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Biomedical subjects

G Walch

Publications and source records attributed to G Walch.

At least 19 recordsLinked to original sources
PubMed1997

The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design.

We have studied the three-dimensional geometry of the proximal humerus on human cadaver specimens using a digitised measuring device linked to a computer. Our findings demonstrated the variable shape of the proximal humerus as well as its variable dimensions. The articular surface, which is part of a sphere varies individually in its orientation as regards inclination and retroversion, and it has variable medial and posterior offsets. These variations cannot be accommodated by the designs of most contemporary humeral components. Although good clinical results can be achieved with current modular and non-modular components their relatively fixed geometry prevents truly anatomical restoration in many cases. To try to restore the original three-dimensional geometry of the proximal humerus, we have developed a new type of humeral component which is modular and adaptable to the individual anatomy. Such adaptability allows correct positioning of the prosthetic head in relation to an individual anatomical neck, after removal of the marginal osteophytes. The design of this third-generation prosthesis respects the four geometrical variations which have been demonstrated in the present study. These are inclination, retroversion, medial offset and posterior offset.

Aged↗
PubMed1996

[The acromio-humeral interval. A study of the factors influencing its height].

PURPOSE OF THE STUDY: The narrowing of the Acromio Humeral Interval (AHI) under 6-7 mm, lower limit reported in normal shoulder, has been considered to be a specific indicator for full-thickness cuff tears. The purpose of this study was to analyse the factors influencing the AHI. METHODS: 264 shoulders were operated on between 1984 and 1994 for full thickness tear of the supraspinatus and infraspinatus associated or not with an anterior cuff lesion. All patients had X-ray with A.P. view of the shoulder in neutral rotation. The AHI was defined as the shortest distance measured between the inferior cortex (dense line) of the acromion and the humerus. CT arthrogram was performed in 84 patients to analyse cuff muscular fatty degeneration. A full thickness tear was confirmed and measured by surgical approach in all cases. RESULTS: There was a moderate significant relationship (p < 0.05) between AHI and symptoms duration. There was a significant relationship between AHI and tear size (p < 0.05). When the supraspinatus tendon was only torn, the mean AHI was 9.5 +/- 0.17 mm (4.5 per cent of narrowing AHI). When supra and infraspinatus tendon were torn, the mean AHI was 7.5 +/- 0.4 mm (28 per cent of narrow AHI) and when an anterior lesion was associated, the mean AHI decreased to 5.4 +/- 0.5 mm and the percentage of narrow AHI increased to 63 per cent. The AHI was not influenced by the biceps rupture: with a similar symptoms duration, the mean AHI was 9 +/- 0.5 mm with biceps tear versus 9.2 +/- 2 mm when the biceps was normal. However, the mean AHI decreased to 5.5 +/- 0.6 mm when the long head of the biceps was dislocated and the AHI was less than 7 mm in 61 per cent of the cases. A highly significant relationship was found between the AHI and the infraspinatus muscle degeneration. We have found 100 per cent incidence of AHI narrowing when the infraspinatus was degenerated (mean AHI 2.2 +/- 1.1 mm). A moderate similar relationship was found concerning the supraspinatus muscle (p < 0.05) and no relationship was found with the subscapularis degeneration. DISCUSSION: The infraspinatus, external rotator of the humerus, seems to be the major active depressor of the humeral head. The biceps tendon, which is a passive depressor of the humerus, has no influence on the AHI whatever it is ruptured or not. However biceps dislocation is associated with significant humeral head superior migration. Symptoms duration and cuff tear size seem to be only secondary factors affecting the AHI. CONCLUSION: AHI narrowing should evocate a severe cuff tear with biceps dislocation or muscular degeneration. In these cases, surgical repair might be questionable. AHI value is more prognostic than diagnostic.

Acromion↗
PubMed1996

[Gleno-humeral arthroscopic arthrolysis for shoulder stiffness. Apropos of 26 cases. Société Française d'Arthroscopie].

UNLABELLED: Shoulder stiffness is a problem which covers many different conditions. In fact there is still a semantic and pathogenetic confusion. The words: capsulite retractile, frozen shoulder, adhesive capsulitis, stiff shoulder contracture have been successively used and this ambiguity renders the literature difficult to interpret. Moreover the cause of the stiffness which depends on the aetiology, is not always clearly known: capsular contraction, capsular adhesion, capsular scarring following trauma or surgery, extra capsular phenomenons in the subacromial bursa, muscles or tendons. MATERIALS AND METHODS: 26 shoulders (25 patients) were reviewed with a follow up of 21 months using the Constant's scoring system. Patients had an average duration of symptoms for 13 months (1 to 27). Pre op passive motion was: abduction: 74 degrees, external rotation: 6 degrees, forward flexion: 84 degrees. The average motion core was 12.9/40. We distinguished three groups: primary frozen shoulder (13 cases) ; bipolar stiffness (3 cases) due to rotator cuff disease ; acquired "surgical" stiffness, (10 cases). The capsular release was performed, at the anterior rim of the glenoid fossa, purely anterior or anterior and inferior, followed by gentle manipulation. If external rotation was not improved the coraco-humeral ligament was detached from its coracoid attachment. Additional procedures were performed:acromioplasty (5 cases), bursectomy (3 cases), SLAP lesion debridement (1 case). Only 2 out 13 primary shoulders required an additional procedure. RESULTS: 1-There were no intra-operative complications (vascular or neural). 2-Range of Motion: the average gain under anesthesia was: abduction: 72 degrees, external rotation: 34 degrees, forward flexion: 86 degrees. Final result was obtained with a mean duration of seven months. There was no difference according to the aetiology. Gain was more important in the primary group (9.69 to 34.9 vs 15.8 to 30.6). 3-Subjective results were better in the primary group. 4-Objective results demonstrated an absolute Constant's score of 70.3, that is to say 83.4 per cent of the contralateral supposed healthy shoulder. There were 3 excellent, 5 very good, 7 good, but 11 fair or poor results. The relative Constant's score was 91 per cent in the primary group and only 76 per cent in the acquired group. The difference was due to the pain and strength which were greatly improved in the primary group. DISCUSSION: Arthroscopic release of shoulder contracture is feasible, safe and effective. For primary frozen shoulder, there is usually spontaneous recovery. Indications for surgery are very few. There is no evidence that arthroscopic release shortens spontaneous evolution. Therefore, we propose it in very selected cases of dramatically limited motion. One year of evolution is an acceptable time. For bipolar stiffnesses, arthroscopy allows one to recognize the exact cause of the stiffness and to treat it, especially the subacromial pathology. In this occurrence, buroscopy must be performed and cuff pathology treated. For acquired surgical stiffnesses, gain of motion is significant. Subjective and objective results are less satisfactory than those of primary frozen shoulder, due to persistance of pain and lack of strength. The alternative is open release, but arthroscopic release has less morbidity. It can be proposed early as soon as capsular tissue has healed (for instance 6 months).

Adult↗
PubMed1995

Arthroscopic stabilization for recurrent anterior shoulder dislocation: results of 59 cases.

Fifty-nine patients with recurrent anterior dislocation of the shoulder underwent the Morgan arthroscopic stabilization with transglenoidal suture of the inferior glenohumeral ligament. All patients were followed-up for an average of 49 months (range, 29 to 71 months). Using Rowe's scoring system, the overall objective results were disappointing. There were 33% excellent results, 9% good, 9% fair, and 49% poor. Twenty-six patients had a further dislocation, and 3 others had recurrent subluxation on average 13 months after the operation. The failures were associated with a preoperative clinical finding of inferior hyperlaxity as demonstrated by a positive sulcus sign, a preoperative radiological finding of a bony lesion on the anterior edge of the glenoid, or an arthroscopic finding of extended ligamentous lesions at the time of operation. The results of this study are clearly worse than those reported by other investigators. Direct comparison between the reported studies is problematic and is discussed. It was concluded that arthroscopic stabilization should only be performed by interested specialists as part of controlled clinical trials.

Adolescent↗
PubMed1995

[MRI of the rotator cuff: evaluation of a new symptomatologic classification].

The different classifications use for the rotator cuff pathology seem to be incomplete. We propose a new classification with many advantages: 1) Differentiate the tendinopathy between less serious (grade 2A) and serious (grade 2B). 2) Recognize the intra-tendinous cleavage of the infra-spinatus associated with complete tear of the supra-spinatus. 3) Differentiate partial and complete tears of the supra-spinatus. We established this classification after a retrospective study of 42 patients operated on for a rotator cuff pathology. Every case had had a preoperative MRI. This classification is simple, reliable, especially for the associated intra tendinous cleavage.

Female↗
PubMed1995

Arthrography and computed arthrotomography study of seventy patients with primary glenohumeral osteoarthritis.

Seventy patients with primary glenohumeral osteoarthritis underwent roentgenographic and computed tomography studies. Glenohumeral joint space loss and a normal acromiohumeral space were the roentgenographic inclusion criteria. Women made up 61% of the sample. The dominant shoulder was affected in 95% of cases and both shoulders in 41%. Mean age at first evaluation was 65 years. Arthrography showed a tear confined to the supraspinatus tendon in 16 cases (23%); no patients had tears involving more than one tendon. Computed tomography demonstrated glenoid retroversion (mean 16 degrees) but was unable to differentiate primary glenoid dysplasia from wear due to osteoarthritis. Posterior subluxation of the humeral head was found in 28 cases (40%) but was not consistently correlated with the presence of glenoid retroversion.

Adult↗
PubMed1995

[Recurrent anterior and multidirectional instability of the shoulder].

PURPOSE OF THE STUDY: Surgical treatment for recurrent anterior instability associated to multidirectional shoulder hyperlaxity: results analysis. MATERIAL: Twenty five patients operated for recurrent anterior dislocation or subluxation with multidirectional hyperlaxity. Age at operation was low (22 years old), there were more females than males, instability was bilateral in 52 per cent cases. METHOD: Five patients underwent a capsular shift followed by a four weeks post operative immobilization. Twenty patients underwent a bone block procedure with the coracoid process associated with a modified capsular shift. Inferior half of the subscapularis muscle was left intact under the coraco-biceps tendon. RESULTS: The results were fair with only 52 per cent excellent or good results. Ten patients (40 per cent) presented a recurrence either a dislocation or a subluxation. Hyperlaxity recurred in all but three patients. The procedure didn't influence the results which were related to the antecedent: the patients with a previous history of voluntary recurrent posterior subluxations achieved 33 per cent fair or poor results. Patients with previous history of recurrent anterior subluxation achieved 100 per cent poor results, whereas the patients without antecedent achieved 85 per cent good to excellent results. DISCUSSION: Establishing a difference between laxity and instability helps to analyse the patients with an unstable shoulder rather than considering traumatic or atraumatic onset of the instability. Identification of the hyperlaxity and of the antecedents must influence the therapeutic discussion. CONCLUSION: We recommend to use the term multidirectional hyperlaxity rather than multidirectional instability to characterize these patients.

Adolescent↗
PubMed1994

Factors of patellar instability: an anatomic radiographic study.

We analyzed the radiographs and computed tomography (CT) scans of 143 knees operated on for symptomatic patellar instability and 67 contralateral asymptomatic knees, together with 190 control knee radiographs and 27 control knee scans, to determine the factors affecting patellar instability. Four factors were relevant in knees with symptomatic patellar instability: (1) Trochlear dysplasia (85%), as defined by the crossing sign (96%) and quantitatively expressed by the trochlear bump, pathological above 3 mm or more (66%), and the trochlear depth, pathologic at 4 mm or less. (2) Quadriceps dysplasia (83%), defined a present when the patellar tilt in extension is more than 20% on the CT scans. (3) Patella alta (Caton-Deschamps) index greater than or equal to 1.2 (24%). (4) Tibial tuberosity-trochlear groove, pathological when greater than or equal to 20 mm (56%). The factors appeared in only 3%-6.5% of the control knees. The etiology of patellar instability is multifactorial. Determination of the factors permits an effective elective therapeutic plan which aims at correcting the anomalies present.

Adolescent↗
PubMed1994

[Isolated lesions of the subscapularis muscle. Apropos of 21 cases].

PURPOSE OF THE STUDY: The goal of this retrospective study is to describe the different anatomic lesions of the subscapularis and to precise the diagnostic value of the clinical and imaging tests. MATERIAL: Twenty-one cases of isolated tear of the subscapularis were operated on between 1989 and 1992. Affecting both sex, this lesion happens in younger patients than the rotator cuff tear concerning supra or infra-spinatus. The onset was most often traumatic but not specific. Four patients had no traumatic history. RESULTS: In 16 cases, the complaint was an unspecific chronic painful shoulder. The Jobe test was positive in 12 cases. The lift-off test was positive in 9 cases. Arthrography showed extravasation of dye into the subacromial bursa in 11 cases. Subscapularis lesion was suspected with the presence of dye spot on the lesser tuberosity on the A.P. view in external rotation (18 cases). Arthro-CT-scan was diagnostic in 12 cases, revealing dye spot touching the lesser tuberosity. At surgery, 3 types of lesions were found: complete ruptures or ruptures concerning the superior two-thirds of the tendon and letting intact the inferior muscular third (15 cases): partial superior lesions (5 cases) and a muscular tear of the inferior two-thirds. The long head of the biceps was dislocated in 5 cases, subluxated in 5 cases, ruptured in 3 cases and normal in 8 cases. DISCUSSION: The mechanisms of these lesions are probably different. The most common mechanism is traumatic but 4 patients had no traumatic injury. Degenerative changes of the tendon or subcoracoid impingement are also evocated. Arthrography permits a good screening but arthro-CT-scan is the most accurate to detect the lesion. Presence of dye touching the lesser tuberosity is a specific sign of the subscapularis lesion.

Adult↗
PubMed1994

[Neer's shoulder prosthesis: results according to etiology].

The outcome of 80 glenohumeral arthroplasties with the Neer prosthesis in 77 patients with degenerative or inflammatory shoulder disease was evaluated after a mean follow-up of three years five months. The arthroplasties were performed because of intractable pain and functional disability due to destruction of the glenohumeral joint. The postoperative rehabilitation program focused on full recovery of joint motion and function in 65 cases and on joint stability with partial recovery of joint motion and function in 15 cases. According to the criteria developed by Neer, the outcome was excellent or satisfactory in 75% of cases and unsatisfactory in 25%. Constant's scores adjusted for age and gender varied widely across diagnostic categories, from a high of 76% in centered glenohumeral osteoarthritis (n = 40) to lows of 59% in rheumatoid arthritis (n = 21) and 45% in posttraumatic osteoarthritis (n = 10) or eccentric osteoarthritis due to cuff disruption (n = 9). At reevaluation, 70% of patients had little or no pain and 90% were satisfied with the outcome. The mean increase in flexion of the arm (39 degrees) was markedly influenced by the diagnosis. The increases in lateral rotation (mean 35 degrees) and medial rotation (four vertebral levels) of the arm were especially appreciated by the patients as having a very beneficial effect on the ability to perform everyday tasks. Complications included instability in three cases (two anterior dislocations and one posterior dislocation), glenoid component loosening in 11 cases (of which only four required reoperation) and rotator cuff tear in eight cases. Our results add to the existing evidence that nonconstrained shoulder implants, such as the Neer prosthesis, are both safe and effective in alleviating pain and improving joint function. They should be used in patients with refractory pain, disability due to restrictions in external and medial rotation of the arm and roentgenographic evidence of glenohumeral joint space loss.

Adult↗
PubMed1993

[Management of acromioclavicular joint dislocation with the Wolter hook-plate. One year follow-up of 35 cases].

Wolter's hook-plate provides active abduction and forward-flexion of up to 90 degrees two days postoperatively. Prebending of the plate and a precise drill hole for the hook in the acromion prevents later impingement of the hook on the humeral head or subluxation in the acromioclavicular joint, respectively. According to the shoulder evaluation form of C.R. Constant, 33 of 35 patients operated on between 1987 and 1991 at the trauma departments in Schwaz/Tirol and Bad Ischl showed excellent results one year postoperatively.

Acromioclavicular Joint↗
PubMed1993

[Results of endoscopic treatment of tendinopathies of the rotator cuff (excluding total ruptures). 1: Non-calcifying tendinopathies].

The authors have studied the result of endoscopic treatment in 129 non ruptured and non calcified tendinitis of the rotator cuff as well as 33 partial thickness tears included in a multicentric study made by the french arthroscopic society. The files included a revision form using Constant's functional evaluation and filled by a physician different from the operator, and a radiological standardized evaluation allowing to appreciate, from A.P. and lateral views, the acromion shape and the importance of the resection. From the analysis of our results it appears that acromioplasty associated with a section of the coraco-acromial ligament (C.A.L.) under arthroscopic control is very efficient in tears of the superficial, bursal face of the rotator cuff. The same did not apply to the tears of the deep, articular face, as their origin is probably different. In non ruptured and non calcified tendinitis, 90 per cent of our patients were subjectively better. According to Constant's index, we noticed 75 per cent of satisfactory results. The importance of acromioplasty was not related to good results. We therefore think that one should relativise the notion of impingement between the coraco-acromial arch and the tendons of the rotator cuff. Acromioplasty is only effective on one of the factors of tendinous pain. The improvement of our indication by a better knowledge of this pathology should allow us to improve the results of an endoscopic procedure which is now well known and whose advantages do not need to be demonstrated any more.

Activities of Daily Living↗