Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Nov 2005
Comparative StudyVolume changes of supraspinatus and infraspinatus muscles after supraspinatus tendon repair: a magnetic resonance imaging study.
Muscle volume was measured, by use of magnetic resonance imaging (MRI), as a direct indicator of functional recovery of the supraspinatus and infraspinatus muscles after supraspinatus tendon repair, because atrophy of the supraspinatus and infraspinatus muscles was observed in all patients with a torn supraspinatus tendon. Seventy-three patients who had a cuff tear limited only to the supraspinatus tendon were included in this study. The University of California, Los Angeles score improved significantly after surgery. ⋯ Muscle volume of the supraspinatus was assessed on images of the oblique coronal plane, and that of the infraspinatus was assessed on images of the axial plane. The width of the supraspinatus muscle did not recover until 6 months postoperatively. Direct measurement of the infraspinatus muscle volume by use of MRI can be a good indicator when evaluating whether the repaired rotator cuffs are actually functioning.
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J Shoulder Elbow Surg · Jul 2005
Comparative Study Clinical TrialA comparison of functional, patient-based scores in subacromial impingement.
The goal of this study was to compare the Oxford Shoulder Score (OSS), the Shoulder Pain and Disability Index (SPADI), and the Short Form 36 (SF-36) for their correlation, agreement, sensitivity to change, and test-retest reliability in patients with a clinical diagnosis of subacromial impingement. All patients attending a specialist subacromial impingement clinic over a 6-month period completed the OSS, SPADI, and SF-36 at each visit. A total of 323 sets of observations were recorded in 110 patients. ⋯ The correlation with total SF-36 was poor (0.37 for OSS and 0.26 for SPADI). The OSS and SPADI showed good effect sizes compared with the total SF-36 score and good test-retest reliability. These data support the use of the OSS or SPADI in patients with subacromial impingement.
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J Shoulder Elbow Surg · Mar 2005
Biceps tenodesis associated with arthroscopic repair of rotator cuff tears.
Associated lesions of the biceps tendon are commonly found during arthroscopic repair of rotator cuff tears. These lesions are treated with tenodesis, classically performed through an open approach. However, it seems reasonable to seek a single approach to correct both lesions; therefore, we have proposed a new arthroscopic technique that allows an exclusive arthroscopic tenodesis by including the biceps tendon in the rotator cuff suture, a surgical technique with a single suture of the rotator cuff that includes the biceps tendon. ⋯ Postoperative evaluation, by use of the UCLA score, after a mean follow-up period of 32.4 months showed satisfactory results in 93.4% of patients: 11 had excellent results, 3 had good results, and only 1 had an unsatisfactory result. In this case a postoperative magnetic resonance imaging scan showed an intact rotator cuff and biceps tenodesis. The suture involving the rotator cuff and the biceps tendon proved effective to correct both lesions, with the main advantage being that an additional approach was not required.
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Restoration of painless and satisfactory elbow function after a fracture of the distal humerus requires anatomic reconstruction of the articular surface, restitution of the overall geometry of the distal humerus, and stable fixation of the fracture fragments to allow early and full rehabilitation. Although these goals are now widely accepted by the orthopaedic community, they may be technically difficult to achieve, especially in the presence of substantial osteoporosis or comminution. Failure, when it occurs, typically occurs at the supracondylar level through loss of fixation in the distal fragments. ⋯ Second, parallel placement of 2 plates in the sagittal plane is as strong or stronger than the 90 degrees /90 degrees orientation. Finally, linking the plates together through the bone, thereby creating the architectural equivalent of an arch, offers the greatest biomechanical stability for comminuted distal humeral fractures. This can be done by interdigitating and locking the screws together as they pass through the distal fragments from the medial and lateral plates placed in the sagittal plane.
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J Shoulder Elbow Surg · Jan 2005
ReviewProximal humeral anatomy in shoulder arthroplasty: Implications for prosthetic design and surgical technique.
Resurfacing arthroplasty of the glenohumeral joint has been established for several decades as a means to restore comfort and function of the shoulder for many afflictions that derange the normal anatomy. Rigorous study of shoulder anatomy in terms relevant to prosthetic geometry, however, did not begin until the 1990s. It has become apparent that normal anatomy is highly variable from individual to individual and that it is aligned somewhat differently than the early modular prosthetic devices. ⋯ Component design and surgical technique are inextricably intertwined. Most surgeons with experience using modern systems feel a greater sense of predictability in achieving their surgical goals when using these systems as compared with earlier ones. How these developments impact implant longevity will only be known with time and further follow-up.