SEARCH · PubMed Health

Results for “Shoulder Injuries”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 613 records · Page 34Linked to original sources

PubMed2004

Glenohumeral arthropathy after arthroscopic anterior shoulder stabilization.

PURPOSE: We present 5 cases of iatrogenic arthropathy after arthroscopic Bankart reconstruction using a metallic suture anchor. TYPE OF STUDY: Retrospective case series. METHODS: Five patients with pain and crepitus on motion were referred to our institution for further evaluation of the previous procedure on anterior shoulder instability. Screw-type metallic suture anchors were used in all cases. All patients were men, with an average age of 23 years (range, 21 to 26). Surgical records on previous procedure were reviewed, and the clinical symptoms were evaluated using a visual analogue scale (VAS), the Simple Shoulder Test (SST), and the Rowe scoring system. The secondary surgery for each patient was performed at an average of 12 months (range, 7 to 20) after the initial arthroscopic stabilization, except in one patient who wanted to postpone the revision surgery. RESULTS: Protrusion of the anchor tip was seen in all and chondral defects in the humeral head with some degree of synovitis were also seen. Slight differences between preoperative and postoperative pain were seen, but almost no improvement in function, including range of motion, stability, and average Rowe score were seen after the second procedure. Patients who underwent revision surgery were dissatisfied with the final outcomes. CONCLUSIONS: Careful attention should be paid when using a metallic suture anchor. A secure, buried placement of the anchor is required in arthroscopic Bankart reconstruction. Poorly placed suture anchors may damage the glenohumeral joint, and if these are not corrected either at arthroscopic surgery or shortly after, the results can be suboptimal. If a patient complains of unusual mechanical symptoms after using anchors, radiographs should be performed. This kind of serious complication can be discovered earlier to prevent the severe destruction of the glenohumeral joint. LEVEL OF EVIDENCE: Level IV.

Adult↗

PubMed2004

Minimally invasive transrotator cuff approach for arthroscopic stabilization of the posterosuperior glenoid labrum.

We describe a novel technique for repair of the superior glenoid labrum posterior to the biceps anchor. This approach optimizes access for fixation of the superior and posterosuperior labrum, but involves significantly less trauma to the rotator cuff and subacromial space compared with previously described transrotator cuff methods. We suspect that the relative lack of trauma to the rotator cuff and subacromial space accounts for the superior clinical scores and lower incidence of postoperative impingement symptoms with this technique compared with previously reported transrotator cuff methods.

Arthroscopy↗

PubMed2004

Arthroscopic Bankart repair in the beachchair position: a cannulaless method using an intra-articular suture relay technique.

In shoulder arthroscopy, cannulas with large diameters (7-9 mm) are commonly used both in the lateral decubitus and the beachchair position because they ensure the easy introduction of instruments into the intra-articular space and provide a clear arthroscopic view through the application of high intra-articular pressure. On the other hand, fluid extravasation and the resulting inconvenience due to the narrowing of the intra-articular working space are also obvious issues. Consequently, this makes arthroscopic stabilization surgery all the more challenging. To avoid these shortcomings of this procedure, we believe cannulas should be used only when necessary such as for knot tying and for transtendon portals. In this article, we report a unique and original method of arthroscopic Bankart repair in the beachchair position with limited use of cannulas of smaller diameter (5 mm) and its advantages over ordinary arthroscopic techniques using large-diameter cannulas in terms of preventing fluid extravasation and keeping a wide working space, which facilitates beneficial intra-articular techniques.

Arthroscopy↗

PubMed2004

The modified beachchair position for arthroscopic shoulder surgery: the La Jolla beachchair.

Arthroscopic surgery of the shoulder is usually performed in the lateral decubitus or beachchair position. The modified beachchair position described here allows arthroscopic procedures to be performed as in the lateral position yet maintains a semiupright orientation and permits conversion to open procedures as in the beachchair position. The results of this technique are reported for 50 consecutive patients with a variety of diagnoses. This modified beachchair position was found to be quickly and easily accomplished with a minimum of special equipment.

Arthroscopy↗

PubMed2004

Lasso repair of SLAP or Bankart lesions: a new arthroscopic technique.

Restoring the anatomic position and securing a torn superior labrum or Bankart lesion to its bony bed on the superior or anterior glenoid is the objective of surgical repair. The following technique describes a method that we have found to be effective, reproducible, and more time-efficient in affecting this goal. This technique allows the sutures to be passed through the soft tissue in a single step and, in addition, makes suture management easier before knot tying.

Arthroscopy↗

PubMed2004

Arthroscopic posterior portal closure.

Posterior "working" portals in arthroscopic posterior stabilization could result in defects of the posterior capsule if not repaired. We describe a single portal technique used to close the posterior portal defect after arthroscopic stabilization. It is a safe and easy-to-perform technique, which could strengthen the structural integrity of the repair.

Arthroscopy↗

PubMed2004

Modified technique for arthroscopic Bankart repair using anchor sutures.

Bankart repair, or one of its modifications, is currently the gold standard procedure for treatment of anterior traumatic shoulder instability. It is now possible to perform the operation arthroscopically with the introduction of suture anchors. As described by Eugene Wolf, arthroscopic shoulder stabilization using the Mitek (Mitek Surgical Products, Ethicon, Edinburgh, U.K.) anchors requires two anterior portals and intra-articular knot tying. However, sliding the anchor on the inside limb of a suture loop could be challenging because the other limb could get tangled in the nitinol arc of the anchor. We describe a modification of the original technique to prevent that possibility and avoid any tension on the repair tissue during anchor passage. The proposed modification involves the use of a cheap, readily available silastic feeding tube to isolate the outside limb of the suture loop and stabilize labral tissues while the anchor is being passed. This tube also serves as a stent for knot tying. By allowing the whole operation to be performed through one anterior portal, the modified technique reduces possible morbidity associated with a second portal and further reduces cost.

Arthroscopy↗

PubMed2004

Superior labrum anterior posterior (SLAP) repair using the Neviaser portal.

Superior labrum anterior posterior (SLAP) repair using suture anchors requires successful passing of sutures through the labrum. The optimal angle for passing a penetrating suture retriever is perpendicular to the superior labrum. The Neviaser (superior-medial) portal, without a cannula, is ideally suited for this procedure. The authors demonstrate their technique and review the anatomy of this portal. The Neviaser portal is illustrated as an important working portal and not merely for inflow or outflow. The authors demonstrate that this is a safe and easy technique for SLAP repair.

Arthroscopy↗

PubMed2004

Arthroscopic bicipital sheath repair: two-year follow-up with pulley lesions.

PURPOSE: The purpose of this study was to evaluate arthroscopic repair in patients who had lesions of both the subscapularis insertion/medial head of the coracohumeral ligament and the lateral head of the coracohumeral ligament and supraspinatus tendon (a type 5 biceps subluxation/instability classification), and to determine if primary repair of the torn structures used to reconstruct the bicipital sheath was associated with a high biceps rupture rate. The null hypothesis, that there is no difference between preoperative and postoperative outcomes, was tested. TYPE OF STUDY: Prospective cohort. METHODS: Since 1995, the author has had 18 patients who had lesions that affected both the medial and lateral wall of the bicipital sheath. An adjunct was added if tendonitis was present with fraying, and the biceps tendon was debrided if the fraying consisted of 50% or less the width of the tendon. This was chosen arbitrarily. Greater than 50% fraying of the biceps tendon was treated with repair of the supraspinatus and subscapularis. The biceps tendon was treated with tenotomy or tenodesis in these cases and these patients were not included in this study. This article reports on the repair technique and results having a minimum of 2-year follow-up. RESULTS: There were 12 male patients (age range, 45 to 80 years; average, 62 years) and 6 female patients (age range, 50 to 85 years; average, 66 years). The dominant extremity was involved in 12 of the 16 extremities. Preoperative, ASES Index, Total Constant scores, Subjective Constant scores, Objective Constant scores, visual analog pain scales, and percent function were 31 +/- 19, 53 +/- 13, 12 +/- 8, 41 +/- 8, 7 +/- 3, and 42 +/- 17, respectively. Postoperative scores were 80 +/- 14, 77 +/- 10, 30 +/- 4, 47 +/- 7, 2 +/- 2, and 84 +/- 14, respectively. The null hypothesis was rejected at a level of P = .001, .001, .001, .05, .001, and .001, respectively. CONCLUSIONS: There was 1 biceps disruption in this cohort following repair, for an incidence rate of 6%. There were 2 patients, active tennis players, who had recurrence of biceps inflammation in the follow-up period with no evidence of biceps subluxation. The arthroscopic technique reported is a primary repair used to reconstruct the normal structures of the groove. This may explain why previous recommendations not to reconstruct the groove because of the high biceps disruption rate have been noted previously. This study did not deepen the groove, tubulize the biceps tendon, or close the rotator interval in nonanatomic fashion. This arthroscopic technique is technically feasible and can alleviate the symptoms of biceps tendon inflammation and/or subluxation in the majority of cases in this cohort. LEVEL OF EVIDENCE: Level IV, Case Series.

Aged↗

PubMed2005

Labral shape after arthroscopic Bankart repair: comparisons between the anchor and Caspari methods.

PURPOSE: Morphological changes after repair of the glenoid labrum were examined using fresh cadavers and clinical cases to compare the anchor and Caspari methods. TYPE OF STUDY: Cadaveric and case series. METHODS: The depth of the glenoid concavity after Bankart repair was measured in 4 shoulders from 2 fresh cadavers. We made positive models of the glenoid cavity with gypsum and measured the distance from the lateral-most extent of the anterior labrum to the medial extent of the glenoid cavity. We also compared the depth of glenoid concavity in clinical cases between the anchor and Caspari methods using air computed tomography arthrography and magnetic resonance imaging. RESULTS: We determined the effective depth as the distance from the lateral-most extent of the anterior labrum to the medial extent of the glenoid cavity. The effective depth in fresh cadaver experiments after the anchor method showed substantial differences at the superior and middle levels of the glenoid labrum compared with the Caspari method. Mean effective depths in clinical cases were 5.8 mm (range, 4.2 to 6.8 mm) after the anchor method and 3.5 mm (range, 2.0 to 5.0 mm) after the Caspari method. Effective depth following the anchor method was significantly greater than that of the Caspari method. CONCLUSIONS: During repair of Bankart lesions for traumatic anterior instability of the shoulder, effective depth was higher following use of the anchor method than with the Caspari method. CLINICAL RELEVANCE: Understanding the shape of the anterior labrum and glenoid concavity after use of the anchor and Caspari methods may help to improve the surgical technique and clinical results of arthroscopic Bankart repair.

Adolescent↗

PubMed2006

Outcomes of isolated type II SLAP lesions treated with arthroscopic fixation using a bioabsorbable tack.

PURPOSE: The objective was to clinically evaluate the treatment of type II Slap lesions repaired surgically using a bioabsorbable device. TYPE OF STUDY: Retrospective clinical follow-up study. METHODS: Forty-one patients with isolated type II SLAP lesions who were treated with arthroscopic fixation were identified. Patients were excluded for rotator cuff tears, instability, or subacromial decompression. Patients completed the L'Insalata and the American Society of Shoulder and Elbow Surgeons (ASES) questionnaires, and underwent a thorough shoulder examination at a minimum of 2 years postoperatively. RESULTS: At a mean of 3.7 years follow-up, 33 of 41 patients returned for physical examination and 6 others returned the L'Insalata questionnaire. The mean L'Insalata and ASES scores were 86.7 and 86.8, respectively; 27 patients reported their satisfaction as good to excellent but only 14 of the 29 athletes returned to their preinjury level of athletics. The average ASES scores were statistically different in patients who had their rotator cuff pierced versus those who did not (P< .05). In addition, 13 of 16 patients who experienced night pain had a cuff piercing approach. CONCLUSIONS: Despite high outcome scores, overall patient satisfaction was only 71%. In addition, up to 41% continued to experience some degree of night pain. Patients treated with a rotator cuff piercing had a significantly poorer outcome. Moreover, the patients who were athletes performed poorer on their outcomes evaluation than did their nonathletic counterparts. Whereas the outcome scores overall were high, this problem is still difficult to treat successfully. This may be because of the high demands of athletes. The data also suggest that placing portals through the rotator cuff may be associated with poorer surgical outcomes. LEVEL OF EVIDENCE: Level III.

Absorbable Implants↗

PubMed2006

Treatment of patients with spinoglenoid cysts associated with superior labral tears without cyst aspiration, debridement, or excision.

PURPOSE: To describe a case series of 10 consecutive patients with spinoglenoid cysts and associated superior labral tears treated by labral repair performed by the same surgeon without formal cyst aspiration, debridement, or excision. METHODS: Ten patients with spinoglenoid cysts and associated superior labral tears demonstrated on preoperative magnetic resonance imaging (MRI) were retrospectively reviewed. Evidence of weakness on examination was further evaluated through nerve conduction studies. All 10 patients underwent surgical repair of the labral tear performed by the same surgeon without formal cyst aspiration, debridement, or excision. Postoperatively, detailed shoulder and neurologic examinations were performed, and follow-up nerve conduction studies and MRIs were obtained. RESULTS: Ten patients were evaluated clinically at a mean of 10.2 months after surgical repair (range, 6 to 27 months). In all, 8 males and 2 females of average age 47.7 years (range, 35 to 56 years) were studied. Preoperative examination revealed that 6 patients had external rotation weakness. Nerve conduction studies performed in these 6 patients confirmed suprascapular neuropathy in 4 of them. Labral repair without formal cyst excision resulted in successful outcomes for all 10 patients after spinoglenoid cysts associated with superior labral tears had been diagnosed. All 4 patients with suprascapular neuropathy recovered strength and demonstrated normal nerve conduction studies postoperatively. In 8 of 10 patients, MRIs performed postoperatively demonstrated complete resolution of the cyst, along with labral healing. All patients were able to return to work with no restrictions on activities, and all were satisfied with their outcomes. CONCLUSIONS: This study demonstrated successful clinical, electromyographic, and MRI outcomes for patients with spinoglenoid cysts and superior labral tears, who were treated by labral repair without formal cyst excision. Treatment given for intra-articular disease is the key component of surgical management. LEVEL OF EVIDENCE: Level IV, case series study.

Adult↗

PubMed2006

Arthroscopic stabilization of superior labral (SLAP) tears with biodegradable tack: outcomes to 2 years.

PURPOSE: This prospective study aimed to document the pain and functional outcomes, over time, of patients whose SLAP lesions had been repaired with biodegradable tacks. METHODS: Superior labral tears were identified in 24 patients from a cohort of 500 patients who had shoulder problems sufficiently disabling to warrant arthroscopic evaluation and management. These labral tears were arthroscopically repaired with 1 to 3 biodegradable tacks (mean, 1.6). Before surgery, all patients completed a questionnaire regarding their shoulder pain and function and were given a systematic clinical examination. To observe their postoperative outcomes over time, the same assessments were made at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years after surgery. RESULTS: After labral reattachment, decreases were noted in the patients' mean shoulder pain scores at rest (64% at 3 months), at night (76% at 3 months), and with activity (73% at 6 months). The most significant reductions in mean scores occurred between 6 and 12 weeks (P < .001). Patient-perceived weakness, instability, and stiffness scores also improved from week 6. The ranking of the patients' "overall problem" reduced from an average ranking of "severe" to "mild" by the third preoperative month (P < .001) and was still at this level by the time of their 2-year follow-up appointment. Activity levels for 22 of 24 patients returned to their preinjury levels by 6 months after surgery. CONCLUSIONS: Arthroscopically delivered biodegradable tacks effectively managed superior labral tears and, on average, resulted in a near-complete improvement of pain and recovery of function by 3 months. These good outcomes did not improve further or deteriorate at the 2-year follow-up appointment. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Absorbable Implants↗

PubMed2006

Arthroscopic treatment of chronic anterior instability of the shoulder in Marfan's syndrome.

We present a case of recurrent anterior shoulder dislocation in a patient with Marfan's syndrome who presented with hyperlaxity that has been treated arthroscopically. We discuss abnormal findings at arthroscopic evaluation, including complete absence of the mid anterior capsule, which left the subscapularis uncovered, and we hypothesize that repetitive trauma to the capsule was not followed by a normal process of remodeling because of a lack of competent elastic fibers and a poor capacity for soft tissue healing. The inferior insertion of the labrum and the inferior glenohumeral ligament seemed normal through the large volume of the pouch. We performed arthroscopic reconstruction of the capsule through dissection of its anteroinferior part with a radiofrequency wand from the glenoid rim and the subscapularis, followed by superior drift of the capsule. The Weitbrecht foramen was then closed with 2 nonresorbable No. 4 sutures, and the capsule was reinserted to the labrum with 2 anchors. A final suture closed the remaining hole in the rotator interval. At 16-month follow-up, the patient emphasized her satisfaction with the results; she was able to keep up with her regular schedule of leisure sports and swimming, painlessly, with no limitations or new episodes of instability.

Adult↗

PubMed2006

Modifying integra as a regeneration template in deep tissue planes.

Contour defects resulting in deformity caused by lack of tissue can be improved by conventional surgery using autologous tissue, but there is always a donor site morbidity. Integra has been available since the early 1980's for use in acute burns and more recently in reconstruction. It has been shown histologically to act as a tissue regeneration template. The regenerated dermis is buried under an autologous thin split-skin graft. In this study, the principle of burying Integra (without the silicone layer) has been applied to deep tissue defects in 12 reconstructive cases. Such regenerated tissues survive at least 3 years after burying. Modification to the technique to avoid visible edges are being developed.

Adult↗

PubMed2006

Normal anatomy and common labral lesions at MR arthrography of the shoulder.

MR arthrography of the shoulder is the most accurate imaging modality in demonstrating abnormalities of the glenoid labrum and associated structures. Tears of the labrum, the capsule or the gleno-humeral ligaments can lead to pain, catching, popping or instability. The anatomy of this region is complex. We present the normal anatomy of the glenoid labrum, biceps anchor and gleno-humeral ligaments together with their normal variants and then describe common labral-ligamentous pathologies.

Cartilage, Articular↗

PubMed2004

Special concerns of the female athlete.

The majority of injuries sustained by female athletes are due to participation in sports rather than their sex. Anatomic, hormonal,and functional differences should be understood when treating the female athlete. Screening should be done for eating disorders and the female athlete triad. Female athletes have increased rates of injury to the anterior cruciate ligament and patellofemoral disorders compared with their male counterparts.

Adult↗

PubMed2006

Imaging of sports injuries of the upper extremity in children.

Competitive athletics in school-aged children has become the norm rather than the exception. The increased repetitive stresses placed on the upper extremity in a wide variety of sports result in a host of injuries unique to the skeletally immature athlete. This article focuses on a discussion of the more common upper extremity injuries encountered in the child athlete and the role of radiography and MRI in diagnosis and management.

Acute Disease↗