Familial ulnar nerve instability.
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Adolescent↗
Biomedical subjects
D J Bokor
Publications and source records attributed to D J Bokor.
Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases.
We studied retrospectively a consecutive series of 547 shoulders in 529 patients undergoing operation for instability. In 41, the cause of instability was considered to be lateral avulsion of the capsule, including the inferior glenohumeral ligament, from the neck of the humerus, the HAGL lesion. In 35, the lesion was found at first exploration, whereas in six it was noted at revision of a previous failed procedure. In both groups, the patients were older on average than those with instability from other causes. Of the primary cases, in 33 (94.3%) the cause of the first dislocation was a violent injury; six (17.4%) had evidence of damage to the rotator cuff and/or the subscapularis. Only four (11.4%) had a Bankart lesion. In patients undergoing a primary operation in whom the cause of the first dislocation was a violent injury, who did not have a Bankart lesion and had no suggestion of multidirectional laxity, the incidence of HAGL was 39%.
Adolescent↗
Results of nonoperative management of full-thickness tears of the rotator cuff.
The results of nonoperative management of 53 patients with full-thickness tears of the rotator cuff proven by arthroscopic examination was as follows. Patients were treated with nonsteroidal antiinflammatory medication, stretching, strengthening, and occasional steroid injections. Average age at presentation was 62.2 years. Patients were evaluated at an average of 7.6 years. Forty patients were male, and the dominant limb was involved in 40 cases. Thirty-four patients were reviewed by questionnaire and physical examination, whereas 19 patients were evaluated by telephone interview only. In 40 patients, the onset of symptoms was associated with an injury. In 12 patients, workmen's compensation was involved. At follow-up evaluation, the 34 shoulders that were available for examination were evaluated for pain, range of motion, strength, and function. Thirty-nine of the 53 patients (74%) assessed subjectively had only slight or no shoulder discomfort. Of the 28 shoulders presenting within three months of injury, 24 (86%) were rated as satisfactory at the time of latest evaluation. Of the 16 patients who initially had had shoulder pain for over 6 months, only nine (56%) were rated as satisfactory. Most patients showed improvement with regard to their ability to perform activities of daily living. Average active total elevation was 149 degrees compared with 121 degrees at initial presentation. Thirty-two of the 34 patients examined (94%) had evidence of weakness on muscle testing and 19 (56%) had demonstrable muscle atrophy.
Activities of Daily Living↗
Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: a cause of anterior shoulder instability.
Recurrent anterior unidirectional shoulder instability is most commonly associated with an avulsion of the glenoid attachment of the labroligamentous complex (Bankart lesion). However, additional capsular injury is often considered necessary to allow anterior dislocation. Five patients undergoing surgical stabilization for recurrent anterior instability were noted to have not only a classic Bankart lesion but also a complete disruption of the lateral capsule from the humeral neck. Repair of this "floating" anterior inferior glenohumeral ligament was accomplished by reattachment of the medial and lateral capsular disruptions and has led to excellent postoperative function in these patients. None of the patients has had instability after an average follow-up of 26 months. Identification and repair of this unusual anatomic lesion is important and if missed may have a significant negative effect on postoperative stability.
Adolescent↗
Variability of measurement of glenoid version on computed tomography scan.
The purpose of the study was to determine the variability of measurement that might occur with rotation of the scapula in the coronal plane when computed tomography scanning is used. Ten dry scapula specimens had 4 sets of computed tomography scans performed at +20 degrees, +10 degrees, neutral, and -10 degrees of scapula rotation. The angle of glenoid version was then measured according to the technique of Friedman. The measured value for glenoid version was noted to vary by as much as 10 degrees on the same specimen with minor rotation of the scapula. This result occurred because of differences in the curvature of the vertebral border of the scapula. The measured angle of glenoid version was most likely to vary with rotation of the scapula 10 degrees downward (i.e., glenoid articular surface facing 10 degrees upward). For accurate and reproducible measurement of the glenoid version, it is essential that in the scout view the glenoid orientation is neutral (i.e., glenoid surface is perpendicular to the plane of the computed tomography cut).
Humans↗
Acute repair of injury to the anterior cruciate ligament. A long-term followup.
We reviewed 30 patients at an average of 7.4 years after acute repair of the anterior cruciate ligament augmented with a loop of iliotibial tract. A noncontact twisting had been the mechanism of injury in 18 of these patients, with 28 having been injured in sports. At followup, 25 patients had not experienced symptoms of instability and 23 were able to return to unrestricted athletic activity; only 5 had been unable or unwilling to return to sporting activity at all. There had been no swelling in 23 patients; however, 17 suffered from pain on exertion. The average Lysholm score was 93.2. Joint laxity was assessed and anteroposterior tibial translation quantified with a KT-1000 arthrometer. Eighteen patients had a normal or 1+ Lachman test and 27 had an absent or 1+ pivot shift. When compared with the results of a similar study performed on this group of patients at 2 years after surgery, there had been little subjective change in knee function. However, objectively there had been significant deterioration of the anteroposterior stability of the knees at 7 years, suggesting failure of the integrity of the repaired ligament with time. An associated medial collateral ligament injury had a significant adverse effect both on the integrity of the anterior cruciate ligament repair and the incidence of postoperative stiffness.
Adult↗