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At least 307 records · Page 17Linked to original sources
PubMed2000

Tendon-Defect and muscle-unloaded models for relating a rotator cuff tear to glenohumeral stability.

Rotator cuff tear and glenohumeral instability are closely related. Any tear may disturb muscle force generation due to pain inhibition. In addition, a full-thickness tear may foster instability by removing a structural element constraining the joint. It was hypothesized that the loss of both dynamic force and static constraint with a rotator cuff tear will affect glenohumeral stability. In a tendon-defect model, dynamic and static elements of the joint were sacrificed. In a muscle-unloaded model, only the dynamic element was removed. The location and size of the defect were also investigated. The effect on instability of a small tendon defect was less than that of muscle unloading, implying that a patient with a small tear would have less instability than a patient with weak or nonfunctioning supraspinatus and infraspinatus muscles. On the other hand, with a larger tear the defect had a greater effect than muscle-unloading because sectioning of the glenohumeral and coracohumeral ligaments was included in the model. Clinically, such a defect in the front is critical for anterior stability because it might insult the important anterior capsule ligamentous complex. Orthopaedic surgeons should pay attention, therefore, to the effect of possible associated lesions of static constraints based on the size and location of the tear in addition to the dynamic stabilizer.

Aged↗
PubMed2004

Arthroscopic rotator interval repair: the three-step all-inside technique.

Many clinical reports have emphasized the importance of rotator interval lesions in patients with glenohumeral instability, and many investigators have described open repair techniques, either as a supplement to other capsule reconstruction or as an isolated procedure. In this article, an original arthroscopic technique for rotator interval closure is described. This technique allows the operator to accurately manage the degree of tightening of the rotator interval, the knot tying, and the suture cutting, under direct intra-articular arthroscopic vision.

Arthroscopy↗
PubMed2004

Arthroscopic humeral avulsion of the glenohumeral ligaments (HAGL) repair.

Humeral avulsion of the glenohumeral ligaments (HAGL lesion) is one of the pathologic lesions that occurs secondary to anterior glenohumeral instability. Although HAGL lesions occur less commonly than Bankart lesions in cases of anterior instability, it is necessary to understand this pathology and to make the necessary repair. An all-arthroscopic technique using suture anchors can be used to repair HAGL lesions, but it is a difficult and demanding technique. To facilitate this type of repair, the surgeon must be: (1) comfortable with both the 30 degrees and 70 degrees arthroscopes, (2) able to establish and use the 5-o'clock portal, (3) able to abduct and externally rotate the arm, and (4) able to ensure secure fixation of the glenohumeral ligaments to bone through adequate knot and loop security.

Acute Disease↗
PubMed2005

Panacryl synovitis: fact or fiction?

PURPOSE: It has been suggested from anecdotal experience that Panacryl suture (Ethicon, Johnson & Johnson, Westwood, MA) may be responsible for an exaggerated inflammatory response. Our goal was to test the null hypothesis that Panacryl causes aseptic synovitis when used on anchors in the case of arthroscopic Bankart and rotator cuff repair. TYPE OF STUDY: Retrospective review of the postoperative outcome, specifically looking for clinical criteria that are associated with aseptic synovitis. METHODS: Eighty-three arthroscopic Bankart and 33 arthroscopic rotator cuff repairs were performed using anchors loaded with Panacryl. The clinical factors associated with synovitis that we assessed were motion, pain, hyperthermia, and swelling. RESULTS: There was no hyperthermia. Two patients had transient swelling and 10 patients had initial transient postoperative pain. One patient had chronic pain and a second arthroscopy was performed 5 months after the initial procedure, which revealed obvious synovitis. Biopsy examinations were performed and these showed typical foreign-body reaction. Two anterior redislocations occurred after new traumas, 2 failed rotator cuff repairs were observed, due to early active motion, and 2 underwent an open revision repair; synovitis was not observed in any of these cases. After 6 months, the loss of external rotation was a mean of 6.7 degrees (Bankart) and 3.3 degrees (rotator cuff repair). The loss of forward elevation was a mean of 5.8 degrees (Bankart) and of 3.3 degrees (rotator cuff repair). CONCLUSIONS: In only 1 of 116 cases of arthroscopic repair was there direct evidence of synovitis. Even in the cases undergoing revision surgery, there was no indication that Panacryl caused aseptic synovitis. Clinical course after these repairs appeared to be similar to historical experience using nonabsorbable braided suture material. Failure rates in each series appeared to be more related to new trauma and use of other implants than to Panacryl suture. LEVEL OF EVIDENCE: Level IV.

Arthroscopy↗
PubMedDate not supplied

The biomechanical role of the subscapularis in latissimus dorsi transfer for the treatment of irreparable rotator cuff tears.

Inferior functional results of latissimus tendon transfer for the treatment of irreparable rotator cuff tears have been reported in the presence of a subscapularis tendon tear. A biomechanical or experimental explanation for the necessity of an intact subscapularis is unavailable. It was, therefore, the purpose of this investigation to study the biomechanical role of the subscapularis in the treatment of a posterosuperior rotator cuff tear with latissimus dorsi transfer. A biomechanical cadaveric model was developed to reproduce glenohumeral motion patterns created by loading of the transferred latissimus dorsi tendon with and without simultaneous action of the subscapularis muscle. Significant differences could be demonstrated not only for translation but also for rotation of the humeral head depending on subscapularis action. In the neutral and in the abducted/externally rotated position of the arm, anterior translation and dislocation of the joint were encountered without subscapularis action. Our results provide evidence that motion patterns of the humeral head are significantly altered in the absence of the stabilizing effect of the subscapularis muscle. The inferior functional results of latissimus dorsi transfer in the presence of subscapularis dysfunction are explained by the loss of centering of the humeral head upon abduction and elevation if subscapularis function is deficient.

Aged↗
PubMed2000

The painful shoulder in the throwing athlete.

Successful nonoperative treatment of shoulder injuries in the throwing athlete requires a team approach. The physician, physical therapist, and athletic trainer work together with the athlete to determine a diagnosis and design a treatment protocol. Injury recovery requires restoration of muscle strength and balance followed by a careful return to a throwing program.

Athletic Injuries↗
PubMed2001

Biochemical markers in the synovial fluid of glenohumeral joints from patients with rotator cuff tear.

It is known that rotator cuff tears are sometimes accompanied by joint destruction. Our purpose was to elucidate the pathology with this condition. Thirty-two synovial fluid (SF) samples aspirated from the glenohumeral joints of patients with rotator cuff tears, including 7 with partial-thickness and 25 with full-thickness tears of the rotator cuff (10 massive and 15 isolated supraspinatus tendon (SSp) tears), were examined. Collagenase (MMP-1), stromelysin 1 (MMP-3), tissue inhibitor of metalloproteinases-1 (TIMP-1) and carboxy-terminal type II procollagen peptide (pCOL Il-C) were measured in the SF using the respective sandwich enzyme immunoassays. Glycosaminoglycan (GAG) was also quantified with a cationic dye binding method using 1,9-dimethylmethylene blue. Levels of any molecules except pCOL II-C in the SF appeared to be higher in full-thickness tears than those in partial-thickness tears. Moreover, levels of MMP-1, MMP-3 and GAG in the SF were significantly higher in massive tears of the rotator cuff in comparison with those in isolated SSp tears. Such significance was not observed in the levels of TIMP-1 or pCOL II C in the SF. We examined the relation of those levels with operative findings or clinical parameters from full-thickness tears, and observed significant correlations of the tear size with the levels of MMP-1, MMP-3 and GAG in the SF. Although these marker molecules in SF do not always originate from cartilage, our results may indicate the potential for accelerated cartilage-degrading activity in the glenohumeral joint in massive tears of the rotator cuff.

Adult↗
PubMedDate not supplied

Arthroscopic "interval slide" in the repair of large rotator cuff tears.

An arthroscopic technique for coracohumeral ligament release from a retracted supraspinatus tendon is presented. The procedure is technically simple and can greatly improve the mobility of retracted rotator cuff tears, thus expanding the application of arthroscopic repair to larger tears.

Aged↗
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↗
PubMed2002

Elbow injuries.

The elbow is a commonly injured joint, yet physicians may be less comfortable treating injuries to the elbow compared with knee and shoulder injuries. Common injuries involving the elbow are tendinosis, instability, tendon ruptures, osteochondritis dissecans, and fractures. Tendinosis is a common overuse injury and may occur on the lateral, medial, or infrequently, the posterior side of the elbow. Injury to the medial or lateral ulnar collateral ligaments may result in instability. Repetitive trauma from overuse is the most common etiologic factor in athletes. Distal biceps and triceps tendon injuries may result in elbow disability in active individuals. Partial tears are more difficult to diagnose than complete ruptures. Osteochondritis dissecans of capitellum affects adolescents involved in overhead throwing athletics. Fractures about the elbow most commonly involve the radial head in adults, and the distal humerus in children. Athletes are prone to elbow injuries resulting from both overuse and acute trauma. Our purpose is to describe the diagnosis and treatment of these common elbow injuries in athletes of all ages.

Adolescent↗
PubMed2004

Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality?

BACKGROUND: Different metal and biodegradable suture anchors are available for rotator cuff repair. Poor bone quality may result in anchor loosening and tendon rerupture. HYPOTHESES: Higher bone mineral density is associated with higher pull-out strength of suture anchors. Depending on anchor placement, pull-out strengths of anchors are different within the greater tuberosity. STUDY DESIGN: Cadaveric biomechanical study. METHODS: Trabecular and cortical bone mineral densities were determined for different regions within the greater tuberosity. Metal screw-type and biodegradable hook-type anchors were cyclically loaded. RESULTS: Mean failure load of metal and biodegradable anchors was 273 N and 162 N, respectively, for the proximal part (P < .01) and 184 N and 112 N, respectively, for the distal part (P < .01). Both types of anchors showed higher failure loads in the proximal-anterior and -middle parts of the greater tuberosity than in the distal part (P < .01). A significant positive correlation was found between cortical bone mineral density and failure load of metal anchors (P < .01). CONCLUSION: Bone quality, anchor type, and anchor placement have a significant impact on anchor failure loads. CLINICAL RELEVANCE: Suture anchors should be placed in the proximal-anterior and -middle parts of the greater tuberosity. In the distal parts, biodegradable hook-like anchors should be used with caution.

Aged↗
PubMedDate not supplied

Results of derotational humeral osteotomy in posterosuperior glenoid impingement.

We identified 20 throwing athletes who continued to have pain after articular debridement for posterosuperior impingement syndrome. These patients were unable to resume sports, and we subsequently performed a derotational humeral osteotomy with a myorraphy of the subscapularis muscle. Patients were observed for an average of 46 months (range, 12 to 69). Eleven patients were able to resume the same sport at the same level, five resumed the same sport at a lower level, three changed sport secondary to persistent pain, and the last patient did not resume any sport and was worse after surgery. Patients returned to sports at an average of 6 months postoperatively (range, 4 to 44) and to their previous level of sports at an average of 12 months (range, 8 to 18). The mean increase in humeral retroversion was 29 degrees (range, 18 degrees to 44 degrees) Three women with preoperative multidirectional hyperlaxity were considered to have failed results. Derotational humeral osteotomy can be considered in the throwing athlete with posterosuperior impingement after failure of all other means of treatment. Careful patient selection and preoperative evaluation of humeral retroversion is important. Best results can be achieved in a motivated patient with low retroversion (< 10 degrees). If retroversion is normal (20 degrees to 30 degrees), the surgical indication is unclear. We do not recommend this surgery for patients with hyperlaxity.

Adult↗