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At least 1,603 records · Page 89Linked to original sources
PubMed1992

Fractures adjacent to humeral prostheses.

In a review of records and radiographs from 1974 through 1988, we identified seven patients who had a humeral fracture after either a total shoulder replacement or a shoulder hemiarthroplasty. All seven patients had complications after the fracture, and five fractures did not unite until an operation was done. All of the fractures that were treated operatively healed without sequelae. Four patients who were managed operatively had satisfactory relief of pain and one had fair relief. One patient who had a non-union refused further treatment for medical reasons. The one fracture that united without operative treatment healed with the tip of the prosthesis outside of the humeral shaft, but persistent pain led to a revision total shoulder replacement. The average time to union after the operation was approximately five months (range, four to seven months). There was a permanent decrease in the motion of the shoulder from preinjury levels in five of the six patients who had union of the fracture.

Aged↗
PubMed2005

Suprascapular nerve entrapment.

It is important to be aware of neuropathy involving the suprascapular nerve. While direct trauma to the suprascapular nerve is the usual cause (direct blow to the base of the neck or posterior shoulder, shoulder dislocation or fracture), the problem may result from overuse injuries (such as repetitive tennis serving or spiking of a volley ball), excessive horizontal adduction, weight lifting, backpacking or no apparent reason. These last three years we have operated 8 cases of suprascapular nerve neurolysis at the level of suprascapular incision, and section of the transverse scapular ligament through the back supraspinal approach.

Brachial Plexus Neuropathies↗
PubMed1998

[Osteosynthesis of proximal humerus fractures].

Only 5% of adult fractures are fractures of the proximal humerus. In 80% of these fractures one can expect a good result, because they are generally nondisplaced, stable and allow early mobilization. However, the other 20% of these fractures present not only problems with reduction and adequate fixation but also the risk of humeral head necrosis and painful shoulder ankylosis. The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration the great extend and the biological aspects of these fractures and provides sufficient stability for early functional therapy. The Neer-classification has proved very useful for both, the indication for and the choice of an operative procedure.

Adult↗
PubMed2006

[Shoulder arthroplasty].

Every year, almost 500 shoulder arthroplasties are performed in Denmark. About two-thirds are done due to fractures of the proximal humerus. Other common indications are rheumatoid arthritis and primary or secondary arthrosis. The prosthesis is fixed with or without bone cement. If the rotator cuff is lacking, an inverse total arthroplasty can be used, and in arthrosis/arthritis with good bone stock, a resurfacing prosthesis can be used. Good pain relief can be expected, but shoulder movement will usually be permanently inhibited.

Arthritis↗
PubMed1993

Radiotherapy alone in breast cancer. Analysis of tumor and lymph node radiation doses and treatment-related complications. The experience of the Gustave-Roussy Institute and the Princess Margaret Hospital.

This retrospective analysis was conducted on breast cancer patients treated by radiotherapy alone at The Princess Margaret Hospital and at the Institut Gustave-Roussy. These patients had either operable tumors, but were unfit for general anesthesia, or had inoperable tumors due to local contraindications to surgery. Previous results showed that a radiation dose increase of 15 Gy can decrease the relative risk of tumor or lymph node recurrence twofold. In this third report, the same data were analyzed to determine the treatment-related complication rates and to correlate these to the radiation dose levels. Overall results were analyzed on 453 patients, but detailed analyses on complications were conducted on 372 patients not developing local recurrence in the first 6 months of follow-up. Each complication was graded on a 3-level previously defined scale. Most frequent complications were skin changes of different degrees, which were usually asymptomatic. More disabling complications were arm edema, impaired shoulder mobility, rib fractures and brachial plexopathy. The incidence of disabling complications was low. The only factor significantly increasing the risk of complications was the radiation dose level to the tumor and axilla. Technical factors such as overlapping fields should also be taken into account. As the more effective control of tumor and lymph nodes obtained in patients treated with higher radiation doses is counterbalanced by an increase in the complication rate, the dose to be delivered for each patient should be carefully chosen according to individual risk factors.

Arm↗
PubMed1989

Double-contrast computed tomography of the shoulder.

As a modality for the study of abnormalities of the shoulder, double-contrast computed tomography (CT) is accurate, is relatively easy to perform, and requires only a low dose of radiation. The results can be extremely helpful in preoperative planning. In this study, CT images were obtained for 247 patients who had undergone routine double-contrast shoulder arthrography. Abnormalities shown on CT images included glenoid labrum attenuation and tears, glenoid fractures, loose joint bodies, intracapsular staples, intra-articular screws, adhesive capsulitis, rotator cuff tears, peritendinitis calcarea, biceps tendon tears, and capsular abnormalities. In the 41 cases in which surgical correlation was available, all of the confirmed abnormalities had been identified on double-contrast CT images. Of the patients with rotator cuff tears, 80% had other abnormalities of the shoulder, and 48% had glenoid labrum tears. Of the patients with peritendinitis calcarea, 40% had glenoid labrum tears, and 33% had rotator cuff tears. Double-contrast CT studies of the shoulder are recommended when patients experience a decrease in range of motion, persistent shoulder pain, or signs of instability. Frequently, patients with rotator cuff tears and peritendinitis calcarea have coexisting abnormalities.

Adolescent↗
PubMed2000

Upper extremity injuries in the paediatric athlete.

Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.

Adolescent↗
PubMed2000

[Surgical repair of the axillary nerve. Results of a five-year follow-up].

INTRODUCTION: We report a series of 19 cases of axillary nerve lesions, which were operated between 1981 and 1995. MATERIAL AND METHODS: There were 14 isolated lesions of the axillary nerve and in 5 patients the lesion to the axillary nerve was associated either with a lesion of the radial nerve or with a lesion of the suprascapular nerve. Fourteen patients sustained shoulder stretch injury, three had fractures of the scapular girdle and two anterior shoulder dislocation. Patients were operated on 9 months after trauma through a combined anterior and posterior approach. The lesion was located in the quadrilateral space. In 17 cases the neuroma was excised and the nerve was reconstituted, using sural nerve grafts. In two cases the nerve was only freed from the surrounding scar tissue. RESULTS: Results were considered as satisfactory in 10 out of 14 isolated axillary nerve lesions. According the Constant score there were 2 very good, 8 good and 2 fair results. In this study, neurolysis and axillary nerve associated with suprascapular nerve lesions gave poor results. DISCUSSION: The successfully reinnervated deltoid muscle adds strength and endurance to the affected shoulder. Electromyographic study remains important in detecting spontaneous return of muscle function and determining the most favorable operative period before severe amyotrophy appears.

Adolescent↗
PubMed1989

The apical oblique radiograph in examination of acute shoulder trauma.

One-hundred and twenty-five patients with acuta trauma to the shoulder were radiographed using anteroposterior and transthoracic views supplemented by an apical oblique projection with the patient seated in posterior oblique position, central beam directed 45 degrees caudad. The two standard views were evaluated prior to the apical oblique view. In 15.2% of the patients lesions were seen only in the apical oblique view, which also provided better examinations in 23.2% of all patients. Mainly dislocations of joints and fractures (in particular posterior glenohumeral dislocations), glenoid fractures, Hill-Sachs lesions and soft tissue calcifications were revealed in this view. Its routine use in acute trauma radiography is recommended.

Female↗
PubMed1983

Shoulder problems of adolescents. How they differ from those of adults.

The adolescent athlete with an open epiphyseal plate presents with different shoulder problems than does the adult. Most shoulder injuries in the adolescent athlete can be treated conservatively with a good prognosis for full return of function. The exception is a glenohumeral dislocation, which will probably recur and need a surgical reconstruction.

Acromioclavicular Joint↗
PubMedDate not supplied

Characteristics of unsatisfactory shoulder arthroplasties.

Failure of shoulder arthroplasty is often defined as a complication or the need for revision, but it may also be viewed as a result that does not meet the expectations of the patient. To enhance our understanding of failed shoulder arthroplasties, we identified the characteristics common to a series of 139 consecutive patients who came to our shoulder consultation service because of dissatisfaction with the result of their shoulder arthroplasty. Primary osteoarthritis (28%) and proximal humeral fractures (26%) were the most common indications for the initial arthroplasty. Seventy-three shoulders (fifty-two percent) had at least one surgery before arthroplasty was performed. Seventy-four percent of the shoulders were stiff, 35% were unstable, and in the total shoulders, 59% of the glenoids were loose. Components were substantially malpositioned in 23%. Forty-two percent of shoulders with a failed hemiarthroplasty had substantial glenoid erosion, and 43% of shoulders that had undergone a hemiarthroplasty for fracture had nonunion of the tuberosities. Patients demonstrated impaired shoulder function; on average, they could perform only 2 of 12 shoulder functions. The rate of revision underestimated the rate of failure, as 23% of arthroplasties did not undergo revision. The challenge of achieving patient satisfaction after arthroplasty may be greater than previously recognized. Many of these unsatisfactory shoulder arthroplasties did not meet the criteria for failure used in previously published series. These observations suggest that greater attention to achieving proper component position, postoperative motion, and in fracture cases, fixation of the tuberosities may lead to increased patient satisfaction after shoulder arthroplasty.

Aged↗
PubMed2006

Early versus late mobilization after hemiarthroplasty for proximal humeral fractures.

This randomized controlled trial compares 2 mobilization regimens after shoulder hemiarthroplasty for acute 3- and 4-part fractures. The aim was to establish whether the length of immobilization plays a role in the functional outcome, tuberosity healing, and subsequent range of motion. The same prosthesis and surgical technique were used. We recruited 59 patients into the study; 31 were randomized to early (2 weeks) mobilization and 28 to late (6 weeks) mobilization. Greater tuberosity migration was assessed with a series of radiographs, and the functional outcome was assessed with the Constant Shoulder Assessment and Oxford shoulder scores. Of the patients, 49 (mean age, 70 years) met the inclusion criteria and were followed up for 12 months. Greater tuberosity migration occurred in 3 cases in the early mobilization group and once in the late mobilization group (P > .10). There was no significant difference in the Constant Shoulder Assessment and Oxford scores between the 2 groups. Although there was a decreased incidence of tuberosity migration in the group undergoing late mobilization, this was not statistically significant.

Adult↗
PubMed2001

Closed suction surgical wound drainage after orthopaedic surgery.

BACKGROUND: Closed suction drainage systems are frequently used to drain fluids, particularly blood, from surgical wounds. The aim of these systems is to reduce the occurrence of wound haematomas and infection. OBJECTIVES: To evaluate the effectiveness of closed suction drainage systems for orthopaedic surgery. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (May 2001), MEDLINE (1996-May 2001) and references from articles. SELECTION CRITERIA: All randomised or quasi-randomised trials comparing the use of closed suction drainage systems with no drainage systems for all types of elective and emergency orthopaedic surgery. DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Twenty-one studies involving 2772 patients with 2971 wounds were included in the analysis. The types of surgery involved were hip and knee replacement, shoulder surgery, hip fracture surgery, spinal surgery, cruciate ligament reconstruction, open meniscectomy and fracture fixation surgery. Many of the studies had poor methodology and reporting of outcomes. Pooling of results indicated no difference in the incidence of wound infection, haematoma or dehiscence between those allocated to drains and the un-drained wounds. There was a tendency to an increased risk of re-operation for wound complications in the group with drains (relative risk (RR) 2.25, 95% confidence intervals (CI) 0.95 to 5.33), but due to the small numbers of cases involved definite conclusions cannot be made for this outcome. Blood transfusion was required more frequently in those who received drains (RR 1.41, 95% CI 1.10 to 1.80). The need for reinforcement of wound dressings (RR 0.22, 95% CI 0.13 to 0.40) and bruising around the operation site was more common in the group without drains. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomised trials to support or refute the routine use of closed suction drainage in orthopaedic surgery. Further randomised trials are required before definite conclusions can be made.

Hematoma↗
PubMed2003

Evaluation of occult cervical spine fractures on radiographs and CT.

The aim of this study was to evaluate occult cervical spine fractures on radiographs and CT. We reviewed radiographs of 68 patients with cervical spine fractures at a level 1 trauma center. Twenty-six patients showed occult fractures on initial radiographs. Of seven odontoid fractures, two were diagnosed only after thinner repeat CT reconstructions. Five facet fractures were best seen on CT reconstructions. Three occult hangman's fractures were seen by CT. A C1 fracture was diagnosed on CT only. Two fractures through the C2 body were seen only by CT. Eight fractures were obscured by patient's shoulders, including five clay shoveler's fractures, a C6 facet fracture, a bilateral C6 pedicle fracture, and a C7-T1 fracture-dislocation. Odontoid, facet, and lower cervical spine fractures are most commonly occult on radiographs. CT, especially high-quality CT reconstructions for odontoid and facet fractures, can improve the diagnosis of cervical spine fracture.

Journal Article↗