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PubMedDate not supplied

[Rotator cuff rupture. Surgical results in relation to the approach].

This paper presents the results of surgery in a total of 43 cases of rupture of rotator muscle sheaths which were followed up. Surgery was carried out from a saber-cut incision (n = 24) and from a transacromial approach (n = 19). The follow-up period for the first group was 42.2 months, for the second 14.3 months. The procedures employed were, almost without exception, the Schuhnestel or continuous suture and transosseous fixation after McLaughlin. In Group I the results were very good and good in 22 patients (91.6%); results in two shoulders were poor. In Group II the results were somewhat poorer, with 76.5% very good and good results; this is attributable principally to the much shorter follow-up period. The poor results are analyzed. The coraco-acromial ligament was severed or resected in 22 cases. Neer acromioplasty is now performed routinely. The surgical approach appears to have no decisive influence on the result. Advantages and disadvantages of the various approaches are described. A particularly important factor is the small therapeutic team (surgeon and physiotherapist).

Adult↗
PubMed1990

[Magnetic resonance tomography of the shoulder. Possibilities of over interpretation of normal findings].

In order to test the criteria for abnormalities of the shoulder as seen on MR, 30 normal shoulders were examined. The examination included T1, proton and T2-weighted SE sequences and T2*-weighted FE sequences, using transverse, oblique coronary and oblique sagittal planes. In 57% there was increased signal intensity in the tendon of the rotator cuff; this might have been interpreted as a rupture of the cuff or tendinitis. Anatomical examination suggests that the finding is due to a normal layer between the long head of the biceps and the tendon joint complex. The anterior glenoid labrum could not be clearly delineated in 57% and the posterior labrum in 5%. In two cases there was a superior, postero-lateral defect in the head of the humerus. The currently accepted criteria for the MRT diagnosis of shoulder abnormalities need to be critically re-evaluated.

Adolescent↗
PubMed1988

[Sonographic evaluation of the rotator cuff following reconstruction of complete ruptures].

This is a report on the results of a clinical and sonographical re-examination of 66 shoulder joints after reconstruction of complete rotator cuff tears. One-third of the patients were asymptomatic, in more than half of them pre-operatively existing complaints had improved, and in 15% no improvement was seen. Clinical findings were without abnormalities in half of the patients. In as many patients indications were found of a still existing rotator cuff syndrome. Sonographically, in 49 out of 66 cases the continuity of the rotator cuff was maintained. In 17 cases indications of tears were found. Remarkable features were, in rotator cuffs with maintained tendon continuity, in 50% of the shoulder joints a thinning out of the tendon and/or echogenic patterns. Tears in the non-operated opposite side were found in 7 cases and thinning out and/or enhanced echogenicity in 12 cases.

Adult↗
PubMed1985

[Differential arthrographic diagnosis of the painful shoulder joint].

60 arthrograms of the shoulder were explored under morphologic and pathologic-anatomic aspects. Differentiation was made between acute and chronic pain. The possible findings in leaking of the contrast material out of the joint capsule are shown and discussed. Signs are quoted of degeneration of soft tissue and bone. The findings in patients with rheumatoid arthritis and a history of shoulder dislocation are summarised. Distension of the joint capsule without shoulder dislocation is described. Filling of the periarticular lymphatics is mentioned in different cases.

Adolescent↗
PubMedDate not supplied

Radiographic assessment of ingrowth total shoulder arthroplasty.

Sixty-two primary ingrowth total shoulder arthroplasties, performed between 1989 and 1992 and with a minimum radiographic and clinical follow-up of 2 years or until the time of revision surgery (mean, 4.6 years), were reviewed. To combine data on both the distribution and the thickness of periprosthetic lucency and change in component position, criteria were used to determine whether a component was radiographically "at risk" for clinical component loosening. A glenoid component was "at risk" when a complete lucent line was present, some part of it being 1.5 mm or greater in width, or when 2 of 3 or 3 of 3 independent observers identified migration or tilt of the component. A humeral component was "at risk" when a lucent line 2 mm or greater in width was present in 3 or more of 8 zones or when at least 2 of 3 independent observers identified tilt or subsidence of the component. Four (6.5%) of the 62 glenoid components and 6 (9.7%) of the 62 humeral components were judged to be "at risk." There were no identifiable patient, disease, or surgical characteristics associated with the development of an "at risk" glenoid or humeral component. Currently, despite this very favorable radiographic assessment, we reserve the use of a tissue ingrowth glenoid component for those patients with bone loss precluding bone cement fixation with a keel type of implant. Because advantages exist for use of a tissue ingrowth humeral component, a press-fitted component with ingrowth surfaces is currently used unless bone deficiencies prevent secure fixation without cement.

Adult↗
PubMedDate not supplied

Comparison of an arthroscopic and an open procedure for posttraumatic instability of the shoulder: a prospective, randomized multicenter study.

From 1993 through 1996, a multicenter study was conducted on the surgical treatment of patients with posttraumatic recurrent anterior shoulder dislocations. Fifty-six patients (40 men, 16 women; mean age 26 years [range 18-51 years]), were evaluated with shoulder arthroscopy. If a Bankart lesion was present, the patients were randomly allocated to either an arthroscopic reconstruction with the use of biodegradable tacks or an open reconstruction with suture anchors. The postoperative rehabilitation protocol for the two groups was identical. In all patients, the range of shoulder motion, stability, and the Constant and Rowe scores were evaluated at 3, 12, and 24 months postoperatively. Thirty patients were surgically treated with the arthroscopic technique and 26 patients with the open technique. In the arthroscopic group, there were recurrences in 7 (23%) of 30 patients at a mean of 13 months (range 5 to 21 months) after surgery. All patients with stable shoulders had a negative apprehension test result. In the open group, there were recurrences in 3 (12%) of 26 patients at a mean of 10 months (range 2 to 23 months) after surgery (P = not significant). In the arthroscopic group, 2 patients had new traumatic redislocations, whereas 1 patient redislocated during an epileptic seizure. In the open group, 1 traumatic redislocation occurred. The 2-year results in this study demonstrate a large number of redislocations after reconstruction, even in the open surgery group. Patient noncompliance with the rehabilitation protocol and predisposing disease may partially explain these results. A tendency was seen toward more redislocations in the arthroscopic group, which emphasizes the importance of correct patient selection and careful surgical technique in the difficult surgical procedure.

Adolescent↗
PubMedDate not supplied

The use of a blade plate and autogenous cancellous bone graft in the treatment of ununited fractures of the proximal humerus.

Stable internal fixation is essential to obtain healing of an ununited fracture of the proximal humerus. Standard plate and screw fixation may be inadequate to secure a small, osteopenic proximal fragment. We used blade plates and autogenous cancellous bone graft to repair ununited fractures of the proximal humerus in 25 patients (19 women and 6 men) with a mean age of 61 years. Healing was documented in 23 of 25 patients (92%). Objective and subjective instruments documented substantial functional improvement in patients with healed fractures. The results were classified as good or excellent in 20 of 25 patients, and few complications were encountered. Blade plate fixation facilitates successful treatment of ununited fractures of the proximal humerus.

Adult↗
PubMedDate not supplied

The vertical-apical suture Bankart lesion repair for anteroinferior glenohumeral instability.

We report the results of the vertical-apical suture Bankart lesion repair in 59 patients with traumatic anteroinferior glenohumeral instability. According to the system of Rowe et al, at a mean follow-up of 42 months (minimum, 2 years), 94.9% (56 patients) had a rating of good or excellent. Three patients had a recurrent dislocation due to further trauma. The mean Rowe score was 94.6, the mean Walch-Duplay score was 94.3, the mean Constant score was 90.4, and the mean rating on a numerical satisfaction scale was 8.7. The mean loss of external rotation with the arm at the side was 2.4 degrees, and in 90 degrees abduction it was 2.2 degrees. Of 44 patients, 35 (79.5%) returned to the same sport at the same level of activity, 7 returned to the same sport at a reduced level of activity, and 2 stopped all sporting activities. There were no complications. We recommend the vertical-apical suture as a technique for Bankart repair that uses absorbable sutures and no suture anchors or tacks.

Adolescent↗
PubMed1991

Workload and musculoskeletal problems: a comparison between welders and office clerks (with reference also to fishermen).

Previous studies have shown that subjective as well as clinical shoulder signs and symptoms are more common among welders than among office clerks. In the present study we wished to further evaluate the influence of different jobs on musculoskeletal problems, as well as the relationship between objective signs and subjective symptoms. This study confirmed that symptoms and signs from the shoulder were more common among the welders, who also had more subjective symptoms and clinical signs from other parts of the musculoskeletal system. Range of motion in different joint systems was, however, similar in the two groups except in external rotation of the shoulder, where welders had a more limited range. The degree of co-existence of subjective symptoms and clinical signs differed between different parts of the musculoskeletal system and was low particularly in the low back, hips, and ankles. This indicates low validity of many common clinical methods for determining musculoskeletal dysfunction. General health was good in both vocational groups and isometric strength for the welders was intermediate between that of office clerks (who had lower strength) and that of fishermen (who had higher strength, as disclosed in a previous investigation). To a similar degree welders and fishermen also had objective signs from most parts of the musculoskeletal system, whereas subjective symptoms from some parts of the body and medical consultations due to these problems were more common among welders. Atrophied shoulder muscles were more common among welders than among fishermen, whereas crepitations in the shoulder tended to be more common among the fishermen. This indicates that heavy dynamic work and prolonged static work may both induce shoulder injuries, but of different types.

Adult↗
PubMed1997

Cine-MR imaging of the shoulder.

PURPOSE: Shoulder lesions are usually examined with the joint in only one or two positions. We examined the shoulder with the joint in a variety of positions. We also assessed the application of cine-MR to the detection of instability and impingement. MATERIAL AND METHODS: The cine-MR examinations were performed in 30 patients and 15 healthy volunteers. We used an open 0.2 T system and a closed 1.0 T system. Spoiled gradient echo 2D T1-weighted images and turbo spin-echo T1- and T2-weighted images were obtained with a field of view of 180 mm. The examinations were videotaped and evaluated later. RESULTS: Normal variations of the glenohumeral joint were easy to recognize. Sub-luxations and luxations of the humeral head as well as rupture of the labrum were identified. It was also possible to identify the labrum with a signal change after arthroscopic refixation. And we were able to objectively assess distances between the osseous structures during dynamic movement. CONCLUSION: Unlike static MR, cine-MR would appear to be useful in visualizing the capsular ligament complex of the gleno-humeral joint in impingement and instability. It also provides information on dynamic changes and may thus prove to be an important tool for shoulder diagnostics. The method may provide an early diagnosis in the sub-acromial impingement syndrome.

Acromion↗
PubMed1985

A comparative study of the aetiological factors in shoulder pain.

Sixty patients presenting consecutively with shoulder pain to a rheumatology clinic have been studied. There was a significant association of shoulder capsulitis with diabetes mellitus and antecedent trauma when compared with supraspinatus tendonitis (SST). There were no immunological or other biochemical differences between the capsulitis and SST patients. The results suggest that patients with shoulder capsulitis should be investigated to exclude diabetes mellitus particularly when there is no history of antecedent trauma.

Acromioclavicular Joint↗