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Biomedical subjects

A A Romeo

Publications and source records attributed to A A Romeo.

10 recordsLinked to original sources
PubMed1999

Arthroscopic treatment of infrapatellar tendonitis.

Infrapatellar tendonitis is a chronic overload lesion in the patellar ligament at the attachment to the lower pole of the patella. This lesion is found primarily in athletes who participate in jumping sports. Magnetic resonance imaging or ultrasound can show the extent of tendon pathology. Patellar tendonitis is treated with modification of activities, medications, and therapy. When conservative measures fail, operative debridement has been recommended. Previous reports have described a technique of open debridement of the patellar tendon, followed by an extended period of rehabilitation before returning to sports. Two athletes with persistent infrapatellar tendonitis were treated with an arthroscopic debridement. Both athletes returned to full activities without restrictions within 8 weeks of surgery. Arthroscopic treatment of infrapatellar tendonitis has not been previously described. This technical note describes the technique and two case reports of the arthroscopic treatment of infrapatellar tendonitis.

Adolescent↗
PubMed1999

Glenohumeral motion after complete capsular release.

The range of glenohumeral motion is primarily limited by the joint capsule. If the capsule is contracted, greater restriction in glenohumeral motion is exhibited. Release of a tight capsule has been an effective means of managing refractory stiffness of the glenohumeral joint. The effect of a complete capsular release on glenohumeral kinematics has not been previously studied in a cadaver model. Elevation, rotation, and translation of eight cadaveric glenohumeral preparations were studied before and after complete capsular release. As the intact joint was positioned near the limits of motion, glenohumeral torque rose rapidly with relatively small concomitant increases in elevation and rotational angles. Notable torque, due to tension in the capsule or cuff, ensued only after glenohumeral elevation reached approximately 80% of maximal range. After complete capsular release, maximal elevation increased on average 15%, yet retained definitive endpoints due to residual tension in the rotator cuff. Axial humeral rotation with an intact capsule decreased as maximum elevation approached, especially at elevation angles greater than 60 degrees. Maximum internal rotation was less than external, for all planes except +90 degrees. After complete capsular release, the greatest net gains for external rotation tended to be in the posterior scapular planes, whereas gains for internal rotation tended to be in the anterior scapular planes. Maximal translation in an intact vented capsule was 21 mm, 14 mm, and 15 mm in the anterior, posterior, and inferior directions, respectively. After complete capsular release, translation increased in all positions with maximal anterior, posterior, and inferior translations of 28 mm, 25 mm, and 28 mm, respectively. In general, relative gains in translation were greater in planes posterior to the scapula and at extremes of the range of motion. Although large glenohumeral translations were measured, no preparation could be dislocated before or after complete capsular release. Complete capsular release significantly increased glenohumeral range of motion and translation. The intact rotator cuff myotendinous units serves to limit the range of motion and translation after all capsuloligamentous attachments are rendered incompetent by complete capsular release.

Cadaver↗
PubMed1999

Repair of full thickness rotator cuff tears. Gender, age, and other factors affecting outcome.

Seventy-two full thickness rotator cuff tears (72 patients) were treated with an open rotator cuff repair between 1986 and 1993. The average postoperative followup was 54 months (range, 24-102 months; standard deviation, 22 months). Fifty-three (74%) patients had no pain, 16 (22%) patients had slight pain without restriction of activities, and three (4%) patients had moderate pain with activity compromise. Women with an associated biceps tendon rupture tended to have worse results. Women had a negative, statistically significant relationship between age and shoulder scoring scales, but age at the time of surgery was not related to any outcome variables for men. A rotator cuff tear greater than or equal to 5 cm2 as determined at the time of surgery was associated with a poorer outcome. The average University of California at Los Angeles score was 32 points (range, 7-35 points; standard deviation, 5 points). The average Constant-Murley score was 78 of 100 points (range, 12-95 points; standard deviation, 15 points). A yes response was given for an average of 10 of 12 questions on the Simple Shoulder Test (range, 0-12 questions; standard deviation, 3 questions). More than 4 years after open rotator cuff repair, patients had a 94% patient satisfaction rate with lasting relief of pain and improved function.

Adult↗
PubMed1998

The humeroscapular motion interface.

Motion between the humerus and scapula commonly is described as glenohumeral motion. However, humeroscapular motion occurs at two distinct sites. In addition to the motion at the diarthrodial glenohumeral joint, movement occurs between the proximal humerus and related structures and the surrounding sleeve of structures, including the acromion, deltoid, coracoid, coracoacromial ligament, and the muscles attached to the coracoid. This site of nonarticular shoulder motion is defined as the humeroscapular motion interface. Nonarticular humeroscapular motion can be documented and measured using standard magnetic resonance imaging techniques. The maximum average interfacial motion using axial images was 29.1 mm, which occurred at the level of the maximum diameter of the humeral head. Interfacial motion varied depending on the site measured. If pathologic conditions such as adhesions secondary to trauma or surgery interfere with or obliterate this space at sites of significant sliding motion, overall shoulder motion will be limited. Successful treatment of shoulder stiffness related to humeroscapular restraints is likely to require restoration of the normal sliding motion at the humeroscapular motion interface, in addition to resolving restraints affecting the glenohumeral joint motion.

Adult↗
PubMed1995

Total shoulder arthoplasty: pearls and pitfalls in surgical technique.

Total should arthroplasty is recommended for the treatment of shoulder arthritis that causes severe pain and loss of function. Successful shoulder arthroplasty is a technically demanding procedure because of lack of intrinsic stability of the glenohumeral joint. The tension of the rotator cuff and glenohumeral capsule must be balanced for mobility and stability. Attention to important anatomic landmarks and glenohumeral relationships ("pearls") minimizes the risk of complications ("pitfalls").

Humans↗
PubMed1984

Prospective reimbursement and the diffusion of new technologies in hospitals.

This paper presents new evidence on the effects of prospective hospital reimbursement on the diffusion of new medical technologies in American hospitals. The probability, speed, and extent of adoption of five specific new technologies in six states, three with prospective reimbursement and three without, are examined using the results of a hospital survey conducted by the American Hospital Association for this study in 1980. The analysis demonstrates the influence of prospective reimbursement on the diffusion of new technologies. It is clear as well that these effects depend upon the specific attributes of the prospective reimbursement program and the characteristics of the technologies themselves.

Capital Expenditures↗
PubMedDate not supplied

Surgical resection of the distal clavicle.

Distal clavicle resection is frequently performed for persistent acromioclavicular pain. However, patient outcome after this procedure has not been well described. The results of subjective and objective retrospective analysis of 23 open distal clavicle resections in 21 patients are reported. Patients were evaluated with a questionnaire, roentgenographs, physical examination, and isokinetic muscle strength testing at an average of 30 months after surgery. Eighteen of 23 shoulders had good or excellent postoperative ratings. All patients had normal motion. No significant weakness of the operated shoulder was seen on objective muscle testing when compared with the unoperated shoulder. The average preoperative Hospital for Special Surgery score was 34, and the average postoperative score was 84. Age and hand dominance were unrelated to postoperative outcomes. Less predictable results were obtained in patients with workmen's compensation and in those patients involved in litigation. Open distal clavicle resection yields good to excellent results in properly selected patients and does not create significant subjective or objective weakness.

Acromioclavicular Joint↗
PubMedDate not supplied

Understanding shoulder arthroplasty.

This article discusses the vital role of the professional nurse when caring for patients who have shoulder replacement surgery. The indications for surgery, recent advances in the surgical procedure, postoperative management, and potential complications are reviewed.

Arthroplasty, Replacement↗
PubMedDate not supplied

Scoring systems for shoulder conditions.

We evaluated the comparability of four commonly used shoulder scoring systems in the United States. Fifty-two patients had 53 shoulder stabilization procedures. Surgical procedures included 34 open Bankart-type repairs, 15 capsular shifts, and 4 arthroscopic stabilizations. Results were assessed using the following scales: 1) Rowe, 2) modified-Rowe, 3) University of California at Los Angeles, and 4) the pre-1994 American Shoulder and Elbow Surgeons scale. No consensus has been reached on the relative value of these systems. We observed significant variations using these systems. A majority of our patients (85%) had excellent results when the University of California at Los Angeles scoring system was used. However, only 38% of the patients had excellent results when the modified-Rowe scale was used. Overall, good or excellent results were observed in 89% to 95% of the patients using these four scoring systems. The University of California at Los Angeles score correlated poorly with the other systems. Interrater reliability between the four systems was poor. Generalized results of an investigation can be biased based on the selection of a scoring system. The lack of a widely accepted scoring system for the shoulder limits comparison of management for shoulder conditions. Thus, a widely accepted shoulder scoring system is needed.

Adolescent↗