Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jan 2008
The anatomy of the quadrilateral space with reference to quadrilateral space syndrome.
Quadrilateral space syndrome is a rare condition in which the contents of the quadrilateral space, the axillary nerve and the posterior circumflex humeral artery, are compressed, leading to vague symptoms of shoulder pain, tenderness over the quadrilateral space on palpation, and teres minor and deltoid denervation. Fibrous bands within the quadrilateral space are often cited in the literature as a cause of compression in quadrilateral space syndrome; however, Cahill and Palmer did not see these bands in cadaveric dissection. These are postulated to cause compression of the quadrilateral space contents in abduction and external rotation of the shoulder. ⋯ Dissection revealed that fibrous bands are a common finding in the quadrilateral space, being present in 14 of 16 shoulders. The most common site for a fibrous band was between the teres major and the long head of the triceps. Where the bands were present, both internal and external rotation of the shoulder caused a reduction in the cross-sectional area of the quadrilateral space.
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J Shoulder Elbow Surg · Jan 2008
Multicenter StudyA method for internal fixation of unstable distal clavicle fractures: early observations using a new technique.
Unstable distal clavicle fractures often require open reduction and internal fixation. A variety of fixation methods have been used and are currently in use. None of the current fixation methods seem to be without problems. We present a new technique and early observations using a distal radius locking T-plate normally used for fixation of distal radius fractures.
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J Shoulder Elbow Surg · Jan 2008
Randomized Controlled TrialExtracorporeal shock wave therapy for calcifying tendinitis of the shoulder.
We prospectively studied extracorporeal shock wave therapy (ESWT) for calcific tendinitis of the shoulder in 46 consecutive patients. All patients were randomly divided into 2 groups: treatment and control. The 33 patients in the treatment group received 2 courses of ESWT at the energy density of 0.55 mJ/mm(2) (1000 impulses). ⋯ In contrast, elimination was partial in 2 control patients (15.3%) and unchanged in 11 (84.7%). There was no significant difference between Gärtner type I and type II groups in the Constant score (P > .05). ESWT shows promise for pain relief and functional restoration of calcific tendinitis with negligible complications.
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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.
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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 .