Journal of shoulder and elbow surgery
-
J Shoulder Elbow Surg · May 2013
The Latarjet coracoid process transfer procedure: alterations in the neurovascular structures.
The Latarjet coracoid process transfer procedure is an established, reliable treatment for glenoid deficiency associated with recurrent anterior shoulder instability, but changes in neurovascular anatomy resulting from the procedure are a concern. The purpose of our cadaveric study was to identify changes in the neurovascular anatomy after a Latarjet procedure. ⋯ The Latarjet procedure resulted in consistent and clinically significant alterations in the anatomic relationships of the musculocutaneous and axillary nerves, which may make them vulnerable to injury during revision surgery.
-
J Shoulder Elbow Surg · May 2013
Midterm results of a total shoulder prosthesis fixed with a cementless glenoid component.
The aim of this study was to evaluate the midterm results and complications of a total shoulder arthroplasty implanted with a metal-backed, bone-ingrowth glenoid component. ⋯ After midterm follow-up, clinical outcomes of patients operated on with a cementless, metal-backed glenoid implant improved significantly. However, an unacceptable rate of complications and revisions was found. Glenoid loosening predominantly occurred in patients with preoperative eccentric glenoid morphology and was also related to cranial migration of the proximal humerus during the follow-up period.
-
J Shoulder Elbow Surg · May 2013
Accurate coracoid graft placement through use of a drill guide for the Latarjet procedure.
The Latarjet procedure has widely become the preferred treatment option for recurrent anterior glenohumeral instability in the presence of glenoid bone loss. The success of this procedure is largely dependent on accurate placement of the coracoid bone graft relative to the glenoid margin. With malpositioning of the coracoid graft, complications can arise, such as recurrent instability if placed too medially or impingement and subsequent early degenerative changes if positioned too laterally. To increase the accuracy and reproducibility of coracoid graft placement, we developed a simple and efficient drill guide that assists in accurate and safe positioning of the graft against the anterior glenoid to provide a congruent articular surface. ⋯ The use of a simple drill guide allows safe and accurate graft placement during an open Latarjet procedure.
-
J Shoulder Elbow Surg · Apr 2013
Rotator cuff healing after continuous subacromial bupivacaine infusion: an in vivo rabbit study.
The objective of this study was to evaluate the effects of continuous subacromial bupivacaine infusion on supraspinatus muscle and rotator cuff tendon healing using gross, biomechanical, and histologic analyses. ⋯ The healing supraspinatus tendons exposed to bupivacaine infusion showed similar histologic and biomechanical characteristics compared with untreated and saline-infused RCR groups. Muscle histology showed fiber damage at 2 weeks for the saline and bupivacaine-treated groups, with no apparent disruption at 8 weeks, suggesting a recovery process. Therefore, subacromial bupivacaine infusion in this rabbit rotator cuff model does not appear to impair muscle or tendon after acute injury and repair.
-
J Shoulder Elbow Surg · Apr 2013
Suprascapular nerve anatomy during shoulder motion: a cadaveric proof of concept study with implications for neurogenic shoulder pain.
The suprascapular nerve (SSN) carries sensory fibers which may contribute to shoulder pain. Prior anatomic study demonstrated that alteration in SSN course with simulated rotator cuff tendon (RCT) tears cause tethering and potential traction injury to the nerve at the suprascapular notch. Because the SSN has been implicated as a major source of pain with RCT tearing, it is critical to understand nerve anatomy during shoulder motion. We hypothesized that we could evaluate the SSN course with a novel technique to evaluate effects of simulated RCT tears, repair, and/or release of the nerve. ⋯ This pilot study demonstrated that the dynamic SSN course can be evaluated and may be altered by a RCT tear. Preliminary results suggest release of the transverse scapular ligament allowed the SSN to move upward out of the notch. This provides a biomechanical proof of concept that SSN traction neuropathy may occur with RCT tears and that release of the transverse scapular ligament may alleviate this by altering the course of the nerve.