Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
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Randomized Controlled Trial Comparative Study Clinical Trial
Subacromial and intra-articular morphine versus bupivacaine after shoulder arthroscopy.
Multiple studies have compared the effects of intra-articular bupivacaine and morphine for postoperative pain control after arthroscopy of the knee. To date, these agents have not been compared in the shoulder. The purpose of this study was to compare intra-articular (IA)/subacromial (SA) morphine, bupivacaine, and placebo after shoulder arthroscopy. ⋯ IA/SA morphine does not contribute to postoperative pain control after shoulder arthroscopy, whereas IA/SA bupivacaine improves pain control during the first 60 minutes after surgery.
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The purpose of this article is to highlight the variability among shoulders in the relationship between the lateral acromion and the humeral head and to describe how this variability may influence a surgeon's choice of patient positioning for shoulder arthroscopy. In cases of increased lateral coverage of the humeral head by the acromion, arthroscopic access to the superior aspect of the glenoid through lateral portals becomes increasingly difficult because of a narrowed corridor of approach. Placing the ipsilateral arm in traction will lower the station of the humeral head and widen the arthroscopic corridor of approach to the superior labrum. Based on preoperative assessment of lateral acromion morphology, if the surgeon determines that inferior displacement of the humeral head of 25% or more of the humeral head diameter will be necessary to achieve adequate arthroscopic accessibility of the superior glenoid through lateral portals, we recommend the lateral decubitus position with continuous traction on the ipsilateral arm over the beach-chair position.
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Health locus of control has been shown to influence the recovery process after injury and surgery. This study attempted to determine relationships between patient perceptions of health locus of control and their perceived functional limitations after anterior cruciate ligament (ACL) rupture. An external health locus of control refers to the belief that one's outcome after injury or surgery is under the control of powerful others or is determined by fate, luck, or chance. An internal health locus of control refers to the belief that one's outcome is directly related to individual patient behaviors. ⋯ Subjects with lower perceived functional limitations regarded their health status as being controlled more by internal factors. It is not proven whether there is a cause-and-effect relationship or which of these parameters is the antecedent. Related reports suggest that perception of control may positively influence functional outcome and disability levels. Patients who perceive preoperative pain and functional limitation to be excessive may have low tolerance for the stressors associated with surgery and postoperative rehabilitation. With these patients, a more conservative surgical and rehabilitation approach may be better. Alternatively, methods to change their perceptions, such as cognitive therapy, may have a positive role.
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The purpose of this study was to examine the effectiveness of an arthroscopically placed intra-articular pain catheter for controlling postoperative pain and also review the results following arthroscopic release of refractor adhesive capsulitis. ⋯ Placement of an intra-articular pain catheter for delivery of bupivacaine was highly effective in controlling postoperative pain. In all cases, postoperative pain was essentially eliminated and this substantially assisted with range of motion exercises. Near complete restoration of range of motion without pain was achieved in 95% of the patients.
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To arthroscopically assess the pattern and extent of intra-articular damage associated with ankle fractures. ⋯ Ankle fractures have a high incidence of concomitant intra-articular pathology with syndesmosis disruption portending a particularly high risk of articular surface injury to the talar dome. Arthroscopy is a valuable tool in identifying and treating intra-articular damage that would otherwise remain unrecognized and may provide prognostic information regarding the functional outcome of these injuries.