Journal of shoulder and elbow surgery
-
J Shoulder Elbow Surg · Nov 2007
Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subscapularis tendon.
Irreparable ruptures of the subscapularis tendon represent a difficult surgical problem. An accepted treatment has been to utilize the pectoralis major as a transfer, using the superior half of the tendon, which involves parts of both the sternal and clavicular heads of the muscle. ⋯ From 22 dissected cadaveric shoulders, it was possible in all cases to obtain a segmentally split tendon suitable for transfer. We describe the morphology of the pectoralis major musculotendinous unit and neurovascular structures pertinent to the performance of a safe and effective transfer.
-
Repetitive valgus stress of the elbow can result in excessive strain or rupture of the native medial ulnar collateral ligament (MUCL). The flexor-pronator mass (FPM) may be particularly important for elbow valgus stability in overhead-throwing athletes. The aim of this study was to identify the relative contribution of each muscle of the FPM--that is, the flexor carpi ulnaris (FCU), flexor digitorum superficialis (FDS), flexor carpi radialis (FCR), and pronator teres (PT)--and of the extensor-supinator mass, including the extensor carpi ulnaris (ECU), extensor digitorum communis (EDC), extensor carpi radialis longus and brevus, and brachioradialis, to elbow valgus stability at 45 degrees and 90 degrees of elbow flexion angles. ⋯ The EDC and ECU created significant valgus movement at 45 degrees and 90 degrees , which became insignificant when the MUCL was transected. Our study suggested that the FCU, FDS, and FCR may function as dynamic stabilizers, with the FCU being the primary stabilizer for elbow valgus stability, incorporating with the MUCL for all tested joint configurations. Our findings also suggest that the ECU and EDC increased MUCL strain and elbow valgus movement at both 45 degrees and 90 degrees .
-
J Shoulder Elbow Surg · Nov 2007
Total shoulder arthroplasty versus hemiarthroplasty for rheumatoid arthritis of the shoulder: results of 303 consecutive cases.
Between January 1, 1976 and December 31, 1991, 195 total shoulder arthroplasties and 108 hemiarthroplasties were performed in 247 patients in patients with rheumatoid arthritis. One hundred and eighty-seven total shoulder arthroplasties and 95 hemiarthroplasties with complete preoperative evaluation, operative records, and minimum 2-year follow-up (mean, 11.6 years) or follow-up until revision were included in the clinical analysis. Twenty patients had died and 1 was lost to follow-up. ⋯ Glenoid periprosthetic lucency was present in 110 of 152 total shoulder arthroplasties (72%). The data from this study indicate that there is marked long-term pain relief and improvement in motion with shoulder arthroplasty. Among patients with an intact rotator cuff, TSA appears to be the preferred procedure for pain relief, improvement in abduction, and lower risk of revision surgery.