One century of shoulder and elbow surgery

Within 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 fu nction. It is used in degenerative omarthrosis, humeral head fractures, rhe umatoid arthritis, and rotator cuff arthropathy. After 10 years, survival o f 93% can be expected and in omarthrosis an outcome score of 85 of 100 poin ts. In recurrent shoulder instability, open surgery is still the gold standard. It allows to accurately adjust capsular tension. Modern arthroscopic techn iques shorten the capsule with sutures or by capsular shrinkage, but suffic ient follow-up is not yet available. Arthroscopic subacromial decompression is the standard procedure for subacr omial disorders. The indication for operative rotator cuff closure must be adjusted to the age and functional expectations of the patient. Smaller def ects can be closed arthroscopically. The operative technique in proximal hu merus fractures is particularly demanding, due to osteoporosis and the risk of avascular necrosis. Magnetic resonance imaging is the preferred imaging technique at the should er, often combined with intravenous or intraarticular contrast injection. E lbow joint replacement is mostly used in rheumatoid arthritis and has achie ved a high technical standard.