PubMed Health⌕ Search

Biomedical subjects

Evan Flatow

Publications and source records attributed to Evan Flatow.

8 recordsLinked to original sources
PubMed2006

Outcomes following open repair of Bankart lesions for recurrent, traumatic anterior glenohumeral dislocations.

Though open stabilization using the Bankart procedure is still considered the "gold standard," few studies have examined the long-term outcomes. Between 1988 and 2001, 64 patients met inclusion criteria and had an open stabilization performed. Forty-one patients were available for follow-up at an average of 6.5 years. Forty (98%) patients reported having a stable shoulder. Average loss of external rotation was 4 degrees and average Rowe score was 96. This study further supports the trustworthiness of an open anatomic subcapsulolabral reconstruction for recurrent anterior instability and provides another standard from which to compare newer surgical methods.

Adolescent↗
PubMed2005

Reliability and reproducibility of radiographs of greater tuberosity displacement. A cadaveric study.

BACKGROUND: Classification of fractures of the greater tuberosity has shown poor reliability, in part as a result of an inability to assess fracture displacement accurately. We used fluoroscopic images of prepositioned osteotomized greater tuberosity fragments in cadavers to determine the accuracy of radiographic interpretation, the interobserver reliability, and the effect that radiographs might have on surgical decision-making. METHODS: Twelve osteotomies of the greater tuberosity (three each with 2, 5, 10, and 15 mm of displacement) were created in whole-body cadavers. Six fluoroscopic images (anteroposterior views in external and internal rotation, anteroposterior views in neutral rotation with 15 degrees of cephalic and 15 degrees of caudal tilt, a lateral outlet view, and an axillary view) were made after each osteotomy. Four experienced orthopaedic surgeons measured displacement in millimeters on seventy-two randomized images. Four views in sequence (the anteroposterior view in internal rotation and the outlet view together, then the axillary view, and then the anteroposterior view in external rotation) of each osteotomy pattern were then viewed, and each surgeon was asked whether surgery would be indicated on the basis of each set of images. RESULTS: No one fluoroscopic view was significantly more accurate than another. There was a trend toward increased accuracy of imaging of minimally displaced (</=5 mm) tuberosity fragments with the anteroposterior view in external rotation. When viewed sequentially, the anteroposterior view in external rotation, evaluated last, altered treatment in nine of forty-eight situations. There was substantial agreement (kappa = 0.71) among the surgeons with respect to their recommendations for treatment of the displaced greater tuberosities after they had inspected the four images. CONCLUSIONS AND CLINICAL RELEVANCE: To our knowledge, we are the first to examine the accuracy and reliability of interpreting images of known displacements of the greater tuberosity. Multiple radiographic views are needed to evaluate displacement of the greater tuberosity appropriately. The anteroposterior view in external rotation can profile the greater tuberosity and help demonstrate small displacements. Treatment decisions should be consistent between surgeons when multiple views are used.

Cadaver↗
PubMed2004

A retrospective radiographic review of hemophilic shoulder arthropathy.

Bleeding into large joints is the most common orthopaedic manifestation of hemophilia. Involvement of the shoulder rarely is reported, lending to its relative neglect in the orthopaedic literature. Through retrospective chart and radiographic reviews, the incidence and progression of radiographic and clinical changes that occur in the shoulder of patients with hemophilia is described. We retrospectively reviewed 822 patient charts and found 93 patients with symptomatic shoulders. Seventy-nine of these 93 patients were rated according to Pettersson's scoring method. The clinical charts were reviewed for the presence of shoulder symptoms and dysfunction. A spectrum of radiographic changes was seen beginning with mild subchondral irregularity and greater tuberosity cyst formation progressing to joint space narrowing, osteophyte formation, marginal erosion, and deformity. Of the 54 patients for whom an adequate shoulder history was available, the severity of symptoms correlated with the Pettersson score. The current study is the largest to date examining the type and progression of radiographic changes caused by hemophilic shoulder arthropathy. We observed a consistent pattern of radiographic changes, the severity of which correlated directly with shoulder symptoms.

Adolescent↗
PubMed2003

Suprascapular nerve entrapment secondary to a lipoma.

Many causes of suprascapular nerve entrapment have been described including a small spinoglenoid notch, a tight ligament, boney spurs, and ganglion cysts. In the current patient, suprascapular nerve entrapment was caused by a lipoma in the suprascapular notch. The patient presented with painful shoulder motion that could have been attributed to rotator cuff and acromioclavicular joint disease. However, magnetic resonance imaging and electromyography were consistent with suprascapular nerve entrapment. Treatment of the rotator cuff disease and excision of the lipoma led to resolution of the patient's symptoms. This case is presented as an unusual cause of suprascapular nerve entrapment with a review of its course and anatomy.

Humans↗
PubMedDate not supplied

A cadaveric study on the anatomy of the deltoid insertion and its relationship to the deltopectoral approach to the proximal humerus.

Elevation of the deltoid insertion (DI) has been recommended, but little is known about its anatomy or importance for deltoid function. The purpose of this study is to determine the dimensions of the DI with specific reference to the deltopectoral approach. The deltoid was exposed and detached at its origin in 36 cadaveric shoulders. The morphology of the DI was documented, and its relationship with the pectoralis major insertion and the axillary and radial nerves was recorded. The anterior, middle, and posterior deltoid muscle fibers entered into the DI in a V-shaped tendinous confluence with a broad posterior band and a narrow separate anterior band, which accounted for the anterior one fifth of the DI (0.44 cm). The deltoid insertion was separated from the pectoralis major insertion by as little as 2 mm in 31 of 36 specimens. The distance between the axillary nerve and the DI averaged 5.6 cm anteriorly and 4.5 cm posteriorly. The distance between the radial nerve and posterior deltoid insertion averaged 2.4 cm proximally and 1.6 cm distally. Exposure during the deltopectoral approach is most limited by the close proximity of the deltoid and pectoralis major insertions. Our study would suggest that partial anterior DI release (greater than one fifth) could compromise the anterior deltoid. The axillary and radial nerves are not at significant risk when operating in the region of the anterior DI.

Brachial Plexus↗
PubMedDate not supplied

Arthroscopic biceps tenodesis.

Surgical treatment of symptomatic pathology of the long head of the biceps tendon generally consists of either biceps tenotomy or tenodesis. Biceps tenodesis is generally recommended for younger patients and has been well described using open techniques. With advancements in arthroscopic ability and equipment, new arthroscopic techniques have recently been reported. These techniques can be especially useful when used in conjunction with other arthroscopic procedures such as distal clavicle resection, rotator cuff repair, and subacromial decompression. We present a modification of the techniques suggested by other researchers. In this technique, a bone anchor is used as a pulley at the bottom of the tunnel to pull the tendon into position. This is followed by interference screw fixation. To our knowledge, this technique has not been previously described.

Arthroscopy↗
PubMedDate not supplied

Magnetic resonance imaging of painful shoulder arthroplasty.

Specialized magnetic resonance imaging (MRI) was performed in 42 painful shoulder arthroplasties, 22 of which underwent subsequent revision surgery, allowing surgical confirmation of the pathology identified on MRI. One hemiarthroplasty was excluded because of motion artifact, leaving 21 studies (19 patients) to be correlated retrospectively to the surgical findings. At the time of revision surgery, there were full-thickness rotator cuff tears in 11 of 21 shoulders; MRI correctly predicted these in 10 of 11 shoulders. Full-thickness subscapularis tears were the most common finding (8/11 shoulders). Of the 21 shoulders, 10 did not have a rotator cuff tear, and MRI correctly predicted the absence of a tear in 8 of 10. MRI also correctly predicted glenoid cartilage wear in 8 of 9 shoulders. With limited pulse-sequence parameter modification, the data from this preliminary study suggest that MRI may be a useful technique with which to determine the integrity of the rotator cuff and residual cartilage and, thus, is potentially a tool in the management of painful shoulder arthroplasty.

Adult↗