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Biomedical subjects

R H Cofield

Publications and source records attributed to R H Cofield.

At least 55 records · Page 3Linked to original sources
PubMed1985

Shoulder arthrodesis and resection arthroplasty.

The indications for shoulder arthrodesis are changing, with paralysis from brachial plexus injuries and sepsis with cartilage loss now accounting for most of the cases. Intra-articular fusion methods, often combined with incorporation of the acromion into the fusion mass, are now the favored techniques. Fusion can be consistently accomplished (between 90% and 95% of patients) with the use of screws, but additional internal fixation with a plate can eliminate the need for prolonged cast treatment after operation. A range of arm positions is satisfactory, with positioning in abduction from 20 to 45 degrees, flexion 20 to 45 degrees, and internal rotation 30 to 60 degrees. After shoulder fusion, pain is usually but not always relieved and function is limited, especially in activities that require arm rotation. Resection arthroplasty has a long history. It is no longer used as a primary procedure. After surgery, stability is usually achieved, active abduction will be less than 90 degrees, and only one half to two thirds of patients will experience satisfactory pain relief. Current indications are essentially limited to salvage after an infected shoulder implant or failed total shoulder arthroplasty with extensive bone loss.

Arthrodesis↗
PubMed1984

The shoulder in sports.

Many sports activities that involve the upper extremity entail similar patterns of movement. Analysis of these activities, a better understanding of the throwing motion, and an awareness of shoulder diseases or injuries have led to a rational plan for investigation and management of shoulder problems. Evaluation often extends beyond the usual medical boundaries and must be based on information obtained from an analysis of sports mechanics, a review of training methods, and a physical examination directed at determination of flexibility, strength, endurance, and the presence of inflammation. Three common sports injuries are damage to the acromioclavicular joint (shoulder separation), instability of the glenohumeral joint, and a spectrum of pathologic changes in the rotator cuff. Sports that are commonly associated with shoulder problems include swimming, baseball, tennis, football, and gymnastics. Treatment may comprise rest, changes in training methods, an alteration of technique, and a physical rehabilitation program. Surgical treatment has a well-defined role, but it is usually optional.

Acromioclavicular Joint↗
PubMed1984

Total shoulder arthroplasty with the Neer prosthesis.

Of seventy-seven total shoulder-replacement arthroplasties with a Neer prosthesis, I evaluated seventy-three replacements in sixty-five patients at two to six and one-half years after the operation. The operations were performed for the treatment of osteoarthritis, rheumatoid arthritis, and old fractures or fracture-dislocations with traumatic arthritis. Postoperatively there was little or no pain even with vigorous activities in most shoulders, and active abduction improved by an average of 44 degrees, to an average of 120 degrees. The amount of abduction that was regained was related to the original diagnosis and to the amount of rotator cuff disease. Complications developed in thirteen shoulders, and five reoperations were necessary. Eight glenoid components showed radiographic evidence of loosening. Fifty-two of the remaining sixty-five shoulders had some radiolucency at the glenoid bone-cement junction.

Adult↗
PubMed1984

Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.

Twenty-seven patients with twenty-seven involved shoulders underwent a second attempt at repair of an initial rotator-cuff repair that had failed. Factors associated with the failure of the initial repair included a massive or large tendon tear, damage to the deltoid origin at the original surgery, and possibly inadequate postoperative external support. Seven patients required a third operation because of continuing pain or weakness. The remaining twenty patients were followed for a minimum of two years (average, forty-eight months) and seventeen of them were examined at an average of forty-six months (range, twenty-six to 118 months) after surgery. Postoperatively, although seventeen patients (63 per cent) still had moderate or severe pain, sixteen (76 per cent) of the twenty-one patients who were operated on to relieve pain reported that the pain was substantially diminished. Active abduction increased an average of 8 degrees, but only seven shoulders gained more than 30 degrees of active abduction. Nineteen shoulders remained moderately or markedly weak in abduction. Over-all, four patients (17 per cent) had a good result; six (25 per cent), a fair result; and fourteen (58 per cent), a poor result. These results suggest that the surgeon should be quite hesitant to propose a second attempt at rotator cuff repair to a patient, as although pain may be diminished, active movement is unlikely to improve.

Adult↗
PubMed1984

Incidence of anterior shoulder dislocation in Olmsted County, Minnesota.

The records of all Olmsted County, Minnesota residents treated for an initial traumatic anterior shoulder dislocation during a ten-year period were reviewed to study the incidence and natural history of this condition. One hundred twenty-four patients had been treated during the study period, and in 116 patients (93.5%) complete follow-up evaluation was available. The overall adjusted incidence of initial traumatic shoulder dislocations was 8.2/100,000 person-years; of all traumatic shoulder dislocations, the rate was at least 11.2/100,000 person-years. Incidence rates were significantly greater for men than for women. There was no urban versus rural difference in incidence or recurrence rates. The authors concluded that shoulder dislocation occurs most frequently in younger male patients and occurs with similar frequency in urban and rural settings. Except for age-related differences in recurrence rates no significant referral bias was found among patients treated at a tertiary care facility as compared with patients from the local community.

Adolescent↗
PubMed1983

Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus.

During the period from 1970 through 1979, proximal humeral arthroplasty with prostheses of the Neer design was performed in 49 shoulders (48 patients) with complex acute or chronic fractures and fracture-dislocations of the proximal humerus. Follow-up evaluation included physical and roentgenographic examination at least two years after surgery for 43 of the 48 patients and averaged 38 months (range, 2-10 years). Of the 43 patients with adequate follow-up evaluation, 16 had acute and 27 (1 bilateral) had chronic fracture problems. Pain relief was satisfactory in all of the 16 shoulders with acute fractures and in 25 of the 28 shoulders with chronic fracture problems. Active abduction averaged 101 degrees in the acute fracture group (range, 35 degrees-160 degrees) and 112 degrees in the chronic fracture group (range, 20 degrees-180 degrees). Complications in shoulders with acute fractures were associated with problems in tuberosity and rotator cuff healing. Complications were more frequent in shoulders with chronic fractures and fracture-dislocations, and were generally related to surgical difficulty, extensive tissue scarring, and distortion of anatomy. The Neer prosthesis affords satisfactory pain relief for both acute and chronic complex fracture-dislocations of the proximal humerus, but the return of function is governed by the security of tuberosity-muscle cuff repair, sufficient protection after operation, and long-term physiotherapy. If possible, surgery should be performed early to avoid the scarring and inelasticity that engender complications and limit functional recovery in shoulders with chronic fractures.

Adult↗
PubMed1983

Acute tears of the rotator cuff. The timing of surgical repair.

Thirty-seven patients had surgical repair within three months after significant ruptures of the shoulder rotator cuff. Twelve were repaired within three weeks (Group 1), six within three to six weeks (Group 2), and 19 within six to 12 weeks after injury (Group 3). Follow-up periods averaged 7.0 years (range, 1.25-21.00 years). Pain relief was generally satisfactory; however, active postoperative abduction averaged 168 degrees for Group 1, 126 degrees for Group 2, and only 129 degrees for Group 3. At open operation, the tear size was graded as small, medium, or large. The correlation of average values of postoperative abduction (148 degrees, 152 degrees, and 133 degrees) with tear size was not statistically significant. Roentgenograms showed that rotator cuff disease is associated with glenohumeral arthritis. With evidence of an acute and complete disruption of the rotator cuff if one must consider surgery, early surgical repair (with 3 weeks of injury) affords the best opportunity for maximal recovery of shoulder function.

Adult↗
PubMed1983

Arthroscopy of the shoulder.

Between December 1979 and June 1982, 74 arthroscopic examinations of the shoulder were done at our institution. Arthroscopy was done in 28 shoulders to evaluate glenohumeral instability, in 23 to assess the joint and tendons before acromioplasty for chronic supraspinatus tendinitis, in 8 to diagnose or stage arthritic diseases, in 7 to define rotator cuff tears, in 3 to assess long-standing periarthritis, in 2 to visualize intra-articular fractures, in 2 to treat infections, and in 1 to evaluate the extent of pigmented villonodular synovitis. Examination of the shoulder with the patient under anesthesia, rather than arthroscopy itself, was more useful in the patients with shoulder instability. In chronic tendinitis, identification of undersurface rotator cuff tears by arthroscopy led to specific treatment. Arthroscopy was valuable in staging intra-articular arthritic diseases and in evaluating articular fractures. It can be used in the diagnosis and treatment of acute infections. Arthroscopy is of minimal value in the assessment of rotator cuff tears and periarthritis or in the treatment of chronic infections.

Adolescent↗
PubMed1982

Subscapular muscle transposition for repair of chronic rotator cuff tears.

Subscapularis transposition into a supraspinatus or supraspinatus and infraspinatus rotator cuff defect has been overlooked as a method of tendon repair. The surgical technique for this type of repair, with or without the concomitant use of a glenohumeral resurfacing prosthesis, is described. Postoperatively, the extremity is supported in a position that does not allow stress to be placed on a repair until healing has occurred. Generally, physical therapy is begun early and continued for many months. In the present series, satisfactory relief of pain was achieved in 22 of the 26 patients. Active abduction in the plane of the scapula averaged 120 degrees for patients with rotator cuffs repair and prosthetic replacement and 130 degrees for those with rotator cuff repair alone. Twelve patients gained more than 30 degrees active abduction, and four lost this amount of motion, or greater, as compared with preoperative capabilities. In two of the 26 patients, the rotator cuff repair was completely disrupted during the acute postoperative period. Twenty-five of the 26 patients were satisfied with the surgical procedure. This type of repair seems to be a secure repair, bring healthy tendon tissue into an area of tendon degeneration and loss of tissue substance. As such, it satisfies the basic surgical principles of achieving repair with healthy tissue that is not under tension. The results compare favorably with those reported in the literature on rotator cuff repair and further suggest that this technique is an acceptable alternative for repairing large or massive rotator cuff tears that have tendon substance loss. However, this technique should not be used for smaller tears, for which more simple techniques are more adequate, because if a retear occurs during the postoperative period, the cuff detect might be quite large, with significant pain postoperatively and functional limitations resulting.

Adult↗
PubMed1981

Tears of rotator cuff.

Tears of the rotator cuff can be very challenging for the surgeon. He should be aware of the variations in the pathologic lesions that can be encountered and should understand the functions of the cuff-capsule mechanisms so that deficiencies can be appropriately defined and treated. A definite diagnosis, based on the history, physical examination, roentgenography, and arthrography, should be made. In some patients with acute tears of the rotator cuff, early operative treatment is warranted. Chronic cuff disease is often treated conservatively. When operative invervention is justified, the anterior or anterosuperior surgical approach is most useful, and the classic plastic surgery flap techniques provide a model for planning and executing the repair. Postoperative external support and the physical therapy program should be tailored to the complexity and the security of the cuff repair.

Humans↗
PubMed1979

Glenohumeral arthrodesis. Operative and long-term functional results.

Seventy-one shoulders of seventy patients were fused for treatment of various conditions, and the results were analyzed after an average follow up of nine years and six months. The operative technique always included the use of internal fixation. The average position of arthrodesis was 45 degrees of abduction and 25 degrees of flexion of the arm, with the flexed forearm rotated 21 degrees above the horizontal plane, measured with the arm abducted and flexed. In sixty-eight shoulders, one operation achieved a solid fusion; in the other three, a second arthrodesis was required. Complications included tenderness over the outer ends of the internal fixation device, which required its removal from seventeen shoulders; a fracture in the fused extremity in ten patients; and a post-operative infection in one. Relief of pain was adequate in three-quarters of the patients. Three-quarters of the patients could perform activities involving reaching the trunk, one-half could do activities requiring reaching the head, and one-quarter were able to do light work with the arm at shoulder level or higher. The position of fusion had little effect on the result. Eighty-two per cent of the entire group believed that they had benefited from the operation, and none of the results deteriorated with time.

Activities of Daily Living↗
PubMed1979

Total joint arthroplasty. The shoulder.

The experience with total shoulder replacement has led to a greater understanding of the large spectrum of pathology which is associated with glenohumeral cartilage loss. For the majority of patients, a simple "resurfacing" prosthesis with muscle repair is the best choice. With this type of implant, pain relief is consistent (92% in 50 shoulders), mechanical failures are rare (2%), and, with repair of all muscles, an opportunity is provided for maximal return of function.

Adult↗
PubMed1977

Status of total shoulder arthroplasty.

Some patients with degenerative, rheumatoid, and traumatic diseases of the glenohumeral joint require treatment primarily to relieve pain. In the absence of complete knowledge of basic mechanical requirements, clinical trials with both constrained and resurfacing prosthesis were initiated. Three types of constrained prostheses were placed in 23 patients. Pain relief was satisfactory, but six reoperations were necessary and motion greater than 90 degrees was rarely achieved. Twenty-five prostheses that were used to replace the glenohumeral articulation, but were not stable by virtue of design, were implanted. Again, pain relief was excellent; mechanical problems were not present, and motion was almost always greater than 90 degrees. Achieving stability by capsular-muscle cuff repair has not been as great a problem as anticipated. These results suggest that more emphasis should be placed on repair of the glenohumeral stabilizing structures than on their replacement.

Adult↗
PubMed1975

Strontium-85 extraction during transcapillary passage in tibial bone.

Indicator dilution experiments were done to determine the extraction of 85Sr during a single passage through capillaries of the tibial diaphysis. Extraction was estimated by injection of 85SrCl2 and a nonpermeant, reference tracer, T-1824-labeled albumin, into the nutrient artery and recording of the effluent venous dilution curves (femoral vein). The mean (+/- SD) maximal instantaneous extraction was 0.53 +/- 0.08 (N = 12). Net retention after 10 min, estimated from venous curves, was 0.41 +/- 0.06 (N = 12), which appeared not substantially different from the retention estimated by direct isotope counting of the tibias for 85Sr, 0.35 +/- 0.06 (N = 12). In a second set of experiments in intact animals, tibial 85Sr extraction after intravenous injection was apparently higher, 0.53 +/- 0.28 (N = 15). Values of tibial diaphyseal blood flow, estimated from washout curves for iodoantipyrine after tibial nutrient artery injection, were 1.47 +/- 0.63 ml/min per 100 g (N = 27). The extraction was not much diminished by higher flows. The estimates of permeability-surface area product (PS) for bone capillaries did increase with flow, suggesting recruitment of more capillaries at higher flows. PS values averaged 0.63 +/- 0.29 (N = 12); we conclude that the capillary membrane is a primary barrier to the passage of 85Sr and presumably other small hydrophilic solutes.

Animals↗