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PubMed1977

Treatment of chronic radiation injury over the shoulder with a latissimus dorsi myocutaneous flap.

We report our experiences in treating chronic radiation injury about the shoulder, a complication of radiation after mastectomy. Left untreated, these can result in chronic infection and/or amputation. The coverage of a large shoulder area presents certain unique problems, which severely limit the usefulness of traditional procedures. We have found that the remarkable size and versatility of the latissimus dorsi myocutaneous flap enables one to use it with relative simplicity and safety. A further great advantage is that it brings new permanent blood supply into this ischemic area, thus favoring rapid healing and durable coverage.

Adult↗
PubMed1984

Ultrasonography of the rotator cuff: surgical correlation.

Rotator cuff tears are a common orthopedic problem. The portions of the cuff most commonly torn are accessible to sonographic examination with appropriate positioning of the shoulder. This study was undertaken to correlate the sonographic appearance of the pathologic rotator cuff with findings at the time of surgical repair. Rotator cuff tears are readily seen with high-resolution real-time sonography. Sonography can demonstrate tears not demonstrated arthrographically. In the appropriate clinical setting arthrography may not be necessary if the sonogram demonstrates characteristic findings.

Adult↗
PubMed1990

Magnetic resonance imaging of the shoulder: rationale and current applications.

Because it can demonstrate a wide range of tissue contrast with excellent resolution, magnetic resonance (MR) imaging has revolutionized imaging in many areas of the musculoskeletal system and has generated excitement among those interested in the painful shoulder. Shoulder impingement syndrome and glenohumeral instability constitute the two major categories of shoulder derangements. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. In addition the imager must have a thorough understanding of shoulder anatomy and pathology. We present a summary of the current status of MR imaging of the shoulder including technical, anatomic, and pathologic considerations and a review of the pertinent literature.

Humans↗
PubMed1993

SLAP lesions of the glenoid labrum diagnosed with MR imaging.

Tears of the superior portion of the glenoid labrum in patients without shoulder instability have recently been described. These tears, which include the "anchor" of the biceps tendon to the labrum, have been labeled "SLAP lesions" (superior labrum anterior to posterior). This study was performed to determine the magnetic resonance (MR) findings in patients with SLAP lesions. Retrospective review of the shoulder arthroscopy reports on patients who underwent MR imaging using a 1.5-T unit and subsequent arthroscopy by a single surgeon identified six patients with SLAP lesions (average age 36 years, range 17-65 years). MR images demonstrated atypical morphology indicative of tear in the superior portion of the labrum in four of the six patients, but only one tear had been identified preoperatively. Radiologists interpreting MR images of the shoulder should be aware of the MR findings of SLAP lesions as these tears can be a significant cause of patient disability and are difficult to diagnose clinically.

Adolescent↗
PubMed1983

Reconstruction of the rotator cuff.

The results of a new operative technique of reconstruction of the rotator cuff are described in 112 cases. The principle of the method is the restoration of the anatomy in order to restore function. Results so far have been encouraging, as 80% of the patients have benefited from the operation.

Female↗
PubMed1980

"Supraspinatus slide" for rotator cuff repair.

The supraspinatus slide procedure described by Debeyre et al. (1965) offers an opportunity for the surgeon to repair certain large and late ruptures of the rotator cuff. In order to re-appraise this procedure and clarify its indications, the authors performed the following study: Firstly 37 rotator cuff ruptures repaired by this method were reviewed. Most of the patients were supplied by the Workmen's Compensation Board of Ontario. The review period was from 1968 to 1977. Secondly, the surgical anatomy of the area was reviewed. Twenty-two (60%) of the patients obtained satisfactory results. They were relieved of pain, gained functional improvement and returned to their previous or a modified occupation. Although the vulnerability of the suprascapular nerve and artery was demonstrated in anatomical dissections, no neurological sequelae were noted and the muscle remained viable in all patients. Electro-myographical studies failed to show supraspinatus muscle denervation in any case. The procedure proved to be useful in the repair of large rotator cuff ruptures that are not amenable to other methods of repair. A young well motivated patient with chronic disability may benefit from this procedure.

Adult↗
PubMed1985

Experimental distal subluxation in the glenohumeral joint.

In an experimental set-up including ten shoulder specimens, increments in the acromiohumeral distance (the subacromial space) were measured on an X-ray radioscope after the vertical stabilizing structures of the glenohumeral joint had been cut. It was found that when only the supraspinatus tendons were cut, the acromiohumeral space only increased by a few millimeters. When first the coracohumeral ligament and then the proximal one-third of the anterior capsule were cut, the acromiohumeral distance was doubled in each case. Distal subluxation did not occur when only the anterior capsule was cut. When the coracohumeral ligament was also cut, the acromiohumeral distance was more than doubled. It is concluded that the most important structures in the pathogenesis of distal subluxation are first the coracohumeral ligament and then the proximal part of the glenohumeral capsule.

Acromion↗
PubMed1982

Performing shoulder arthrography without image converters in the field of orthopedic accident surgery.

This paper describes a method by which a shoulder arthrography may be carried out without the aid of fluoroscopy. To provide all patients with the best therapy possible, one should be able to perform arthrographies without having to own an image intensifier. The process of mixing a radiopaque substance with a local anesthetic agent combined with air will in itself dissolve existing adhesions during the tapping of the joint, as a result of which this diagnostic procedure will turn into therapy. In cases of extensive lacerations of the joint capsule, it is not possible to obtain a clear outline of the intra-articular structures, but on the other hand we shall frequently meet with a diffuse outflow of the mixture into the surrounding musculature. No allergic reactions to the radiopaque substance were observed.

Adolescent↗
PubMed2005

Arthroscopic tenodesis for lesions of the long head of the biceps.

OBJECTIVE: Resection of the intraarticular part of the long head of the biceps and tenodesis to decrease shoulder pain due to a pathologically altered biceps tendon and to improve shoulder function. INDICATIONS: Tenosynovitis. State of prerupture. Instability (subluxation or dislocation of tendon from intertubercular groove). Intraarticular entrapment secondary to hypertrophy of the long head of the biceps in the presence of an intact cuff. To be performed during arthroscopic cuff repair or during debridement of an irreparable cuff tear. CONTRAINDICATIONS: Very thin, frayed, almost ruptured biceps tendon. Complete rupture of the long head of the biceps. SURGICAL TECHNIQUE: Standard arthroscopy with 30 degrees scope inserted through the posterior portal. Detachment of the long head from the glenoid origin. Longitudinal opening of the bicipital groove. Exteriorization and doubling of the tendon. Drilling of a socket starting in the groove but perforating the posterior cortex only with a guide wire. Passing of the tendon in an anteroposterior direction and securing the anchorage with a bioresorbable PLA interference screw. RESULTS: Between 1997 and 1999, an arthroscopic tenodesis was performed in 43 patients. Minimum follow-up 2 years. The absolute Constant Score improved from 43 points preoperatively to 79 points at the time of follow-up. No loss of elbow extension or flexion; power of biceps after tenodesis 90% of opposite side. Early on, two failures of tenodesis occurred.

Adult↗
PubMed2002

[The sublabral foramen. Congenital or an acquired variance?].

The sublabral foramen is considered to be a clinically asymptomatic, isolated variant of the anterior-superior capsulo-labral-complex. It may be observed during shoulder arthroscopy and may implicate problems in differential diagnosis of traumatic lesions. In an anatomic study on 89 macroscopically healthy shoulder specimens the age distribution and the incidence in relation to the varying shape of the glenoid as feasible factors of influence for a sublabral foramen (SF) were analyzed in order to elucidate the unknown pathogenesis of SF. In addition histologic sections of three SF samples were obtained. Mean age of the specimens with a sublabral foramen [n=20; 69 (37-84) years] was significantly higher (p=0.04) compared to samples without a sublabral foramen [n=69; 59 (18-94) years]. An increased incidence of a sublabral foramen in relation to a distinct shape of the glenoid could not be established although a prevalence of a glenoid with anterior notch was observed. The results indicate an age-related development of the sublabral foramen,thus in younger patients with an anterior-superior capsulolabral displacement local signs of trauma and involvement of the biceps anchor should be controlled before definitive diagnosis.

Adolescent↗
PubMed2003

[Open versus arthroscopic shoulder stabilization. An analysis of the treatment costs].

In this study the total costs of clinical open and arthroscopic anterior shoulder stabilization were evaluated, analyzed and compared. From 1988 to 1998 147 patients underwent open (Bankart) or arthroscopic (ASK) anterior shoulder stabilization. We randomized two groups of 30 patients for each method (Bankart: 25 male, 5 female, 29 years of age; ASK: 25 male, 5 female, 26 years of age) and evaluated the costs of their clinical treatment. The total cost was significantly ( p<0.05, Mann-Whitney U-Test) higher for the open (5639 euro) than for the arthroscopic (4601 euro) therapy. There was a significant difference between the groups for the average cost of surgery (Bankart: 2741 euro; ASK: 2315 euro, p<0.05) and the average postoperative treatment cost (Bankart: 2202 euro; ASK: 1630 euro, p<0.05) whereas the average preoperative treatment cost was not significantly different (Bankart: 669 euro, ASK: 657 euro). The staff costs for the surgical procedure (Bankart: 1800 euro (32%), ASK: 1319 euro (29%)) and the postoperative staff costs of the nurses (Bankart: 1271 euro (23%), ASK: 997 euro (22%)) represented the greatest parts of the total costs. The average duration of the clinical treatment was 15.8 days for the open- and 12,4 days for the arthroscopic group.

Adult↗
PubMed2003

[Anatomy of the superior labrum complex of the shoulder].

The outstanding progress achieved in MRI and arthroscopic techniques has forced orthopedic surgeons to consider the anatomy of the shoulder joint in detail. The superior labrum complex shows a broad range of variations, which is the reason for some difficulties regarding diagnostic conclusions as well as therapeutic considerations. In particular, the differentiation between the normal and pathological adherence of the labrum is a serious clinical problem. The glenoid labrum consists of circularly arranged collagenous fibers attached to the osseous margin of the glenoid by a fibrocartilaginous transitional zone. The cranial part of the labrum is more compact than the caudal one. It is also connected to the joint capsule and the integrated ligaments. Most of the fibers of the long head of the biceps tendon insert at the supraglenoid tubercle, only some of them continue in the fibrous ring. So-called SLAP lesions have to be differentiated from variations. In up to 18% of the patients normal clefts can be seen, e. g., sublabral holes, and in less than 6% other rare variations, e. g., the so-called Buford complex.

Arthroscopy↗
PubMed2003

[MR imaging of variants of the superior labral-bicipital complex and SLAP lesions].

In the detection of SLAP (superior labral anterior to posterior) lesions of the shoulder MR arthrography shows a significantly higher sensitivity compared with conventional MR techniques and therefore, represents the method of choice in diagnostic imaging of the superior labral-bicipital complex. On the basis of morphological criteria it mostly allows distinction of traumatic lesions and anatomic variants of the superior labrum and the biceps anchor as well as classification of detected SLAP lesions (types 1-4 according to Snyder). However, the differentiation of a SLAP type 2 lesion and a sublabral recess can be very difficult, even if all distinction criteria are considered.

Cartilage, Articular↗
PubMed2002

Magnetic resonance imaging of the shoulder: a review of potential sources of diagnostic errors.

Shoulder magnetic resonance (MR) imaging and MR arthrography are frequently utilized in the evaluation of shoulder pain and instability. The clinical scenario and imaging findings may be confusing to clinicians and radiologists and may present diagnostic challenges for those involved in evaluating and treating shoulder pathology. Often rotator cuff and labral abnormalities may be coexistent, clinical manifestations of denervation syndromes may be confusing to clinicians, and normal anatomic variations, imaging pitfalls, and various artifacts may cause dilemmas for the radiologist. This article will review the most frequently encountered mimickers and pitfalls of MR imaging of the shoulder.

Artifacts↗
PubMed1990

Arthroscopic assisted rotator cuff repair: preliminary results.

Arthroscopic assisted rotator cuff repair is a method of performing an arthroscopic subacromial decompression with repair of the rotator cuff through a limited deltoid splitting approach. We evaluated 25 patients with a minimum of 1 year follow-up. Based on the UCLA shoulder rating, 80% of the patients were rated as excellent or good. There was significant improvement in pain, function, motion, and strength. Ninety-six percent of the patients were satisfied with the procedure. Of the patients with small or moderate size tears, 100% received a satisfactory rating. Arthroscopic assisted rotator cuff repair is presented as an attractive alternative in treating symptomatic patients with complete tears of the rotator cuff.

Arthroscopy↗