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At least 667 records · Page 37Linked to original sources
PubMed2003

Laser-assisted thermal capsulorrhaphy.

PURPOSE: The purpose of this study was to review the clinical results of laser-assisted thermal capsulorrhaphy in patients with glenohumeral instability. TYPE OF STUDY: A case series of consecutive patients with shoulder instability treated with laser-assisted thermal capsulorrhaphy by one surgeon. METHODS: From 1994 through 1997, 60 shoulders in 59 patients (27 men, 32 women) with no previous shoulder surgery underwent laser-assisted thermal capsulorrhaphy. The direction of instability was classified as anterior in 30, posterior in 7, anteroposterior in 4, and multidirectional (MDI) in 19. Patients were evaluated on the basis of pain, recurrent instability, function, and satisfaction. RESULTS: Nine patients were lost to follow-up evaluation, and 9 patients underwent revision surgery (7 MDI, 1 anterior, I posterior). Of the remaining 42 patients, none underwent further surgery; the average follow-up time was 38.4 months (range, 24 to 66 months); and pain scores improved from 7.8 +/- 2.6 (1-10 scale) to 1.7 +/- 2.6. postoperatively. In addition, 86% of patients reported none or rare episodes of instability compared with 37% preoperatively. Painless overhead use of the shoulder improved from 12% to 73%. Scores based on the American Shoulder and Elbow Surgeons (ASES) rating system improved from 61.0 +/- 2.6 to 89.5 +/- 15.0 (P <.05). Patient satisfaction for the remaining 42 patients, on a 1 to 10 scale, averaged 8.0 +/- 2.8. CONCLUSIONS: Based on these results, we conclude that laser-assisted thermal capsulorrhaphy is an effective adjunct in the treatment of anterior and posterior instability. Patients with MDI treated with this technique have high failure rates. We recommend caution when approaching MDI patients with this technique.

Adolescent↗
PubMed1994

Arthroscopic labral repair to the glenoid rim.

The purpose of this study was to develop a new arthroscopic approach for traumatic instability that effectively reattaches avulsed capsulolabral tissue to the glenoid articular rim with sutures. This technique does not depend on fixation devices, trans-scapular drilling, or implantation of suture anchors. We attached a three-dimensional position sensor and force and torque transducer to the humerus and scapula of eight normal cadaveric shoulders to measure the normal, surgically unstable (arthroscopic Bankart lesion), and repaired preparations. We assessed eight motion ranges and six laxity tests. Capsulolabral release increased all passive ranges and allowed significant translational increases on posterior drawer and crank testing. After repair, motion was never decreased and there were no differences in laxity relative to normal. Neurovascular structures were never at risk. Our arthroscopic repair provides anatomic reattachment and effective deepening of the glenoid con-cavity similar to that achieved by open repair. This new method restores joint stability, preserves motion, and can withstand forceful loads. Ongoing clinical trials will substantiate whether the technique is as safe and reliable as shown cadaverically.

Adult↗
PubMed1993

The anterior labroligamentous periosteal sleeve avulsion lesion: a cause of anterior instability of the shoulder.

Recurrent anterior unidirectional instability of the shoulder is not always associated with a classic Bankart lesion, which is an avulsion of the anterior labroligamentous structures from the anterior glenoid rim. Because the anterior scapular periosteum ruptures, the labrum and the attached ligaments are found to float out anterior to the glenoid rim when viewed arthroscopically. The anterior labroligamentous periosteal sleeve avulsion (ALPSA) of the supporting anterior inferior ligamentous and labral structures of the shoulder joint was found in four of eight acute primary anterior shoulder dislocations. This lesion differs from the Bankart lesion because the anterior scapular periosteum does not rupture, thereby allowing the labroligamentous structures to displace medially and rotate inferiorly on the scapular neck. These lesions eventually heal, and lead to recurrent anterior dislocations because of the subsequent incompetence of the anterior inferior glenohumeral ligament. An arthroscopic technique that converts the ALPSA lesion to a Bankart lesion and subsequently reconstructs the supporting anterior inferior structures of the shoulder has been successful in 26 cases (4 acute and 22 chronic) which were followed for > or = 2 years. Only one dislocation occurred, and it was the result of severe trauma.

Acute Disease↗
PubMed1993

The rotator crescent and rotator cable: an anatomic description of the shoulder's "suspension bridge".

Twenty fresh frozen cadaver shoulders were dissected in order to study the rotator cable-crescent complex. The rotator crescent is a term that we have used to describe the thin, crescent-shaped sheet of rotator cuff comprising the distal portions of the supraspinatus and infraspinatus insertions. The crescent was found to be bounded on its proximal margin by a thick bundle of fibers that we have called the rotator cable. This cable-crescent configuration was found to consistently span the insertions of supraspinatus and infraspinatus tendons. The dimensions of the rotator cable and crescent were measured by a digital micrometer. The rotator cable was found to be a very substantial structure, averaging 2.59 times the thickness of the rotator crescent that it surrounded. This anatomic study supports the concepts of stress-shielding of the rotator crescent by the stout rotator cable and stress transfer by this loaded cable system.

Aged↗
PubMed1986

Arthroscopy and stability testing of the shoulder joint.

A consecutive series of 32 patients with shoulder problems was examined with arthroscopy. Seventeen of these patients with suspected unstable shoulders were also tested for instability under fluoroscopic control. Results were analyzed for two age groups and with reference to preoperative diagnosis. Stability testing was of more value than arthroscopy in the treatment of younger patients with shoulder instability. Arthroscopy was of some value in choosing treatment in the older age group of patients.

Adolescent↗
PubMed1997

Periarticular fiber system of the shoulder joint.

The structure and attachment of the glenoid labrum were examined from the functional point of view in 42 shoulder-joint cavities using a combination of macroscopic and microscopic techniques. The labrum continues the long tendon of the biceps as far as the ventral glenoid notch and is supplemented by a connecting band between the superior and inferior glenohumeral ligaments. In the upper quadrants, the periarticular fibers are broadly attached to the neck of the scapula and separated by a gap from the articular cartilage. In the lower quadrants, they are attached to both the neck of the scapula and the joint surface. The periarticular structures consist of bundles of parallel collagen fibers that run round the entire circumference of the cavity. The labrum, glenohumeral ligaments, and inserting tendons form a basket of fibers around the neck of the scapula, which constitutes a functional unit: the periarticular fiber system (PAFS). This acts as a tension-brace for the joint cavity and takes part in the local transmission of pressure through the cavity. Detachment of the labrum, or the labral-biceps anchor, should only be diagnosed when it can be shown that the tissue between the PAFS and the upper part of the neck of the scapula has been torn, and that the extent of the gap formation reaches laterally and caudally beyond the peripheral edge of the cartilage.

Adolescent↗
PubMed1997

Glenoid-labral cyst entrapping the suprascapular nerve: dissolution after arthroscopic debridement of an extended SLAP lesion.

Glenoid labral cysts are commonly associated with labral tears, which can cause pain or instability. We present the case of a patient, referred for neurological complaints, who was actually suffering from supraspinatus nerve entrapment syndrome. Electroneurogram studies showed an isolated lesion of the branch to the infraspinatus muscle. Magnetic resonance imaging confirmed a glenoid labral cyst extending from the cranial glenoid to the scapular notch. After arthroscopic debridement of an extended SLAP-lesion that had caused joint fluid extrusion, the dissolution of the cyst was associated with complete neurological recovery. The patient is pain free and range of motion is normal. An attempt at an arthroscopic procedure seems warranted in cases like this, since cysts that accompany labral tears can dissolve after rigorous debridement of the torn labrum, much like meniscal cysts. Extended and hazardous open excisions can thus be avoided.

Arthralgia↗
PubMed1997

Arthroscopic management of refractory shoulder stiffness.

Glenohumeral stiffness is a major cause of shoulder disability and pain. Conventional management strategies often fail to yield consistent or prompt return of comfort and function. Over the past 5 years, we have employed a prospective approach to the evaluation and management of glenohumeral stiffness using arthroscopic release of capsular contractures for the most refractory. This report concerns the first 30 patients who failed at least 6 months (28 month mean) of nonoperative management for unilateral refractory shoulder stiffness and who were managed by arthroscopic capsular release. Fourteen patients were diabetic. Follow-up averaged 33 months (range 12 to 56 months). Each patients' motion and strength was documented according to the American Shoulder and Elbow Surgeons standard examination. Functional outcome measures were patient-assessed using the Simple Shoulder test before and after surgery. Before surgery, active range-of-motion of the affected shoulder average 41% of the opposite asymptomatic side. The day after surgery, motion had improved dramatically to a mean of 78%. An additional 15% of motion was gained after discharge from the hospital. The final motion averaged 93% of the opposite side. All Simple Shoulder Test (SST) parameters and six of nine SF-36 health status scores were improved significantly. Only 6% of patients were able to sleep comfortably on their side and 35% could place 1 lb. on a shelf at shoulder height before surgery. After surgery, 73% were able to sleep comfortably on the affected side and 83% were able to place 1 lb. on a shelf at shoulder height. There were no differences among all outcome measures between diabetic or nondiabetic patients. Three patients developed recurrent refractory stiffness. The only complication was a single axillary neuropraxia which resolved spontaneously. No patient developed instability. Arthroscopic capsular release can be a safe and effective tool in the management of refractory shoulder stiffness.

Adult↗
PubMed1998

Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears.

One hundred two type II SLAP lesions without associated anterior instability, Bankart lesion, or anterior inferior labral pathology were surgically treated under arthroscopic control. There were three distinct type II SLAP lesions based on anatomic location: anterior (37%), posterior (31%), and combined anterior and posterior (31%). Preoperatively, the Speed and O'Brien tests were useful in predicting anterior lesions, whereas the Jobe relocation test was useful in predicting posterior lesions. Rotator cuff tears were present in 31% of patients and were found to be lesion-location specific. In posterior and combined anterior-posterior lesions, a drive-through sign was always present (despite absence of anterior-inferior labral pathology or a Bankart lesion) and was eliminated by repair of the posterior component of the SLAP lesion. We conclude that SLAP lesions with a posterior component develop posterior-superior instability that manifests itself by a secondary anterior-inferior pseudolaxity (drive-through sign), and that chronic superior instability leads to secondary lesion-location-specific rotator cuff tears that begin as partial thickness tears from inside the joint.

Adolescent↗
PubMedDate not supplied

Synovial metastasis of the shoulder detected by arthroscopy as the presenting manifestation of lung adenocarcinoma.

A case in which a post-traumatic shoulder impairment revealed the presence of the joint involvement by a metastatic localization of lung adenocarcinoma is presented. The patient was a 60-year-old white man, a smoker, in apparent healthy condition complaining of pain and stiffness from a 1-year-old traumatic accident to the right shoulder sustained during a tennis match. He had been unsuccessfully treated for 6 months with physical therapy. Because of the negativity of the usual imaging studies, a diagnostic arthroscopy was performed. It revealed the presence of a traumatic rupture of the glenoid labrum and of an atypical gelatinous synovial formation in the medial wall of the joint; it was histologically and immunohistochemically diagnosed as adenocarcinoma, probably originating in the lung or in the gastrointestinal tract. The pulmonary origin of the neoplasm was confirmed by computed tomography. The patient underwent chemotherapy and eventually died with contralateral lung and femur metastases 8 months after the diagnosis. The clinical importance of this rare observation is discussed.

Adenocarcinoma↗
PubMed1999

Overlap endoscopic SLAP lesion repair.

The fixation of the superior labrum using the punch-chop needle overlap technique (Aeratec Inc, Uniondale, NY) for reattaching torn labral tissue to bone allows ease of suture placement for type II SLAP lesion repair with fixation overlapping the superior rim of the glenoid and without the use of anchors. The technique presented includes preparation of the superior glenoid rim, drilling of the glenoid tunnels for the punch needles, and peripheral suturing of the labrum.

Acromioclavicular Joint↗
PubMed1989

Total shoulder arthroplasty in rheumatoid arthritis.

Twenty-nine Neer-type total shoulder arthroplasties were performed in 26 patients with rheumatoid arthritis. The average age was 55.5 years and the average follow-up period was 37 months. On a 100-point scoring system, the average preoperative score of 25 improved to 71 after surgery. The most significant improvement was noted in pain relief. Radiographs demonstrated nonprogressive radiolucent lines in 86% of the glenoid components and 31% of the humeral components. Surgical problems included bone loss of the glenoid, acromioclavicular joint arthritis, and rotator cuff tears, in 7 of 29 shoulders. Follow-up study demonstrated poorer results for patients with rotator cuff tears. However, significant pain relief was achieved in 93% of our patients, despite limited functional improvements.

Adult↗
PubMedDate not supplied

A review of self-report scales for the assessment of functional limitation and disability of the shoulder.

A shoulder disorder affects a patient's overall quality of life. Self-report outcome measures can be used to assess the effects of shoulder dysfunction in terms of patients' functional limitations and disabilities. Selection of a shoulder-specific scale from the numerous scales available can be overwhelming. The purpose of this study was to review the self-report scales in current use for assessing the shoulder joint. A MEDLINE literature search was performed to locate scales appropriate to the assessment of function and disability of the shoulder. Only scales with established measurement properties were selected for review. Eleven scales were reviewed. Methodological and practical criteria were established to evaluate each scale. All scales met the minimal criteria, but not all scales were equal with regard to the criteria established for analysis.

Health Status Indicators↗
PubMedDate not supplied

Electromyographic analysis of deltoid and rotator cuff function under varying loads and speeds.

The purpose of this study was to compare the effect of increasing loads and doubling speed on the deltoid and rotator cuff muscles during isotonic scapular plane abduction (scaption) with neutral humeral rotation. These muscles were studied in 16 volunteers with asymptomatic shoulders with the use of fine wire electromyography. The addition of load to the arm during scaption caused an increase in electromyographic activity during the first 90 degrees of motion. Furthermore electromyographic activity decreased during the final 30 degrees of motion with each increase in load. Doubling the speed caused an increase in electromyographic activity during the first 60 degrees of motion while causing a decrease in activity in the final 60 degrees. This study demonstrates the response of the rotator cuff and deltoid muscles to varying loads and speeds during the most basic shoulder motion. With the data obtained in this study, rehabilitation exercises and experimental shoulder models can be refined to reflect this more physiologic situation.

Adult↗
PubMedDate not supplied

Anterior acromioplasty: effect of litigation and workers' compensation.

Seventy-five consecutive anterior acromioplasties were performed in 74 patients with chronic inflammation of the supraspinatus tendon caused by the impingement syndrome. Thirty-six patients (49%) had filed workers' compensation claims (group 1), 21 patients (28%) were involved in accident litigation (group 2), and 17 patients (23%) had no financial gain associated with their shoulder pain (group 3). The patients were followed up for a minimum of 12 months after surgery (range 12 to 48 months). Sixty-one patients (82%) had excellent results, 11 patients (15%) had good results, and 2 patients (3%) failed to improve from surgery. Ninety-one percent of employed patients were able to return to full employment. Although group 1 patients required a significantly longer time to return to work (average 14.2 weeks vs. 4.7 weeks in group 2 and 2.5 weeks in group 3), these patients were all involved in heavy labor demanding a more complete return of shoulder endurance. Satisfactory pain relief and return to preinjury work activities can be achieved by acromioplasty in patients who have the potential for secondary gain.

Accidents, Traffic↗