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Biomedical subjects

R J Neviaser

Publications and source records attributed to R J Neviaser.

At least 19 recordsLinked to original sources
PubMed1997

Evaluation and management of failed rotator cuff repairs.

Revision rotator cuff reconstruction should be based on the clinical problem, not the mere presence of a cuff defect. A functional deltoid is critical to the success of such surgery. Reconstructive procedures on the cuff include direct repair, interpositional grafting, and tendon transfers associated with an appropriate decompression. Decompression without repair-merely de bridement of the cuff-carries a significant risk of creating a severe functional loss and a poor outcome.

Acromion↗
PubMed1997

Biceps activity during shoulder motion: an electromyographic analysis.

Electromyographic responses in 44 shoulders from 30 subjects were examined. Fourteen shoulders from 13 patients had documented rotator cuff tears. The remaining volunteers had normal cuff integrity by history and examination. Electromyographic responses were recorded from the long head of the biceps, brachioradialis (elbow control), and from the supraspinatus (shoulder control). Elbow related biceps activity was minimized by using a brace locked in neutral forearm rotation and 100 degrees flexion. Analysis of normal and rotator cuff deficient data was performed in a masked fashion and electromyographic activity normalized as a percent of maximal muscle contraction during 10 shoulder motions based on the scapular plane. Normal shoulders in all ranges of active motion exhibited significant supraspinatus activity (20%-50% maximum muscle contraction). The response followed patterns expected for a shoulder stabilizer. In contrast, with every normal shoulder, biceps and brachioradialis activity remained insignificant (1.7%-3.6% maximum muscle contraction) and did not follow a patterned response. In patients with rotator cuff tears, biceps activity remained low (1.6%-4.4% maximum muscle contraction). As opposed to previous studies using electromyography about the shoulder, this trial examined shoulder specific biceps activity by relaxing the elbow. No significant biceps activity was observed in any shoulder, including patients with rotator cuff tears. Given these findings, any function of the long head of the biceps in shoulder motion does not involve active contractions.

Adult↗
PubMed1994

Incomplete rotator cuff tears. A technique for diagnosis and treatment.

The size and location of intratendinous and joint side rotator cuff tears can be diagnosed by a technique known as positional arthrography. The site and extent of the tears diagnosed preoperatively by this technique correlated well with intraoperative findings in a study group of 200 patients who underwent a combined arthroscopic and open procedure to localize, identify, and repair incomplete rotator cuff tears.

Arthrography↗
PubMed1993

Anterior dislocation of the shoulder and rotator cuff rupture.

Thirty-seven patients older than 40 years of age were seen after sustaining primary anterior dislocations of the shoulder. An associated rupture of the rotator cuff in each patient had been missed, often being mistaken for an axillary neuropathy. Eleven of these patients developed recurrent anterior instability that was due to rupture of the subscapularis and anterior capsule from the lesser tuberosity. In no patient was there a Bankart lesion. Repair of the capsule and subscapularis restored stability in all of the patients with recurrence.

Adult↗
PubMed1990

Observations on impingement.

The combined interaction of four elements produces lesions of the rotator cuff, commonly known as impingement. The elements are: vascular, degenerative, traumatic, and mechanical or anatomic factors. The elements are interrelated, and each affects the tendons in a manner that contributes to tendon weakening. It is unlikely that any one element is solely responsible for cuff lesions; the nature of each lesion is determined by the factors that predominate in that individual case. The net result is degeneration of the tendons.

Humans↗
PubMed1989

Tenosynovitis.

The two types of tenosynovial infections in the hand are acute pyogenic and chronic atypical mycobacterial. Each has specific diagnostic criteria and a different therapeutic approach. If untreated or maltreated through misdiagnosis, either type can lead to significant long-term disability.

Acute Disease↗
PubMed1988

Concurrent rupture of the rotator cuff and anterior dislocation of the shoulder in the older patient.

Thirty-one patients who were unable to abduct the involved arm after reduction of a primary anterior dislocation of the glenohumeral joint were found to have a ruptured rotator cuff. All of the patients were more than thirty-five years old. Twenty-nine of them were initially presumed to have had an injury to the axillary nerve, although this injury was confirmed in only four of the twenty patients who had electrodiagnostic studies. In eight patients, the subscapularis tendon and anterior part of the capsule had ruptured from the lesser tuberosity. Recurrent instability developed in all eight patients, and repair of these structures alone was successful in restoring stability. The association between primary anterior dislocation of the glenohumeral joint and rupture of the rotator cuff in the older patient who cannot abduct the arm after reduction is poorly appreciated, as it is often missed. In our series of such patients, the incidence of injury to the axillary nerve was 7.8 per cent, as compared with 100 per cent for rupture of the rotator cuff. However, the comparative rates of occurrence of these two entities in older patients who have an anterior dislocation have not been determined.

Adult↗
PubMed1987

Ruptures of the rotator cuff.

Tears of the rotator cuff are a common entity. These tears frequently require surgical decompression and reconstruction. A number of options are available, depending on the quality of the tissues and one's ability to close the tear directly. Fortunately, in almost all cases direct closure of the cuff is possible after decompression. Early postoperative passive motion is useful in hastening recovery. Resistive exercises should be avoided early in the rehabilitation period.

Acute Disease↗
PubMed1987

Radiologic assessment of the shoulder. Plain and arthrographic.

Five standard radiographic projections are useful in screening patients with shoulder complaints. Three are AP views: internal rotation, external rotation, and 100-degree abduction. The other two are the axillary and bicipital groove views. Single-contrast arthrography is valuable in diagnosing full-thickness rotator cuff tears, adhesive capsulitis, and lesions of the biceps. It also is useful in determining deep-surface, incomplete cuff tears and, occasionally, anterior instability.

Arthrography↗
PubMed1987

Injuries to the clavicle and acromioclavicular joint.

Fractures of the clavicle are a common lesion best treated by closed means. In the unusual instance that nonunion develops or early irreversible vascular or neurologic compromise is present, an intramedullary Knowles pin is the preferred method of fixation. Injuries of the acromioclavicular joint usually can be treated symptomatically. Types 3A and B require early operative intervention. For the few patients who have late symptoms from types 2 or 3, an acromioclavicular arthroplasty, joint stabilization, and transference of the coracoacromial ligament to form a superior acromioclavicular ligament are used.

Acromioclavicular Joint↗
PubMed1987

The frozen shoulder. Diagnosis and management.

The differentiation between the stiff and painful shoulder without any joint capsule involvement and with capsule involvement (true adhesive capsulitis) must be established before a rational treatment can be prescribed. Arthrography establishes the correct diagnosis of adhesive capsulitis. Treatment of the stiff and painful shoulder is through prevention and exercise. The treatment of adhesive capsulitis includes prevention, exercises, manipulation, and capsulotomy. Each treatment method is determined by specific criteria. Arthroscopy is not useful for either diagnosis or treatment of adhesive capsulitis but may be useful for recognition of the four stages of the disease.

Female↗
PubMed1986

On resection of the proximal carpal row.

Thirty-one patients (30 men and one woman) ranging from 19 to 64 years of age underwent proximal row carpectomy for posttraumatic arthrosis of the carpus. The injuries included transscaphoid perilunate dislocations with late subluxation and arthritis, ununited scaphoid fractures with arthritis, scapholunate dissociations with arthritis, and acute carpal injuries, including dislocations and comminuted fractures. The follow-up period ranged from two to 12 years. Wrist motion and grip strength were satisfactory. There were two failures, both of which converted to wrist arthrodesis.

Adult↗
PubMed1983

Proximal row carpectomy for posttraumatic disorders of the carpus.

Twenty-four patients (23 men and one woman) from 19 to 65 years old underwent proximal row carpectomy following carpal injuries. The injuries were 10 transscaphoid perilunate dislocations with late subluxation and arthritis, 10 ununited scaphoid fractures with arthritis, three scapholunate dissociations with arthritis, and one acute carpal dislocation. All were followed for from 3 to 10 years. Although the result depended on the original injury, wrist extension was 65% to 70% of normal, flexion was 48% to 65%, ulnar deviation 85 1/2, and radial deviation 17%. Grip strength was equal to that in the opposite hand. There was one failure that was converted to a successful fusion.

Adult↗