Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jul 1999
Relation between the painful shoulder and the cervical spine with narrow canal in patients without obvious radiculopathy.
It is well known that cervical radiculopathy sometimes causes shoulder pain. Hypothesizing that the cause of painful shoulder is related to the cervical spine in the absence of obvious radiculopathy, we measured the anteroposterior diameter of the spinal canal and the range of motion of the cervical spine in patients with painful shoulder on lateral cervical radiographs of the spine. Painful shoulder was diagnosed in 76 patients (24 men and 52 women; mean age 57.6 years). ⋯ When women only or men only were assessed, the results were nearly the same between groups. The cervical spine without obvious radiculopathy appears to be involved in patients with a painful shoulder. We speculate that the shoulder is affected by irritation of a cervical nerve root or referred pain.
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J Shoulder Elbow Surg · Jul 1999
Surgical anatomy of the posterior shoulder: effects of arm position and anterior-inferior capsular shift.
The purposes of this study were to evaluate anatomically various surgical intervals to the posterior shoulder and to determine the effects of varying arm positions and anterior-inferior capsular shift (AICS) on the relation of the posterior neurovascular structures to fixed bony landmarks. Fourteen cadaveric shoulders were dissected. The posterior surgical anatomy was defined, and the distances from fixed bony landmarks to neurovascular and musculotendinous structures were determined with digital calipers. ⋯ The anatomic relations of the suprascapular nerve were unchanged after AICS. On the basis of this study, surgical exposure of the posterior shoulder with a deltoid split from the PLCA, followed by an IS split, appears to be anatomically safe. The arm position should be in neutral rotation, especially if previous anterior capsular procedures have been performed, which can alter the posterior neurovascular anatomic relations.
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J Shoulder Elbow Surg · May 1999
Arthroscopic relationship of the axillary nerve to the shoulder joint capsule: an anatomic study.
Twelve right shoulders in fresh cadavers were dissected to determine the relation of the axillary nerve to the shoulder capsule and glenoid. Needles transfixed the nerve to the capsule and into the shoulder joint. Arthroscopy was performed to determine the location of the needles on the glenoid clock. ⋯ The axillary nerve was held to the shoulder capsule with loose areolar tissue in the zone between 5 and 7 o'clock and was close to the glenoid in the neutral position, in extension, and in internal rotation. With shoulder abduction, external rotation, and perpendicular traction, the capsule became taut and the axillary nerve moved away from the glenoid. Abduction, external rotation, and perpendicular traction increase the zone of safety during arthroscopic anteroinferior capsulotomy adjacent to the glenoid between the 5 and 7 o'clock positions.
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J Shoulder Elbow Surg · Mar 1999
The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis.
Excessive posterior translation of the residual clavicle after distal clavicle resection can be associated with significant postoperative pain. Although the acromioclavicular capsule has been identified as the primary restraint to translation of the clavicle along this axis, the individual contributions of the anterior, posterior, superior, and inferior components of the capsular ligament have not been established. The purpose of this study was to define the relative roles of the individual acromioclavicular capsular ligaments in preventing posterior translation of the distal clavicle in normal acromioclavicular joints in a human cadaver model. ⋯ However, sectioning of the superior and posterior ligaments had statistically significant effects (P < .05). These capsular structures contributed 56% +/- 23% (+/- SEM) and 25% +/- 16%, respectively, of the force required to achieve a given posterior displacement. To avoid excessive posterior translation of the clavicle after distal clavicle excision, surgical techniques that spare the posterior and superior acromioclavicular capsular ligaments should be used.
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J Shoulder Elbow Surg · Mar 1999
Extensile approach to the anterolateral surface of the humerus and the radial nerve.
A proposed approach to the anterolateral surface of the humeral shaft that would allow for exploration of the radial nerve was studied in 30 cadaver arms. The incision starts proximally along the posterior border of the deltoid muscle and extends anteriorly and distally over the lateral border of the biceps muscle. A deep dissection is made in the internervous plane between the deltoid and the triceps muscles proximally and between the longitudinally split fibers of the brachialis muscle distally. ⋯ Proximally, the radial nerve can be exposed by elevating the lateral head of the triceps muscle from the humerus. Distally, the radial nerve can be exposed between the brachioradialis and the brachialis muscles. A plate can be applied on the anterolateral surface of the humerus without having to elevate the firmly attached anterior deltoid insertion.