How would you treat the partially torn biceps tendon?
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Arthroscopy↗
Biomedical subjects
J W Byrd
Publications and source records attributed to J W Byrd.
Hip arthroscopy. The supine position.
Hip arthroscopy is an effective technique. It can be performed successfully either supine or in the lateral position, but there appear to be modest advantages of the supine approach. Arthroscopy offers a less invasive alternative to arthrotomy for traditionally recognized forms of hip pathology, such as loose bodies or impinging osteophytes. Arthroscopy also offers a method of treatment for many conditions (including labral tears, acute articular injuries, and damage to the ligamentum teres) that previously went unrecognized and untreated. In the past, these patients were simply resigned to living within the constraints of their symptoms. Several dictums about hip arthroscopy must be acknowledged. First, the key to a successful outcome lies in proper patient selection. A technically well-executed procedure will fail when performed for the wrong reason, or when the outcome fails to meet the patient's expectations. Second, the patient must be properly positioned for the procedure to go well. Poor positioning will assure a difficult procedure. Third, simply gaining access to the hip joint is not an outstanding technical accomplishment. The paramount issue is accessing the joint in as atraumatic a fashion as possible. Due to its constrained architecture and dense soft tissue envelope, the potential for inadvertent iatrogenic scope trauma is significant and, perhaps unavoidable to some extent. Therefore, every reasonable step should be taken to keep this concern to a minimum. Perform the procedure as carefully as possible and be certain that it is being performed for the right reason. After accessing the joint, the techniques of operative arthroscopy for the hip employ existing strategies established in other joints. Because of the restraints imposed by the hip, however, technical deficiencies may be more apparent.
Arthroscopes↗
Hip arthroscopy in athletes.
The limited data (n = 42) and diverse pathology within this study make statistical analysis difficult, although the observations are still meaningful. Diagnostic arthroscopy has defined elusive causes of disabling hip pain in an athletic population including occult labral and chondral damage and rupture of the ligamentum teres. Operative arthroscopy has been effective in reducing the symptoms associated with many of these forms of pathology. For more evident causes of hip pain, such as loose bodies or impinging osteophytes, arthroscopy offers an excellent alternative to traditional open techniques. This study has defined that many intraarticular disorders initially may go unrecognized. The benefit of earlier diagnosis seems intuitive and may minimize extraneous investigative studies, but there are a few caveats. First, various forms of extraarticular pathology (e.g., muscle strains) far outnumber intraarticular injuries and thus the temptation for an extensive intraarticular work up for every hip injury should be avoided. Second, as mentioned, does earlier diagnosis always mean early intervention? There is much that we may not fully understand regarding the natural history of many of these intraarticular disorders that we are only now learning to diagnose.
Adolescent↗
Lateral impact injury. A source of occult hip pathology.
Arthroscopy has helped greatly in understanding the nature of many intra-articular disorders of the hip. It also has provided a better understanding of the pathomechanics and natural progression. This knowledge has aided in improving interpretative clinical skills and investigative techniques. Isolated traumatic chondral injury can occur as a result of impact loading over the greater trochanter. There seems to be a particular propensity for this injury in young physically fit adult males apt to incur this type of blow as a consequence of sport or activity. Initially, this injury may appear innocuous with variable dysfunction. When present, arthroscopy can reliably discern the pathology and often result in significant symptomatic improvement. The long-term consequences of these lesions are still concerning. Although symptomatic improvement from arthroscopic intervention is encouraging, for some cases the long-term influence may only be the knowledge provided for counseling the patient. Nonetheless, arthroscopy can be valuable in both the assessment and management of chondral injuries.
Accidental Falls↗
Elbow arthroscopy for neglected osteochondritis dissecans of the capitellum.
We reviewed results of elbow arthroscopy for neglected osteochondritis dissecans (OCD) of the capitellum. Of more than 140 patients having elbow arthroscopy at our institution, 10 patients (11 elbows) had OCD of the capitellum and fulfilled inclusion criteria. Criteria included symptoms of at least 2 years' duration, loss of motion for at least 6 months, or radiographic evidence of secondary degenerative changes. One patient was lost to follow-up. The remaining 9 (10 elbows) were male patients with a median age of 20 years (range, 15 to 58 years). Follow-up averaged 4.6 years (range, 2 to 8 years). Using a 100-point system, postoperative elbow scores averaged 92 (range, 55 to 100). All patients returned to preoperative activities, though only 8 of 10 believed that surgery resulted in improvement. Elbow arthroscopy for neglected OCD can result in functional improvement. However, results are not as good as those reported with earlier intervention.
Adolescent↗
Prospective analysis of hip arthroscopy with 2-year follow-up.
PURPOSE: Numerous indications, but little outcome data, have been reported for hip arthroscopy. The purpose of this prospective study is to report the 2-year results of hip arthroscopy performed on a consecutive series of patients for a variety of disorders. TYPE OF STUDY: Case series. MATERIALS AND METHODS: There were 38 procedures performed on 35 patients who have achieved 2-year follow-up. All patients were assessed with a modified Harris hip score (pain and function) preoperatively and postoperatively at 1, 3, 6, 12, and 24 months or until a subsequent procedure was performed. Variables studied included age, sex, diagnosis, duration of symptoms, onset of symptoms, center-edge angle, Workers' Compensation, and pending litigation. RESULTS: Follow-up was obtained on all patients. The median score improved from 57 to 85 points. This included 10 cases (9 patients) who underwent a subsequent procedure at an average of 10 months (6 total hip arthroplasty, 1 core decompression, 3 second arthroscopy) with an index score of 54 compared with 52 at the time of the second procedure. The median improvement for the following diagnoses was: loose body (34), labral lesion (27), synovitis (26), chondral injury (18), arthritis (14), and avascular necrosis (-11). Of the variables studied, the most statistically significant finding was that older men with longer duration of symptoms did worse. Two complications occurred in 1 patient: partial neuropraxia of the lateral femoral cutaneous nerve and focal myositis ossificans along the anterior portal tract. CONCLUSIONS: Hip arthroscopy can be performed for a variety of conditions (except end-stage avascular necrosis) with reasonable expectations of success and an acceptable complication rate. This is the first report to quantitate the results of hip arthroscopy for a heterogeneous population.
Adolescent↗
Avoiding the labrum in hip arthroscopy.
SUMMARY: Iatrogenic joint damage is a potential complication of any arthroscopic procedure. The anatomic constraints of the hip cause particular concern. The greatest risks are perforation of the acetabular labrum and scuffing of the articular surface. Careful attention to the details of the technique described can reduce the likelihood of this problem. With current technology, some occasional damage is unavoidable. However, all steps should be taken to minimize the likelihood and magnitude of such occurrences.
Acetabulum↗
Arthroscopy of the elbow for synovial chondromatosis.
Two cases of arthroscopic removal of multiple loose bodies are presented. Successful results were achieved, and patients had 4-year follow-up. Both cases involved classic manifestations of synovial chondromatosis. Associated degenerative changes were present in one case; histologic examination could not confirm synovial origin of the disease. Arthroscopy for removal of symptomatic loose bodies is an excellent choice as exemplified by these two cases. Care should be taken to review histologic findings, which may help in understanding the natural history of this type of process.
Arthroscopy↗
Traction versus distension for distraction of the joint during hip arthroscopy.
Distraction is the most popular technique used in hip arthroscopy. It has been postulated that, if adequate distraction cannot initially be achieved with traction, it will be overcome by distension. The purpose of this study is to quantitate the additive effects of traction and distension in achieving distraction of the hip joint for arthroscopy. Eleven consecutive patients undergoing hip arthroscopy in the supine position on a fracture table were studied. Radiographs of the hip were obtained before and immediately after applying 50 pounds of traction. The hip was then immediately distended with 40 mL saline, and a third radiograph was obtained. After correcting for magnification, distraction was measured for traction alone (DT) and traction plus distension (DTD). A paired t-test was used to compare DT and DTD. Additionally, the ratio of distraction attributed to distension was compared with distraction attributed to traction ([DTD--DT]/DT) and was defined as the delta percent (delta %). Adequate distraction for arthroscopy was able to be achieved in all cases. Distraction due to traction alone (DT) ranged from 2.8 mm to 10.3 mm, with an average of 6.2 mm. Distraction due to traction plus distension (DTD) ranged from 4.8 m to 10.3 mm, with an average of 7.2 mm. The difference between DT and DTD was statistically significant (P < .05). The change in distraction due to distension (delta %) ranged from 0% to 81% with an average of 22%. This study shows that distension may facilitate distraction but the degree is variable.
Adult↗
Labral lesions: an elusive source of hip pain case reports and literature review.
Three cases are presented highlighting varied aspects of labral lesions as a primary or contributing source of mechanical hip pain; including one chronic labral tear associated with old trauma, an acutely entrapped labrum, and a degenerative labral tear associated with osteoarthritis. The diagnosis of labral lesions may be elusive. Arthrography, double-contrast arthrography followed by computerized tomography, and magnetic resonance imaging all have been reported in the assessment of these lesions with variable success. Often, the clinical presentation, including history and physical examination, will yield useful information. A fluoroscopically guided intra-articular injection of the hip is a very useful diagnostic tool for differentiating an intra-articular source of hip symptoms, such as labral lesions, from an extra-articular source. Labral tearing can readily be assessed by arthroscopy and many can be successfully addressed by operative arthroscopy. However, there are many variations in the arthroscopic anatomy of the acetabular labrum.
Acetabulum↗
Hip arthroscopy for posttraumatic loose fragments in the young active adult: three case reports.
PURPOSE. To demonstrate the usefulness of arthroscopy in the management of posttraumatic loose fragments of the hip in the young active adult. CASE SUMMARY. Operative arthroscopy of the hip has been performed successfully in 30 consecutive cases, with the patient supine. Three of these procedures were performed for posttraumatic loose fragments in young athletic males. All three underwent debridement. The age ranged from 17 to 28 years (average 23 years). Follow-up ranged from 14 to 33 months (average 22 months). Although each case was unique, each had a successful outcome. RELEVANCE. This reflects the merits of arthroscopic techniques in the assessment and management of specific disorders about the hip. The technique is safe and reproducible.
Acetabulum↗
Hip arthroscopy: an anatomic study of portal placement and relationship to the extra-articular structures.
The purpose of this study is to accurately describe the relationship of the major neurovascular structures to standard portals used in hip arthroscopy. Placement of three standard arthroscopic portals was simulated in eight fresh paired cadaveric hip specimens by placing Steinmann pins into the joint under fluoroscopic control. The specimens were then dissected and the relationship of the portals to the following structures was recorded: lateral femoral cutaneous nerve, femoral nerve, ascending branch of the lateral circumflex femoral artery, superior gluteal nerve, and sciatic nerve. The lateral femoral cutaneous nerve had divided into three or more branches at the level of the anterior portal. The anterior portal averaged only 0.3 cm from one of these branches. The average minimum distance from the anterior portal to the femoral nerve was 3.2 cm. The ascending branch of the lateral circumflex femoral artery averaged 3.7 cm from the anterior portal. A terminal branch of this vessel was present in three specimens 0.3 cm from the portal. The superior gluteal nerve averaged 4.4 cm superior to the anterolateral and posterolateral portals. The sciatic nerve averaged 2.9 cm from the posterolateral portal. From this study, these portal placements appear to be safe. Proper positioning depends on careful attention to the topographical anatomy about the hip. Avoidance of the important structures depends on proper positioning and proper technique in portal placement.
Arthroscopy↗
Elbow arthroscopy for arthrofibrosis after type I radial head fractures.
The purpose of this study was to provide emphasis on recognizing arthrofibrosis as a potential complication of nondisplaced radial head fractures and the role of arthroscopy in its management. This series consists of five patients treated with arthroscopic debridement for arthrofibrosis after type I radial head fractures. Arthroscopy was considered only if the patient's range of motion had plateaued with significant residual loss of motion after an aggressive physical therapy program. Arthroscopy was performed an average of 6 months postinjury, and follow-up averaged 24 months. The primary complaint was limitation of motion, especially extension, which was improved in all cases. A secondary complaint, painful crepitation, was also subjectively improved in all patients. There were no complications. Arthrofibrosis after type I radial head fractures is a well-recognized entity. Arthroscopic debridement may be a useful adjunct in its management for patients with significant residual functional deficit after an aggressive conservative program.
Adult↗
Hip arthroscopy utilizing the supine position.
The purpose of this article is to demonstrate the merits of the supine position in arthroscopic surgery about the hip. Twenty consecutive patients successfully underwent arthroscopy by this technique. The procedure is performed on a standard fracture table with fluoroscopy. Traction is used to distract the hip for introduction of the instruments. Three standard arthroscopic portals are routinely used. Two portals are placed laterally over the superior aspect of the greater trochanter, and one is placed anteriorly. The procedure is effective and reproducible. It is user friendly to both the surgeon and the operating room staff. Additionally, the procedure uses existing operating room equipment with only minor modifications.
Adolescent↗
Clostridium botulinum type-C intoxication associated with consumption of processed alfalfa hay cubes in horses.
An episode of nervous system dysfunction was observed in horses on 17 premises in 4 counties of southern California. Thirty-eight horses were affected, and 31 of those died. The common clinical signs of disease in the affected horses were: increased appetite; anxious attitude; rythmic, intermittent muscle tremors in the area of the tricep muscles; decreased palpebral tone; mydriasis; small hard fecal balls; and tendency to become sternally recumbent with the neck extended. The temporal distribution of cases on all 17 premises suggested a relationship between exposure to a common batch of alfalfa hay cubes and manifestations of similar clinical signs of disease in affected horses. Fifteen horses were submitted for necropsy. Diagnosis of botulism was established on the basis of detection of type-C1 toxin in the feed, in intestinal contents of 1 horse, and in the liver of the aforementioned horse and another horse. Toxigenic strains of Clostridium botulinum type-C were isolated from intestinal contents of 5 affected horses, one of which also contained type-C1 and type-C2 toxins. Seven of 10 horses treated with type-C antitoxin and plasma obtained from horses hyperimmunized with C botulinum type-C toxoids survived.
Animal Feed↗
The profile view of the acromion.
A previously undescribed roentgenographic view shows the acromion in "profile." A sagittal view of the acromion outlines its bony architecture, specifically, the subacromial portion. This view is clinically useful in the perioperative evaluation of patients with impingement syndrome and can be especially revealing in some cases of persistent symptomatic impingement following previous acromioplasty. The view also provides an excellent perspective for roentgenographic examination of os acromiale. It is reproducible and relatively easy to obtain. The acromion is but one component of the subacromial arch, but this view is a valuable additional diagnostic tool to be used in evaluating the sometimes perplexing problem of impingement syndrome.
Acromion↗
Nocardiosis associated with low dose methotrexate for rheumatoid arthritis.
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Administration, Oral↗
Regional migratory osteoporosis and tarsal tunnel syndrome.
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Ankle Joint↗