Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Oct 2013
Minimally displaced fractures of the greater tuberosity: outcome of non-operative treatment.
Minimally displaced (<3 mm) and non-displaced fractures of the proximal humerus are a common source of disability; nevertheless, there is no agreement on the recommended rehabilitation program in these patients. The purpose of this study was to evaluate the outcome of this group of patients and describe the rehabilitation protocol we have used for the treatment of this injury. ⋯ When the diagnosis of a minimally displaced fracture of the proximal humerus is made, the patient can be reassured that a favorable outcome is anticipated with a staged rehabilitation protocol. Nevertheless, clinicians and patients should be aware that full recovery from the injury may take an average of 8 months.
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While shoulder arthroplasty is a well established treatment for a variety of conditions about the shoulder, the results of shoulder replacement in younger patients are not as predictable. The purpose of this study is to examine the indications for shoulder arthroplasty in patients 59 years old and younger, and to analyze revision rates between younger and older patients. ⋯ This study suggests patients 59 years and younger have an increased risk of revision at early follow-up. The higher risk of revision in younger patients receiving hemiarthroplasty may support the use of total shoulder arthroplasty in patients 59 years of age and younger.
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J Shoulder Elbow Surg · Oct 2013
Randomized Controlled TrialEfficacy of continuous subacromial bupivacaine infusion for pain control after arthroscopic rotator cuff repair.
Arthroscopic rotator cuff repair can be a painful outpatient procedure. The purpose of this study was to evaluate the efficacy of continuous subacromial bupivacaine infusion to relieve pain after arthroscopic rotator cuff repair. We hypothesized that patients receiving continuous subacromial bupivacaine infusions after arthroscopic rotator cuff repair will have less postoperative pain in the early postoperative period than placebo and control groups. ⋯ The use of continuous bupivacaine subacromial infusion catheters resulted in no detectable pain reduction after arthroscopic rotator cuff repair based on visual analog scale scores and narcotic medication consumption.
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J Shoulder Elbow Surg · Oct 2013
Comparative StudyNeer Award 2012: cerebral oxygenation in the beach chair position: a prospective study on the effect of general anesthesia compared with regional anesthesia and sedation.
Devastating neurologic ischemic episodes, such as stroke and deafness, have occurred in patients undergoing shoulder surgery in the beach chair position. We hypothesized that awake patients would be able to avoid significant cerebral deoxygenation events (CDEs) compared with anesthetized patients when procedures were performed in the beach chair position. ⋯ Patients in the beach chair position treated with regional anesthesia and sedation had almost no cerebral desaturation events, unlike patients who had general anesthesia. Avoidance of general anesthesia in the beach chair position may reduce the risk of ischemic neurologic injury.
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J Shoulder Elbow Surg · Oct 2013
Comparative StudyAcromioclavicular joint ligamentous system contributing to clavicular strut function: a cadaveric study.
We hypothesized that the clavicle overrides the acromion during certain shoulder motions for individuals with acromioclavicular (AC) joint separation producing clinical symptoms. We measured 3-dimensional clavicular and scapular motions in AC joint separation models during humerothoracic motions, which should be impacted by the loss of AC joint continuity. ⋯ Scapular and clavicular kinematics were affected in AC separation models. Abduction with humeral internal rotation resulted in a decrease in scapular posterior tilt and upward rotation in AC separation models, and thereby could lead to AC joint articulation dysfunction.