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Biomedical subjects

G Walch

Publications and source records attributed to G Walch.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1993

[Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff].

The authors studied the results of the arthroscopic treatment of the chronic calcifying tendinitis within a multi-center study of the French Society of Arthroscopy. 112 patients were available for the study. All shoulders had a preoperative radiographic clinical and radiographic evaluation. At follow up, functional results were assessed, using the Constant score, and X rays allowed to appreciate the acromial shape and the calcific deposit aspect. Several arthroscopic procedures were used on the calcification (respect or removal), and the coracoacromial arch (respect, ACL release or acromioplasty). This study found an objective success rate of 89 per cent and a patient subjective satisfaction rate of 82 per cent. Based on follow up radiographs, 88 per cent of the patients had a complete disappearance of the calcific deposit. There were no recurrence, no secondary rotator cuff tear. The results were not correlated with the age of the patients, or with the radiographic aspect (type, size, localization) of the calcification. The results were correlated with the arthroscopic procedure: they were better when the calcification had been removed (superior to deposit respect). Associated acromioplasty gave no better results: it was only considered as necessary when the calcification was not found (12 per cent). The greatest care must be taken in the surgical indication for this pathology because of a high rate of spontaneous resorption. The authors conclude that the arthroscopic surgery is a very effective method for chronic calcific tendinitis, compared to open procedure.

Adult↗
PubMed1993

[Comminuted open tibial fracture. An alternative treatment method].

The treatment of comminuted fracture of the tibia is one of the problem cases in operative fracture care. In our department we favour stabilization with the aid of interlocking nails, providing absolute fixation of the interlocking screw is possible. The patient is positioned on the Maquet table, and the fracture of the tibia is temporarily reduced by the Goetze percutaneous cerclage wiring technique. The special feature of our method is that we remove the wires after nailing. In this way the advantages of both techniques, anatomical reduction with cerclage wires and the stability and possibility of early mobilization afforded by interlocking nailing are combined. Poor blood flow in the periosteum is avoided by the immediate removal of the wires.

Fibula↗
PubMed1993

[Postero-superior glenoid impingement. Another impingement of the shoulder].

An impingement occurring between the deep side of the supraspinatus tendon and the postero-superior edge of the glenoid cavity was evidenced in a young sports thrower presenting with a partial tear of the deep side of the tendon. This impingement occurred when the arm was in abduction-retropulsion and in forced lateral rotation. It was visualized on arthroscopy. The semiology was mixed, including signs of anterior instability and cuff impairment. The possible causes of partial tears of the deep side of the supraspinatus are discussed: sub-acromial impingement of NEER, anterior instability with secondary impingement, postero-superior glenoid impingement.

Adult↗
PubMed1992

[Radio-cinematographic study of active elevation of the prosthetic shoulder].

In order to verify whether it is possible to reproduce the physiologic anterior elevation of the shoulder with a non constrained Neer type prosthesis, the authors have examined the dynamic comportement of 21 total shoulder arthroplasties. Recording of anterior active elevation with video-fluoroscopy and evaluation glenohumeral motion and scapulothoracic motion allowed to distinguish 3 types of biomechanics after total shoulder replacement. A first group of prosthesis (4 cases) had normal biomechanics with conservation of a normal scapulohumeral rythm. This concerned arthroplasties performed for necrosis or osteoarthritis with no cuff tear or loose bone stock and no technical error. A second group of prosthesis (10 cases) had an abnormal biomechanics. There was a superior excursion of the humeral head prosthesis without real glenohumeral motion. A more severe pathology (cuff tear arthropathy, rheumatoid arthritis, old traumas) with bone and/or muscular destruction was sufficient to explain this elevation possible only because of the scapulothoracic motion. Finally, there was a third group of prosthesis (7 cases) which had a reversed scapulohumeral rythm: there was less motion between the prosthetic components but the scapulothoracic motion was unchanged. Three factors can be responsible for this reversed scapulohumeral rythm: 1) The initial pathology, because of the difference in the cuff trophicity. 2) The surgical technic because of the difficulties to respect the position of the joint line and the lever arms. 3) The prosthesis itself, because of the higher degree of conformity and stability between the prosthetic components.

Adult↗
PubMed1992

[Surgical treatment of rotator cuff rupture. Prognostic factors].

A retrospective study of 67 total ruptures of the rotator cuff operated on was carried on, with an average follow-up of 25 months. The lesions were characterised by their size (19 tears of less than 2 cm, 30 between 2 and 4 cm, 18 over 4 cm) and location (27 tears of the supraspinatus, 15 tears of the supraspinatus extending to the front (coraco-humeral, long biceps, subscapular), 20 supra and infra-spinatus, 5 "massive" tears). The tendon of the long biceps was pathological in half of the cases. Fourteen patients presented with a subacromial osteoarthritis. All patients benefited from a decompression and repair of the rupture. Whereas the subjective results indicate 92 per cent satisfied patients, from the objective point of view the average score with Constant's rating was 62.5 pts with 53 per cent favorable results. Evaluation of force was a particular subject of attention: the results obtained with three charts were compared; the conclusion was in favour of an objective measurement using a dynamometer but with a weighting according to age and sex. The characteristics of the tear (location especially), the state of the long biceps, the presence of a subacromial osteoarthritis and the pre-operative mobility affected statistically and significantly the final result. The authors reserve reconstructive surgery for tears without osteoarthritis, isolated lesions of the supraspinatus having the best prognosis. The existence of a subacromial osteoarthritis, always a sign of a massive tear, in elderly patients should lead one to choose a procedure a minima under arthroscopy.

Adult↗
PubMed1991

Focal myositis: a pseudotumoral form of polymyositis.

The authors report a case of pseudotumoral focal myositis found in a 55 year-old man, in the anteroexternal area of the right leg. The diagnosis was based on the pathological findings, the absence of any further clinical signs or laboratory findings, and no further development over time. They compare their patient's characteristics with cases found in the literature (24 cases during the past 20 years). Diagnostic certainty confirms the benign character of this pathology, which contrasts with the gravity of the classical form of polymyositis.

Electromyography↗
PubMed1991

[Interlocking nailing of compound lower leg fractures].

Seventy-eight patients with lower leg fractures treated by interlocking nailing at the hospital in Schwaz were reviewed. The overall results were satisfying. There were nine misalignements, two of which underwent subsequent correction. Two infections took place, one after precipitant bone grafting at another place and another one following new trauma. Seven first and five second degree open fractures had an uneventful healing. Interlocking nailing was found to be the treatment of choice for compound fractures with open or closed soft tissue injury of first or second degree after Tscherne. Compared with a previous study about ski injuries, complex fracture patterns combined with severe closed soft tissue lesions showed an increasing incidence during the last ten years. This contrast with the decreasing number of ski injuries in general.

Adult↗
PubMed1991

[2 roentgen projections for the subacromial space before and following acromioplasty. Results of a study series of 40 patients].

It is suggested that two radiological projections of the scapula, an AP view and a lateral (tunnel) view, be obtained in order to estimate the form and size of the acromion before and after acromioplasty. In order to evaluate the standardized films precisely, a film must have been taken for comparison before the surgery. As the method described is easily reproducible, it can be used to evaluate the effect of an acromioplasty irrespective of whether the procedure was an open or an arthroscopic one. The radiological results can be correlated with the functional results at the beginning of rehabilitation and at the end of this period. More sophisticated studies might require a more elaborate X-ray technique than the one proposed in this article.

Acromion↗
PubMed1991

[Postero-superior glenoid impingement. Another shoulder impingement].

An impingement occurring between the deep side of the supraspinatus tendon and the posterosuperior edge of the glenoid cavity was evidenced in a young sports thrower presenting with a partial tear of the deep side of the tendon. This impingement occurred when the arm was in abduction-retropulsion and in forced lateral rotation. It was visualized on arthroscopy. The semiology was mixed, including signs of anterior instability and cuff impairment. The possible causes of partial tears of the deep side of the supraspinatus are discussed: sub-acromial impingement of NEER, anterior instability with secondary impingement, postero-superior glenoid impingement.

Adult↗
PubMed1991

[Surgical treatment of painful shoulders caused by lesions of the rotator cuff and biceps, treatment as a function of lesions. Reflections on the Neer's concept].

On the basis of their clinical and surgical experience of 480 shoulders operated upon for rotator cuff pathology, together with a review of the literature, the authors undertake a critical analysis of the Neer impingement syndrome. Since this syndrome cannot explain all lesions and above all cover all rotator cuff pathology, they suggest an anatomical classification based upon a description of lesions. They describe their indications for surgery on the basis of their results and of those from the literature.

Calcinosis↗
PubMed1990

[Clinical examination of the traumatized shoulder].

In emergencies clinical examination and straight radiography are enough to make a diagnosis and indicate the kind of treatment required. When radiography gives normal results, slight and brief immobilization prevents the occurrence of retractile capsulitis. A second clinical examination, performed a fortnight later, provides a better evaluation of the severity of soft tissue lesions.

Fracture Fixation, Internal↗
PubMed1990

[Traumatic acromio-clavicular pathology].

Based on clinical and radiological findings, four types of acromioclavicular disjunction are described. Stage I and II require nothing more than orthopaedic appliances, whereas surgery is mandatory in stage IV. Treatment of stage III disjunctions varies from on school of orthopaedists to the other. Fractures of the lateral third of the clavicle may lead to diagnostic errors, and tomography is justified at the slightest doubt concerning the integrity of the acromial end of that bone.

Acromioclavicular Joint↗