Recognition and treatment of refractory capsular contracture of the shoulder.
Explore the source record for details and available documents.
Contracture↗
Biomedical subjects
G M Beim
Publications and source records attributed to G M Beim.
Acromioclavicular joint injuries.
OBJECTIVE: To discuss the anatomy and biomechanics of the acromioclavicular (AC) joint, along with the clinical evaluation and treatment of an athlete with an AC joint injury. DATA SOURCES: I searched MEDLINE from 1970 through 1999 under the key words "acromioclavicular joint," "clavicle," "acromioclavicular separation," and "acromioclavicular dislocation." Knowledge base was an additional source. DATA SYNTHESIS: AC joint injury is common in athletes and a source of significant morbidity, particularly for athletes in overhead sports. Because this injury can masquerade as other shoulder conditions, the examiner must understand the anatomy and biomechanics of the shoulder in order to perform a systematic clinical evaluation and identify the injury. CONCLUSIONS/RECOMMENDATIONS: Careful attention to the clinical evaluation allows the clinician to categorize the athlete's AC joint injury and institute appropriate treatment in a timely fashion, thus permitting the athlete to return to sport as quickly and safely as possible.
Journal Article↗
The treatment of symptomatic os acromiale.
During a four-year period, fourteen individuals (fifteen shoulders) who had been seen at the shoulder service of our institution because of pain in the shoulder had a radiographic finding of an os acromiale. On clinical examination, the pain appeared to be due to an unstable os acromiale because the patients had point tenderness over the acromion and pain on forward elevation of the shoulder. The diagnosis of an os acromiale was confirmed on radiographs, magnetic resonance images, or a bone scan. Eight patients had an associated tear of the rotator cuff. The os acromiale was located in the pre-acromion in one shoulder, the meso-acromion in eleven shoulders, and the meta-acromion in three shoulders. At the operation, the anterior aspect of the acromion was found to be unstable in all shoulders. Eleven patients (twelve shoulders) had open reduction of the os acromiale and insertion of an autogenous iliac-crest bone graft. Of those patients, four (five shoulders) had open reduction and internal fixation with a tension-band procedure with use of pins and wires. Only one of those shoulders had a solid osseous union, and the other four shoulders had a non-union that was due to a disruption of the fixation. The remaining seven patients (seven shoulders) had open reduction and internal fixation with use of cannulated screws and a tension-band construct; a solid osseous union was achieved in all but one of them. One patient had excision of the pre-acromion, which relieved the pain. Two patients who had had failed open reduction and internal fixation had excision of a grossly unstable os acromiale in the meso-acromion; both patients had pain and weakness after this procedure. Of the twelve shoulders that had open reduction and bone-grafting, seven had union of the os acromiale; the average time to radiographic and clinical union was nine weeks (range, seven to twenty weeks). We concluded that, although it is rare, symptomatic unstable os acromiale does occur and can be effectively treated with use of autogenous bone-grafting and internal fixation with a rigid tension-band construct and cannulated screws.
Acromion↗
Combined Bankart and HAGL lesion associated with anterior shoulder instability.
Traumatic anterior shoulder instability has been shown to be associated with a spectrum of capsulolabral pathology, including separation of the labrum (Bankart lesion), capsular rupture, and humeral avulsion of the glenohumeral ligaments (HAGL lesion). We describe a case of combined Bankart and HAGL lesions, a condition that has not been described before. Careful anatomic repair of both components of this bipolar capsular injury resulted in an excellent outcome.
Adolescent↗
Intramedullary plugs in cemented hip arthroplasty.
The use of intramedullary plugs in cemented total joint arthroplasty is currently considered standard practice by most surgeons. In this in vitro study, the authors evaluated the holding power, migration, and leakage of four commonly used plug types--bone, acrylic bone cement, and two polymeric plugs from different manufacturers. Only acrylic bone cement plugs prevented distal leakage of cement and did not migrate under the influences of pressurized cement injection.
Bone Nails↗
Recognition and treatment of refractory posterior capsular contracture of the shoulder.
SUMMARY: Limitation of internal rotation has been reported in conjunction with impingement syndrome of the shoulder. A group of 9 patients was identified who had discrete, painful loss of internal rotation associated with refractory impingement syndrome. The duration of symptoms averaged 18 months (range, 11 to 33 months), and all patients failed a course of physical therapy specifically addressing loss of internal rotation. Six patients reported traction as the mechanism of injury, and 3 developed motion loss and pain following a posterior capsular shift procedure. All patients underwent arthroscopy, and were observed to have a thickened posterior capsule. An arthroscopic release of the posterior capsule improved motion in all patients, with substantial relief of pain. At an average of 19 months follow-up (range, 11 to 35 months), internal rotation in 90 degrees of abduction improved from 10 degrees preoperatively to 47 degrees postoperatively, and there were no complications related to the procedure. We conclude that chronic loss of internal rotation secondary to posterior capsular contracture may be an explanation for refractory pain in some patients with an initial diagnosis of impingement syndrome. This condition appears to be amenable to arthroscopic posterior capsular release.
Adult↗
Classics in conventional radiography of the foot.
The authors display a variety of conditions that can be recognized using standard pedal radiographs. Letter markings on the enclosed x-rays denote the particular areas of interest. Brief descriptions of the pathologic conditions are also provided.
Bone Diseases↗