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What's New — Shoulder — August 2026

19 new articles published this month.

Themes: Reverse Shoulder Arthroplasty Complications · Arthroplasty Implant and Infection Issues · Athletic Shoulder Performance and Injury · Rotator Cuff and Calcific Tendinitis Treatment · Instability, Biomechanics and Nerve Topics

Digest generated 2026-09-04 19:49:44+00:00.

Highlights

Reverse Shoulder Arthroplasty Complications

This month's digest features a cluster of studies examining complications and revision considerations following reverse total shoulder arthroplasty (RTSA). A systematic review of primary RTSA in patients younger than 65 years reports pooled functional outcomes and complication/revision rates in this growing demographic [1]. Instability remains the dominant concern: a tertiary centre series of 42 dislocated RTSAs found most dislocations occurred early (81% within 6 weeks), with loss of compression the commonest mechanism, and modular component exchange achieving stability in 86% [5]. Complementing this, a systematic review and meta-analysis identified risk factors and classified instability mechanisms after RTSA [18]. Scapular stress fracture after RTSA was analyzed in a propensity score, matched study of 551 primary RTSAs, clarifying its incidence and clinical impact [13]. A case report describes deltoid muscle rupture managed with open transosseous repair following RTSA in a patient with os acromiale [6].

Arthroplasty Implant and Infection Issues

Several articles address implant selection, biologic response, and infection workup across shoulder arthroplasty. A retrospective comparison of 199 primary RSAs found semi-inlay and onlay humeral stems achieve comparable outcomes through different patterns of glenoid and humeral lateralization and distalization [4]. A national registry study of anatomic total shoulder arthroplasty examined how glenoid polyethylene type (highly cross-linked vs conventional), humeral head size, and head composition influence revision risk for glenoid loosening and wear [14]. In the revision setting, a single-centre study of 81 presumed aseptic shoulder and elbow revisions questioned the value of pre-operative biopsies, finding both false positives and newly identified infections, leaving their routine use uncertain [3]. Finally, a review of GLP-1 receptor agonists discusses implications of incretin therapies for obesity, metabolic optimization, and perioperative complications in hip, knee, and shoulder arthroplasty [9].

Athletic Shoulder Performance and Injury

Sports-related shoulder research this month spans performance testing, injury surveillance, and social media education. A cross-sectional study of 62 competitive swimmers found shoulder pain and hip stability isometric test performance were significantly associated with modified Closed Kinetic Chain Upper Extremity Stability Test performance, underscoring kinetic chain contributions [2]. In female collegiate baseball and softball players, ultrasound-based surveillance revealed high rates of shoulder and elbow pain and structural imaging abnormalities, with early sport participation as a contributing factor [15]. Addressing patient education, a cross-sectional analysis of 173 TikTok videos on glenohumeral dislocation demonstrated that content produced by healthcare professionals achieved higher quality scores than general-user videos [19]. Together these studies highlight screening, kinetic chain assessment, and digital health literacy in the athletic shoulder population.

Rotator Cuff and Calcific Tendinitis Treatment

Two studies inform treatment decision-making for common rotator cuff pathology. A systematic review and meta-analysis of randomised controlled trials concluded that arthroscopic and mini-open rotator cuff repair yield comparable clinical and structural outcomes for small to medium full-thickness tears, supporting either approach based on surgeon preference and patient factors [10]. For refractory calcific tendinitis, a propensity score, matched retrospective cohort of 72 patients compared ultrasound-guided percutaneous aspiration and lavage with arthroscopic debridement, stratified by Gärtner type; both techniques improved pain and function scores at 12 months, with subgroup analysis addressing whether calcification morphology influences treatment response [16]. These findings help clinicians match procedure choice to tear size and calcific deposit characteristics.

Instability, Biomechanics and Nerve Topics

A group of articles covers glenohumeral instability, basic biomechanics, and nerve disorders of the shoulder girdle. A letter and accompanying authors' response debate whether preoperative instability episode count should substitute for anatomic factors such as glenoid bone loss and off-track morphology in predicting recurrence after arthroscopic Bankart repair [7, 8]. An experimental and computational study using inertial sensors and OpenSim modeling characterized sternoclavicular joint kinematics and forces during shoulder movements, providing validated normative biomechanical data [12]. In nerve-related conditions, a letter discusses long thoracic nerve variants associated with medial scapular winging in thoracic outlet syndrome [11], while a single-surgeon cohort reports outcomes of modified partial radial-to-axillary nerve transfer as the index procedure for isolated axillary nerve injury, including motor endplate morphometric analysis [17].

Articles by Theme

Reverse Shoulder Arthroplasty Complications (5)

1. Johri M, Bouzid N, Thibeault JW, et al. Outcomes of primary reverse total shoulder arthroplasty in patients younger than 65 years: A systematic review. Shoulder & Elbow 2026. doi:10.1177/17585732261476954

This systematic review with meta-analysis pooled outcomes from 13 studies of primary reverse total shoulder arthroplasty in patients under 65 years (weighted mean age 55.4 years, follow-up 2-7.8 years). Pooled results showed forward flexion of 133.2°, external rotation of 38.1°, and moderate PROM scores (e.g., ASES 69.5, Constant-Murley 62.9), with reported complication and revision rates. Clinically, RTSA in younger patients yields functional but not normal motion and durable mid-term outcomes, supporting its cautious use in this population while counseling on complication risk.

5. Asaad O, Raval P, Raja H, et al. Management of the dislocated reverse total shoulder arthroplasty: A tertiary centre experience. Shoulder & Elbow 2026. doi:10.1177/17585732261472448

This tertiary centre review of 42 surgically treated dislocated reverse total shoulder arthroplasties (2013-2023) analyzed timing, mechanism, and revision strategies. Most dislocations occurred early (81% within 6 weeks) and loss of compression was the dominant mechanism (78.5%), with loss of containment (12%) and impingement (9.5%) less common; stability was restored in 86%, most often via modular component exchange (47.5%). Clinically, early postoperative dislocation should prompt evaluation of compression, and modular exchange is an effective first-line revision strategy.

6. Ketelaar E, Hoenecke H, Valk J, et al. Open transosseous repair of proximal deltoid muscle rupture following reverse total shoulder arthroplasty in a patient with os acromiale: a case report. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100753

This case report describes open transosseous repair of a proximal deltoid muscle rupture occurring after reverse total shoulder arthroplasty in a patient with an os acromiale. The authors detail intraosseous repair with deltoid sleeve advancement to the acromion/os acromiale, addressing a rare but devastating complication. The report highlights the importance of recognizing deltoid origin insufficiency after RTSA, particularly in patients with os acromiale, and demonstrates that transosseous repair is a feasible reconstructive option.

13. Chul-Hyun Cho B, Sohn H, Kim D. Clinical impact of scapular stress fracture after reverse total shoulder arthroplasty: a single-center propensity score–matched analysis. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.024

This propensity score-matched single-center study of 551 reverse total shoulder arthroplasties identified 30 cases of postoperative scapular stress fracture and compared outcomes against 84 matched controls. The analysis examined how fracture location, treatment modality, and radiographic union influenced clinical scores and range of motion. The findings clarify the clinical significance of SSF after rTSA and inform management decisions for this complication.

18. Ulenberg N, Herbstreit S, Dudda M, et al. Risk Factors for instability and dislocation after reverse total shoulder arthroplasty: a systematic review. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.027

A systematic review of ten retrospective studies identified eleven significant risk factors for instability or dislocation after reverse total shoulder arthroplasty, including male sex, younger age, opioid use disorder, revision surgery, and prior subluxation, with meta-analysis of odds ratios for factors reported across multiple studies. Instability mechanisms were classified using the Abdelfattah (Frankle) classification. The results can guide preoperative risk stratification and targeted intraoperative strategies to reduce this common and difficult revision complication.

Arthroplasty Implant and Infection Issues (4)

3. Howard M, Thomas W, Evans J, et al. Pre-operative biopsies in the revision setting – helpful or harmful?. Shoulder & Elbow 2026. doi:10.1177/17585732261474495

This single-centre study of 81 presumed aseptic revision shoulder/elbow procedures compared outcomes in 40 patients who had pre-operative biopsies versus 41 who did not. Pre-revision biopsy showed low sensitivity (54%), 7 positive biopsies led to antibiotics, but intraoperative cultures revealed persistent infection in only 4/7 and new infection in 6 previously negative cases, while 13/41 non-biopsied patients were culture-positive at revision. The authors conclude routine pre-revision biopsies may be harmful or misleading, and intraoperative sampling with a low threshold for antibiotic treatment remains important.

4. Paciotti M, De Rosa A, Franceschetti E, et al. Semi-inlay and onlay humeral stems in reverse shoulder arthroplasty achieve comparable outcomes through different patterns of glenoid and humeral lateralization and distalization: A retrospective study from the FP-UCBM Shoulder Study Group. Shoulder & Elbow 2026. doi:10.1177/17585732261473902

This retrospective study of 199 primary reverse shoulder arthroplasties compared onlay versus semi-inlay humeral stems using radiographic lateralization/distalization angles (LSA, DSA, GLA, HLA, GDA, HDA) and clinical outcomes (Constant-Murley, SST, VAS, ROM). At mean follow-up, both stem designs achieved comparable clinical and functional outcomes, but through different patterns of glenoid versus humeral lateralization and distalization. Surgeons can therefore select stem configuration based on bone stock and geometry preferences, expecting similar results provided overall joint lateralization and distalization are achieved.

9. Avram GM, Indelli PF, Violante B, et al. GLP‐1 receptor agonists in hip, knee and shoulder arthroplasty: Implications for obesity, osteoarthritis, metabolic optimisation and complications. Knee Surgery, Sports Traumatology, Arthroscopy 2026. doi:10.1002/ksa.70557

This editorial reviews the emerging role of GLP-1 receptor agonists in patients undergoing hip, knee, and shoulder arthroplasty, synthesizing evidence on weight loss, metabolic optimization, inflammation, and perioperative outcomes such as periprosthetic joint infection and readmission. It concludes that while retrospective data suggest benefits, the evidence remains observational and confounded. Clinicians should weigh potential metabolic and cardiovascular gains against uncertain candidacy and timing decisions until randomised data are available.

14. Gill DR, Corfield S, McCau M, et al. The impact of glenoid polyethylene type, humeral head size and composition on revision risk following primary anatomic total shoulder arthroplasty for osteoarthritis. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.021

This national registry cohort study of primary anatomic total shoulder arthroplasty for osteoarthritis assessed revision risk by glenoid polyethylene type (highly cross-linked vs. non-XLPE), humeral head size, and head composition. Using Kaplan-Meier survivorship and adjusted Cox models, it determined whether head size/composition effects on glenoid wear-related revision differ by polyethylene type. Results guide implant selection to reduce glenoid loosening and polyethylene wear failures.

Athletic Shoulder Performance and Injury (3)

2. Santos GAD, Santos MLD, Solon-Júnior LJF, et al. Association between shoulder pain, muscle strength, and closed kinetic chain performance tests in swimming athletes: Cross-sectional study. Shoulder & Elbow 2026. doi:10.1177/17585732261473900

This cross-sectional study of 62 competitive swimmers (30 with shoulder pain, 32 asymptomatic) examined associations between shoulder pain, kinetic chain muscle strength, and upper limb performance tests (mCKCUEST, UQYBT, ULRT). Shoulder pain and hip stability (HIPSIT) strength were significantly associated with mCKCUEST performance (model R² = 28%), while knee extensor and scapular protractor strength explained 35% of variance in the UQYBT medial direction, and lower trapezius strength was linked to superolateral reach. Findings support screening and rehabilitating proximal kinetic chain deficits, not just the shoulder, in swimmers with shoulder pain or performance limitations.

15. Tsukahara Y, Jyoto E, Sato R. Risk of Shoulder/Elbow Injuries and Imaging Abnormalities in Female Collegiate Baseball and Softball Players. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.026

This cross-sectional study of 67 female collegiate baseball and softball players used questionnaires and diagnostic ultrasound to characterize shoulder and elbow injury prevalence and structural abnormalities. Shoulder pain was reported by roughly 36% of softball and 64% of baseball players, with abnormal shoulder ultrasound findings in 79-100% of players. The high burden of asymptomatic imaging abnormalities highlights the need for surveillance and injury-prevention strategies in female overhead athletes.

19. Driad C, Sonesaksith-Turcotte X, Sandman É, et al. Healthcare Professionals Produce Higher Quality Content for Shoulder Dislocation on TikTok. JAAOS: Global Research and Reviews 2026. doi:10.5435/jaaosglobal-d-24-00337

This cross-sectional study evaluated the first 173 TikTok videos on 'shoulder dislocation,' classifying content into six categories and scoring quality with the validated DISCERN instrument, comparing videos from healthcare professionals (HCPs) versus general users. HCP-produced videos demonstrated higher information quality than those from general users. The findings suggest that directing patients toward professional-created social media content could improve the quality of health information they encounter online.

Rotator Cuff and Calcific Tendinitis Treatment (2)

10. Yuwarungsikul C, Mathurunyanont K, Sirisoonthron J, et al. Arthroscopic and Mini-open Rotator Cuff Repair Yield Comparable Clinical and Structural Outcomes in Small to Medium full-thickness tears: A Systematic Review and Meta-analysis of Randomized Controlled Trials Importance. Journal of ISAKOS 2026. doi:10.1016/j.jisako.2026.101193

This systematic review and meta-analysis of randomised controlled trials compared arthroscopic versus mini-open rotator cuff repair in small to medium full-thickness tears. Both techniques yielded comparable clinical and structural outcomes. Surgeons can choose either approach based on preference and expertise without compromising results in this tear-size subgroup.

16. Mi Y, Jiang B, Pan S, et al. Gärtner Type and Outcomes After US PAL Versus Arthroscopic Debridement for Calcific Tendinitis: A Retrospective Cohort Study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.029

This propensity score-matched retrospective cohort of 72 patients with refractory calcific tendinitis compared ultrasound-guided percutaneous aspiration and lavage versus arthroscopic debridement, stratified by Gärtner calcification type. Both approaches improved outcomes at 12 months, but a significant treatment-by-Gärtner-type interaction showed differential efficacy by calcification morphology. Calcification type should therefore guide the choice between US-PAL and arthroscopic debridement.

Instability, Biomechanics and Nerve Topics (5)

7. Qu X, Li D, Tang X, et al. Episode Count Should Not Substitute for Anatomy in Arthroscopic Bankart Repair: Letter to the Editor. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261464187

This letter to the editor critiques Lin et al's finding that 2 preoperative dislocation episodes predict recurrence after arthroscopic Bankart repair, arguing that episode count is an indirect surrogate rather than a biological threshold. The authors emphasize that recurrence is better explained by age, glenoid bone loss, off-track morphology, and bipolar bone defect interaction, noting Lin et al's own data showed greater structural damage above the threshold. They advocate for anatomic risk stratification (e.g., glenoid track assessment) rather than relying on episode counts for surgical decision-making.

8. Lin RT, Gilbert R, Lin A. Episode Count Should Not Substitute for Anatomy in Arthroscopic Bankart Repair: Response. The American Journal of Sports Medicine 2026. doi:10.1177/03635465261464192

This is the authors' response to Qu et al's letter challenging the use of a 2-dislocation threshold for predicting recurrence after arthroscopic Bankart repair. The authors address three points: episode count as a surrogate versus biological cutoff, the complementary role of anatomic factors in surgical planning, and the clinical utility of the threshold. They defend episode count as a practical, accessible risk-stratification tool that complements, rather than replaces, anatomic assessment in guiding treatment decisions.

11. Afshar A, Tabrizi A, Shariyate MJ. Letter regarding “The Association of Long Thoracic Nerve Variants with Medial Scapular Winging in Thoracic Outlet Syndrome: A Clinical and Anatomical Study”. The Journal of Hand Surgery 2026. doi:10.1016/j.jhsa.2026.04.017

This letter critiques a study linking long thoracic nerve intramuscular variants to medial scapular winging in neurogenic thoracic outlet syndrome, arguing that dorsal scapular nerve entrapment may also contribute to or accentuate these findings. It urges consideration of alternative nerve entrapments when evaluating scapular dyskinesia in TOS. This has implications for preoperative diagnosis and surgical planning.

12. Irshad TB, Pascoletti G, Zanetti EM. The biomechanics of the sternoclavicular joint: an experimental and computational study. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.025

This combined experimental-computational study quantified sternoclavicular joint kinematics and kinetics using inertial sensors on live subjects feeding an OpenSim musculoskeletal model, validated against transcortical pin and instrumented prosthesis data. It found at least 25° of elevation and 35° of retraction, with joint forces peaking near 75% of body weight, though IMU-based retraction measurements underestimated angular displacement due to skin motion artifact. The model offers a reliable noninvasive tool for SCJ biomechanical assessment, with caveats for retraction measurements.

17. Gupta R, Johnston TR, Lee C, et al. Modified Partial Radial to Axillary Nerve Transfer as the Index Procedure for Isolated Axillary Nerve Injury. Journal of Shoulder and Elbow Surgery 2026. doi:10.1016/j.jse.2026.07.023

In a single-surgeon retrospective cohort of 16 patients with isolated axillary nerve injury confirmed by EMG, partial radial-to-axillary nerve transfer was performed as the index procedure after failed conservative management, with donor-site morbidity assessed and deltoid biopsies analyzed for motor endplate morphology. The study reports shoulder range of motion and MRC strength outcomes at minimum 2-year follow-up across a wide range of injury-to-surgery intervals (2-120 months). Findings support nerve transfer as a primary reconstructive option for axillary nerve palsy rather than reserving it for salvage, though the small, heterogeneous cohort limits generalizability.

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