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Biomedical subjects

D M Dines

Publications and source records attributed to D M Dines.

At least 19 recordsLinked to original sources
PubMed2001

Coracoid impingement syndrome, rotator interval reconstruction, and biceps tenodesis in the overhead athlete.

Anterior shoulder problems are extremely common in throwing athletes. Coracoid impingement syndrome, lesions of the long head of the biceps tendon, and rotator interval lesions are included in the extensive differential diagnosis which exists for anterior shoulder pain. In this article, we focus on the anatomy, pathophysiology, clinical presentation, diagnosis, and surgical treatment of these conditions.

Aftercare↗
PubMed2000

Proximal humerus malunions.

Malunion of a proximal humerus fracture often is painful and debilitating. Operative management of this deformity is technically demanding and frequently results in a relatively high rate of complications. Reconstruction involves a spectrum of procedures including excision of bony prominences, tuberosity osteotomy and realignment, and shoulder arthroplasty. This article covers the etiology, classification, diagnosis, and management of these complex injuries. A successfully performed reconstruction diminishes the patient's pain and potentially increases function.

Fractures, Ununited↗
PubMed2000

Arthroscopy for failed shoulder arthroplasty.

PURPOSE: It was the purpose of this study to describe the specifics of technique and results of arthroscopic evaluation and treatment of failed shoulder arthroplasties in 10 patients with early and late complications of shoulder arthroplasty. TYPE OF STUDY: Case series. MATERIALS AND METHODS: Ten patients (2 bilateral) underwent 13 arthroscopies after poor results following shoulder arthroplasty. The arthroscopic diagnoses ranged from rotator cuff tears in 5 shoulders, fibrosis and scarring of the long head of the biceps in 5 shoulders, impingement and biceps tendinitis in 1 shoulder, and capsular contracture in 1 shoulder. We performed 4 mini-open rotator cuff repairs, 1 open rotator cuff repair with revision of the humeral component, 5 arthroscopic debridements of the long head of the biceps, 2 arthroscopic decompressions with biceps tenodesis, and 1 arthroscopic capsular release. RESULTS: Before arthroscopy, the preoperative Hospital for Special Surgery (HSS) scores were 6 fair and 6 poor. At latest follow-up, there were 3 excellent, 4 good, and 5 fair results. There was a statistically significant improvement in HSS scores and range of motion for all patients in this study. All patients were satisfied with the results of the procedure. There were no infections or wound problems and neurovascular status was unaltered after arthroscopy. There was 1 intraoperative complication, a periprosthetic humerus fracture after manipulation in an osteoporotic woman with rheumatoid arthritis. CONCLUSION: Arthroscopy proved to be a reliable diagnostic and therapeutic tool in dealing with some of the postoperative complications encountered both early and late after shoulder arthroplasty. Careful attention to surgical technique, including use of blunt trocars, traction, and intraoperative prophylactic antibiotics, can minimize complications of arthroscopy in this setting.

Adult↗
PubMed1999

Arthroscopic assisted rotator cuff repair.

The advent of the arthroscope has revolutionized orthopaedic surgery, particularly for injuries to the knee or shoulder. The enhanced visualization accompanied by minimal soft tissue injury afforded by the arthroscope has been applied successfully to the treatment of many shoulder girdie pathologies, most notably impingement syndrome and rotator cuff injuries. As such, the traditional open surgery with the incumbent morbidity, while still utilized for more complex tears is finding less application in smaller tears to the rotator cuff. This review will address the history, indications, technique, and results of arthroscopic rotator cuff repair.

Journal Article↗
PubMed1998

Glenoid replacement in total shoulder arthroplasty.

The outcome of total shoulder arthroplasty is largely based on the quality of glenoid component fixation, which, in turn, is related to the amount and quality of bone stock, glenohumeral stability, and rotator cuff function. This article discusses the anatomic and pathologic indications for glenoid replacement, surgical techniques, and results.

Arthroplasty, Replacement↗
PubMed1997

Familial calcification of the superior transverse scapular ligament causing neuropathy.

Two patients, members of the same family, were found to have entrapment of the suprascapular nerve from a calcified superior transverse scapular ligament. The chief complaint in both cases was pain and weakness and atrophy of the supraspinatus and infraspinatus muscles. The nerve entrapment was confirmed by electromyographic studies and required surgical decompression to relieve the symptoms in both patients. Release of the entrapped nerve resulted in complete pain relief and full return of strength at 1-year followup.

Adult↗
PubMed1995

Arthroscopic fixation of superior labral lesions using a biodegradable implant: a preliminary report.

Twenty-two patients were treated for symptomatic lesions of the superior glenoid labrum in association with instability of the tendinous insertion of the long head of the biceps brachii. A biodegradable implant was used to fix the labrum to the bony glenoid using an arthroscopic technique. At 2-year average follow-up, satisfactory results were obtained in 86% of the patients. Two patients, both of whom had undergone concomitant subacromial decompression, continued to complain of pain after the procedure; 3 patients had restricted motion postoperatively, and 1 required manipulation under anesthesia. Twelve of 13 overhead athletes were able to return to full premorbid function. Arthroscopic fixation of unstable lesions of the superior labrum led to a resolution of symptoms in the majority of patients. There were no complications related to the use of the biodegradable implant.

Adolescent↗
PubMed1995

The conservative management of the unstable shoulder including rehabilitation.

The conservative management of shoulder instability depends on a well-defined program that emphasizes early diminution in the patient's symptoms, appropriate immobilization, and a well-defined precise rehabilitation program that can be individually tailored to meet the patient's needs. Immobilization should be considered in younger patients less than 20 years of age for between 3 to 4 weeks in order to enhance capsulolabral complex healing. Older patients may be immobilized for a shorter period of time. Analgesic medication and local physical therapeutic modalities may be used to decrease the patient's symptomatic complaints. Once the immobilization period has ended, a precise and specific rehabilitation program tailored for the individual needs of the patient should be undertaken. The rehabilitation program should emphasize early and safe regaining of normal ROM, strengthening of the dynamic stabilizers of the shoulder, and strengthening of the scapular stabilizing muscles of the shoulder. Finally, rehabilitation programs that enhance the patient's neuromuscular control over the glenohumeral joint should be considered in the conservative management of the unstable shoulder.

Arm Injuries↗
PubMed1994

Modular shoulder hemiarthroplasty for acute fractures. Surgical considerations.

Displaced fractures of the proximal humerus with concomitant comminution, interruption of vascular supply, and articular incongruity often require prosthetic replacement for successful treatment. In these difficult cases, the success of prosthetic replacement is dependent on proper patient selection, appropriate surgical technique, and a well-supervised postoperative rehabilitation program. Careful surgical technique should ensure proper placement of the humeral component at the correct height and version, and proper position and fixation of the displaced tuberosities. Supervised rehabilitation emphasizing early range of motion and strength when the tuberosities have healed improves results. The authors found that a modular design humeral implant allows for improved tensioning of the soft tissues and reconstruction of the tuberosities.

Arthroplasty↗
PubMed1993

Instability of the shoulder after arthroplasty.

A replacement arthroplasty was performed in 236 shoulders at The Hospital for Special Surgery from 1984 through 1989. Ten patients (eight women and two men) from that group were identified as having instability of the shoulder at the time of follow-up, and the results for these patients were reviewed retrospectively. The ages of the patients ranged from fifty-six to seventy-nine years. The instability was anterior in seven of the patients and posterior in three. The anterior instability was caused by a rupture of the repaired subscapularis tendon. The operative treatment of the anterior instability consisted of mobilization and repair of the tendon, but three of the seven patients continued to have instability. A static stabilizer, consisting of an allograft of Achilles tendon, was inserted in these three patients, and the result was a success. The etiology of the posterior instability (three patients) was multifactorial. Treatment consisted of correction of any soft-tissue imbalance and revision of the prosthetic components as necessary. All ten patients were followed clinically and radiographically for at least two years. All of the patients had some loss of motion of the shoulder as compared with the motion before the dislocation. There were no neurovascular complications, problems related to the allografts, or any other complications. We concluded that proper balancing of the soft tissues and positioning of the prosthetic components are essential to a successful arthroplasty of the shoulder. The postoperative rehabilitation should include a physical therapy program in which the range of motion of the arm that was achieved in the operating room is not exceeded.(ABSTRACT TRUNCATED AT 250 WORDS)

Achilles Tendon↗
PubMed1992

Modular hemiarthroplasty for fractures of the proximal part of the humerus.

A new biomodular prosthesis was used for the treatment of a displaced fracture of the proximal part of the humerus in twenty-two shoulders in twenty-two patients. The fractures were classified according to the Neer system; there were thirteen four-part, five three-part, and four head-splitting fractures. There were fifteen women and seven men, and the mean age was seventy years (range, forty-nine to eighty-seven years). The hemiarthroplasty was performed an average of eleven days (range, one to forty-five days) after the injury. The deltopectoral interval was used in all patients, and the prosthesis was implanted with cement in twenty of the shoulders. All of the patients participated in a supervised program of rehabilitation. The patients were followed for an average of thirty-six months (range, twenty-six to forty-nine months). Twenty of the twenty-two patients had a good or excellent result. The active forward elevation averaged 119 degrees; external rotation, 40 degrees; and internal rotation, to the twelfth thoracic vertebra. All of the patients except for the two who had a poor result had satisfactory relief of pain. The two patients who had a poor result had a successful revision with a modular prosthesis of the same design. The modular head could be removed, enabling the surgeon to gain access to the glenoid and to adjust the soft tissues. The over-all scores correlated inversely with the age of the patients and the interval from the injury to the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

The coracoid impingement syndrome.

Coracoid impingement results from encroachment on the coracohumeral space, presenting as anterior shoulder pain and clicking, particularly in forward flexion, medial rotation, and adduction. In eight shoulders in seven patients, coracohumeral decompression by excision of the lateral 1.5 cm of the coracoid with re-attachment of the conjoined tendon gave pain relief in all, and complete relief in six. This procedure is described and recommended.

Adolescent↗
PubMed1989

Total knee arthroplasty in patients with psoriasis.

Patients with progressive psoriasis have an increased infection rate when having total joint arthroplasty. Therefore, maximum precautions should be taken in the perioperative period as well as with long-term follow-up care to prevent joint sepsis in these patients. In particular, skin care should be meticulous. Special attention should be given to use of a topical corticosteroid or other dermatologic treatment when total joint arthroplasty is considered.

Anti-Bacterial Agents↗
PubMed1985

The roentgenographic evaluation of anterior shoulder instability.

Retrospective evaluations of roentgenograms of 83 patients with unilateral shoulder instability were surveyed to evaluate the usefulness of various radiographic projections and to correlate the information with the osseous pathology associated with prior glenohumeral dislocation. The Hill-Sachs and the osseous Bankart defects were considered pathognomonic radiographic signs of glenohumeral joint instability. Based on history, physical examination, and examination under general anesthesia, patients were divided into three categories--(1) dislocation group, (2) subluxation group, and (3) combination group. Roentgen projections evaluated included the anteroposterior view with the humerus in internal and external rotation, axillary view, West Point view, Stryker notch, and Didiee view. The Hill-Sachs defect on the posterolateral aspect of the humeral head was best demonstrated on the combination of an internal rotation and a Stryker notch view. The osseous Bankart defect on the anteroinferior glenoid rim was best documented on the Didiee and West Point views. The external rotation and axillary view did not add significantly to the preoperative radiographic findings. In a patient with an unstable shoulder, a radiographic series that includes an internal rotation, a Stryker notch view, and either a West Point or a Didiee view would maximize the diagnostic yield per radiographic cost, time, and exposure.

Adolescent↗
PubMed1978

Supracondylar osteotomy in thalassemia.

The skeletal system manifestations of thalassemia are characterized by severe osteoporosis, frequent fractures and delayed healing. Permanent deformity and disability can complicate the fractures. Surgical correction of deformity by osteotomy of severely osteoporotic bone and immobilization without internal fixation was successful in a 20-year-old woman. While operative correction of deformity is not routinely recommended, the good experience with this case suggests that similar orthopedic procedures can be included in the treatment of thalassemia.

Adult↗
PubMed1976

Fractures in thalassemia.

Fractures occur frequently in patients with homozygous beta-thalassemia. A study was made of the fractures noted in a group of patients who were followed at the Thalassemia Clinic at The New York Hospital-Cornell Medical Center. Results indicate that these patients often sustain fractures which are multiple and which frequently heal with resultant deformities.

Adolescent↗
PubMedDate not supplied

Humeral head osteonecrosis: clinical course and radiographic predictors of outcome.

Forty-two patients (65 shoulders) with osteonecrosis of the humeral head were reviewed. Minimal follow-up was 2 years or until shoulder arthroplasty was performed for persistent severe pain and disability not responsive to conservative treatment. Thirteen shoulders had surgery shortly after presentation, whereas 22 others initially treated conservatively required surgery. Thirty shoulders in 20 patients have been treated without surgery and were evaluated at an average of 10 years after initial presentation. Fifteen shoulders are doing satisfactorily, whereas 15 others are doing poorly. Overall, 37 (71%) shoulders had clinical progression of disease requiring shoulder arthroplasty or resulting in severe pain and disability. All had radiographic stage III, IV, or V, and 41 (85%) had articular surface incongruity of 2 mm or greater. Humeral head drilling was not effective in preventing clinical or radiographic progression in stage III.disease. Radiographic stages of III or greater and documented radiographic disease progression were significantly associated with a poor outcome.

Adrenal Cortex Hormones↗