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Biomedical subjects

L M Shall

Publications and source records attributed to L M Shall.

7 recordsLinked to original sources
PubMed1992

Arthroscopic release of a posttraumatic flexion contracture in the elbow: a case report and review of the literature.

Open arthrotomy has been the standard of treatment for posttraumatic flexion contractures of the elbow. Utilizing standard arthroscopic techniques combined with electrocautery, anterior capsulotomy was performed without complication. Immediate improvement in extension was demonstrated. Multiple cadaveric dissections evidenced the safety of the approach as the humeral capsular attachment is isolated from the neurovascular structures by the brachialis muscle. This technique serves to underscore the utility of elbow arthroscopy in patients with dysfunction previously only amenable to open joint procedures.

Adult↗
PubMed1991

Femoral instrumentation using the anterosuperior iliac spine as a landmark in total knee arthroplasty. An anatomic study.

Twenty-six adult cadavers were utilized in an anatomic study designed to measure intramedullary femoral alignment in relation to the anterosuperior iliac spine. Fifty femurs were measured to determine the reliability of the anterosuperior iliac spine as an accurate landmark for distal femoral resection in total knee arthroplasty (TKA). A precision machined stainless steel U-shaped parallel alignment guide was fabricated and inserted into the femoral canals of intact adult cadavers. The guide's relationship to the anterosuperior iliac spine was measured and recorded. All hips were maintained in neutral alignment. Independent variables recorded included gender, knee alignment, and side of lower extremity. The range for medial deviation was 1-28 mm for the right femur and 2-25 mm for the left femur (average, 8.5 mm). The range for lateral deviation was 3-14 mm for the right femur and 2-17 mm for the left femur (average, 10.3 mm). There was no statistical correlation between the independent variables of side measured, gender, and measured offset at the anterosuperior iliac spine. Based on this highly variable pattern of alignment, utilizing simulated intraoperative technique, use of the anterosuperior iliac spine does not provide a landmark accurate enough to repeatedly produce a distal femoral resection within 2 degrees-3 degrees of ideal. Use of the anterosuperior iliac spine may lead to less than ideal femoral resection and malpositioning of total knee components.

Arthroplasty↗
PubMed1990

Effect of inosine supplementation on 3-mile treadmill run performance and VO2 peak.

The purpose of this study was to investigate the ergogenic effect of oral inosine (IN) supplementation (6,000 mg.d-1 for 2 d) upon 3-mile run time (3MTIME) and VO2 peak. Nine highly trained endurance runners participated in a double-blind, placebo (PL), crossover study. Each subject undertook an IN or PL trial, consisting of three exercise tests: a submaximal warm-up run (SUBRUN), a competitive 3-mile treadmill run (3MRUN), and a maximal treadmill run (MAXRUN) to determine VO2 peak and time to exhaustion (MAXTIME). Additional measurements during the 3MRUN and MAXRUN included oxygen uptake (VO2), ventilation (VE), respiratory exchange ratio (R), and ratings of perceived exertion (RPE); blood samples were also taken prior (PRERUN) to the SUBRUN test and following the SUBRUN, 3MRUN, and MAXRUN tests in order to assess glucose, pyruvate, lactate, phosphorus, 2,3-DPG, hemoglobin, and uric acid. Analyses of the data revealed no significant effect of oral IN supplementation either upon 3MTIME (IN = 18.31 +/- 1.21; PL = 18.33 +/- 1.15 min) or VO2 peak (IN = 58.6 +/- 5.1; PL = 60.7 +/- 4.5 ml O2.kg-1.min-1) or upon other dependent variables. MAXTIME was significantly longer during the PL trial (P less than 0.05), suggestive of a possible impairment effect of oral IN supplementation. Based upon our data, we conclude that IN is not an effective ergogenic aid to enhance athletic performance of an aerobic nature.

Administration, Oral↗
PubMed1988

Compression neuropathy of the radial nerve as a complication of elbow arthroscopy: a case report and review of the literature.

Arthroscopic surgery of the elbow was performed in a 14-year-old male athlete for diagnosis and treatment of osteochondritis dissecans of the capitellum. Anterolateral and anteromedial portals were used in accordance with described technique. Postsurgical examination revealed an immediate and complete palsy of the posterior interosseous nerve. This complication was attributed to the manipulation of the arthroscope and instrumentation in close proximity to the radial nerve. Neuromuscular function returned to normal over a 6-month period. This case demonstrates the importance of portal placement and instrument manipulation in arthroscopic evaluation and treatment of the elbow. Further study is necessary to develop technical and procedural improvements to assure safe and effective arthroscopic treatment.

Adolescent↗
PubMedDate not supplied

Fluoroscopic evaluation for subtle shoulder instability.

Fifty patients with unilateral shoulder symptoms and a variety of diagnoses were evaluated with stress testing of both shoulders under general anesthesia using fluoroscopic documentation just before surgery. An axillary lateral view of the glenohumeral joint was taken in neutral rotation and 90 degrees of abduction; this was termed "neutral position." Anterior and posterior translational stresses were then applied and spot radiographs taken. Measurements were made and the translation was expressed as a percentage of displacement of the humeral head with respect to the glenoid. The asymptomatic side was used as a control. We determined that up to 14% anterior translation and up to 37% posterior translation is normal. Using these guidelines, attempts were made to confirm or predict the presence of stability or instability. Thirty-one patients were correctly identified as stable; 14 were correctly identified as unstable. Three patients with anterior shoulder pain were classified as unstable and found to have Bankart lesions at surgery. Overall, specificity was 100% and sensitivity was 93%. Using discriminant function analysis, a difference score of 10% between the symptomatic and control shoulder was generated. This was useful in eliminating interobserver variations in the examination for predicting stability or instability. We recommend this examination as a valuable adjunct to confirm the presence and direction of shoulder instability and predict subtle instability patterns in patients with recalcitrant undiagnosed shoulder pain.

Adolescent↗
PubMedDate not supplied

The free synovial graft as a shield for collagen ingrowth in cruciate ligament repair.

The anterior cruciate ligament (ACL) was excised bilaterally in the knee joint of three dogs and was replaced in a conventional manner with a composite polyglycolic acid (PGA) and Dacron braided ligament prosthesis. In one knee of each dog, the ligaments were wrapped with a free synovial graft taken from the suprapatellar pouch in an attempt to keep the prosthesis extrasynovial, while the ligaments in the opposite three knees were left uncovered and thus directly exposed to synovial fluid. The dogs were killed at approximately one year postoperation, and microscopic sections of all ligaments were taken. The three knees with the synovial sheath showed a significantly greater bulk of fibrous tissue along the ligament scaffold grossly and a greater abundance of collagen producing cells microscopically, compared to the unwrapped ligaments. The gross and microscopic findings were identical in each of the three knees with the covered ligaments and were equally consistent in the three that had been left unprotected from the synovial fluid. These findings suggest that a free synovial graft may simulate the normal protective role of the synovial membrane and allow and/or induce collagen ingrowth in synthetic or autogeneic tissue stints for the repair of acute cruciate ligament tears.

Animals↗