John E. Kuhn

Objective: The majority of the published literature regarding the septal aperture (SA) dates to the last 200 years. The archeological literature is sparse. The collection from Tombos along the Nile River (1400–656 BCE) provides an opportunity for further study of SA in ancient populations. The purpose of this study was to determine the prevalence and shape of SA in the population as well as the size of the humerus and correlate that with and without SA in the Tombos population. Methods: Adult humerus specimens from the Tombos skeletal population with intact distal humeri were studied using both photography and caliper measurements. The caliper and photographic methods gave equal results. Results: There were 164 distal humeri; an SA was present in 40.9%. There were no differences by sex, age group, or laterality. Of the 34 individuals with bilateral intact paired humeri, 47% had SAs. The involvement was bilateral in 13, left in 2, and right in 1. The shapes of the apertures were oval/elliptical in 73%, irregular in 15%, and circular in 12%. Those humeri with an SA had smaller epicondylar breadths, vertical humeral head diameters, humeral shaft diameters, condylar articular width, and trochlear articular width. There were no differences in the coronoid or olecranon fossa width/height. The 41% prevalence of SA in the Tombos population is similar to the 45%–60% in other African archeological studies but higher than the 20%–37% in prehistoric Native Americans. Smaller humeri had a higher prevalence of SA similar to several modern‐day studies. Conclusions: The etiology of SA is not definitively known, with mechanical, structural, and genetic etiologies postulated. A high prevalence of bilaterality is supportive of a genetic etiology; our 81% prevalence of bilaterality suggests a strong genetic component in the etiology of SA in this particular population.

The Multicenter Orthopaedic Outcomes Network Shoulder Group conducted a prospective cohort study of 452 patients with symptomatic atraumatic rotator cuff tears treated with a physical therapy program to determine the predictors of failure of nonsurgical treatment, to provide insight into indications for surgery. After 10 years, we found the following: (1) Physical therapy was effective for over 70% of patients. (2) PROMs showed statistical and clinical improvement after 12 weeks of therapy and did not decline over 10 years. (3) Cuff tear severity did not correlate with pain, duration of symptoms, or activity level. (4) Of those who had surgery, 56.7% had surgery in the first 6 months while 43.3% had surgery between 6 months and 10 years. (5) Early surgery was primarily driven by low patient expectations regarding the effectiveness of therapy. (6) Later surgery predictors included workers' compensation status, activity level, and patient expectations. (7) Only 1 patient had a reverse arthroplasty (0.2% of the cohort). These data suggest that physical therapy is an effective and durable treatment of atraumatic symptomatic rotator cuff tears and most patients successfully treated with physical therapy do not exhibit a decline in patient-reported outcomes over time. Reverse arthroplasty after nonsurgical treatment is exceptionally rare.

Background: A prospective cohort study was conducted to assess the predictors of failure of nonoperative treatment, defined as the patient undergoing surgery for symptomatic, atraumatic full-thickness rotator cuff tears. We present the 10-year follow-up data of this population to determine if predictors for surgery change over time, and secondarily we report the outcomes of the cohort. Methods: At the time of enrollment, demographic, symptom, rotator cuff anatomy, and patient-reported outcome data were collected in patients with symptomatic, atraumatic full-thickness rotator cuff tears. Patients underwent a standard physical therapy protocol for 6 to 12 weeks. Patient data were then collected at 1, 2, 5, 7, and 10 years. Failure of nonoperative treatment was defined as the patient electing to undergo surgery. Results: Of the 452 patients in the original cohort, 20 patients (5%) withdrew from the study, 37 (9%) died before 10 years, and 40 (9%) were otherwise lost to follow-up. A total of 115 patients (27.0%) underwent a surgical procedure at some point during the 10-year follow-up period. Of these patients, 56.5% underwent surgery within 6 months of enrollment and 43.5%, between 6 months and 10 years. Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery. Workers’ Compensation status and activity level were more important predictors of later surgery. Patient-reported outcome measures all improved following physical therapy. For patients who did not undergo a surgical procedure, patient-reported outcome measures did not decline over the 10-year follow-up period. Conclusions: Low patient expectations regarding the efficacy of physical therapy were found to be a predictor of early surgery, whereas Workers’ Compensation status and activity level were predictors of later surgery. Physical therapy was successful in >70% of patients with symptomatic, atraumatic full-thickness rotator cuff tears at 10 years. Outcome measures improved with physical therapy and did not decline over the 10-year follow-up period. Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

(1) Background: Full-thickness rotator cuff tears (RCTs) impact 25% of those over 60 and 50% over 80; however, minimal data exists on public understanding; (2) Methods: The primary outcome was to determine the public’s baseline understanding of RCTs utilizing a 36-question survey regarding anatomy and function, risk factors, diagnosis and treatment options, and expectations. Secondarily, we evaluated the effect of an educational video and informational handout created by the authors to improve understanding. Participants ≥ 18 years were recruited from the senior author’s clinic and online discussion platforms over a 5-month period; (3) Results: Baseline surveys were completed by 382 individuals: 56% men, 64% Caucasian, 27% with at least a master’s degree, and 56% with very little or no RCT knowledge. Mean correct answer scores improved from 47% to 68% posteducational intervention (p < 0.001). Males, higher education level, healthcare experience, and a higher self-rated understanding of RCTs were significantly correlated with higher survey performance (p < 0.001); (4) Conclusions: The public’s knowledge of RCTs at baseline was poor, with demographic factors correlating with survey performance. The educational intervention effectively enhanced participants’ understanding. By focusing on common misconceptions, this data can help clinicians align patient expectations and enhance patient outcomes.