Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Apr 2013
Rotator cuff healing after continuous subacromial bupivacaine infusion: an in vivo rabbit study.
The objective of this study was to evaluate the effects of continuous subacromial bupivacaine infusion on supraspinatus muscle and rotator cuff tendon healing using gross, biomechanical, and histologic analyses. ⋯ The healing supraspinatus tendons exposed to bupivacaine infusion showed similar histologic and biomechanical characteristics compared with untreated and saline-infused RCR groups. Muscle histology showed fiber damage at 2 weeks for the saline and bupivacaine-treated groups, with no apparent disruption at 8 weeks, suggesting a recovery process. Therefore, subacromial bupivacaine infusion in this rabbit rotator cuff model does not appear to impair muscle or tendon after acute injury and repair.
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J Shoulder Elbow Surg · Apr 2013
Suprascapular nerve anatomy during shoulder motion: a cadaveric proof of concept study with implications for neurogenic shoulder pain.
The suprascapular nerve (SSN) carries sensory fibers which may contribute to shoulder pain. Prior anatomic study demonstrated that alteration in SSN course with simulated rotator cuff tendon (RCT) tears cause tethering and potential traction injury to the nerve at the suprascapular notch. Because the SSN has been implicated as a major source of pain with RCT tearing, it is critical to understand nerve anatomy during shoulder motion. We hypothesized that we could evaluate the SSN course with a novel technique to evaluate effects of simulated RCT tears, repair, and/or release of the nerve. ⋯ This pilot study demonstrated that the dynamic SSN course can be evaluated and may be altered by a RCT tear. Preliminary results suggest release of the transverse scapular ligament allowed the SSN to move upward out of the notch. This provides a biomechanical proof of concept that SSN traction neuropathy may occur with RCT tears and that release of the transverse scapular ligament may alleviate this by altering the course of the nerve.
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J Shoulder Elbow Surg · Apr 2013
Randomized Controlled TrialEfficacies of corticosteroid injection at different sites of the shoulder for the treatment of adhesive capsulitis.
A corticosteroid injection in the glenohumeral joint conducted blindly is technically demanding with a low rate of accuracy despite satisfactory clinical outcomes in the treatment for adhesive capsulitis. This study prospectively compared the clinical outcomes of patients with idiopathic adhesive capsulitis treated by a single corticosteroid injection in different locations of the shoulder. ⋯ The efficacy of a single corticosteroid injection was not found to be related to the site of injection. However, a single corticosteroid injection provided faster pain relief, a higher level of patient satisfaction, and an earlier improvement in shoulder motion and function than medication in patients with adhesive capsulitis.
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J Shoulder Elbow Surg · Apr 2013
Comparative StudyBiomechanical analysis of a novel locking plate with smooth pegs versus a conventional locking plate with threaded screws for proximal humerus fractures.
Repair of proximal humeral fractures with locking plates has greatly improved outcomes. However, an alarming rate of complications including screw cutout and impingement under the acromion has recently been reported. A novel locking plate with smooth pegs was developed to reduce these risks. The purpose of this study was to compare these 2 fixation methods with a cadaveric biomechanical study. ⋯ The SP group demonstrated superior biomechanical characteristics to the TS group in regards to cyclic bending.
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J Shoulder Elbow Surg · Apr 2013
The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on glenoid fossa involvement.
Fractures of the glenoid frequently require surgical treatment. A comprehensive and reliable scapula classification system involving the glenoid fracture patterns is needed to describe the underlying pathology. The AO Scapula Classification Group introduces an appropriate novel system that is presented along with its inter-rater reliability and accuracy. ⋯ This new system for scapular glenoid fractures has proved to be sufficiently reliable and accurate when applied by experienced shoulder surgeons. Further validation of the most detailed system, as well as involvement of surgeons with different levels of training in the framework of clinical routine and research, however, should be considered.