We assessed the relative value of lag signs for the evaluation of rotator cuff rupture in a prospective study of 100 consecutive painful shoulders with impingement syndrome, stages 1 to 3. Lag signs were compared with the Jobe and lift-off signs. Three tests were designed to assess the main components of the rotator cuff: the external rotation lag sign (ERLS) for the supraspinatus and the infraspinatus tendons, the drop sign for the infraspinatus, and the internal rotation lag sign (IRLS) for the subscapularis tendon. For assessment of the supraspinatus and infraspinatus the ERLS was less sensitive but more specific than the jobe sign. The drop sign was the least sensitive but was as specific as the ERLS. Partial ruptures of the supraspinatus remained concealed to the ERLS. For assessment of the subscapularis the IRLS was as specific but more sensitive than the lift-off sign. Partial ruptures of the subscapularis tendon could be missed by the lift-off sign but were detected by the IRLS. The magnitude of the lag correlated with the size of the rupture for both the ERLS and the IRLS. Clinical testing for lag signs was efficient, reproducible, and reliable. In patients with little or no restriction of motion it enhanced the accuracy of clinical diagnosis in rotator cuff lesions.

Adolescent↗

PubMedDate not supplied

The clinical relevance of posttraumatic avascular necrosis of the humeral head.

Twenty-five patients with a partial or complete collapse of the humeral head caused by post-traumatic avascular necrosis underwent clinical and radiologic evaluation at an average of 7.5 years (range 2.3 to 17.6 years) after having an underlying proximal humeral fracture. Posttraumatic humeral head necrosis was always associated with disability. The overall shoulder function as assessed with the Constant score was 46 points, corresponding to a functional shoulder value of 51% of an age- and sex-matched normal control group. The clinical outcome was significantly related to the anatomic alignment of the fragments of the humerus by the time of healing. In 13 patients (group 1) treatment resulted in an anatomic or nearly anatomic healing of the fracture, and in 12 other patients (group 2) avascular necrosis and collapse ensued in addition to malunion of 1 or more of the fracture fragments. Subjective overall outcome (P < .0001) and pain (P < .0001) were significantly better in group 1. Active anterior elevation averaged 125 degrees in group 1 and 80 degrees in group 2 (P = .0007), and abduction averaged 110 degrees in group 1 and 63 degrees in group 2 (P = .007). The relative shoulder score according to Constant was 65% of an age- and sex-matched normal population for group 1 and 41% for group 2 (P = .001). The results obtained in group 1 were comparable to those reported after hemiarthroplasty for complex humeral fractures. A proximal humeral fracture that is at risk for avascular necrosis has to be reduced anatomically if joint-preserving treatment is selected. If anatomic reduction cannot be obtained, other treatment options such as arthroplasty should be considered.

Adolescent↗

PubMedDate not supplied

The pattern of pain produced by irritation of the acromioclavicular joint and the subacromial space.

To characterize the patterns of pain caused by selective irritation of the acromioclavicular joint and of the subacromial space, hypertonic saline solution was injected 15 times into the acromioclavicular joints of 10 healthy volunteers and 10 times into the subacromial space of 9 healthy volunteers. Irritation of the acromioclavicular joint produced pain directly over the joint, in the antero-lateral neck, in the trapezius-supraspinatus region, and in the anterolateral deltoid. Irritation of the subacromial space produced pain in the region of the lateral acromion, the deltoid muscle, and occasionally in the forearm or the fingers but did not produce pain in the neck or in the trapezius region. Neither acromioclavicular nor subacromial irritation produced pain at the posterior aspect of the shoulder. This information may assist in accurate clinical diagnosis and in the selection of optimal imaging studies for the evaluation of shoulder pain.

Acromioclavicular Joint↗

PubMedDate not supplied

Structural changes of the rotator cuff caused by experimental subacromial impingement in the rat.

Subacromial impingement of the infraspinatus tendon was experimentally created in 28 young adult rats by thickening the undersurface of the acromion with either one or two platelike bony transplants of the ipsilateral scapular spine. Nine nonoperated and eight shoulders that had undergone a sham operation served as control groups. The rats were killed after 2 days and after 1, 2, 4, 8, 16, and 32 weeks for histologic evaluation. All rats with experimental subacromial impingement showed an infraspinatus tear on the bursal side of the tendon. An isolated tear on the articular side or within the tendon was not seen. Two plates caused larger tears than one (P = .04), and more long-standing impingement was associated with larger lesions (P = .002). Multiple chondrocytes were observed within the tendon adjacent to the bony transplants. No calcium deposits were found. In the subacromial space rapid thickening of the bursa was observed. The undersurfaces of the bony transplants showed no evidence of abrasion or remodeling caused by the tendon. The shoulders of the control groups were found intact without any alteration. Experimental subacromial impingement in the rat caused bursal side rotator cuff tears. The type of partial tears that are most frequently observed in clinical practice, that is, intratendinous and articular side tears, were not seen in this experimental model.

Acromioclavicular Joint↗

PubMedDate not supplied

Passive tension in the supraspinatus musculotendinous unit after long-standing rupture of its tendon: a preliminary report.

Incomplete functional recovery after rotator cuff surgery can be caused by rerupture or incomplete restoration of the contractile properties of the muscle-tendon-bone unit. We measured the passive tension generated in the supraspinatus musculotendinous unit at the time of repair of the supraspinatus tendon performed for the treatment of long-standing rupture in four patients and compared our results with the values of an intact musculotendinous unit. In stepwise elongation from 10 to 20 mm, passive tension increased by a factor of 2.2 +/- 0.4 in the study group. In the control case passive tension increased by a factor of only 1.3. Mean tension in 60 degrees of abduction was 14.25 +/- 3.4 N in the four long-standing ruptures and 10 N in the control case. If the arm was brought to the side, tension rose to 25 N in the control case, whereas mean tension increased to 59.25 +/- 12.7 N in long-standing rupture of the supraspinatus muscle. Our findings demonstrate that passive tension in the supraspinatus is increased after long-standing rupture of its tendon. This result suggests that active force generation by this muscle will be compromised after surgery and that the high strain after repair may expose the musculotendinous unit to further damage.

Adult↗

PubMedDate not supplied

Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging.

Forty-one patients scheduled for shoulder surgery underwent computed tomography (CT) and magnetic resonance imaging (MRI) examination of their affected shoulder to verify whether fatty degeneration of the rotator cuff muscles could reproducibly be assessed by CT or by MRI and whether the grading with the 2 methods was comparable. In addition, rotator cuff muscle cross-sectional areas were measured on parasagittal MRI scans to establish a possible correlation between rotator cuff muscle atrophy and fatty degeneration. Interobserver reproducibility for grading fatty degeneration was good to excellent for CT and for MRI. The correlation between MRI and CT was fair to moderate and remained unsatisfactory, even if the classification system was simplified with only a 3- rather than a 5-grade scale as originally proposed. The degree of fatty degeneration was significantly related to the amount of atrophy of the respective muscles.

Adult↗

PubMedDate not supplied

Determination of surface topography of biological specimens at high resolution by scanning tunnelling microscopy.

Although techniques are available for the determination of the three-dimensional structure of biological specimens, for example scanning electron microscopy, they all have some serious drawback, such as low resolution, the requirement for crystals or for the sample to be analysed in a high vacuum. In an attempt to develop a technique for high-resolution three-dimensional structure analysis of non-crystalline biological material, we have tested the applicability of scanning tunnelling microscopy (STM), a method that has been used successfully in the analysis of metal and semiconductor surface structures. We report here that scanning tunnelling electron microscopy can be used to determine the surface topography of biological specimens at atmospheric pressure and room temperature, giving a vertical resolution of the order of 1 A. Our results show that quantum mechanical tunnelling of electrons through biological material is possible provided that the specimen is deposited on a conducting surface.

Atmospheric Pressure↗

PubMedDate not supplied

Shoulder function after arthroscopic anterior stabilization of the glenohumeral joint using an absorbable tac.

Among the advantages of arthroscopic stabilization could be less loss of range of motion and, with that, better functional outcome. In each of 24 shoulders, arthroscopic anterior repair of instability was performed through use of cannulated resorbable tacs (Suretacs), and the clinical outcome, especially the function, was examined in 20 shoulders after a mean follow-up of 3.4 years. The study included a retrospective analysis of 10 shoulders with documented recurrent anterior dislocations, 3 shoulders with posttraumatic subluxations, and 7 shoulders with painful apprehension and unequivocally clear Bankart lesions at arthroscopy. The evaluation of the recurrent dislocators revealed recurrence in 20%, residual instability in 10%, and a mean loss of external rotation of 28.5 degrees. No recurrence or residual instability was encountered in the other 2 groups. Mean loss of external rotation was 15 degrees in the group of subluxators and 20 degrees in the group of painful shoulders with intraoperatively evident instability. Through use of the Rowe score, failure was found in 30% of the dislocators; no failures were noted in the other groups. The painful shoulders with intraoperatively evident instability had significantly (P < .05) better Rowe scores than shoulders that had documented dislocation. Our series confirmed a relatively high failure rate for arthroscopic anterior stabilization of recurrent anterior dislocators. Our series did not confirm that arthroscopically successfully stabilized shoulders recover full function and mobility. In the light of the relatively high rate of residual instability and incomplete functional recovery in successfully stabilized shoulders, we have discontinued use of this technique for the treatment of recurrent dislocators.

Adolescent↗

PubMedDate not supplied

Anatomy and functional aspects of the rotator interval.

The anatomy of the region between the supraspinatus and subscapularis tendons, called the rotator interval, was studied in 22 shoulders of 12 cadavers. Its function was then examined by sequential cutting of tendon or rotator interval structures. The rotator interval was found to be composed of parts of the supraspinatus, subscapularis, coracohumeral ligament, superior glenohumeral ligament, and glenohumeral joint capsule. A medial part composed of 2 layers was defined and distinguished from a more lateral part composed of 4 layers. The most superior 3 layers of the lateral part formed a fibrous plate. The medial part was found to primarily limit inferior translation and, to a lesser extent, external rotation. The fibrous plate of the lateral part of the rotator interval mainly limited external rotation of the adducted arm. The coracohumeral ligament played a key role in external rotation as well as in inferior translation.

Adolescent↗

PubMedDate not supplied

Impingement of the deep surface of the subscapularis tendon and the reflection pulley on the anterosuperior glenoid rim: a preliminary report.

Sixteen patients underwent detailed arthroscopic evaluation; all had moderate to severe, primarily unexplained shoulder pain provoked by anterior elevation and internal rotation, and all were nonresponsive to subacromial injection of local anesthetic. None of the patients had any symptoms or signs of instability. Partial subscapularis lesions were documented in 10 of 13 patients who had undergone preoperative arthro-magnetic resonance imaging. At arthroscopy, an isolated lesion of the common humeral insertion of the superior glenohumeral and coracohumeral ligaments (a so-called pulley lesion) was found in 3 cases, a lesion associating a pulley and an articular side partial subscapularis lesion in 10 cases, and an isolated articular side partial subscapularis tear in 3 cases. The most painful movement, which consisted of flexion and internal rotation, caused impingement of the involved ligamentous and/or capsular insertions in all patients. If the arm was elevated above 90 degrees, the zone of mechanical contact was between the long head of the biceps and the pulley region and superiormost aspect of the labrum; if elevation was decreased, impingement occurred between the tendinous insertion of the subscapularis and the anterior glenoid labrum and rim. This study suggests that in addition to the posterosuperior impingement of the supraspinatus tendon originally described by Walch, anterosuperior impingement of the deep surface of the subscapularis is a form of intraarticular impingement responsible for painful structural disease of the shoulder.

Adult↗

PubMedDate not supplied

Effect of amine/sodium fluoride rinsing on toothbrush abrasion of softened enamel in situ.

The aim of this study was to test the effect of fluoride rinsing on the prevention of toothbrush abrasion of softened enamel in situ. For softening, the samples were immersed in 0.1 M citric acid (pH 3.5) for 3 min. Eight test subjects had to make 5 runs in which 4 slabs per run were attached to intraoral appliances. They were as follows: (1) no softening, no fluoride rinsing (control 1); (2) softening, no fluoride rinsing (control 2); (3) softening, rinsing in situ with a sodium/amine fluoride rinsing solution (250 ppm F) for 30 s; (4) rinsing in situ with the sodium/amine fluoride rinsing solution (250 ppm F) for 30 s, softening; (5) softening, rinsing in situ with an experimental amine fluoride-containing rinsing solution (250 ppm F) for 30 s. After exposure for 60 min to the oral milieu, the volunteers brushed the samples for 30 s with toothpaste and the loss of tooth substance was determined. For each test person, the secretion rate of resting and paraffin-stimulated saliva, buffering capacity and pH were measured. Toothbrush abrasion in situ was not significantly lower using the fluoride rinsing solutions before or after softening the enamel compared to no rinsing (p > 0.05). Multiple linear regression analyses revealed that 57% of the variation in toothbrush abrasion could be attributed to the severity of softening (p < 0.001) and the pH of stimulated saliva (p < 0.001). It was concluded that a single rinse for 30 s had no statistically significant effect on the prevention of toothbrush abrasion of softened enamel.

Adult↗

PubMedDate not supplied

Primary pleomorphic adenoma of the external auditory canal diagnosed by fine needle aspiration cytology. A case report.

BACKGROUND: Pleomorphic adenoma (PA) arising in the external auditory canal (EAC) is a very rare neoplasm, thought to be derived from ceruminous glands. CASE: A 43-year-old male presented with a slowly growing mass in the right EAC. Clinical and radiologic examinations showed a well-circumscribed tumor limited to the EAC, without a connection to the parotid gland. Fine needle aspiration cytology (FNAC) revealed the typical cytologic findings of PA. The diagnosis was confirmed by histologic examination. CONCLUSION: This case illustrates that together with clinical and radiologic findings, primary PA of the EAC can confidently be diagnosed by FNAC.

Adenoma, Pleomorphic↗

PubMedDate not supplied

Skier's thumb. Surgical treatment of recent injuries to the ulnar collateral ligament of the thumb's metacarpophalangeal joint.

Acute rupture of the ulnar collateral ligament of the metacarpophalangeal (MCP) joint of the thumb is often sustained in downhill skiing accidents an is hence called "skier's thumb." All complete ruptures seen at our hospital between 1975 and 1979 were operated using the "fishhook" pullout wire technique. Follow-up results 29 months after early operation are presented for 47 cases. The overall results are excellent in 29, good in 14, and fair in 3 patients. Our result had to be considered a failure. No patient had serious functional impairment or major constant pain. No patient took any pain medication. No reintervention was necessary. The distal bony avulsions showed the most favorable prognosis, and the ligamentous midsubstance tears, the least favorable. The fishhook pullout wire technique can be used in both ligamentous and bony avulsions of the ulnar collateral ligament and provides good or excellent results in 90% of the cases.

Athletic Injuries↗

PubMedDate not supplied

Selecting board members.

Explore the source record for details and available documents.

Governing Board↗