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R L Pradhan

Publications and source records attributed to R L Pradhan.

13 recordsLinked to original sources
PubMed2001

A rare anatomic variant of the superior glenohumeral ligament.

The attachment of the superior glenohumeral ligament (SGHL) to the upper pole of the glenoid is variable and 3 types have been described. We report an anatomic variant of SGHL attachment to the upper pole of the glenoid that has not heretofore been reported in the literature. In this case, the SGHL overrode the biceps origin, continued to the superior labrum posteriorly, and had no attachment to the middle glenohumeral ligament or the anterior labrum. This variant was detected during routine arthroscopic examination undertaken before surgery on a rotator cuff tear.

Adult↗
PubMed2000

Effects of biceps loading and arm rotation on the superior labrum in the cadaveric shoulder.

Effects of loading the long head of the biceps brachii (LHB) and arm rotation on the strain of the superior labrum (anterior and posterior) in 10 fresh frozen cadaveric shoulder joints were studied. Loads were applied to the rotator cuff muscles to stabilize the humeral head. The strain of the anterior and posterior portions of the labrum with the biceps loaded with 0.42 kg, 1.36 kg, and 2.31 kg were measured using linear transducers. The humerus was rotated externally (30, 45, 60, and 90 degrees) and internally (30, 45, and 60 degrees) with the arm elevated 60 degrees at glenohumeral joint (simulated 90 degrees elevation of arm to the trunk). The strain increased with an increase in the weight of the load to LHB and with increase in rotation angle both internally and externally. Since the strain in the posterior portion was larger than that of the anterior portion it seems likely that the labrum, especially the posterior portion, is subject to large strain during biceps loading and arm rotation.

Aged↗
PubMed1999

Position of immobilization after dislocation of the shoulder. A cadaveric study.

BACKGROUND: After reduction of a shoulder dislocation, the torn edges of a Bankart lesion need to be approximated for healing during immobilization. The position of immobilization has traditionally been adduction and internal rotation, but there is little direct evidence to support or discredit the use of this position. The purpose of the present study was to determine the relationship between the position of the arm and the coaptation of the edges of a simulated Bankart lesion created in cadaveric shoulders. METHODS: Ten thawed fresh-frozen cadaveric shoulders were used for experimentation. All of the muscles were removed to expose the joint capsule. A simulated Bankart lesion was created by sectioning the anteroinferior aspect of the capsule from the labrum. With linear transducers attached to the anteroinferior and inferior portions of the Bankart lesion, the opening and closing of the lesion were recorded with the arm in 0, 30, 45, and 60 degrees of elevation in the coronal and sagittal planes as well as with the arm in rotation from full internal to full external rotation in 10-degree increments. RESULTS: With the arm in adduction, the edges of the simulated Bankart lesion were coapted in the range from full internal rotation to 30 degrees of external rotation. With the arm in 30 degrees of flexion or abduction, the edges of the lesion were coapted in neutral and internal rotation but were separated in external rotation. At 45 and 60 degrees of flexion or abduction, the edges were separated regardless of rotation. CONCLUSIONS: The present study demonstrated that, in the cadaveric shoulder, there was a so-called coaptation zone in which the edges of a simulated Bankart lesion were kept approximated without the surrounding muscles.

Aged↗
PubMedDate not supplied

Function of the 3 portions of the inferior glenohumeral ligament: a cadaveric study.

The stabilizing function of the inferior glenohumeral ligament of the anterior band and posterior band has been investigated, but little is known about the function of the axillary pouch. The strain of the 3 portions of the inferior glenohumeral ligament in 17 fresh-frozen cadaveric shoulders was measured with use of linear transducers. The measurements were performed under the following conditions: 0 degrees, 30 degrees, 45 degrees, and 60 degrees of glenohumeral elevation in the coronal, scapular, and sagittal planes and internal to external rotations in 10 degrees increments. The anterior band and axillary pouch showed significant strain increases when the arm was elevated and externally rotated in the coronal and scapular planes but no increase in the sagittal plane. The posterior band showed no strain in the coronal and scapular planes, but a significant strain increase with the arm elevated and internally rotated in the sagittal plane. We conclude that the anterior band and axillary pouch, which showed the greatest strain in abduction and external rotation, are anterior stabilizers, whereas the posterior band, which showed the greatest strain in flexion and internal rotation, is a posterior stabilizer. We recommend that the 6 o'clock position be firmly repaired during the Bankart procedure.

Aged↗
PubMedDate not supplied

Superior labral strain during the throwing motion. A cadaveric study.

We studied the strain on the superior labrum of 10 fresh-frozen cadaveric shoulders with the arm in simulated positions of a pitching motion. We used linear transducers to measure the strain in both the anterior and posterior superior labrum with the arm in various planes and rotations simulating the motions of pitching: early cocking, late cocking, acceleration, deceleration, and follow-through. Predetermined loads, according to the percent of maximum voluntary contraction of the biceps muscle during each phase of pitching, were calculated and applied to the long head of the biceps tendon using a spring device. Only during the late cocking phase, when the arm was in maximal external rotation, was the increase in strain statistically significant for the anterior and posterior portions and the strain on the posterior portion significantly greater than that on the anterior portion of the labrum. The increased strain in the posterior portion may be due to the anatomic orientation of the long head of the biceps tendon at the superior labrum. The increased strain in the late cocking phase may contribute to the detachment of the labrum with the eccentric contraction of the biceps muscle that occurs with rapid extension of the elbow.

Aged↗
PubMedDate not supplied

Effect of superior capsule and coracohumeral ligament release on strain in the repaired rotator cuff tendon. A cadaveric study.

Twelve cadaveric shoulders were used to determine the effects of release of the superior capsule and the coracohumeral ligament on the strain in the repaired rotator cuff tendon. A rotator cuff tear (2 cm wide and 1.5 cm long) was created and repaired under a 3-kg tensile force. The strain in the repaired tendon was measured with use of linear transducers with the arm in 50 different positions. Release of either the superior capsule or the coracohumeral ligament diminished the tension of the repaired rotator cuff by an average of 25% with the arm in adduction. Release of both of these structures further reduced the tension by an average of 44% in adduction and 43% to 60% with the arm in 15 degrees of elevation. The maximum reduction of tension in the repaired rotator cuff occurred when both the superior capsule and coracohumeral ligament were divided and when the arm was positioned in adduction and in 60 degrees of external rotation. Release of the coracohumeral ligament is equally as efficient as releasing the superior capsule in reducing the strain of the repaired rotator cuff. Releasing both structures seems to be desirable when releasing one structure or the other is not sufficient.

Aged↗
PubMedDate not supplied

Effect of arm elevation and rotation on the strain in the repaired rotator cuff tendon. A cadaveric study.

In 14 cadaveric shoulders, a rotator cuff tear (2 cm wide and 1.5 cm long) was created and repaired under a 3-kg tensile force with the arm in adduction. Strain on the repaired tendon was measured at 0 degrees, 15 degrees, 30 degrees, and 45 degrees of elevation in the sagittal, scapular, and coronal planes and from 60 degrees of internal rotation to 60 degrees of external rotation. The strain in all of the planes decreased significantly with the arm elevated more than 30 degrees. With 30 degrees of elevation in the scapular and coronal planes, the strain increased in internal rotation and decreased in external rotation. In all of the positions measured, the strain in the sagittal plane was significantly greater than in the other planes. We concluded that more than 30 degrees of elevation in the coronal or scapular plane and rotation ranging from 0 degrees to 60 degrees of external rotation compose the safe range of motion after repair of the rotator cuff.

Aged↗
PubMedDate not supplied

Acute sacrococcygeal dislocation (anterior type): a case report.

Sacrococcygeal dislocation is a rare injury. A twenty nine year old male presented to us with pain over the lowest part of spine of 5 days duration. He fell down on stairs with his buttock landing directly over the edge of the stairs. On examination, a step was felt in the continuity of sacrum and coccyx. The tip of the coccyx was not palpable. Per rectal examination revealed a small bump on running the finger along the sacrococcygeal curvature. On plain radiographs of sacro coccygeal region, lateral view revealed anterior dislocation of the coccyx over the sacrum. On antero posterior view, the injury could not be identified. Under general anaesthesia, an attempt to reduce the dislocation per rectally was tried, but failed. The patient was treated conservatively with analgesics. He refused surgery, as he was relieved of pain with analgesics.

Adult↗
PubMedDate not supplied

Results of autogenous trephine biopsy needle bone grafting in fractures of radius and ulna.

Cortico-Cancellous bone graft harvested from the anterior iliac crest by the conventional open method is associated with more morbidity and is more time consuming as compared to the percutaneous method using trephine biopsy needle. The aim of the study was to determine whether cancellous bone graft harvested from anterior iliac crest using trephine biopsy needle consistently achieved bone union in comminuted fractures and fractures of more than 3 weeks duration of radius and ulna and also to determine the morbidity at the donor site. Autogenous cancellous bone graft was harvested percutaneously from 28 iliac crests in 16 patients and applied at fracture sites of 30 forearm bones using a 4mm trephine biopsy needle after the fractures had been fixed with plate and screws. The patients were followed up regularly upto 6 to 9 months post - operatively in the OPD to determine the union status of the fractured bones and the morbidity at the donor site. 29 of the 30 fractures of the forearm bones united without any problems. The shaft of a trephine got bent during the harvesting procedure at the beginning of the study due to improper technique. Cancellous bone graft harvested from the anterior iliac crest results in predictable good union results in comminuted fractures of forearm bones and also fractures presenting after 3 weeks of injury. It is also an easier and quicker way of harvesting bone graft and is associated with lesser morbidity and earlier recovery as compared to conventional open method.

Biopsy, Needle↗
PubMedDate not supplied

Isokinetic external rotation strength of shoulder : correlation with age and muscle size.

The purpose of this study was to determine the correlation between quantitative (cross sectional areas) evaluation of the posterior cuff muscles and mechanical strength in asymptomatic shoulders with special reference to aging. The cross-sectional area of the combined infraspinatus and teres minor muscles were measured, in the sagittal oblique magnetic resonance images, in eighty-one patients with a mean age of 44.06 years (range 19 - 74). These areas were correlated with the measured isokinetic strength in external rotation at angular velocities of 60 deg/s and 180 deg/s using Cybex 770 NORM. The results show that there was a gradual decrease in size of the muscles as the age of the individual increases. A strong correlation was found between aging and combined cross-sectional area and peak torque as well. The correlation between combined cross-sectional area and peak torques at both angular velocities were less strong. Further, the correlation between the peak torque/cross-sectional area ratio with aging was also less significant, which may imply that the decrease in the muscle strength was greater than the change in muscle area. Our results suggest that there may be other qualitative and biochemical factors that may determine the true strength of the muscles in the aged population.

Adult↗
PubMedDate not supplied

Reduction of acute anterior shoulder dislocations: comparing intraarticular lignocaine with intravenous anesthesia.

Anterior shoulder dislocation is the most common dislocation in the body. Various methods of anesthesia are available for reduction. The objective of this study was to compare the application of intra-articular anesthesia with intravenous anesthesia for reduction of acute anterior shoulder dislocation. This study was conducted at Kathmandu Medical College Teaching Hospital (KMCTH) and Kathmandu Hospital and comprised of patients coming with anterior dislocation of shoulder from July 2001 to June 2005. Forty-five patients aged 17-55 years with no associated fractures of adjoining bones were included in the study. In twenty-three patients, reduction was done using intra-articular anesthesia and in 22 patients intravenous anesthesia was given. In five patients (three in intra-articular group and two in intravenous group) the reduction technique had to be changed to the Hippocratic method. In these three patients intravenous anesthesia had to be given after intra-articular anesthesia failed to relieve pain and spasm. In the intravenous group two patients had to be admitted overnight while in the intra-articular group none had to be admitted to the hospital. However, in the intra-articular group the average time taken from injection to reduction was significantly longer (<.001). The use of intra-articular lignocaine for reduction of shoulder dislocation is safe and effective especially when patients present early. In patients presenting late (more than 5 hours) intravenous anesthesia should be primarily considered as the method for shoulder reduction.

Acute Disease↗