Journal of shoulder and elbow surgery
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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 .
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Adhesive capsulitis of the shoulder is a common disorder, yet literature on its natural history is limited. This study examined patient characteristics, treatment patterns, and response to treatment of the disease in a large series of patients with this condition. Charts of 234 patients treated at our institution for adhesive capsulitis were reviewed retrospectively. ⋯ External rotation improved from an average of 26 degrees +/- 16 degrees pretreatment to 59 degrees +/- 18 degrees posttreatment. With supervised treatment, most patients with adhesive capsulitis will experience resolution with nonoperative measures in a relatively short period. Only a small percentage of patients eventually require operative treatment.
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J Shoulder Elbow Surg · Sep 2007
Temporal expression of 8 growth factors in tendon-to-bone healing in a rat supraspinatus model.
Growth factors play an important role in supraspinatus tendon-to-bone healing. The objective of this study was to evaluate the temporal expression of 8 different growth factors in tendon-to-bone healing in an animal model. We hypothesize that growth factors exhibit unique temporal profiles that correlate to specific stages in the acute process of the supraspinatus tendon. ⋯ Immunohistochemical staining was done using antibodies for basic fibroblast growth factor (bFGF), bone morphogenetic protein 12 (BMP-12), BMP-13, BMP-14, cartilage oligomeric matrix protein (COMP), connective tissue growth factor (CTGF), platelet-derived growth factor-B (PDGF-B), and transforming growth factor-beta1 (TGF-beta1). Immunoassays showed an increase in the expression of all growth factors at 1 week, followed by a return to control or undetectable levels by 16 weeks in both the insertion and midsubstance. Future studies will investigate the different impacts of growth factor expression in tendon to bone healing.
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J Shoulder Elbow Surg · Sep 2007
Comparative StudyComparison of elbow contracture release in elbows with and without heterotopic ossification restricting motion.
We compared 16 patients with post-traumatic heterotopic ossification (HO) restricting elbow motion (but not complete bony ankylosis) after elbow trauma with 21 patients with capsular contracture alone to test the hypothesis that HO is associated with diminished motion after release. Patients with burns or head injury were excluded. ⋯ After all subsequent procedures (including procedures to address residual stiffness in 1 patient in the HO cohort and 4 patients in the capsular contracture cohort), the flexion arc averaged 116 degrees in the HO cohort and 98 degrees in the capsular contracture cohort (P = .19). Open release of post-traumatic elbow stiffness is more effective when HO hindering motion is removed than when there is capsular contracture alone.