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Biomedical subjects

E V Craig

Publications and source records attributed to E V Craig.

34 records · Page 2Linked to original sources
PubMed1986

The acromioclavicular joint cyst. An unusual presentation of a rotator cuff tear.

An unusual presentation of a full-thickness tear of the rotator cuff is the acromioclavicular (AC) joint cyst. This is formed when glenohumeral joint fluid leaks through the full-thickness cuff tear and into a diseased AC joint, eventually distending the superior capsule. Often, communication between the cyst and the glenohumeral joint can be demonstrated on shoulder arthrogram. It is essential to recognize that the presenting cyst is usually indicative of an underlying full-thickness rotator cuff tear, which is often massive and which will be difficult to reconstruct. This clinical finding is reported in the following two cases to emphasize the important relation between AC joint disease and rotator cuff abnormalities. Attempted excision of this cyst without recognition of its pathogenesis usually leads to cyst recurrence and unimproved symptoms.

Acromioclavicular Joint↗
PubMed1984

Ultrasonography of the rotator cuff: surgical correlation.

Rotator cuff tears are a common orthopedic problem. The portions of the cuff most commonly torn are accessible to sonographic examination with appropriate positioning of the shoulder. This study was undertaken to correlate the sonographic appearance of the pathologic rotator cuff with findings at the time of surgical repair. Rotator cuff tears are readily seen with high-resolution real-time sonography. Sonography can demonstrate tears not demonstrated arthrographically. In the appropriate clinical setting arthrography may not be necessary if the sonogram demonstrates characteristic findings.

Adult↗
PubMed1984

A new high-pressure injection injury of the hand.

A high-pressure injection injury to the hand followed an unusually benign course, probably because of the nature of the substances injected, Freon and isopropyl alcohol. This is in marked contrast to the usually devastating result of injection of paint, grease, or diesel fuel under pressure. This type of injury may be seen more frequently in the future since the two substances injected are used for the cleaning and maintenance of computers and computer parts.

1-Propanol↗
PubMed1984

Dorsal carpal dislocation and flexor tendon rupture in rheumatoid arthritis: a case report.

A unique case of dorsal carpal dislocation of a rheumatoid wrist with an unusual pattern of flexor tendon rupture and median nerve compression is reported. The carpus was relocated and fused to the radius. The distal ulna was resected. Grafting and adjacent suturing of the tendons restored function, but late follow-up showed development of secondary deformities.

Arthritis, Rheumatoid↗
PubMed1984

The posterior mechanism of acute anterior shoulder dislocations.

A tear of the rotator cuff often accompanies primary acute anterior dislocations of the shoulder in older patients. These structures, weakened by wear or degeneration, tear when the shoulder dislocates, permitting the humerus to hinge on intact anterior structures. Three typical cases illustrate the posterior structural reactions to acute anterior dislocation.

Acute Disease↗
PubMed1984

The geyser sign and torn rotator cuff: clinical significance and pathomechanics.

The geyser radiographic sign on shoulder arthrogram is characterized by leakage of dye from the glenohumeral joint into the subdeltoid bursa. The dye outlines the acromioclavicular joint. It is usually an indication of a full-thickness cuff tear of long duration. The clinical occurrence and pathomechanics of this finding indicate that repair is generally difficult.

Acromioclavicular Joint↗
PubMed1983

Cuff-tear arthropathy.

In this report we describe the clinical and pathological findings of cuff-tear arthropathy in twenty-six patients and discuss the differential diagnosis and a hypothesis on the pathomechanics that lead to its development. This lesion is thought to be peculiar to the glenohumeral joint because of the unique anatomy of the rotator cuff. Following a massive tear of the rotator cuff there is inactivity and disuse of the shoulder, leaking of the synovial fluid, and instability of the humeral head. These events in turn result in both nutritional and mechanical factors that cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head. A massive tear also allows the humeral head to be displaced upward, causing subacromial impingement that in time erodes the anterior portion of the acromion and the acromioclavicular joint. Eventually the soft, atrophic head collapses, producing the complete syndrome of cuff-tear arthropathy. The incongruous head may eventually erode the glenoid so deeply that the coracoid becomes eroded as well. Although treatment of cuff-tear arthropathy is extremely difficult, the preferred method appears to be a resurfacing total shoulder replacement with rotator-cuff reconstruction and special rehabilitation. We think that it is important to recognize cuff-tear arthropathy as a distinct pathological entity, as such recognition enhances our understanding of the more common impingement lesions. Cuff-tear arthropathy is especially difficult to treat, and although many tears of the rotator cuff do not enlarge sufficiently to allow this condition to develop, it is a factor to consider when deciding whether or not a documented tear of the rotator cuff should be surgically repaired.

Aged↗
PubMedDate not supplied

Clinical significance of sonographic findings in the abnormal but intact rotator cuff: a preliminary report.

Shoulder pain is a common orthopedic problem. Clinical examination is often nonspecific and arthrography is normal in those patients with the most frequent cause of shoulder pain--noncalcific tendonitis secondary to impingement. Ultrasonography has recently shown itself to be of value in the diagnosis of rotator cuff tears. In addition to the diagnosis of tears, however, sonography can demonstrate abnormalities within the intact rotator cuff tendon. These abnormalities consist of changes in echogenicity and thickness of the tendon. The patterns of abnormality demonstrated correlate with pathologic changes seen in tendonitis. This preliminary study suggests that the ability to demonstrate an abnormal rotator cuff tendon has potential for becoming a valuable aid to the orthopedist in allowing confident diagnosis of rotator cuff disease in the presence of nonspecific symptomatology and an intact tendon.

Humans↗
PubMedDate not supplied

Ultrasonography of the rotator cuff. Normal and pathologic anatomy.

Forty-eight patients with shoulder pain and 15 normal volunteers underwent rotator cuff imaging using high resolution real time ultrasound. The potential diagnostic value of sonography in detecting rotator cuff tears was evaluated by correlating ultrasound findings with surgical findings in 19 patients, 12 of whom also underwent preoperative arthrography. The preoperative ultrasound diagnosis was correct in 18 of the 19 patients undergoing surgery for possible rotator cuff tears. In the group of 12 surgical patients undergoing both preoperative arthrography and sonography, ultrasound correctly predicted the presence of a rotator cuff tear in 12 of 12 patients, while arthrography predicted cuff tears in only nine of 12. Good anatomic definition of the rotator cuff was obtained in both symptomatic and asymptomatic groups. The characteristic appearance of the normal and pathologic rotator cuff is described. Rotator cuff sonography promises to be a valuable new diagnostic tool for evaluating patients with suspected rotator cuff tears.

Adult↗
PubMedDate not supplied

Arthroscopic treatment of partial rotator cuff tears in young athletes. A preliminary report.

Forty-three athletes under age 40, more than half of which were collegiate or professional, with partial rotator cuff tears were treated arthroscopically and observed for a minimum of 24 months. By history and mechanism of injury, two main groups were identified. Group A had 14 patients with acute, traumatic injuries. All 14 had inflamed subacromial bursas, but increased glenohumeral translation and labral lesions were uncommon. Twelve patients (86%) had satisfactory postoperative results and nine (64%) returned to preinjury sports after arthroscopic subacromial decompression and tear debridement. Group B had 29 overhead athletes with insidious, atraumatic shoulder pain. They were not as successful with debridement (19 [66%] satisfactory and 13 [45%] return to preinjury sports). Within Group B, three subgroups were identified based on the examination under anesthesia and subacromial inflammation. Group B1 (8 patients) had normal-appearing subacromial spaces and often increased anterior glenohumeral translation with posterior labral tears. These patients did poorly after arthroscopic tear debridement (3 [38%] satisfactory and 2 [25%] return to sports). Group B2 (12 patients) had inflamed subacromial bursas and increased glenohumeral translation. This group had marginal results with debridement (7 [58%] satisfactory and 6 [50%] return to sports). Group B3 (9 patients) with subacromial inflammation, yet without increased glenohumeral translation, had excellent pain relief (100%) but less than half (4) returned to preinjury sports.

Adult↗
PubMedDate not supplied

The combined dynamic and static contributions to subacromial impingement. A biomechanical analysis.

Ten human cadaveric shoulders were tested with a dynamic shoulder model simulating physiologic rotator cuff, deltoid, and biceps muscle forces. The combined effect of the muscle forces and acromial structure on subacromial impingement was measured with minimally invasive, miniature pressure transducers. Shoulders with large acromial spurs had significantly greater impingement pressures at the anterolateral acromion in neutral, internal, and external rotation compared with those with flatter acromia. Application of a biceps muscle force reduced anterolateral acromial pressures by 10%. Failure to simulate a supraspinatus force decreased acromial pressure 52% in shoulders with type III acromia in neutral rotation. Without rotator cuff forces applied, the maximum deltoid muscle force required to elevate the arm increased by 17%. Acromial pressures were increased when no rotator cuff forces were applied, but the increases were not significant. After an anterior acromioplasty, pressures decreased by 99% anteriorly. However, failure to achieve a flat surface posteriorly increased pressures in this location, especially with the shoulder in external rotation. Modeling the rotator cuff and deltoid muscle forces demonstrated the importance of the muscular force couple to center the humeral head during elevation of the arm. The inferior forces of the infraspinatus, teres minor, and subscapularis muscles were necessary to neutralize the superior shear force produced by the deltoid and supraspinatus muscles.

Acromioclavicular Joint↗