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At least 523 records · Page 29Linked to original sources
PubMedDate not supplied

Persistent hiccups after attempted interscalene brachial plexus block.

OBJECTIVE: We describe a case of persistent hiccups after attempted interscalene brachial plexus block. CASE REPORT: A 38-year-old man was admitted for arthroscopic repair of a right shoulder injury. An interscalene block was attempted in the preoperative area and combined with general anesthesia for surgery. The procedure lasted 5(1/4) hours. After transfer to the recovery room, the patient complained of severe right shoulder pain and had no discernible sensory or motor block. He was noted to be hiccuping. The patient was discharged home the following morning but returned 2 days later complaining of persistent hiccups since surgery, with associated insomnia and nausea. He was readmitted and given chlorpromazine 50 mg intravenously every 8 hours and metoclopramide 10 mg intravenously every 6 hours. The patient was discharged 4 days later on chlorpromazine 25 mg by mouth every 8 hours and baclofen 5 mg by mouth every 12 hours, with hiccups greatly reduced in both intensity and frequency. Hiccups ceased 1 day after discharge. Eighteen days after surgery, he was off all medication with no return of his hiccups; 1 month later he remains hiccup free. CONCLUSIONS: Persistent hiccups have many postulated causes, including several that are common in the perioperative period, but this is the first time to our knowledge that persistent hiccups have been described in association with attempted interscalene brachial plexus block.

Adult↗
PubMed2004

Arthroscopic repair of SLAP lesions with a bioknotless suture anchor.

The diagnosis and treatment of SLAP tears have improved with the development of arthroscopic shoulder surgery techniques. With types 2 and 4 tears, the goal is to restore stability to the labrum and biceps anchor and achieve healing to the glenoid. Suture repair with anchors is currently the repair technique of choice. The purpose of this article is to report a fast and simple method for arthroscopic SLAP repair that uses knotless suture anchors and obviates complex suture management and arthroscopic knot tying.

Absorbable Implants↗
PubMedDate not supplied

The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder.

The authors conducted a study to determine if the long head of the biceps muscle and its attachment at the superior glenoid labrum play a role in stability of the shoulder in an overhead position. Their study used a dynamic cadaveric shoulder model that simulated the forces of the rotator cuff and long head of biceps muscles as the glenohumeral joint was abducted and externally rotated. Their data suggest that the long head of the biceps muscle contributes to anterior stability of the glenohumeral joint by increasing the shoulder's resistance to torsional forces in the vulnerable abducted and externally rotated position. The biceps muscle also helps to diminish the stress placed on the inferior glenohumeral ligament. Detachment of the superior glenoid labrum is detrimental to anterior shoulder stability as it decreases the shoulder's resistance to torsion and places a greater magnitude of strain on the inferior glenohumeral ligament.

Elasticity↗
PubMedDate not supplied

Biomechanical performance of Bankart repairs in a human cadaveric shoulder model.

The objective of this study was to develop a method to evaluate the biomechanical performance of Bankart repairs in a human cadaveric shoulder in a clinically relevant orientation. Twenty fresh-frozen human cadaveric shoulder girdles were used to compare the biomechanical performance of intact anteroinferior capsulolabral complexes with the biomechanical performance of three Bankart lesion reconstruction techniques. Repairs were performed on surgically created Bankart lesions. Evaluations were performed with the shoulders in glenohumeral abduction and external rotation. The repair techniques employed interosseous sutures, Mitek GII suture anchors, or Acufex T-Fix devices. The suture material used in all repairs was No. 2 Ti-Cron. The biomechanical performance of the three reconstruction techniques did not differ, but each was significantly inferior compared with that of the intact shoulder samples. The interosseous repairs failed by suture pullout through soft tissue. Repairs in the Mitek GII group failed by pullout of the suture anchors, suture breakage, or pullout of the suture through soft tissue. Repairs in the T-Fix group failed by pullout of the suture through soft tissue or failure of the polymer portion of the T-Fix suture.

Biomechanical Phenomena↗
PubMedDate not supplied

Biomechanical properties of the biceps-labral complex submitted to mechanical stress.

PURPOSE: To determine biomechanical properties of the superior labrum-biceps tendon complex submitted to continuous and sudden mechanical strain. METHODS: Eighteen shoulder specimens from 15 unclaimed corpses, ages ranging from 20 to 40 years, were submitted to continuous or sudden tensile tests using 3 different traction machines. Shoulders presenting signs of degenerative diseases or preexisting traumatic lesions were excluded. RESULTS: Rupture of the distal portion of the long hand of the biceps occurred when stretching forces reached 290N in continuous traction and 384N in sudden traction. No labral-complex lesions were observed. CONCLUSION: Either a simple continuous or a sudden uniaxial traction of the arm do not play a role in the genesis of superior labrum anterior-posterior (SLAP) lesions in the shoulder joint.

Adult↗
PubMed2005

The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity.

INTRODUCTION: There is little outcome data on functional results after non-operative treatment of greater tuberosity fractures, and no clear evidence in minimally displaced (1-5 mm) fractures of the greater tuberosity showing that the results of non-operative treatments are good enough. This study assesses the relationship between degree of displacement in non-operatively treated patients and shoulder function. MATERIALS AND METHODS: We evaluated the radiographs and function in 135 patients after non-operative treatment of minimally displaced (1-5 mm) fractures of the greater tuberosity at a mean time of 3.7 years (2-20 years) after injury. Shoulder function was assessed using the Vienna Shoulder Score (VSS), the Constant Score (CS) and the UCLA-Score. RESULTS: 97% of the evaluated patients had good or excellent results. Patients with a displacement of more than 3 mm had slightly worse results compared to those with less displacement, but this was not statistically significant. Female patients had significantly better results than male patients, and patients in the eighth and ninth decade had significantly worse results compared to younger patients. CONCLUSION: We recommend non-operative treatment in all patients with minimally displaced fractures of the greater tuberosity, as most obtain very good results. The best results followed treatment with Gilchrist bandages or Mitella slings for 3 weeks, followed by intensive rehabilitation.

Adolescent↗
PubMedDate not supplied

The synergistic action of the capsule and the shoulder muscles.

The existence of a reflex arc from the glenohumeral capsule to several muscles crossing the shoulder joint was determined in the feline model. Three branches of the axillary nerve terminating in the glenohumeral capsule were identified and electrically stimulated with supramaximal, 100-microseconds pulses using bipolar hook electrodes. Stimulation of the anterior and the inferior axillary articular nerves elicited electromyographic activity in the biceps, subscapularis, supraspinatus, and infraspinatus muscles. Stimulation of the posterior axillary articular nerve elicited electromyographic activity in the acromiodeltoid muscle. Transection of the three articular nerves just distal to their emergence from the main axillary nerve resulted in the absence of any electromyographic activity in the muscles on stimulation, confirming the afferent nature of the articular branches. The time from application of the stimulus to the appearance of a response in the muscles varied from 2.7 msec in the biceps to 3.1 msec in the supraspinatus. The existence of a reflex arc from mechanoreceptors within the glenohumeral capsule to muscles crossing the joint confirms and extends the concept of synergism between the passive (ligaments) and active (muscles) restraints of the glenohumeral joint. This provides new information in orthopaedic sciences that has direct application in modification of surgical repairs and therapeutic modalities of shoulder injuries.

Animals↗
PubMed1990

[Transposition of scapular muscles in the treatment of injuries of the rotator cuff of the shoulder (RCS)].

An experience of 13 cases of short rotator muscles advancement is reported. These procedures were found to be available in treatment of rotator cuff avulsions with retraction, when anatomical reinsertion or shoe-lace suture after Mclaughlin appeared to be impossible. The authors had performed advancement of the supraspinatus alone in 10 cases and simultaneous advancement of supra-, infraspinatus and teres minor in 3 cases. Only one poor result was obtained that can't but confirm a most high efficacy of the procedures described.

Adult↗
PubMed2004

Multidirectional kinematics of the glenohumeral joint during simulated simple translation tests: impact on clinical diagnoses.

At the end ranges of motion, the glenohumeral capsule limits translation of the humeral head in multiple directions. Since the 6-degree of freedom kinematics of clinical tests are commonly utilized to diagnose shoulder injuries, the objective of this study was to determine the magnitude and repeatability of glenohumeral joint kinematics during a simulated simple anteroposterior translation test in the anterior and posterior directions. A magnetic tracking system was used to determine the kinematics of the humerus with respect to the scapula in eight cadaveric shoulders. At 60 degrees of glenohumeral abduction and 0 degrees of flexion/extension, a clinician applied anterior and posterior loads to the humerus at 0 degrees, 30 degrees, and 60 degrees of external rotation until a manual maximum (simulating a simple translation test) was achieved. Prior to each test, the reference position of the humerus shifted posteriorly 1.8+/-2.0 and 4.1+/-3.8 mm at 30 degrees and 60 degrees of external rotation, respectively. Anterior translation decreased significantly (p < 0.05) from 18.2+/-5.3 mm at 0 degrees of external rotation to 15.5+/-5.1 and 9.9+/-5.5 mm at 30 degrees and 60 degrees, respectively. However, no significant differences were detected between the posterior translations of 13.4+/-6.4, 17.1+/-5.0, and 15.8+/-6.0 mm at 0 degrees, 30 degrees, and 60 degrees of external rotation, respectively. Coupled translations (perpendicular to the direction of loading) at 0 degrees (6.1+/-4.0 and 3.8+/-2.9 mm), 30 degrees (4.7+/-2.7 and 5.9+/-3.1 mm), and 60 degrees (2.3+/-2.3 and 5.0+/-3.5 mm) of external rotation were in the inferior direction in both the anterior and posterior directions, respectively. Based on the data obtained, performing a simulated simple translation test should result in coupled inferior translations and anterior translations that are a function of external rotation. The low standard deviations demonstrate that the observed translations should be repeatable. Furthermore, capsular stretching or injury to the anterior-inferior region of the capsule should be detectable during clinical examination if excessive coupled translations exist or no posterior shift of the reference position with external rotation is noted.

Biomechanical Phenomena↗
PubMedDate not supplied

[Thoracic outlet syndrome].

The term thoracic outlet syndrome (TOS) defines neuro-vascular disorders produced in the upper extremities due to the external compression of the brachial plexus, subclavian artery and vein (neurovascular bundle) within the thoracic outlet. Thoracic outlet syndrome may be produced by bone malformations, fibromuscular anomalies, neck, and shoulder injuries, and postural defects. Clinical symptoms of this syndrome are diversified. However, neurological disorders are diversified. However, neurological disorders are prevailing. Thoracic outlet syndrome is two-fold more frequent in women than in men, especially in the period of physiologic descent of the shoulder girdle. Clinical diagnosis is based mainly on physical examination. Doppler segmental blood pressure measurements, limb oscillography, rheography, X-ray of the neck and brachial girdle, arteriography, intravenous digital subtraction angiography, phlebography of the limbs, and nerve conduction studies are being used to confirm the diagnosis. Differential diagnosis should consider cervical discopathy and carpal tunnel syndrome. The treatment is usually conservative by means of physiotherapy. Carefully planned, prolonged conservative therapy (for months) produces favourable effects in the majority of cases. Patients with severe symptoms of the thoracic outlet syndrome should be treated surgically. Surgery is being successful in 80% of cases.

Diagnosis, Differential↗
PubMed2006

Simplified single-portal V-shaped SLAP repair.

We present a simplified and cost-effective method for repair of a type II SLAP lesion that requires only 1 working portal in the rotator interval-the lateral anterosuperior portal (LASP)-which is about 3 cm more lateral than the standard ASP. The rotator cuff tendon or muscle are not violated when using this portal, which provides an unproblematic 30 degrees angle for the drill hole. The biceps root can be firmly reattached anteriorly and posteriorly using 1 double-loaded absorbable bone anchor with a suture eyelet. The first stitch is performed using a straight suture hook to pierce the anterior biceps root from the front. A PDS utility suture helps to shuttle the braided suture in a retrograde manner through the labrum. We then tie a sliding knot seating solidly on top of the labrum. The second stitch is placed with a 45 degrees curved suture hook allowing us to pierce the labrum posteriorly to the biceps from above. Again, a sliding knot will be seated on top of the posterior biceps root, pressing it firmly onto the previously abraded bone. The completed repair looks like a V and produces secure fixation of the biceps, thus eliminating the peel-back phenomenon.

Absorbable Implants↗