Complications of shoulder surgery.
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Adult↗
Biomedical subjects
E V Craig
Publications and source records attributed to E V Craig.
Soft-tissue balancing in total shoulder arthroplasty.
When a total shoulder arthroplasty is performed, restoration of the anatomy to near normal is important in order to achieve a stable implant. So as not to sacrifice stability, it is not uncommon for soft tissues to be either over tightened or insufficiently released. This article analyzes the various factors to consider in order to obtain appropriate soft-tissue balancing for a successful total shoulder arthroplasty.
Arthritis, Rheumatoid↗
Partial-thickness rotator cuff tears. Pathogenesis and treatment.
Partial-thickness rotator cuff tears are now acknowledged to be an important entity in the spectrum of the impingement syndrome. The pathogenesis of partial-thickness tears is often age- and activity-related. Surgical decision making is influenced by the extent of the tear and the associated bony and soft-tissue pathology.
Aging↗
Shoulder arthroscopy in the throwing athlete.
The throwing athlete is a unique patient. High demands on the shoulder, combined with poor tolerance for slight changes in performance, make this a particularly difficult group of patients to treat successfully. In addition, there is overlap between multiple pathologic conditions in the shoulder, including rotator cuff tendinopathy, shoulder instability, SLAP lesions, acromioclavicular arthrosis, and scapulothoracic problems. These disorders rarely occur in isolation in the throwing athlete. Arthroscopy of the shoulder may be invaluable as a diagnostic tool to confirm clinical and radiographic abnormalities, to identify associated intra-articular and extra-articular pathologic conditions, and to treat a variety of these lesions without the attendant morbidity of open surgical repair and reconstruction.
Arm Injuries↗
The radiology of total shoulder replacement.
The indications for total shoulder replacement and the radiologic evaluation prior to the operation are discussed in depth in this article. Different approaches to clinical problems are also discussed and illustrated, as are normal findings. This is followed by a discussion of the complications of shoulder reconstruction, including infection, fractures, and heterotopic bone formation. A review of the results is also given followed by a brief mention of a number of other orthopedic shoulder devices and plates.
Humans↗
The clinical presentation of shoulder instability including on field management.
In the athlete, shoulder instability may result from external high-energy trauma or repetitive overuse. Our understanding of how shoulder instability may contribute to and result from shoulder injury has improved considerably during the past decade. In addition, the delicate balance between mobility and stability and the interrelationship between instability and rotator cuff disease make the clinical management of the unstable shoulder and its field treatment a challenge for physicians, therapists, trainers, and others responsible for the care of injured athletes.
Arm Injuries↗
[Evaluation of the rotator cuff with magnetic tomography].
Rotator cuff tears are difficult to diagnose clinically, both in the acute and the chronic phase. Both conservative and surgical treatment give the best results if the injury is detected early. Magnetic resonance imaging (MRI) has recently been introduced for diagnoses of cuff tears. The purpose of this study was to establish the accuracy of MRI in relation to surgical findings in the same patient group. MRI was used in the diagnosis of 25 patients who later underwent surgery for injury to the rotator cuff. During the surgery, 19 total tears were identified, of which 15 had been described by MRI. MRI showed a sensitivity of 79% and a specificity of 83%. The predictive value of a positive test was 83%. In experienced hands, MRI is extremely accurate for detecting rotator cuff injuries, but ultrasonography should still be the first method of diagnosis in Norway, because of its accuracy when used by experienced practitioners, and its availability and low cost.
Adult↗
MRI of the shoulder.
MRI of the shoulder is widely considered the imaging modality of choice in the evaluation of shoulder pain and the clinical impingement syndrome. This is because of its direct evaluation of all of the soft tissue structures of the subacromial space, as well as its ability to depict the relationship of the overlying osseous and soft tissue structures of the coracoacromial arch. It also provides information regarding the capsulolabral anatomy and, with the addition of MR arthrography, is becoming recognized as the imaging modality of choice for instability workup. MRI evaluation, when combined with the always important clinical history, physical examination, and radiographs, provides the referring clinician and orthopedic surgeon with the most anatomic and pathological information possible. This, in turn, allows the most informed decision making possible regarding conservative management or surgical treatment.
Humans↗
Radiologic features of shoulder instability.
Roentgenographic studies in a patient with shoulder instability generally identify the presence of a Hill-Sachs lesion, the presence of bony abnormalities of either the anterior or posterior rim, the presence or absence of fractures, and thick pathologic changes in the joint structure, which not only may provide insight into the diagnosis, but also may give the clinician insight into whether these pathologic changes are likely to be improved with operative and nonoperative treatment modalities. Clearly, the anteroposterior view, particularly with internal rotation, seems important in the diagnosis of the unstable shoulder. The West Point axillary view seems to be a useful one to identify the presence of glenoid rim problems. An additional view, such as the Stryker notch view, may identify the extent and presence of Hill-Sachs lesion when this may not be present on the other two views. Computed tomography arthrography, magnetic resonance imaging scan, and stress testing probably has limited applicability in the routine roentgenographic diagnosis of the unstable shoulder.
Acute Disease↗
Shoulder problems in the weekend athlete.
With more competitive and recreational athletic pursuits now being undertaken by an aging population, the painful shoulder is seen frequently in the weekend athlete. Episodic stresses to soft-tissue restraints and musculotendinous units around the shoulder lead to a variety of overused pathologic entities. The two most common shoulder problems in the weekend athlete are irritation, swelling, and mechanical impingement; and tearing of the rotator cuff with traumatic shoulder instability (typically of an anterior direction).
Arthroscopy↗
Rheumatoid disease.
This article documents the developments in surgery for the rheumatoid hand that have been made during the last 40 years and reviews the pertinent literature.
Arthritis, Rheumatoid↗
Ultrasonography of rotator cuff tears: a review of 500 diagnostic studies.
Ultrasonography of the rotator cuff has been shown to be of value in diagnosing rotator cuff tears. This report summarizes our experience with our first 500 diagnostic examinations. All patients were examined in the hyperextended internal rotation view with commercially available high-resolution real-time ultrasound equipment. Patients were diagnosed as having a rotator cuff tear if a focal echogenic lesion or a defect within the rotator cuff was identified. This study confirmed the value of ultrasonography for the diagnosis of rotator cuff tears. Accuracy, sensitivity, and specificity all exceeded 90%, and correlated with surgical findings. This was better than arthrography in the same patient population. Ultrasound is an accurate noninvasive method of examining the rotator cuff for the presence of tears. We suggest that rotator cuff ultrasonography is the procedure of choice for the diagnosis of tears if adequate instrumentation is available.
Arthrography↗
Noninvasive imaging of the rotator cuff.
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Humans↗
Total shoulder replacement.
It appears that total shoulder replacement can be performed with a high degree of patient satisfaction, with few complications, and with long-term results which certainly appear to rival the success of other arthroplasties. However, the technique is extremely demanding and requires an experienced shoulder surgeon, who must successfully resolve numerous intraoperative variables and problems, must be able to deal with factors which may affect the stability and strength of the implant, and must individualize the postoperative rehabilitation according to quality of bone and soft tissue, as well as the specific needs and desires of the patient. However, when performed technically satisfactorily with proper patient selection, with meticulous attention to the details of the soft tissue surrounding the implant, and with attention to the postoperative rehabilitation, the results have been impressive. Total shoulder replacement has successfully taken its place in the armamentarium of other total joint replacements which have dramatically altered the quality of life in the arthritic patient.
Arthritis↗
Management of tumors of the shoulder girdle.
The differential diagnosis of all painful shoulders includes tumors of a wide variety. Evaluation of a shoulder tumor has several areas in common with other musculoskeletal neoplasms, but the function of the rotator cuff is a key consideration in treatment goals. Thorough evaluation of patients with persistent pain requires not only routine radiography, but also radionuclide imaging, computed tomographic (CT) scanning, magnetic resonance imaging, and angiography. As with all tumors, the importance of the biopsy cannot be overemphasized. A poorly executed biopsy can make limb salvage impossible. Surgical treatment of shoulder tumors will depend on age, type of tumor, extent of tumor, and neoplasm aggressiveness. Though in some instances limb sparing is not possible, a variety of reconstructive options exists that will salvage the distal limb and obtain satisfactory surgical margins.
Bone Neoplasms↗
Sonography of the postoperative rotator cuff.
In experienced hands, high-resolution real-time sonography has been shown to be an accurate noninvasive method for diagnosis of rotator cuff tears. The sonographic appearance of the postoperative rotator cuff has not been previously reported. Forty postoperative patients were studied sonographically 1 week to 6 years after rotator cuff repair. The postoperative rotator cuff is abnormally echogenic and can be very similar in appearance to a small rotator cuff tear in a nonoperated patient. Soft-tissue planes about the tendon are distorted or absent. Criteria for diagnosis of retear must be different from those used in detecting new tears in a nonoperated cuff. Postoperative echogenicity is normal, but the finding of a defect or gap within the rotator cuff tendon is the only accurate sign of a recurrent rotator cuff tear.
Humans↗
Subacromial impingement syndrome in hereditary multiple exostoses.
An unusual cause of subacromial pain was observed in a 32-year-old woman with multiple exostoses. The pain was the direct result of the mechanical impingement syndrome from these exostoses. Hereditary multiple exostoses should be investigated systematically, because many other, more common pain-producing conditions are possible. Secondary malignant degeneration of one of the cartilaginous coverings of the exostoses is very rare.
Acromion↗
Biomechanical study of the ligamentous system of the acromioclavicular joint.
The ligamentous structures of the acromioclavicular joint were studied by gross examination and quantitative measurement in twelve human cadaver specimens. Distances between insertions at various extreme positions of the clavicle were studied with the biplane radiographic technique. Ligamentous contributions to joint constraint under displacements were determined by performing load-displacement tests along with sequential sectioning of the ligaments. Twelve modes of joint displacement were examined. The acromioclavicular ligament acted as a primary constraint for posterior displacement of the clavicle and posterior axial rotation. The conoid ligament appeared to be more important than has been previously described. That ligament played a primary role in constraining anterior and superior rotation as well as anterior and superior displacement of the clavicle. The trapezoid ligament contributed less constraint to movement of the clavicle in both the horizontal and the vertical plane except when the clavicle moved in axial compression toward the acromion process. The various contributions of different ligaments to constraint changed not only with the direction of joint displacement but also with the amount of loading and displacement. For many directions of displacement, the acromioclavicular joint contributed a greater amount to constraint at smaller degrees of displacement, while the coracoclavicular ligaments, primarily the conoid ligament, contributed a greater amount of constraint with larger amounts of displacement.
Acromioclavicular Joint↗