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Evan L Flatow

Publications and source records attributed to Evan L Flatow.

14 recordsLinked to original sources
PubMed2004

Multidirectional instability: surgical decision making.

Although previous authors have described multidirectional instability of the shoulder, it was not until 1980 that Neer and associates solidified the current understanding and treatment of inferior and multidirectional instability. They emphasized the importance of differentiating this condition from the more common unidirectional instabilities and introduced the concept of an inferior capsular shift to globally tension the capsule anteriorly, inferiorly, and posteriorly, while thickening and reinforcing it on the side of greatest instability (i.e., anterior or posterior). Since the time of this initial description, the diagnosis and treatment of multidirectional instability has been fraught with difficulty and confusion. More recently, the advent of shoulder arthroscopy has blazed the trail for minimally invasive techniques to correct multidirectional instability, including arthroscopic thermal capsulorrhaphy and suture plication. However, despite strong opinions regarding these surgical techniques, when comparing open approaches to arthroscopic techniques for the treatment of multidirectional instability, long-term outcomes of arthroscopic techniques have yet to replicate those of open surgery.

Arthroscopy↗
PubMed2003

Management of glenohumeral arthritis: a role for arthroscopy?

When nonoperative measures fail in the treatment of glenohumeral arthritis, arthroscopy has emerged as a viable therapeutic option. It is valuable as a diagnostic and therapeutic intervention and has a low morbidity and low complication rate. Arthroscopic techniques can be performed in the younger patient or athlete wishing to delay arthroplasty or in the elderly patient with associated comorbidities wishing to avoid a larger operation. In those with inflammatory arthropathies, arthroscopy with associated debridement and synovectomy can relieve pain, improve function, and delay progression of the disease. In the athlete and young patient with osteoarthritis, arthroscopy allows recognition and treatment of coexisting pathologies in which procedures such as subacromial decompression and capsular release have proven to be of benefit. Arthroscopic debridement, abrasion arthroplasty, and microfracture techniques seem to be of some benefit; however, it remains unclear who the ideal candidate is. Overall it is generally viewed that patients improve and benefit most when intervention is early in the course of the disease. Although the role of arthroscopy in the treatment of glenohumeral arthritis is evolving, in certain situations and patients it is thus a viable option and another tool in the armamentarium of the orthopedic surgeon.

Arthritis↗
PubMed2003

Anatomy of the posterior rotator interval: implications for cuff mobilization.

Release of the posterior rotator interval between the supraspinatus and infraspinatus tendons may be necessary to obtain appropriate mobilization for an anatomic rotator cuff repair. Ten cadaver shoulders were dissected to expose the region between the infraspinatus and supraspinatus from the spinoglenoid notch to the greater tuberosity. Measurements were made from the spinoglenoid notch to the glenoid rim, the glenoid rim to the confluence of the supraspinatus and infraspinatus musculotendinous junction, and from the confluence of the tendons to the insertion on the humerus. The histologic features of the posterior rotator interval were examined. The posterior rotator interval is a clear structure, consisting of the glenohumeral capsule medially, which fuses with the supraspinatus and infraspinatus tendons laterally. The average length of the posterior rotator interval was 77.8 mm which includes the distance from the spinoglenoid notch to the glenoid rim (25 mm; standard deviation, 2.89 mm; range, 21-28 mm), from the glenoid to the tendon confluence (25 mm; standard deviation, 1.95 mm; range, 21-28 mm), and from the tendon confluence to insertion (28 mm; standard deviation, 2.36 mm; range, 24-31 mm). Release of the posterior rotator interval can be important to realign the supraspinatus tendon if it is retracted and scarred at its posterior edge.

Arthroscopy↗
PubMed2003

Transitioning to arthroscopic rotator cuff repair: the pros and cons.

There has been much recent enthusiasm regarding complete arthroscopic rotator cuff repair, and it is becoming apparent that, for many, this newer technique may be a preferable alternative to the more traditional mini-open rotator cuff repair. Several short-term studies have demonstrated that complete arthroscopic repair has excellent results comparable with those of mini-open repair, which is also an excellent technique. The choice of which procedure may be better for an individual patient or surgeon can be based on a variety of considerations, including the patient's expectations, the pathoanatomy of the cuff, and the surgical experience of the surgeon. The relative merits and disadvantages of arthroscopic rotator cuff repair are discussed on the basis of those considerations. When a surgeon is deciding which procedure to perform, it is important that the basic principles of rotator cuff repair not be compromised and that he or she perform the procedure that is most reproducible given his or her level of experience; however, for those who are now utilizing miniopen repair, arthroscopic repair may have important advantages and may be worth pursuing in the future. If a surgeon chooses to obtain the skills necessary to perform a complete arthroscopic repair, performance of the mini-open procedure offers an excellent opportunity to make an orderly transition.

Arthroscopy↗
PubMed2003

[Close needling for the treatment of calcifying tendinitis].

OBJECTIVE: To study the effect of close needling in the treatment of calcifying tendonitis. METHODS: Seventeen patients with calcifying tendonitis who had received close needling treatment were followed-up for 9.3 months on average. An 18-gauge or 16-gauge needle was used during needling. X-ray examination was given 4, 6, 8 and every 4 weeks after needling. SST (simple shoulder test) questionnaire, ASES (American Shoulder & Elbow Surgeon) score, constant-Murley score and UCLA score were adopted for evaluation before and after treatment. RESULTS: Calcium deposition disappeared within 4 - 20 weeks mean 9.4 weeks in 15 of the 17 patients after needling for 1 - 3 times. Average ASES score before treatment was 47.7 (34 - 59), forward elevation was 90 degrees (70 degrees - 100 degrees ), external rotation was 15 degrees (0 degrees - 30 degrees ), and internal rotation was L3-4 (L1-buttock). Average constant-Murley score before treatment was 44.6 (34 - 54), UCLA score was 11.6 (8 - 15), and numbers of questions for "yes" in SST questionnaire was 3.4 (2 - 5). After needling the average ASES score was 87.1 (72 - 91), forward elevation was 143.5 degrees (120 degrees - 160 degrees ), external rotation was 40 degrees (30 degrees - 50 degrees ), internal rotation was T(8)-T(9), constant-Murley score was 87.8 (64 - 94), UCLA score was 29.5 (19 - 33), and numbers of questions for "yes" in SST questionnaire was 9.1 (6 - 12). Significant difference was found between before and after needling (ASES: P < 0.01, forward elevation, external rotation and internal rotation: P < 0.01, constant-Murley: P < 0.01, UCLA: P < 0.01, SST: P < 0.01). CONCLUSIONS: Close needling is an effective method for the treatment of calcifying tendonitis. Symptoms and disability are greatly relieved non-surgically in most of patients. Care should be taken in differential diagnosis of degenerative calcification in chronic rotator cuff disease.

Adult↗
PubMed2002

Controversial topics in shoulder arthroscopy.

This is a review of the symposium entitled Controversial Topics in Shoulder Arthroscopy 2001, presented at the Arthroscopy Association of North America 20th Annual Meeting in Seattle, Washington in April of 2001. The covered topics include micro-instability, partial thickness rotator cuff tears, pathology of the biceps tendon, and thermal capsulorrhaphy.

Adolescent↗
PubMed2002

Comparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations: a randomized, prospective study.

BACKGROUND: Acute anterior glenohumeral dislocations have been commonly treated with closed reduction and the use of intravenous sedation. Recently, the use of intra-articular lidocaine has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. The purpose of this study was to evaluate the value of local anesthesia compared with that of the commonly used intravenous sedation during the performance of a standardized reduction technique. METHODS: In a prospective, randomized study, skeletally mature patients with an isolated glenohumeral joint dislocation and no associated fracture were randomized to receive either intravenous sedation or intra-articular lidocaine to facilitate reduction of the dislocation. Reduction was performed with the modified Stimson method. The two groups were compared with regard to the rate of successful reduction, pain as rated on a visual analog scale, time required for the reduction, time from the reduction until discharge from the emergency department, and cost. RESULTS: Thirty patients were enrolled in the study. Five (two in the lidocaine group and three in the sedation group) required scapular manipulation in addition to the Stimson technique to reduce the dislocation. The lidocaine group spent significantly less time in the emergency department (average time, seventy-five minutes compared with 185 minutes in the sedation group, p < 0.01). There was no significant difference between the two groups with regard to pain (p = 0.37), success of the Stimson technique (p = 1.00), or time required to reduce the shoulder (p = 0.42). The cost of the intravenous sedation was $97.64 per patient compared with $0.52 for use of the intra-articular lidocaine. CONCLUSIONS: Use of intra-articular lidocaine to facilitate reduction with the Stimson technique is a safe and effective method for treating acute shoulder dislocations in an emergency room setting. Intra-articular lidocaine requires less money, time, and nursing resources than does intravenous sedation to facilitate reduction with the Stimson technique.

Adolescent↗
PubMed2002

Failed surgical management of partial thickness rotator cuff tears.

Some authors have recommended that rotator cuff tears <50% of tendon thickness be debrided and those involving >50% of the tendon be treated with miniopen repair. We hypothesize that if indications for selecting between simple debridement and tendon repair were appropriate, then both groups should have comparable outcomes. Thirty-nine patients with partial rotator cuff tears met inclusion criteria and were available for retrospective analysis. Twenty-six percent of patients who underwent debridement and 12.5% of patients who had mini-open repair had unsatisfactory results according to Neer's criteria.

Adult↗
PubMedDate not supplied

Releases of subscapularis contracture: an anatomic and clinical study.

Correction of anterior subscapularis contracture is an important step in soft-tissue balancing at the time of total shoulder replacement (TSR). An anatomic and clinical investigation was undertaken to investigate the effect of steps involved in subscapularis release. In 14 cadaveric shoulders studied, the subscapularis insertion consisted of three regions: a thick superior tubular tendon (STT), a flat middle tendon, and an inferior portion where the muscle fibers insert directly into the humerus. In 16 consecutive patients undergoing primary TSR for osteoarthritis, measurements of subscapularis length were taken after different releases. An average of 0.9 cm (confidence interval, 0.7-1.1 cm) of excursion was added after anterior capsular release, and an additional 0.7 cm (confidence interval, 0.5-0.9 cm) of excursion was obtained after STT release. Incision of the STT is an alternative means of gaining subscapularis length when balancing the soft tissues in patients with osteoarthritis undergoing TSR.

Arthroplasty, Replacement↗
PubMedDate not supplied

Attrition sign in impingement syndrome.

Extrinsic compression of the rotator cuff by the coracoacromial arch has been accepted as a major factor in the etiology of bursitis, cuff tendonitis, and rotator cuff tears. Other etiologies for rotator cuff syndrome have also been proposed in various patient populations. These include repetitive microtrauma and underlying instability with tensile overload, particularly in the younger (younger than 35) athletic population. In this evolving field, the arthroscopist must to be able to recognize arthroscopic signs of impingement syndrome. Therefore, this paper discusses evaluating rotator cuff syndromes and reviews the signs of subacromial impingement found at bursoscopy. We also offer several tips to maximize visualization during shoulder bursoscopy.

Arthroscopy↗
PubMedDate not supplied

Loss of subscapularis function after total shoulder replacement: A seldom recognized problem.

Little attention has focused on subscapularis integrity after total shoulder replacement (TSR). We have noted that several patients have loss of internal rotation and subscapularis function on follow-up, leading to our review of success in restoring subscapularis function after TSR. A retrospective review was done of the records of 41 patients after TSR performed between 1995 and 2000. Mean follow-up was 1.9 years. Terminal internal rotation was evaluated by the lift-off and belly-press examinations. Subscapularis function was assessed by the patients' ability to tuck in a shirt. The subscapularis was repaired anatomically in 9 cases and through bone tunnels in 32 patients. Abnormal results were found for 25 of 37 lift-off examinations (67.5%) and 24 of 36 belly-press examinations (66.6%). Of 25 patients with an abnormal lift-off finding, 92% reported reduced subscapularis function (Fisher exact test, P <.01). Despite meticulous attention to subscapularis repair, suboptimal return of function was found on clinical examination and assessment of activities of daily living.

Aged↗
PubMedDate not supplied

Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs.

BACKGROUND: Open rotator cuff repairs have led to excellent clinical results; however, several studies have linked postoperative structural integrity to patient outcomes. The purpose of this study is to prospectively assess postoperative cuff integrity after open rotator cuff repair and assess its relationship to clinical outcome. HYPOTHESIS: Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes. STUDY DESIGN: Prospective nonrandomized clinical outcomes study. METHODS: Forty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospective study. A standardized evaluation was performed preoperatively and postoperatively at annual intervals. All patients underwent postoperative magnetic resonance imaging at least 1 year after surgery. Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison. RESULTS: Thirty-two patients were available for evaluation. Overall, the patients experienced a significant (P < .05) improvement in their American Shoulder and Elbow Surgeons survey (40-85) and Constant (53-80) scores. The overall retear rate was 31%. Although patients with large tears preoperatively and retears postoperatively had lower overall outcomes scores, this was not significant. CONCLUSION: These data support open rotator cuff repair as an effective technique that restores excellent shoulder function. The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff. In fact, those with a retear still had a significant improvement in all clinical areas assessed, including strength.

Adult↗