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Biomedical subjects

C S Neer

Publications and source records attributed to C S Neer.

At least 19 recordsLinked to original sources
PubMed1992

The anatomy and potential effects of contracture of the coracohumeral ligament.

In 63 anatomic specimens of the shoulder, the coracohumeral ligament was found to be a clear, well-developed structure in 59 and absent or vestigial in four. The origin of the coracohumeral ligament was consistently found at the base of the coracoid process. The insertion was more variable, between the rotator interval, supraspinatus, and subscapularis. In fresh specimens, the coracohumeral ligament was tight with maximal external rotation, which increased an average of 32 degrees on sectioning this ligament only. The coracohumeral ligament has been found to be shortened in various pathologic states. Its release may be required to restore restricted external motion when doing arthroplasties or to allow adequate mobilization of the tendons when repairing retracted tears of the rotator cuff.

Aged↗
PubMed1988

Archer's shoulder. Recurrent posterior subluxation and dislocation of the shoulder in two archers.

Two right-handed archers presented with posterior instability of the shoulder. A 19-year-old Japanese and a 26-year-old white male archer developed pain and instability of the shoulder of 6 months' duration. Both had engaged in archery for several years. Both exhibited a positive apprehension test and recurrent posterior subluxation and dislocation by flexing the arm to 80 degrees with internal rotation. Both could reduce the instability with a snap by extending the arm. For the subluxation, Neer's inferior capsular shift procedure via a posterior approach was performed. For the dislocation, a posterior bone block was added to the inferior capsular shift. The posterior capsular redundancy was marked in both cases. At 5 and 9-years follow up respectively, both were doing archery and full activities without pain. These cases are thought to be examples of how a repetitive force can cause shoulder instability.

Adult↗
PubMed1988

Glenoid bone-grafting in total shoulder arthroplasty.

Abnormal glenoid architecture resulting from loss of bone usually is listed among the contraindications to total shoulder arthroplasty using an unconstrained prosthesis. However, in a series of 463 consecutive replacement procedures that were performed between 1973 and 1985, in only two patients did the lack of bone make the implantation of a glenoid component impossible. Of the remaining sixty-five shoulders that had an abnormal glenoid, twenty were successfully treated with a large, internally fixed bone graft or grafts and forty-five, with smaller bone grafts that were not internally fixed. Nineteen of the twenty shoulders that had a large graft or grafts were followed for two years or more (average, 4.4 years). The clinical results were judged to be excellent in sixteen and satisfactory in one, and the desired limited goals were obtained in two. Two fixation screws broke and one screw was worn by contact with the humeral component. None of the glenoid components clinically loosened or migrated, and no patient has needed further surgical treatment. Although bone-grafting was necessary in only twenty (4.3 per cent) of the 463 replacement procedures, this procedure provided sufficient osseous support to allow implantation of a component in a severely damaged glenoid.

Adult↗
PubMed1987

A functional analysis of shoulder fusions.

Seventeen shoulder fusions with relatively normal musculature were analyzed with particular interest to the ability of the fused extremity to perform activities of daily living. Joints fused for paralysis were excluded. No patient was able to work overhead or with arms abducted as required for activities such as hammering, house painting, or climbing a ladder. Many patients had difficulty functioning at head level for hygienic purposes. Many were unable to perform functions behind the back, although waist-level function approached normal. The position of rotation was the most critical factor in approaching optimum function. Fusions in positions of internal rotation reduced the ability to comb hair, wash the face, or to otherwise use the hand at head level. Fusion in a position of excessive external rotation made it impossible for the patient to reach the opposite axilla or belt buckle. There was a range of acceptability of abduction of forward flexion that did not appear to compromise the eventual functional result. The recommended position is 25 degrees to 40 degrees abduction, 20 degrees to 30 degrees flexion, and 25 degrees to 30 degrees of internal rotation. Even at the ideal position, shoulder fusion produces significant limitations in function. For patients with painful, nonfunctional shoulders who need arthrodesis, these limitations should be clearly discussed, along with the pros and cons of surgical treatment in general.

Activities of Daily Living↗
PubMed1987

Locked posterior dislocation of the shoulder.

Of forty patients with forty-one locked posterior dislocations of the shoulder, the diagnosis had been missed by the initial physician in the majority. A motor-vehicle accident, a seizure, an alcohol-related injury, or electroshock therapy had caused the dislocation in these patients, and the average interval from injury to diagnosis was one year. Twenty-five of the forty-one dislocations had been diagnosed in less than six months. An axillary radiograph confirmed the diagnosis in all shoulders and demonstrated the approximate size of the impression defect. There were no associated displaced fractures of the humerus, but in twenty of the shoulders there was an undisplaced fracture of the proximal part of the humerus. The average length of follow-up was 5.5 years. For seven shoulders the deformity was accepted. Treatment in the others consisted of closed reduction, which was attempted in twelve shoulders and was successful in six of the twelve; transfer of the subscapularis tendon, which was attempted in nine shoulders and was successful in four; transfer of the lesser tuberosity, which was successful in all four shoulders that were so treated; hemiarthroplasty, which was performed in nine shoulders and was successful in six (the other three required revision); and total arthroplasty in ten shoulders, one of which dislocated postoperatively and was not treated. Once the diagnosis is established, the majority of patients with this lesion can be successfully managed.

Adolescent↗
PubMed1985

Involuntary inferior and multidirectional instability of the shoulder: etiology, recognition, and treatment.

Multidirectional and inferior instability of the shoulder is not rare. Etiological factors include various combinations of (a) repetitive injuries, (b) inherent joint laxity, and (c) one or more major injuries. It is seen in athletic and active patients without generalized joint laxity and as well in sedentary patients with hypermobile joints. Standard operations for unidirectional anterior or posterior dislocations fail to correct multidirectional instability because they do not correct inferior instability and they may displace the head in fixed subluxation to the opposite side leading to severe arthritis ("arthritis of dislocations"). Proper detection depends on suspecting its possibility in all types of patients and in a wide age range as well. Helpful signs include the sulcus sign, positive apprehension test in multiple directions, stress roentgenograms and fluoroscopy, and evaluations under anesthesia. Arthroscopy may be helpful in doubtful cases, but the findings require clinical interpretation. Selection of patients with multidirectional instability for surgery is extremely difficult because it requires not only great care in determining all directions of instability and planning the repair but also determining the motivation of the patient and excluding the possibility of some other condition being present that is causing pain rather than the joint laxity. The results of inferior capsular shift have continued to withstand the test of time and, though it is more difficult than standard procedures, is considered a very helpful procedure in the treatment of these difficult lesions. The principle is to reduce capsular laxity on all three sides by shortening and reinforcing and to reduce the joint volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Unconstrained shoulder arthroplasty.

Shoulder arthroplasty is in a stage of development that is ahead of replacement of other joints, if one considers not only movement and function but also durability. It is a difficult and demanding procedure requiring a meticulous cement and rotator cuff technique. Stability of a nonconstrained implant depends on its height and the length of the head version. Active motion depends on the rotator cuff and deltoid. Neither loss of bone nor tears of the rotator cuff contraindicate a nonconstrained replacement; however, massive defects of the muscles or bone are treated with a "limited goals rehabilitation" program to achieve stability with less motion. Shoulder replacement seems to enjoy unique durability; however, glenoid component follow-up is limited to 11 years. Up to now the incidence of reoperation for loosening of a glenoid component in 455 patients reported in four recent series combined was under 1%, and most radiolucent lines at the glenoid are believed to be attributable to errors in technique rather than loosening. Because of recent breakage of two polyethylene glenoid components, a standard-sized metal-backed glenoid component has been made available for general use and is preferred especially in active patients and those with sloping glenoids. The 600% glenoid component is no longer used; however, it is expected that the 200% component will be made available for general use after adequate clinical trial of the new holding device.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Cuff-tear arthropathy.

In this report we describe the clinical and pathological findings of cuff-tear arthropathy in twenty-six patients and discuss the differential diagnosis and a hypothesis on the pathomechanics that lead to its development. This lesion is thought to be peculiar to the glenohumeral joint because of the unique anatomy of the rotator cuff. Following a massive tear of the rotator cuff there is inactivity and disuse of the shoulder, leaking of the synovial fluid, and instability of the humeral head. These events in turn result in both nutritional and mechanical factors that cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head. A massive tear also allows the humeral head to be displaced upward, causing subacromial impingement that in time erodes the anterior portion of the acromion and the acromioclavicular joint. Eventually the soft, atrophic head collapses, producing the complete syndrome of cuff-tear arthropathy. The incongruous head may eventually erode the glenoid so deeply that the coracoid becomes eroded as well. Although treatment of cuff-tear arthropathy is extremely difficult, the preferred method appears to be a resurfacing total shoulder replacement with rotator-cuff reconstruction and special rehabilitation. We think that it is important to recognize cuff-tear arthropathy as a distinct pathological entity, as such recognition enhances our understanding of the more common impingement lesions. Cuff-tear arthropathy is especially difficult to treat, and although many tears of the rotator cuff do not enlarge sufficiently to allow this condition to develop, it is a factor to consider when deciding whether or not a documented tear of the rotator cuff should be surgically repaired.

Aged↗
PubMed1982

Revision of humeral head and total shoulder arthroplasties.

A prospective study was undertaken of 40 revisions of humeral head and total shoulder arthroplasties performed during the past nine years. The average follow-up period was 42 months. Surgical revision consisted of conversion to unconstrained total shoulders in 34 shoulders, fixed-fulcrum total shoulder in one shoulder, and "cleanout" of the implant and cement in five shoulders, of which three were later fused. The indications for fusion were (1) infection, and (2) extensive loss of shoulder muscles, including both the deltoid and rotator cuff. Neither loss of bone nor rotator cuff defects were considered contraindications to unconstrained total shoulder arthroplasty; however, the results of this study emphasize the need for a good initial humeral head arthroplasty, insofar as the function of revisions is often impaired by muscle damage, bone loss, and scar.

Adolescent↗
PubMed1981

On the disadvantages of radical acromionectomy.

We studied thirty consecutive patients who previously had a radical acromionectomy performed elsewhere. All had poor results from the procedure. Twenty-seven had persistent pain, all had marked weakness of the shoulder, and none could raise the arm above the horizontal. Eight had had serious wound complications. All objected to the appearance of the shoulder. We concluded that radical acromionectomy weakened the deltoid both by removing its lever arm and by encouraging retraction of the deltoid muscle became adherent to either the rotator cuff or the humerus, or both, and soon became fibrotic and permanently shortened. This combination of factors makes a successful reconstruction of the deltoid mechanism especially difficult.

Acromion↗