The Journal of bone and joint surgery. American volume
-
J Bone Joint Surg Am · Nov 2000
Stabilized subcutaneous ulnar nerve transposition with immediate range of motion. Long-term follow-up.
Anterior transposition of the ulnar nerve at the elbow produces generally good results regardless of whether the nerve is transposed subcutaneously, intramuscularly, or submuscularly. The eventual recovery of nerve function is related less to the specific surgical technique than to the severity of the intrinsic nerve pathology. A primary variable in surgical management is the duration of postoperative elbow immobilization. The purpose of this study was to review the longterm results of a specific technique of subcutaneous anterior transposition of the ulnar nerve that utilizes a stabilizing fasciodermal sling. The study compared the results of immediate and late institution of a range of motion postoperatively. ⋯ This technique of stabilized subcutaneous anterior transposition of the ulnar nerve yielded predictably good results for a wide spectrum of patients. Patients returned to their occupation sooner when the elbow had been mobilized immediately.
-
J Bone Joint Surg Am · Oct 2000
Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment.
Idiopathic adhesive capsulitis is a commonly recognized but poorly understood cause of a painful and stiff shoulder. Although most orthopaedic literature supports treatment with physical therapy and stretching exercises, some studies have demonstrated late pain and functional deficits. The purpose of this study was to evaluate the outcome of patients with idiopathic adhesive capsulitis who were treated with a stretching-exercise program. ⋯ The vast majority of patients who have phase-II idiopathic adhesive capsulitis can be successfully treated with a specific four-direction shoulder-stretching exercise program. Although measurable limitations and deficiencies were noted at the outcome evaluation, these appeared to be acceptable to most of the patients and did not affect their general health status. Patients with more severe pain and functional limitations before treatment had relatively worse outcomes. More aggressive treatment such as manipulation or capsular release was rarely necessary, and the efficacy of early use of these treatments should be further studied.
-
J Bone Joint Surg Am · Sep 2000
Noninvasive imaging predicts failure load of the spine with simulated osteolytic defects.
The clinical management of lytic tumors of the spine is currently based on geometric measurements of the defect. However, the mechanical behavior of a structure depends on both its material and its geometric properties. Quantitative computed tomography and dual-energy x-ray absorptiometry were investigated as noninvasive tools for measuring the material and geometric properties of vertebrae with a simulated lytic defect. From these measures, yield loads were predicted with use of composite beam theory. ⋯ Image-predicted vertebral yield loads and analytical models that approximate loads applied to the spine during activities of daily living can be used to calculate a factor of fracture risk that can be employed by physicians to plan appropriate treatment or intervention.
-
J Bone Joint Surg Am · Aug 2000
Comparative Study Clinical TrialComparison of arthroscopic and open anterior shoulder stabilization. A two to six-year follow-up study.
Sixty-three consecutive patients with recurrent traumatic anterior shoulder instability underwent operative repair. The decision to select either arthroscopic Bankart repair or open capsular shift was based on the findings of an examination under anesthesia and the findings at the time of arthroscopy. Thirty-nine patients with only anterior translation on examination under anesthesia and a discrete Bankart lesion underwent arthroscopic Bankart repair with use of absorbable transfixing implants. Twenty-four patients with inferior translation in addition to anterior translation on examination under anesthesia and capsular laxity or injury on arthroscopy underwent an open capsular shift. ⋯ Arthroscopic and open repair techniques for the treatment of recurrent traumatic shoulder instability yield comparable results if the procedure is selected on the basis of the pathological findings at the time of surgery.