary fixation. Patients were excluded for concomitant pat...

Patients with patellofemoral pain syndrome (PFPS) often have nonspecific findings on clinical examination. A tight knee and diminished patellar mobility in particular, may contribute to anterior knee pain. Qualifying patients with anterior knee pain of > 4 weeks were sequentially examined by 2 physicians who used the patellar mobility tests. The te...

The purpose of this study was to compare the forearm supination and elbow flexion strength of the upper extremity in patients who have had an arthroscopic long head of the biceps tendon (LHBT) release with patients who have had an LHBT tenodesis. Cybex isokinetic strength testing (Cybex Division of Lumex, Ronkonkoma, NY) was performed on 17 patient...

Shoulder pain is a common, costly, and recalcitrant affliction. One treatment for shoulder pain is intra-articular injection of corticosteroid. Clinical opinion is that injection guided by palpation is accurate and effective, and there is some evidence to support a positive effect of injection on pain. However, great controversy exists as to the ac...

During the pitching motion, velocity is generated by the upper extremity kinetic chain on internal rotation of the shoulder and trunk translational/rotational motion. This generation of power places significant forces and torques on the elbow and shoulder. Elbow valgus torque and shoulder rotational torque are theoretically linked to elbow injury....