Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · May 2008
The sensory branch distribution of the suprascapular nerve: an anatomic study.
The suprascapular nerve is responsible for most of the sensory innervation to the shoulder joint and is potentially at risk during surgery. In this study, 31 shoulders in 22 cadavers were dissected to investigate the sensory innervation of the shoulder joint by the suprascapular nerve, with special reference to its sensory branches. ⋯ In 74.2% of the shoulders, an acromial branch was also found, originating just proximal to the scapular neck, running to the infraspinatus tendon. These cadaveric results indicate that sensory branches to the shoulder joint are more common and numerous than previously described and therefore should be considered in shoulder surgery and nerve blocks to this area.
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J Shoulder Elbow Surg · May 2008
Pulsed radiofrequency applied to the suprascapular nerve in painful cuff tear arthropathy.
The purpose of this study was to assess the efficacy of pulsed radiofrequency (PRF) applied to the suprascapular nerve for pain relief in medically unfit patients with painful cuff tear arthropathy. Twelve patients with chronic shoulder pain due to cuff tear arthropathy were recruited. The mean age was 68 years (range, 60-83 years). ⋯ Ten patients showed improvement in the VAS score (P = .24) and Constant score (P = .005) and eleven in the Oxford score (P = .001). There was a deterioration in the VAS scores between 3 and 6 months, suggesting that the benefits were starting to wear off with time (P > .05). We conclude that PRF may be a useful therapeutic adjunct in patients with painful, end-stage rotator cuff tear arthropathy who are medically unfit for surgery.
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J Shoulder Elbow Surg · Mar 2008
Beach chair position with instrumental distraction for arthroscopic and open shoulder surgeries.
Arthroscopy is widely used in the diagnosis and treatment of shoulder disorders. It can be performed in the lateral or sitting position (beach chair). Both have advantages and disadvantages. ⋯ We have also not had difficulty visualizing or approaching the glenohumeral and subacromial spaces in the treatment of shoulder disorders. It is a safe, practical, easy, and fast set up. Its versatility makes it particularly helpful for the less experienced arthroscopic surgeon.
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J Shoulder Elbow Surg · Jan 2008
Multicenter Study Comparative StudyThe surgical approach for locking plate osteosynthesis of displaced proximal humeral fractures influences the functional outcome.
This study evaluated the influence of the surgical approach for locking plate osteosynthesis in proximal humeral fractures during a 1-year period. We performed a comparative study in 83 patients to evaluate possible benefits for an early functional result for function, pain, activity levels, radiographic evaluation, and complications. In 39 cases, the extended anterolateral deltoid-splitting approach was used (group DS); in 44 cases, the deltopectoral approach was used (group DP). ⋯ One case of avascular necrosis was observed in group DS and 3 in group DP. We conclude that the choice of approach for exposure of the proximal humerus region may influence the functional outcome. Stable osteosynthesis is important, but the outcome of operatively treated proximal humerus fractures is dependent on soft tissue management as well.
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J Shoulder Elbow Surg · Jan 2008
Randomized Controlled TrialSubacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial.
Subacromial decompression surgery is associated with significant postoperative pain. We compared interscalene block (ISB) with subacromial bursa block (SBB). Sixty consecutive patients with subacromial impingement syndrome, scheduled for arthroscopic subacromial decompression surgery, were randomized into 3 groups receiving ISB (n = 19), SBB (n = 19), or no block (n = 15 [controls]). ⋯ The time to first bolus was earlier in the control group (mean, 42.1 minutes) compared with both the SBB (mean, 92.6 minutes) and ISB (mean, 119.0 minutes) groups (P < .001). The oral analgesic intake was less in the SBB and ISB groups than in the controls (P = .004). Although ISB remains the gold standard, SBB provides effective, safe, and easily administered postoperative analgesia in patients with an intact rotator cuff undergoing arthroscopic subacromial decompression.