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S J Snyder

Publications and source records attributed to S J Snyder.

At least 19 recordsLinked to original sources
PubMed2003

[SLAP-lesions of the shoulder].

The advent of shoulder arthroscopy, as well as our improved understanding of shoulder anatomy and biomechanics, has led to the identification of previously undiagnosed lesions involving the superior labrum and biceps tendon anchor. Although the history and physical examinations as well as improved imaging modalities (i. e. magnetic resonance arthrography) are extremely important in understanding the pathology, the definitive diagnosis of SLAP lesions ("superior labrum anterior and posterior") is accomplished through diagnostic arthroscopy. Treatment of these lesions is directed according to the type of SLAP lesion. In general, type I and III SLAP lesions are debrided, whereas type II and many type IV lesions are repaired. The purpose of this article is to review the anatomy, classification, diagnosis and current treatment recommendations.

Arthroscopy↗
PubMed1997

Technique of arthroscopic rotator cuff repair using implantable 4-mm Revo suture anchors, suture Shuttle Relays, and no. 2 nonabsorbable mattress sutures.

This article reviews an arthroscopic technique used to repair small- and medium-sized rotator cuff tears using a retrievable screw-in suture anchor and permanent braided sutures. The cuff is shaved, the bone is prepared arthroscopically, and a subacromial decompression is performed. After implanting the anchors, the sutures are passed through the cuff using Shuttle Relay suture passers and a suture punch. To complete the repair, the sutures are tied using a knot-pusher.

Arthroscopes↗
PubMed1995

The arthroscopic Mumford procedure: an analysis of results.

A total of 50 arthroscopic distal clavicle resections were performed for acromioclavicular joint pathology at our institution between 1990 and 1993. Follow-up on 50 shoulders (100%) was obtained at an average postoperative time of 2 years. Data were collected via physical examination, radiograph review, University of California at Los Angeles (UCLA) shoulder score, and questionnaire. Average patient age was 42 years. Preoperatively all patients showed acromioclavicular joint tenderness, whereas 80% had a positive adduction test. The diagnosis of acromioclavicular degeneration was made by a combination of physical examination and radiographs (100%), acromioclavicular joint injection (4%), bone scan (44%), and magnetic resonance imaging (30%). Intraoperatively, a Claviculizer (Smith-Nephew Dyonics, Andover, MA) burr was used through standard portals in a subacromial approach to the acromioclavicular joint. There were no intraoperative complications. Forty-one patients (82%) had their general anesthetic augmented with an intrascalene block, and all procedures were done on an outpatient basis. The average distal clavicle resection was 14.8 mm. Calcifications within the resected clavicle zone were noted in the shoulders of four of the patients (16%) who returned for radiographic follow-up. The UCLA shoulder score ranked 47 shoulders (94%) good to excellent and 3 fair (6%). Subjective patient satisfaction recorded 47 (94%) good to excellent results, with an average pain relief grade of 87%. Forty-five patients (98%) would recommend the procedure. The arthroscopic Mumford procedure effectively treats acromioclavicular joint pathology. The amount of bone removed can be precisely determined with the Claviculizer burr and reliably reproduced. The procedure has low associated morbidity and high patient satisfaction regarding functional outcome.

Acromioclavicular Joint↗
PubMed1994

The Buford complex--the "cord-like" middle glenohumeral ligament and absent anterosuperior labrum complex: a normal anatomic capsulolabral variant.

Two hundred consecutive shoulder arthroscopy videotapes were retrospectively reviewed, paying specific attention to the anatomy of the anterosuperior glenoid quadrant and especially the labroligamentous complex. Normal glenohumeral anatomy and all variations were carefully evaluated and recorded. Twenty-four (12%) patients had a sublabral foramen below the anterosuperior labrum; a "cord-like" middle glenohumeral ligament was present in 75% (18 of 24) of those cases or 9% of the study population. A smaller group of patients demonstrated a unique variant of normal capsulolabral anatomy that, for convenience, is termed the "Buford complex." This unusual variant was noted in 3 of the 200 (1.5%) shoulders and was distinguished by a "cord-like" middle glenohumeral ligament that originated directly from the superior labrum at the base of the biceps tendon and crossed the subscapularis tendon to insert on the humerus. There was no anterior-superior labral tissue present between this attachment and the midglenoid notch. This unusual-appearing anatomical variation may lead the surgeon to confuse this complex with a sublabral hole or a pathologic labral detachment. The labral tissue of the remaining three glenoid quadrants was normal. If the Buford complex is mistakenly reattached to the neck of the glenoid, as illustrated in our case example, severe painful restriction of rotation and elevation will occur.

Acromioclavicular Joint↗
PubMed1993

Antioxidant enzyme status of ischemic and postischemic liver and ischemic kidney in rats.

The specific activity of seven enzymes involved in protecting tissue from oxidative stress was determined in rat kidneys subjected to 0, 2, 4, or 8 h of normothermic ischemia and in isolated rat livers during control perfusion, after 2 h ischemia, and after 2 h ischemia plus 1 h of reperfusion. In general, none of the antioxidant enzymes measured showed any consistent variation throughout the ischemic period even though mitochondrial function was significantly decreased, indicating substantial cell injury. Glutathione peroxidase (Se-GSH-Px) activity remained constant during 8 h of ischemia, although a small (29%) increase above control activity was noted at 4 h of ischemia. Se-independent GSH-Px activity (non-Se-GSH-Px) and glutathione reductase (GSSG-Red) remained constant up to 8 h of ischemia, when we measured an increase of 158% above controls in non-Se-GSH-Px and a decrease of 35% relative to controls in GSSG-Red. In perfused livers, the only change in enzyme activity after 2 h of ischemia was an increased GSSG-Red activity of 21% above control. This increase persisted into the reperfusion phase (35% above control activity) and was accompanied by decreases in both forms of GSH-Px (28% Se-GSH-Px and 44% non-Se-GSH-Px).

Animals↗
PubMed1993

Arthroscopic management of instability of the shoulder.

Anterior shoulder dislocation in the young athlete may be difficult to treat and, without proper care, usually results in recurrent episodes of instability. By permitting direct visualization of all intraarticular pathology, the arthroscope assists in the diagnosis and helps to determine appropriate therapeutic interventions. Numerous techniques have been developed for arthroscopic reconstruction of unstable shoulders. These can be classified according to the type of fixation employed. The categories include metal devices such as staples or screws, absorbable devices, and suture-based methods, both anterior and transglenoid. An anterior suture anchor method using a new suture passing device known as a Shuttle Relay (Linvatec Corp, Largo, Fla), which allows the surgeon to incorporate non-absorbable mattress sutures in the repair, is described in detail.

Adolescent↗
PubMed1993

Magnetic resonance arthrography of the shoulder. A new technique of shoulder imaging.

Although magnetic resonance imaging is very sensitive and even though pathology in the rotator cuff is readily detected, it is often difficult to distinguish between complete rotator cuff tears, partial rotator cuff tears, and area of tendinitis. This article reports the results of a new technique for evaluation of shoulder pathology, which the authors have labeled magnetic resonance arthrography, and compares the results of magnetic resonance arthrography with those of conventional magnetic resonance imaging.

Adolescent↗
PubMed1993

Our technique for the arthroscopic Mumford procedure.

This article describes a new technique and instrumentation for performing arthroscopic distal clavicle resection safely and accurately using the three standard portals for shoulder arthroscopy. A simple six-step surgical technique is reviewed. Clinical results of patients who have undergone an arthroscopic Mumford procedure using this technique are presented also.

Acromioclavicular Joint↗
PubMed1993

Evaluation and treatment of the rotator cuff.

The use of the arthroscope for evaluation and treatment of rotator cuff problems is becoming more common. Technology has advanced to the point where we can now not only positively diagnose early rotator cuff problems, but successfully treat them; many times without open shoulder surgery. Arthroscopic cuff debridement and decompression are the mainstays of surgical prevention. Arthroscopic suture fixation of delaminated cuff tears or small rotator cuff avulsions is now possible. The miniopen rotator cuff approach is excellent for repairing most larger full-thickness tears. This article reviews all of these current topics and offers step-by-step surgical techniques used and recommended by the author.

Arthrography↗
PubMed1993

Evaluation and treatment of biceps tendon pathology.

Until recently, the role of the long head of the biceps tendon as a source of shoulder pain had been controversial. With careful examination, improved imaging techniques, and arthroscopy, a specific diagnosis can be made. In 95% of patients, biceps tendinitis is secondary to a primary diagnosis of impingement syndrome. Subluxation of the biceps tendon and primary biceps tendinitis are diagnoses of exclusion. However, in the properly selected patient, both respond well to biceps tenodesis. Rupture of the long head of the biceps tendon can be the end result of any of these pathologic processes. In the older sedate patient, conservative treatment results in little functional loss and a mild cosmetic deformity. In the young active patient, especially those who perform tasks that require supination strength, a primary biceps tenodesis should be performed, as well as decompression if there is any evidence of impingement. The key to successful treatment of lesions of the long head of the biceps tendon is recognition of associated pathologic findings in the shoulder. With advances in arthroscopy, the orthopedist can tailor treatment exactly to the pathology, minimizing morbidity and maximizing a successful outcome.

Arthroscopy↗
PubMed1992

Arthroscopic-assisted anterior cruciate ligament reconstruction with the semitendinosus tendon: comparison of results with and without braided polypropylene augmentation.

Fifteen chronic anterior cruciate ligament-deficient knees were arthroscopically reconstructed with a semitendinosus tendon polypropylene (STP) augmented composite graft. A comparison group of 28 reconstructions with the semitendinosus tendon (ST) but without augmentation was simultaneously reviewed. The mean follow-up in the STP group was 31 months (range of 24-42 months) and in the ST group it was 34 months (range 26-54 months). Both patient groups had similar age, sex, preinjury functional sports level, injury-to-surgery interval, and associated meniscal pathology. Good-to-excellent subjective results were reported in 86% of STP patients and 78% of ST patients, whereas 86% of the STP patients and 88% of the ST patients returned to sports activity. Objective examination revealed 73% of the STP group and 82% of the ST group to have a negative or 1+ Lachman test result. A negative pivot shift was noted at follow-up in 80% of the STP group and in 82% of the ST group. KT-1000 testing revealed 60% of the STP patients and 61% of the ST patients to have less than or equal to 3 mm of side-to-side difference. In the STP group there was no evidence of graft breakage, deep infections, or sterile effusions. Overall subjective and functional results were uniformly better than objective results in both patient groups. Analysis of subjective, objective, and functional results reveal no difference in outcome between the STP and the ST patient groups.

Adult↗
PubMed1992

Rotator cuff disease: assessment with MR arthrography versus standard MR imaging in 36 patients with arthroscopic confirmation.

Standard proton-density- and T2-weighted magnetic resonance (MR) imaging and MR arthrography were used to depict rotator cuff disease in 36 shoulders in 36 patients; the findings were compared with arthroscopic findings in every patient. In 19 rotator cuffs normal at arthroscopy, MR arthrography revealed no tear in 16 patients, a partial tear in one patient, and a full-thickness tear in two patients. Standard proton-density- and T2-weighted images were normal in 15 of these patients and revealed a partial tear in two patients and a full-thickness tear in two patients. In 13 partial tears found at arthroscopy, MR arthrography showed a partial tear in six patients, no tear in five patients, and a full-thickness tear in two patients; standard MR imaging revealed a partial tear in one patient, no tear in 10 patients, and a full-thickness tear in two patients. All four full-thickness tears proved with arthroscopy were correctly diagnosed with both MR imaging methods. The main advantage of MR arthrography was better depiction of partial tears in the articular surface.

Adolescent↗
PubMed1992

Injuries of the superior portion of the glenoid labrum involving the insertion of the biceps tendon: MR imaging findings in nine cases.

The goal of this investigation was to describe the MR appearance of traumatic fraying or detachment of the superior portion of the glenoid labrum including the insertion of the tendon of the long head of the biceps. This condition is caused either by an acute injury or by repeated overhead motion during participation in sports. In nine patients with such a lesion, the arthroscopic report and MR images were available for review. These patients were 22-64 years old (mean, 38). In four patients only fraying was noted during arthroscopy, in four patients the superior part of the labrum was detached together with the insertion of the biceps tendon, and in one case there was a bucket-handle tear of the superior portion of the labrum. The MR images were retrospectively evaluated by three osteoradiologists in conference. Signal changes within the labrum and detachment of the labrum were noted, and the findings were compared with the results of arthroscopy. MR imaging did not allow recognition of simple fraying. In two of the five cases with arthroscopic findings of detachment of the superior labrum from the glenoid rim, differentiation between complete and partial labral detachments was not possible even with MR arthrography. However, in these cases the patient's age and history led to the correct diagnosis. We conclude that early traumatic abnormalities of the superior portion of the labrum cannot be detected with MR imaging. Complete detachment, however, can be demonstrated if the patient's age and history are taken into consideration.

Adult↗