title: Current practice in shoulder pathology: results of a web-based survey among a community of 1,084 orthopedic surgeons.
abstract: OBJECTIVE
  The aim of this study was to report orthopedic surgeons' management of choice for difficult clinical scenarios of shoulder pathologies.
  
  
  METHODS
  A web questionnaire was developed including four clinical scenarios of shoulder pathologies. Subsequently, opinions were solicited from more than 1,000 members of an international association of surgeons specialized in sports traumatology and knee surgery (ESSKA).
  
  
  RESULTS
  The response rate was 40% (412 questionnaires). For scenario 1, first anterior dislocation of the shoulder, the most indicated treatment for 71% of respondents was an arthroscopic Bankart repair (P < 0.001). For scenario 2, shoulder arthritis with concentric erosion and cuff tear, 38% chose a shoulder replacement, while 37% preferred a supraspinatus tendon repair in combination with long head of biceps (LHB) tenodesis or tenotomy. For scenario 3, large tendon tears with 70% fatty infiltration of the infraspinatus tendon and lateral LHB instability, 70% of surgeons considered that, among conservative treatments, hyaluronic acid injection was not an appropriate management. Arthroscopic rotator cuff repair, arthroscopic acromioplasty, and LHB tenotomy gained larger consensus (81, 80, and 79% of respondents, respectively). A double-row technique for rotator cuff repair was preferred to a single-row technique (P = 0.02). Scenario 4, adhesive capsulitis, split the respondents equally, with 51% in favor of a surgical approach and 49% in favor of a conservative approach (N.S.).
  
  
  CONCLUSIONS
  On-line questionnaires have the potential to improve knowledge about current trends in clinical practice and can help orthopedic surgeons to develop guidelines.
  
  
  METHODS
  Cross-sectional; Level V (expert opinion).
authors.affiliation: Dipartimento Di Scienze Medico-Chirurgiche, Università Degli Studi Di Milano, IRCCS, Policlinico San Donato, Milan, Italy. pietro.randelli@unimi.it
authors.forename: P
authors.initials: P
authors.lastname: Randelli
authors.forename: P
authors.initials: P
authors.lastname: Arrigoni
authors.forename: F
authors.initials: F
authors.lastname: Cabitza
authors.forename: V
authors.initials: V
authors.lastname: Ragone
authors.forename: P
authors.initials: P
authors.lastname: Cabitza
mesh_terms: D000368:Aged; D001168:Arthritis / Q000150:complications* / Q000601:surgery; D001182:Arthroscopy; D002062:Bursitis / Q000601:surgery*; D005260:Female; D006306:Health Surveys; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000293:injuries* / Q000601:surgery; D019637:Orthopedic Procedures; D009985:Orthopedics; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012783:Shoulder Dislocation / Q000601:surgery*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000601:surgery*; D055815:Young Adult