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Biomedical subjects

G M Gartsman

Publications and source records attributed to G M Gartsman.

At least 19 recordsLinked to original sources
PubMed1998

Arthroscopic repair of full-thickness tears of the rotator cuff.

We present the results of arthroscopic repair of full-thickness tears of the rotator cuff in seventy-three patients (thirty-nine men and thirty-four women). The average age of the patients at the time of the operation was 60.7 years (range, thirty-one to eighty-two years). All of the patients were followed for at least two years (average, thirty months; range, twenty-four to forty months). The shoulders were evaluated with the rating scale of the University of California at Los Angeles, the shoulder index of the American Shoulder and Elbow Surgeons, and the functional rating scale of Constant and Murley. In addition, the patients completed the Short-Form 36 Health Survey (SF-36) preoperatively and at the yearly follow-up evaluations. Eleven tears were small (less than one centimeter in length), forty-five were medium (one to three centimeters), eleven were large (more than three to five centimeters), and six were massive (more than five centimeters). The average length of the tear was twelve millimeters, and the average width was twenty-seven millimeters. Sixty-nine tendons were repaired anatomically, and four were repaired an average of three millimeters (range, two to eight millimeters) medial to the anatomical insertion of the tendon. An average of 2.3 (range, one to four) suture anchors were used in the repair. Sixty-three glenohumeral joints were normal, and ten had an intra-articular lesion. Seven patients had a concomitant resection of the acromioclavicular joint. The average duration of the operation was fifty-six minutes (range, thirty-five to ninety minutes). The active and passive ranges of motion improved significantly after the procedure (p = 0.0001). The strength of resisted elevation improved from 7.5 to 14.0 pounds (3.4 to 6.3 kilograms) (p = 0.0001). The average total score according to the rating scale of the University of California at Los Angeles improved from 12.4 to 31.1 points; the average total score according to the shoulder index of the American Shoulder and Elbow Surgeons, from 30.7 to 87.6 points; and the average absolute score according to the rating system of Constant and Murley, from 41.7 to 83.6 points (p = 0.0001 for all comparisons). The average score for the pain component of the rating scale of the University of California at Los Angeles improved from 2.4 to 8.6 points; fifty-seven (78 per cent) of the seventy-three patients rated the relief of pain as good or excellent on the visual-analog scale. The average score for satisfaction improved from 0.4 to 4.6 points; sixty-six patients (90 per cent) rated their satisfaction as good or excellent at the time of the most recent examination. None of the shoulders were rated as good or excellent before the operation, whereas sixty-one (84 per cent) were so rated at the most recent follow-up evaluation after the index procedure. In addition, significant improvements (p = 0.0015) were noted in the scales and summary measures of the SF-36. Arthroscopic repair of full-thickness tears of the rotator cuff produced satisfactory results with regard to traditional orthopaedic criteria as well as with regard to patient-assessed criteria such as satisfaction, pain relief, and general health. The arthroscopic method offers several advantages, including smaller incisions, access to the glenohumeral joint for the inspection and treatment of intra-articular lesions, no need for detachment of the deltoid, and less soft-tissue dissection. However, these advantages must be considered against the technical difficulty of the method, which limits its application to surgeons who are skilled in both open and arthroscopic procedures on the shoulder.

Activities of Daily Living↗
PubMed1998

Early effectiveness of arthroscopic repair for full-thickness tears of the rotator cuff: an outcome analysis.

Fifty consecutive patients completed standardized questionnaires regarding general health status as well as function of the shoulder before and an average of thirteen months after arthroscopic repair of a full-thickness tear of the rotator cuff. Comparison of the preoperative and postoperative responses to the questions demonstrated highly significant improvements in the patient's assessment both of general health and of function of the shoulder. The Short Form-36 (SF-36) General Health Survey revealed significant improvements in the most recent follow-up scores compared with the preoperative scores with regard to physical functioning (p = 0.0001), role-physical (p = 0.0001), bodily pain (p = 0.0001), vitality (p = 0.0001), social functioning (p = 0.0001), role-emotional (p = 0.006), mental health (p = 0.0213), and physical component summary (p = 0.0001). The University of California at Los Angeles (UCLA) Shoulder Score, the Constant Shoulder Score, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Index showed significant improvements in all postoperative total and component scores (p = 0.0001). Most importantly, all three shoulder-rating systems demonstrated significant improvements in the postoperative scores for pain and function (p = 0.0001). While a general health status instrument such as the SF-36 can document the impact of an orthopaedic condition on a patient as well as the results of treatment, a more complete representation of the patient's condition requires the use of region-specific self-assessment questionnaires and evaluation by a physician.

Activities of Daily Living↗
PubMed1997

Full-thickness tears: arthroscopic repair.

Arthroscopic repair of rotator cuff tears is an option for a surgeon with advanced arthroscopic skills and a thorough knowledge of open repair technique. Surgical indications and a detailed description of operative technique are presented. Arthroscopic rotator cuff repair offers theoretical advantages over open repair, but long-term studies are needed to demonstrate its effectiveness.

Arthroscopy↗
PubMed1997

The rotator cuff. Commentary.

To add clinical perspective to the articles of this two-issue collection, eight prominent shoulder surgeons discuss their approach to the treatment of rotator cuff disease. There is broad agreement in many areas, however, significant controversies remain.

Adult↗
PubMed1997

The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears.

To evaluate the incidence of associated glenohumeral lesions in patients with a full-thickness rotator cuff tear, an arthroscopic examination of the glenohumeral joint was performed in 200 shoulders in 195 consecutive patients before arthroscopic rotator cuff repair. One hundred twenty-one (60.5%) had coexisting intraarticular abnormalities. Ninety-six (48%) had minor abnormalities, and 25 patients (12.5%) had major coexisting intraarticular abnormalities. Major lesions (that required operative treatment, changed postoperative rehabilitation, or altered the expected end result) noted at arthroscopic examination were osteoarthritis in nine patients, partial biceps tendon tears in three, labrum tears in three, Bankart lesions in two, superior labrum anterior posterior lesions in five, and glenohumeral synovitis in three patients. Glenohumeral arthroscopy can provide valuable information in patients with a complete rotator cuff tear.

Arthroscopy↗
PubMed1997

Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression.

Thirty-three consecutive patients in whom an irreparable tear of the rotator cuff had been treated with operative debridement and subacromial decompression were evaluated both preoperatively and postoperatively with regard to pain, ability to perform activities of daily living, range of motion, strength, and satisfaction. The assessments were performed with the Shoulder Score Index of the American Shoulder and Elbow Surgeons and the scoring systems of the University of California at Los Angeles and Constant and Murley. At the time of follow-up, twenty-six patients thought that the condition of the shoulder was improved; three, that it was unchanged; and four, that it was worse after the operation. There was a significant decrease in pain (p = 0.001) and significant increases in the range of motion (p = 0.038) and the ability to perform activities of daily living (p = 0.016). However, these improvements were inferior to those in reported series in which torn rotator cuffs had been repaired. Strength with elevation was decreased after the operations in the present series (p = 0.0007).

Activities of Daily Living↗
PubMed1996

Arthroscopic assessment of rotator cuff tear reparability.

To evaluate the efficacy of arthroscopic techniques in determining the potential reparability of complete rotator cuff tears, a clinical investigation was performed. The parameters of tear size measurement, tendon quality, tendon mobility, and suture anchor placement were evaluated. These parameters were determined using both arthroscopic and open surgical technique. No statistically significant differences were noted when the arthroscopic findings were compared with the findings at open rotator cuff repair. Arthroscopic techniques can reliably assess rotator cuff tear size, tendon quality, tendon mobility, and suture anchor placement.

Arm Injuries↗
PubMed1993

The shoulder: common clinical problems.

The diagnosis and management of shoulder pain presents a challenge to health care professionals. Shoulder problems affect the quality of life for many people by impacting on activities of daily living and on job performance. For these people a variety of treatment modalities, including surgery, exist. This article presents an overview of common shoulder problems and some of the nonsurgical and surgical treatment modalities that can be used to relieve these problems.

Adult↗
PubMed1990

Arthroscopic acromioplasty for lesions of the rotator cuff.

Arthroscopic acromioplasty was done for a lesion of the rotator cuff in 165 patients: 100 who had stage-II impingement syndrome (no actual tear of the rotator cuff) (group 1), forty who had a partial tear (group 2), and twenty-five who had a full-thickness tear (group 3). The operation consisted of acromioplasty, resection of the coracoacromial ligament and subacromial bursa, and removal of osteophytes, when present, near the inferior aspect of the acromioclavicular joint. In the patients who had a partial or complete tear, minimum debridement of the rotator cuff also was performed. In group 1, eighty-six patients (eighty-nine shoulders) were available for review at a minimum follow-up to two years (average, 31.2 months). The preoperative ratings for pain, activities of daily living, work, and sports improved markedly in eighty-one patients postoperatively. The most common findings at operation were proliferative subacromial bursitis and an acromial protuberance. Two complications were recorded. Seven patients had a subsequent open operation on the shoulder. In group 2, the average follow-up was 28.9 months (range, twenty-four to forty-eight months). Of the forty patients, thirty-three had a major improvement in the ratings for pain, activities of daily living, work, and sports. One complication, transient palsy of the lateral femoral cutaneous nerve, was noted. Two patients who had an unsatisfactory result had a second operation: one, open acromioplasty and the other, repair of the rotator cuff. In group 3, the average follow-up was 30.8 months (range, twenty-four to fifty-five months). There were fourteen satisfactory and eleven unsatisfactory results. Of the twenty-five patients, seven later had open repair of the rotator cuff, and six had a satisfactory result from that procedure. No complications were recorded. It was concluded that arthroscopic acromioplasty is effective in the treatment of isolated stage-II impingement and partial tears of the rotator cuff. Arthroscopic treatment of complete tears produced over-all results that were inferior to those of traditional open repair. Arthroscopic subacromial decompression cannot be supported as treatment for complete tears of the rotator cuff.

Acromioclavicular Joint↗
PubMed1988

Surgical correction of severe knee pterygium.

Knee flexion contracture secondary to a severe pterygium is a disabling condition. Full surgical correction has not been possible because of the sciatic nerve and its terminal branches. Our technique to obtain full correction is to divide the nerve near the neuromuscular junction and bridge the defect with multiple sural nerve cable grafts. Microscopic technique is used.

Acute Disease↗
PubMed1986

Carpal arch alteration after carpal tunnel release.

A retrospective clinical study quantitated postoperative widening of the transverse carpal arch after carpal tunnel release in a group of 50 patients. The relationship of this widening with postoperative pain, forearm circumference, grip strength, and wrist range of motion was evaluated. Mean widening of the transverse carpal arch after carpal tunnel release is 10.4% or 2.7 mm. A direct relationship exists between widening of the transverse carpal arch and loss of grip strength. Residual pain, forearm circumference, and wrist range of motion are not related to widening of the transverse carpal arch.

Adult↗
PubMed1985

Blood vessel implantation into ischemic bone.

Blood vessel implantation, core decompression, and core decompression plus cancellous bone grafting were compared in 36 adult mongrel dogs to evaluate their relative effectiveness in revascularizing an ischemic femoral head. Each of the methods resulted in a reversal of the ischemic changes to varying degrees. Blood vessel implantation resulted in increased new bone formation at the site of vessel implantation but no significant revascularization in the peripheral portion of the femoral head. The method of creating avascular necrosis of the femoral head of the canine, as described by Hori, was studied in a controlled fashion. Although ischemic changes were noted in our hands, the model failed to produced findings consistent with avascular necrosis.

Angiography↗