Anterosuperior labrum lesions of the shoulder joint: pathogenesis, arthroscopic treatment, and results.
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Arthroscopy↗
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Results for “Shoulder Injuries”
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Combination of microfracture and periostal-flap for the treatment of focal full thickness articular cartilage lesions of the shoulder: a prospective study.
Focal full-thickness articular cartilage lesions of the shoulder are less common than those of the lower extremity but are often symptomatic and may progress to degenerative osteoarthritis. This prospective study evaluated our clinical results for cartilage repair in five patients with chondral defects localized at the humeral head using a combination of microfracture and periostal flap, all by deltoidopectoral approach. Mean follow-up was 25.8 months (range 24-31) and consisted of a clinical examination, Constant score examination, radiography, and magnetic resonance imaging; three patients underwent a second-look arthroscopy an average of 8 months following cartilage repair. We found the Constant score significantly improved over the preoperative level, from 43.4% to 81.8%. Pain was reduced significantly to 18.6 points. Radiography and magnetic resonance imaging showed progression of the osteoarthritis in two patients. Second-look arthroscopy revealed a significantly reduced cartilage lesion. This is the first report of a combination of microfracture and a periostal flap for repair of focal full-thickness cartilage lesions at the shoulder. Short-term follow-up clinical results were satisfactory. It is essential to address the underlying pathology. Results must be reconfirmed in a long-term study.
Adolescent↗
Absorbable implants for open shoulder stabilization. A 7-8-year clinical and radiographic follow-up.
Eighteen consecutive patients who had recurrent, unidirectional, post-traumatic shoulder instability were included. All these patients underwent surgery using an open Bankart technique involving absorbable suture anchors. The median age at the index operation was 27 (16-50) years. One subluxation and two re-dislocations occurred during the follow-up period of 90 (80-95) months. At the 90-month control, the Rowe and Constant scores were 94 (63-100) points and 88.5 (65-100) points, respectively. The strength measurements on the index side in 90 degrees abduction revealed 8.1 (3.7-17.2) kg compared with 7.6 (2.7-17.6) kg on the contra lateral side (n.s.). The external rotation in abduction was 80 (60-95) degrees compared with 100 (70-120) degrees for the contra lateral side (p = 0.0015). Signs of minor or moderate degeneration were found in five of 18 patients (28%) on the preoperative radiographs. There was a significant continuous increase in degenerative changes during the follow-up period as seen on the seven, 33 and 90-month radiographs (p = 0.01, 0.03 and 0.01, respectively). On the 90-month radiographs, 12 of 18 patients (67%) had minor, moderate or severe degenerative changes (p = 0.0004 preoperative vs. 90 months). On the 7-month radiographs, two of 18 patients (11%) had invisible or hardly visible drill holes in conjunction with the absorbable implants. On the 90-month radiographs, 12 of 18 patients (67%) had invisible or hardly visible drill holes (p = 0.003 7 months vs. 90 months). In the long term, the method resulted in stable, well-functioning shoulders in 15 of 18 patients (83%). The stabilisation was not, however, able to prevent further increases in radiographic degenerative changes during the 7-8-year follow-up. The drill holes used for the absorbable suture anchors appeared to heal in the majority of patients during the follow-up period.
Absorbable Implants↗
Diagnosis of SLAP lesions with Grashey-view arthrography.
OBJECTIVE: To examine the accuracy of Grashey views obtained during shoulder arthrography in the diagnosis of clinically relevant superior labrum anterior-posterior (SLAP) lesions. DESIGN AND PATIENTS: Grashey views obtained during diagnostic arthrography (conventional and MR) were used to examine the superior labrum. Twenty-eight of 118 shoulder arthrograms obtained during a 27-month period fulfilled study criteria and were correlated for accuracy using arthroscopically confirmed grade 2-4 SLAP lesions as the standard of reference. Arthrograms were graded using the consensus method. Prevalence, sensitivity, specificity, and accuracy were 21%, 50%, 86%, and 79%. The appearance of the superior labrum on the Grashey view was compared subjectively with MR arthrography. Sources of errors were analyzed. CONCLUSION: Grashey views obtained during shoulder arthrography can diagnose clinically relevant SLAP lesions with moderately high specificity, moderate accuracy, and limited sensitivity. Findings on the Grashey view closely resemble those seen on coronal oblique MR arthrography. Grashey views should be considered in patients undergoing shoulder arthrography.
Arthrography↗
Non-contrast MR imaging of the glenohumeral joint. Part II. Glenohumeral instability and labrum tears.
MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved.
Humans↗
MRI of Little Leaguer's shoulder.
The MRI appearance of 'Little Leaguer's shoulder' has not been previously reported in the radiology literature. Purported etiologies include proximal humeral epiphyseolysis, osteochondrosis of the proximal humeral epiphysis, stress fracture of the proximal humeral epiphyseal plate, and rotational stress fracture of the proximal humeral epiphyseal plate. We describe magnetic resonance imaging findings in four patients and review the literature.
Adolescent↗
An unusual cause of the quadrilateral space impingement syndrome by a bone spike.
The quadrilateral space impingement syndrome is a clinical syndrome resulting from compression of the axillary nerve and the posterior circumflex humeral artery, with subsequent focal atrophy of the teres minor, with or without involvement of portions of the deltoid muscle. This entity has many etiologies. We are reporting a case of this syndrome caused by a bone spike from a malunited old scapular fracture following a motor vehicle accident. The bone spike impinged on the axillary nerve as it passes through the quadrilateral space, causing focal atrophy of the teres minor muscle. The abnormality was well demonstrated by MD-CT.
Accidents, Traffic↗
Labrum repair combined with arthroscopic reduction of capsular volume in shoulder instability.
We performed arthroscopic treatment of traumatic anterior and anteroinferior shoulder instability combining three procedures--labrum repair, reduction of capsular volume and suture of the rotator cuff interval--with the aim of analysing the results with regard to stability and function. Between January 1999 and December 2003, 27 patients underwent arthroscopic treatment for labrum repair with metal anchors, reduction of capsular volume through thermal capsulorrhaphy and suture of rotator cuff interval. These patients were evaluated in the pre- and postoperative period using the UCLA and Rowe scales and in the postoperative period using the ASES scale. During a mean follow-up period of 32.4 months (range 22-74 months) all shoulders remained stable. Using the UCLA scale, there was improvement from the preoperative period, with a mean score of 24.7, to the postoperative period, with a mean of 32.81. Improvement was also shown by the Rowe scale, with a mean score of 39.81 in the preoperative period and 90.74 in the postoperative period. On the ASES scale the mean score was 92.22. All shoulders remained stable and there was marked functional improvement in the patients who were treated. These results are comparable to those obtained with open surgery, observing similar patient selection criteria.
Adolescent↗
MR arthrographic variability of the arthroscopically normal glenoid labrum: qualitative and quantitative assessment.
The purpose of this study was to assess qualitatively and quantitatively the MR arthrographic variability of the arthroscopically normal glenoid labrum. Form and signal abnormalities of arthroscopically normal labral parts were analyzed on axial and coronal MR arthrograms of 55 consecutive patients (mean age 43.8 years, age range 21-76 years) referred mainly for suspected rotator cuff lesions. Length and width of the labrum were measured. One hundred twenty-one of 241 (50%) arthroscopically normal labral parts demonstrated normal (low) signal intensity and normal form on MR arthrograms. Increased linear or globular signal intensity was present in 74 of 241 (31%) normal labral parts, deformed or fragmented labra in 28 (12%), complete separation of the labrum from the glenoid in 4 (2%), a cleft in 5 (2%), attenuation in 4 (2%), and complete absence in 5 (2%), respectively. The mean size of the normal labrum varied between 3.8 x 3.3 mm at the subscapularis bursa level (anteriorly) and 6.1 x 5.6 mm at the inferior portion of the glenoid (anteriorly). The size was not significantly different between arthroscopically normal and abnormal labral parts (p = 0.13-0.83). Since the MR appearance of the arthroscopically normal glenoid labrum varies considerably concerning signal intensity, form, and size, only major tears or detachments of the labrum should be diagnosed.
Adult↗
MRI of the shoulder.
Shoulder imaging is one of the major applications in musculoskeletal MRI. In order to analyze the images it is important to keep informed about anatomical and pathological findings and publications. In this article MRI technique, anatomy and pathology is reviewed. Technical considerations about MR sequences and examination strategy are only shortly discussed with emphasis on turbo spin echo and short T1 inversion recovery imaging. Basic anatomy as well as recent findings, including macroscopic aspects of the supraspinatus fat pad, composition of the supraspinatus muscle belly, and variability of the glenohumeral ligaments or coracoid ligament, are presented. Basic pathological conditions are described in detail, e. g. instability particularly problems in differentiating the various subtypes of labral pathology. Rotator cuff diseases are elucidated with emphasis on some rarer entities such as subscapularis calcifying tendinitis, coracoid impingement, chronic bursitis producing the double-line sign, prominent coraco-acromial ligament and the impingement due to an inflamed os acromiale.
Acromioclavicular Joint↗
Postoperative functional outcome and stability in recurrent traumatic anteroinferior glenohumeral instability: comparison of two different surgical capsular reconstruction techniques.
INTRODUCTION: Patients (n=62) with recurrent traumatic anterior or anteroinferior glenohumeral instability were prospectively evaluated with reference to the surgical reconstruction technique performed. MATERIALS AND METHODS: Neer's T-plasty procedure was performed in group I (n=31) while a modified, anatomically orientated, anteroinferior capsular shift was performed in group II (n=31). All patients underwent an additional Bankart repair. After 18.1 (group II) and 22.2 (group I) months, patients were assessed in terms of subjective satisfaction, objective stability, range of motion, and functional outcome. RESULTS: No significant differences (91.5% group II, 87.8% group I) were noted between the study groups regarding the patient's subjective evaluation (p=0.17106). Results of Rowe's (93.1% group II, 87.9% group I; p=0.14419) and Constant's Score (96.5% group II, 93.8% group I; p=0.16582) showed no significant differences for both collectives. Postoperative lack of external rotation remained significantly smaller in group II (5.6 degrees +/-2.5 degrees ) compared with group I (9.8 degrees +/-2.5; p=0.00028). Although no significant differences (p=0.612) were found, the rate of recurrence was obviously smaller in group II (group II vs group I: 6 patients). CONCLUSIONS: Our results demonstrate no significant differences between the two capsular reconstruction techniques regarding patient's satisfaction, Rowe and Constant Scores. However, the anatomically orientated anteroinferior capsular shift leads to a significantly smaller external rotation deficit and seems to offer a more reliable postoperative stability.
Adolescent↗
Four-part posterior fracture--dislocations of the shoulder. Treatment by limited open reduction and percutaneous stabilization.
Ten patients who had been treated by limited open reduction and percutaneous stabilization for four-part posterior fracture-dislocation of the shoulder were followed-up for an average of 3.2 years postoperatively. According to the criteria of Neer, the result was excellent in nine patients, with an average Constant score of 95.7. There was one failure who showed complete avascular necrosis. All patients with excellent results had at least 1 mm of the neck portion of the head fragment intact.
Adult↗
One-shot CT and MR arthrography of the shoulder with a mixture of iodinated and paramagnetic contrast agents using arthroscopy as a gold standard.
PURPOSE: Our aim was to perform computed tomography arthrography (CTA) and magnetic resonance arthrography (MRA) of the shoulder as a one-shot examination and to evaluate its value on the basis of arthroscopy as a gold standard. MATERIALS AND METHODS: Fifteen men and 16 women with planned arthroscopy for chronic (n=17) or traumatic tear of the rotator cuff (n=8), congenital atraumatic (n=1) or traumatic glenohumeral instability (n=2), traumatic tear of the rotator cuff with glenohumeral instability (n=1), or "frozen shoulder" (n=2) underwent plain helical CT in neutral position and intra-articular CT-guided injection of a mixture of iodinated and paramagnetic contrast agents (gadodiamide at 1:250 and iobitridol 350 at 1:5 in 20 ml of saline solution). CT helical scans in intra- and extrarotation and T1-weighted MRA scans in the neutral position were obtained. CTA and MRA were evaluated separately and jointly (CTA-MRA) in different blinded sessions, giving a 0-3 score to the agreement of CTA, MRA, and CTA-MRA with arthroscopy. RESULTS: The injected volume of the solution ranged from 10 to 24 ml. No side effects were observed. CTA obtained a score of 2.33+/-0.62, MRA 2.47+/-0.52, and CTA-MRA 2.67+/-0.49. Significant differences were found for CTA-MRA versus CTA (p=0.0281) and MRA (p=0.0277). There was no significant difference for CTA versus MRA. CONCLUSIONS: CTA and MRA can be performed as a one-shot exam. CTA-MRA seems to give more information than CTA or MRA separately.
Adult↗
Botulinum toxin A in orthopaedic surgery.
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Botulinum Toxins↗
Radiographic examination of the acute shoulder.
Since 1988 the routine shoulder examination at our department has consisted of the anteroposterior projection (AP), the transthoracic projection (TT) and the apical oblique projection (AO). To save discomfort to the patients - including unnecessary X-rays - as well as time and money, we wanted to see, whether one of the projections could be omitted from the primary examination without losing diagnostic information. Retrospectively, 125 acute shoulder examinations were reevaluated - each projection separately - and the findings from the three radiographs of each shoulder compared. In 47 patients the examinations were normal. The remaining 78 patients had a total of 112 lesions. The AO alone showed 17 of 112 lesions (15%) of which eight were isolated lesions. The AO together with the AP presented 111 of 112 lesions, and with a supplementary TT obtained in case of fracture, no lesions were overlooked. Based on this present material and the literature, we recommend that the routine radiographic examination of the acute shoulder includes the AO and the AP, to be supplemented with the TT - or another lateral projection - in case of humeral fracture.
Adolescent↗
[Isokinetic strength measurement and training of the shoulder: methodology and results].
OBJECTIVE: To evaluate the contribution of isokinetic methods of shoulder strength measurement and training. METHOD: A Medline search of English and French publications, including referenced articles, allowed us to analyse non-indexed publications. Eighty-seven articles were retained for analysis. RESULTS: The isokinetic evaluation of the shoulder is valid. Although reproducibility of shoulder evaluation is inferior to that of the knee, it is nevertheless satisfactory when a rigorous test method is used. Normal values for the rotators, abductors-adductors, and extensors-flexors depend on diverse parameters such as age, gender, fat mass, and the type and intensity of physical activity. The agonist to antagonist ratio is particularly informative in pathological conditions. The ratio is modified in cases of impingement syndrome and shoulder instability, and this modification appears to be a cause rather than a consequence of pathologic features. The ratio generally remains modified post-surgery, and normalization must be a major focus of post-surgery rehabilitation. CONCLUSION: Isokinetic measurement, particularly disturbances in the agonist-antagonist balance, is a reference method for evaluating shoulder muscle strength and detecting deficits in specific muscle groups seen in certain shoulder abnormalities. Such measurement is a valuable tool for orienting rehabilitation towards the deficient muscle groups, complements classical techniques of muscle strengthening, and is an accurate means for following the rehabilitation progress.
Humans↗
Arthroscopic approach to traumatic anterior shoulder instability.
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Arthroscopy↗
Arthroscopic findings in atraumatic shoulder instability.
PURPOSE: The goal of this study was to evaluate the intra-articular pathology in patients with atraumatic shoulder instability who did not respond to conservative treatment. TYPE OF STUDY: Prospective case series. METHODS: Of 226 patients treated for shoulder instability over a 2-year-period, 43 patients (average age, 27.5 years; 26 men and 17 women) were classified as having atraumatic instability. None had responded to physiotherapy. The intra-articular pathology was documented during diagnostic arthroscopy before the definitive surgical procedure. RESULTS: Three types of lesions of the capsulolabral complex were defined: incomplete labral lesions, pathologic elongation of the capsule or "non-Bankart lesions" (type I), classic Bankart lesions (type II), and complex lesions of the labrum and capsule (type III). Type I was found in 19 patients (44.2%); type II lesions were seen in 13 (30.2%); and type III in 11 (25.6%) patients. Hill-Sachs lesions were found in 26 shoulders (60.5%). Chondral lesions of the glenoid were seen in 10 shoulders (23%); SLAP lesions in 5 (11.7%); and partial, articular-side defects of the supraspinatus tendon in 3 (6.9%) patients. CONCLUSIONS: Atraumatic onset of shoulder instability does not imply the absence of intra-articular lesions, at least in patients not showing a response to physiotherapy. Arthroscopy is helpful to diagnose the definite intra-articular pathology. LEVEL OF EVIDENCE: Level IV.
Adult↗