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Biomedical subjects

W Z Burkhead

Publications and source records attributed to W Z Burkhead.

14 recordsLinked to original sources
PubMed2001

Technique for repair of the subscapularis tendon.

Patients with sudden loss of active motion after an external rotation or hyperextension injury should be viewed with a high index of suspicion for a subscapularis tear. Exaggerated external rotation and the presence of a positive lift off or belly press test on physical examination combined with appropriate imaging studies will lead to an early diagnosis. Careful surgical repair combined with a thoughtful rehabilitation program will lessen both the length and degree of disability from this clinical entity.

Accidental Falls↗
PubMed2001

Results of decompression and rotator cuff repair in patients 65 years old and older: 6- to 14-year follow-up.

At an average of 9.2 years after surgery, 47 patients with 51 shoulders who had undergone rotator cuff repair and subacromial decompression through an open Rockwood 2-stage acromioplasty-type approach were reviewed. All patients were 65 years or older at the time of their initial index procedure. Results were rated by patient satisfaction, the Constant's score, American Shoulder and Elbow Surgeons (ASES) Evaluation, and Neer rating. Subjectively, the patients were highly satisfied, with a 94.1 overall satisfaction rate. Objectively, the average Constant's score was 82 when normalized to the opposite shoulder and age. According to the Neer rating scale, there were 20 (39%) excellent, 26 (51%) satisfactory, and 5 (10%) unsatisfactory results. When assessing the ASES Evaluation, the patients who had undergone an extensile deltotrapezial takedown had increased strength in their lateral deltoid as compared with a cohort of individuals who had undergone the VY exposure. There was no statistically significant difference in subjective or objective results. For the most part, open rotator cuff repair and subacromial decompression in older patients has a high level of success with respect to pain relief, independent living, and when desired, reasonable sports participation.

Aged↗
PubMed2000

Revision surgery after failed subacromial decompression.

The purpose of this study was to assess the results of revision subacromial decompression and identify clinical and psychological factors that influence its outcome. Thirty-five patients with intact rotator cuffs who underwent surgery for recurrent stage II impingement were studied at a mean follow-up time of 43 months post-surgery. Twenty-seven patients were satisfied with their surgery. The UCLA Scoring System rated 18 of 35 with good/excellent results and 17 of 35 poor/fair results, 22 patients had worker's compensation injuries, which correlated with poor outcome (P=0.0067). Patients with concomitant brachial plexopathy and/or compressive neuropathies were associated with unsatisfactory results (P=0.02).

Adult↗
PubMed2000

Nonoperative treatment of rotator cuff tears.

Rotator cuff tears and subacromial impingement are second only to acromioclavicular joint disorders as the most common causes of shoulder pain. Although most orthopedic surgeons are willing to initially treat shoulder impingement syndrome conservatively, they are reluctant to manage rotator cuff tears-especially full-thickness tears-nonoperatively. The purpose of this article is to explain the biomechanical rationale of nonoperative treatment, review the literature pertaining to nonoperative treatment of full-thickness rotator cuff tears, and describe a nonoperative treatment program.

Biomechanical Phenomena↗
PubMed2000

Tendon ruptures about the shoulder.

Although degeneration and strain of musculotendinous structures are frequent causes of shoulder pain, sudden violent injuries in young individuals can lead to complete musculotendinous ruptures. Some of these conditions lend themselves well to nonoperative treatment. This article will enable the physician to determine the clinical diagnosis and formulate a treatment plan for each patient as an individual. Some patients may be satisfied with an accurate diagnosis only, while others demand more aggressive operative care.

Biomechanical Phenomena↗
PubMed1995

Débridement of degenerative, irreparable lesions of the rotator cuff.

A modified Neer acromioplasty, subacromial decompression, and débridement of massive, irreparable lesions of the supraspinatus and infraspinatus tendons was performed in fifty-seven patients. Fifty patients (fifty-three shoulders) were followed for an average of six and one-half years. The average age of the patients was sixty years (range, thirty-eight to seventy-four years). The results, as rated on the basis of pain, function, range of motion, strength, and satisfaction of the patient, were satisfactory in forty-four shoulders (83 per cent) and unsatisfactory in nine (17 per cent). A favorable outcome was observed in shoulders in which both the anterior portion of the deltoid muscle and the long head of the biceps tendon were intact and in which a previous acromioplasties or operations on the rotator cuff had been performed. An unsatisfactory outcome was observed in shoulders in which the anterior part of the deltoid muscle was weak or absent or in which a previous acromioplasty and attempted repair of the rotator cuff had been performed. The active forward flexion of the shoulder improved from an average of 105 degrees preoperatively to an average of 140 degrees postoperatively. The results of the present study suggest that, with proper rehabilitation, adequate decompression of the subacromial space, anterior acromioplasty, and débridement of massive tears of the rotator cuff can lead to the relief of pain and the restoration of shoulder function.

Acromion↗
PubMed1992

Treatment of instability of the shoulder with an exercise program.

One hundred and forty shoulders in 115 patients that had a diagnosis of traumatic or atraumatic recurrent anterior, posterior, or multidirectional subluxation were treated with a specific set of muscle-strengthening exercises. Only twelve (16 per cent) of the seventy-four shoulders (sixty-eight patients) that had traumatic subluxation had a good or excellent result from the exercises, compared with fifty-three (80 per cent) of the sixty-six shoulders that had atraumatic subluxation. For this reason, each patient who has instability of the shoulder should be thoroughly evaluated if a successful result from conservative treatment is to be expected. Every effort must be made to identify the etiology of the instability through careful history-taking, physical examination, and radiographic evaluation.

Adolescent↗
PubMed1979

Occult cervical spine injuries in fatal traffic accidents.

Post-mortem radiographs as well as careful inspection at autopsy of 100 consecutive traffic accident victims revealed an incidence of cervical spine injury of 24%. All but four of the 24 fractures and/or dislocations were localized to the level between the occiput and the axis. One half of the cases were not clinically suspected of having spine injuries before the detailed postmortem search. Seventeen of the 24 cervical spines were resected en bloc and the pathologic anatomy of the injuries was determined. The high incidence of cervical spine injuries and the anatomic findings at dissection have clinical implications for physicians who manage multiply traumatized patients. The need for immobilization and early radiographic evaluation of patients with cervical spine injuries is emphasized.

Accidents, Traffic↗
PubMed1979

The pathological anatomy of fatal atlanto-occipital dislocations.

Nine atlanto-occipital dislocations were found in postmortem examinations of 112 victims of multiple trauma. Axial traction facilitated roentgenographic identification of the injury. A hyperextension mechanism of injury was suggested by the associated injuries, including submental lacerations and mandibular fractures. Atlanto-occipital dislocations were more frequent in children than in adults. A pure dislocation injury without fracture was identified.

Adolescent↗
PubMedDate not supplied

Biologic resurfacing of the glenoid with hemiarthroplasty of the shoulder.

A porous-coated humeral head replacement with biologic resurfacing of the glenoid was performed in 14 patients between 1989 and 1992. Six of the 14 patients had greater than 2 years of follow-up and form the basis of this report. The patients ranged in age from 33 to 54 years. Diagnoses were osteoarthritis in one, postreconstruction arthritis in four, and posttraumatic arthritis in one. The biologic resurfacing was done with either autogenous fascia lata or anterior shoulder capsule. All patients were relieved of pain. Average postoperative positions were elevation 138 degrees, external rotation 50 degrees, and internal rotation to the T12 spinous process. These results represent average increases of 57 degrees, 45 degrees, and six spinal segments, respectively. No donor site complications occurred. With Neer's rating scale there were five excellent results and one satisfactory result. We conclude that biologic resurfacing of the glenoid appears to improve the results of hemiarthroplasty and may well be the procedure of choice for young patients with end-stage glenohumeral arthritis.

Adult↗
PubMedDate not supplied

The rotator cuff-deficient arthritic shoulder: diagnosis and surgical management.

The symptomatic rotator cuff-deficient, arthritic glenohumeral joint poses a complex problem for the orthopaedic surgeon. Surgical management can be facilitated by classifying the disorder in one of three diagnostic categories: (1) rotator cuff-tear arthropathy, (2) rheumatoid arthritic shoulder with cuff deficiency, or (3) degenerative arthritic (osteoarthritic) shoulder with cuff deficiency. If it is not possible to repair the cuff defect, surgical management may include prosthetic arthroplasty, with the recognition that only limited goals are attainable, particularly with respect to strength and active motion. Glenohumeral arthrodesis is a salvage procedure when other surgical measures have failed. Arthrodesis is also indicated in patients with deltoid muscle deficiency. Humeral hemiarthroplasty avoids the complications of glenoid loosening and is an attractive alternative to arthrodesis, resection arthroplasty, and total shoulder arthroplasty. The functionally intact coracoacromial arch should be preserved to reduce the risk of anterosuperior subluxation. Care should be taken not to "overstuff" the gleno-humeral joint with a prosthetic component. In cases of significant internal rotation contracture, subscapularis lengthening is necessary to restore anterior and posterior rotator cuff balance. If the less stringent criteria of Neer's "limited goals" rehabilitation are followed, approximately 80% to 90% of patients treated with humeral hemiarthroplasty can have satisfactory results.

Arthritis, Rheumatoid↗