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G M Gartsman

Publications and source records attributed to G M Gartsman.

At least 19 recordsLinked to original sources
PubMed2001

All arthroscopic rotator cuff repairs.

The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages of glenohumeral joint inspection, treatment of intra-articular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of this method, which limits its application to surgeons skilled in both open and arthroscopic shoulder operations. This article contains many technical pearls to, as much as possible, simplify and improve all arthroscopic cuff repair.

Acromion↗
PubMed2001

The measurement level and trait-specific reliability of 4 scales of shoulder functioning: an empiric investigation.

OBJECTIVE: To evaluate 4 scales of shoulder function with respect to (1) their precision at different levels of shoulder function and (2) the measurement level of their raw scores (interval vs ordinal). DESIGN: Partial credit model calibration. SETTING: Office of private practice orthopedic surgeon with practice limited to the shoulder. PARTICIPANTS: One-hundred ninety-two shoulder patients. INTERVENTIONS: Participants completed the American Shoulder and Elbow Surgeons Patient Self-Evaluation Form (function subscale, modified), the disability subscale of the Shoulder Pain and Disability Index, the Simple Shoulder Test, and the function subscale of the University of Pennsylvania Shoulder Scale. MAIN OUTCOME MEASURES: The patients' responses were calibrated by using a partial credit model. We calculated standard errors of measurement and plotted the 95% confidence interval for different levels of shoulder functioning. We compared scales' raw scores with their equal interval measures obtained in the Rasch calibration. RESULTS: The scales did not measure all levels of shoulder functioning with equal precision, suggesting that commonly used reliability estimates misrepresent scale precision in certain subpopulations. CONCLUSIONS: The scales' raw scores were found to be not of equal interval, calling into question the scoring systems recommended by the developers of these scales and the use of the scores in some statistical procedures.

Adult↗
PubMed2001

Arthroscopic rotator cuff repair.

The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages of glenohumeral joint inspection, treatment of intraarticular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of the method, which limits its application to surgeons skilled in open and arthroscopic shoulder operations.

Arthroscopy↗
PubMed2001

What's new in shoulder surgery.

The purpose of this update on shoulder surgery is to discuss, in summary fashion, topics presented at selected orthopaedic meetings during the time-period of August 1999 to July 2000. Sources for this article were presentations and symposia at meetings of the American Orthopaedic Society for Sports Medicine (Specialty Day, Orlando, Florida, March 2000, and the Twenty-sixth Annual Meeting, Sun Valley, Idaho, June 2000), the Arthroscopy Association of North America (Specialty Day, Orlando, Florida, March 2000, and the Nineteenth Annual Meeting, Miami, Florida, April 2000), the American Academy of Orthopaedic Surgeons (Sixty-seventh Annual Meeting, Orlando, Florida, March 2000), the American Shoulder and Elbow Surgeons (Specialty Day, Orlando, Florida, March 2000, and the Sixteenth Annual Meeting, Philadelphia, Pennsylvania, October 1999), and the American Orthopaedic Association (113th Annual Meeting, Hot Springs, Virginia, June 2000).

Arthroscopy↗
PubMed2000

Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis.

BACKGROUND: The indications for resurfacing of the glenoid in patients who have osteoarthritis of the shoulder are not clearly defined; some investigators routinely perform hemiarthroplasty whereas others perform total shoulder arthroplasty. METHODS: Forty-seven patients (fifty-one shoulders) who were scheduled to have a shoulder arthroplasty for the treatment of degenerative osteoarthritis were randomly assigned, according to a random-numbers table, to one of two groups: replacement of the humeral head with resurfacing of the glenoid with a polyethylene component with cement (total shoulder arthroplasty [twenty-seven shoulders]) or replacement of the humeral head without resurfacing of the glenoid (hemiarthroplasty [twenty-four shoulders]). All patients received the same type of humeral component, and all operations were performed by or under the direct supervision of the same surgeon. The patients were followed for a mean of thirty-five months (range, twenty-four to seventy-two months) postoperatively. Evaluation was performed with use of the scoring systems of the University of California at Los Angeles and the American Shoulder and Elbow Surgeons. RESULTS: No difference was observed between the preoperative scores for the two groups of patients. Postoperatively, the mean scores with use of the University of California at Los Angeles system and the American Shoulder and Elbow Surgeons system were 23.2 points (range, 10 to 31 points) and 65.2 points (range, 15 to 94 points), respectively, after hemiarthroplasty and 27.4 points (range, 9 to 34 points) and 77.3 points (range, 3 to 100 points), respectively, after total shoulder arthroplasty. With the numbers available for study, no significant difference was found between the two operative groups with respect to the postoperative score. (Thirty-five subjects per group would be needed, assuming an effect size of 0.60 and a power of 0.80.) Total shoulder arthroplasty provided significantly greater pain relief (p = 0.002) and internal rotation (p = 0.003) than hemiarthroplasty did. Total shoulder arthroplasty also provided superior results in the specific areas of patient satisfaction, function, and strength, although none of these differences were found to be significant, with the numbers available. Total shoulder arthroplasty was associated with increased cost ($1177), operative time (thirty-five minutes), and blood loss (150 milliliters) per patient compared with hemiarthroplasty. To date, none of the total shoulder arthroplasties in the study group have been revised. Hemiarthroplasty yielded equivalent results for elevation and external rotation. Three of the twenty-five patients who had had a hemiarthroplasty needed a subsequent operation for resurfacing of the glenoid. The mean cost for the revision operations was $15,998. CONCLUSIONS: Total shoulder arthroplasty provided superior pain relief compared with hemiarthroplasty in patients who had glenohumeral osteoarthritis, but it was associated with an increased cost of $1177 per patient.

Aged↗
PubMed2000

Arthroscopic treatment of anterior-inferior glenohumeral instability. Two to five-year follow-up.

BACKGROUND: Previous studies on arthroscopic treatment of anterior-inferior glenohumeral instability have focused on the repair of lesions of the anterior-inferior aspect of the labrum (Bankart lesions) and have demonstrated failure rates of as high as 50 percent. The current investigation supports the concept that anterior-inferior instability is associated with multiple lesions and that success rates can be increased by treating all of the lesions at the time of the operation. We present the results of arthroscopic treatment of anterior-inferior gleno-humeral instability after a minimum duration of followup of two years. METHODS: The study group consisted of fifty-three patients who had a mean age of thirty-two years (range, fifteen to fifty-eight years) at the time of the operation. There were forty-four male and nine female patients. The mean interval from the time of the operation to the final follow-up evaluation was thirty-three months (range, twenty-six to sixty-three months). The scores on the American Shoulder and Elbow Surgeons (ASES) Shoulder Index and the rating systems of Constant and Murley, Rowe et al., and the University of California at Los Angeles (UCLA) were recorded preoperatively and at the time of the final follow-up. RESULTS: Preoperatively, none of the patients had an overall rating of good or excellent according to the system of Rowe et al.; however, 92 percent (forty-nine) of the fifty-three patients had a rating of good or excellent at the time of the final follow-up. The mean score improved from 45.5 points to 91.7 points on the ASES Shoulder Index, from 56.4 points to 91.8 points with the system of Constant and Murley, from 11.3 points to 91.9 points with the system of Rowe et al., and from 17.6 points to 32.0 points according to the UCLA Shoulder Score (p = 0.001 for all comparisons). The mean passive external rotation with the shoulder in 90 degrees of abduction measured 88.2 degrees. Thirty-four of thirty-eight patients returned to their desired level of sports activity following the operation. Four patients who had persistent instability were considered to have had a failure of the index operation, and one of them had a second operative procedure. CONCLUSIONS: The results of the present study suggest that our technique of arthroscopic treatment of anterior-inferior glenohumeral instability is better than previous arthroscopic techniques and is equivalent to open repair. We believe that the improved rate of success demonstrated in the present study was the result of repair not only of the anterior-inferior (Bankart) lesion but also (where necessary) of inferior and superior labral tears. Additionally, soft-tissue tension within the capsule and ligaments was corrected with use of a suture technique but was supplemented by laser thermal capsulorrhaphy in forty-eight of the fifty-three shoulders. Rotator interval repair was considered a critical factor in fourteen of the fifty-three shoulders.

Adolescent↗
PubMed2000

Comparison of the University of California-Los Angeles Shoulder Scale and the Simple Shoulder Test with the shoulder pain and disability index: single-administration reliability and validity.

BACKGROUND AND PURPOSE: Shoulder scales are often used to evaluate treatment efficacy, yet little is known about the psychometric properties of these scales. Only one scale has undergone psychometric scrutiny: the Shoulder Pain and Disability Index (SPADI). This study compared 2 shoulder measures-the University of California-Los Angeles (UCLA) Shoulder Scale and the Simple Shoulder Test (SST)-with the SPADI. SUBJECTS: One hundred ninety-two patients with shoulder disorders were recruited from one physician's office to complete the self-report sections of the 3 scales. METHODS: Cronbach alpha values and standard errors of measurement (SEM) were calculated for each of the multi-item subscales. Validity was examined through calculation of correlation coefficients among the 3 scales. Factor analysis was completed to assess the underlying constructs of the SPADI and the SST. RESULTS: Cronbach alpha values ranged from.85 to.95. The SEM values for the multi-item scales ranged from 4.75 to 11.65. Evidence for validity to reflect function was indicated by the correlation between the SST and the SPADI disability subscale. The factor analysis of the SPADI revealed loading on 1 factor, whereas the SST loaded on 2 factors. CONCLUSION AND DISCUSSION: All scales demonstrated good internal consistency, suggesting that all items for each scale measure the same construct. However, the SEMs for all scales were high. Factor loading was inconsistent, suggesting that patients may not distinguish between pain and function.

Adolescent↗
PubMed1998

Arthroscopic repair of full-thickness tears of the rotator cuff.

We present the results of arthroscopic repair of full-thickness tears of the rotator cuff in seventy-three patients (thirty-nine men and thirty-four women). The average age of the patients at the time of the operation was 60.7 years (range, thirty-one to eighty-two years). All of the patients were followed for at least two years (average, thirty months; range, twenty-four to forty months). The shoulders were evaluated with the rating scale of the University of California at Los Angeles, the shoulder index of the American Shoulder and Elbow Surgeons, and the functional rating scale of Constant and Murley. In addition, the patients completed the Short-Form 36 Health Survey (SF-36) preoperatively and at the yearly follow-up evaluations. Eleven tears were small (less than one centimeter in length), forty-five were medium (one to three centimeters), eleven were large (more than three to five centimeters), and six were massive (more than five centimeters). The average length of the tear was twelve millimeters, and the average width was twenty-seven millimeters. Sixty-nine tendons were repaired anatomically, and four were repaired an average of three millimeters (range, two to eight millimeters) medial to the anatomical insertion of the tendon. An average of 2.3 (range, one to four) suture anchors were used in the repair. Sixty-three glenohumeral joints were normal, and ten had an intra-articular lesion. Seven patients had a concomitant resection of the acromioclavicular joint. The average duration of the operation was fifty-six minutes (range, thirty-five to ninety minutes). The active and passive ranges of motion improved significantly after the procedure (p = 0.0001). The strength of resisted elevation improved from 7.5 to 14.0 pounds (3.4 to 6.3 kilograms) (p = 0.0001). The average total score according to the rating scale of the University of California at Los Angeles improved from 12.4 to 31.1 points; the average total score according to the shoulder index of the American Shoulder and Elbow Surgeons, from 30.7 to 87.6 points; and the average absolute score according to the rating system of Constant and Murley, from 41.7 to 83.6 points (p = 0.0001 for all comparisons). The average score for the pain component of the rating scale of the University of California at Los Angeles improved from 2.4 to 8.6 points; fifty-seven (78 per cent) of the seventy-three patients rated the relief of pain as good or excellent on the visual-analog scale. The average score for satisfaction improved from 0.4 to 4.6 points; sixty-six patients (90 per cent) rated their satisfaction as good or excellent at the time of the most recent examination. None of the shoulders were rated as good or excellent before the operation, whereas sixty-one (84 per cent) were so rated at the most recent follow-up evaluation after the index procedure. In addition, significant improvements (p = 0.0015) were noted in the scales and summary measures of the SF-36. Arthroscopic repair of full-thickness tears of the rotator cuff produced satisfactory results with regard to traditional orthopaedic criteria as well as with regard to patient-assessed criteria such as satisfaction, pain relief, and general health. The arthroscopic method offers several advantages, including smaller incisions, access to the glenohumeral joint for the inspection and treatment of intra-articular lesions, no need for detachment of the deltoid, and less soft-tissue dissection. However, these advantages must be considered against the technical difficulty of the method, which limits its application to surgeons who are skilled in both open and arthroscopic procedures on the shoulder.

Activities of Daily Living↗
PubMed1998

Early effectiveness of arthroscopic repair for full-thickness tears of the rotator cuff: an outcome analysis.

Fifty consecutive patients completed standardized questionnaires regarding general health status as well as function of the shoulder before and an average of thirteen months after arthroscopic repair of a full-thickness tear of the rotator cuff. Comparison of the preoperative and postoperative responses to the questions demonstrated highly significant improvements in the patient's assessment both of general health and of function of the shoulder. The Short Form-36 (SF-36) General Health Survey revealed significant improvements in the most recent follow-up scores compared with the preoperative scores with regard to physical functioning (p = 0.0001), role-physical (p = 0.0001), bodily pain (p = 0.0001), vitality (p = 0.0001), social functioning (p = 0.0001), role-emotional (p = 0.006), mental health (p = 0.0213), and physical component summary (p = 0.0001). The University of California at Los Angeles (UCLA) Shoulder Score, the Constant Shoulder Score, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Index showed significant improvements in all postoperative total and component scores (p = 0.0001). Most importantly, all three shoulder-rating systems demonstrated significant improvements in the postoperative scores for pain and function (p = 0.0001). While a general health status instrument such as the SF-36 can document the impact of an orthopaedic condition on a patient as well as the results of treatment, a more complete representation of the patient's condition requires the use of region-specific self-assessment questionnaires and evaluation by a physician.

Activities of Daily Living↗
PubMed1997

Full-thickness tears: arthroscopic repair.

Arthroscopic repair of rotator cuff tears is an option for a surgeon with advanced arthroscopic skills and a thorough knowledge of open repair technique. Surgical indications and a detailed description of operative technique are presented. Arthroscopic rotator cuff repair offers theoretical advantages over open repair, but long-term studies are needed to demonstrate its effectiveness.

Arthroscopy↗
PubMed1997

The rotator cuff. Commentary.

To add clinical perspective to the articles of this two-issue collection, eight prominent shoulder surgeons discuss their approach to the treatment of rotator cuff disease. There is broad agreement in many areas, however, significant controversies remain.

Adult↗
PubMed1997

The incidence of glenohumeral joint abnormalities associated with full-thickness, reparable rotator cuff tears.

To evaluate the incidence of associated glenohumeral lesions in patients with a full-thickness rotator cuff tear, an arthroscopic examination of the glenohumeral joint was performed in 200 shoulders in 195 consecutive patients before arthroscopic rotator cuff repair. One hundred twenty-one (60.5%) had coexisting intraarticular abnormalities. Ninety-six (48%) had minor abnormalities, and 25 patients (12.5%) had major coexisting intraarticular abnormalities. Major lesions (that required operative treatment, changed postoperative rehabilitation, or altered the expected end result) noted at arthroscopic examination were osteoarthritis in nine patients, partial biceps tendon tears in three, labrum tears in three, Bankart lesions in two, superior labrum anterior posterior lesions in five, and glenohumeral synovitis in three patients. Glenohumeral arthroscopy can provide valuable information in patients with a complete rotator cuff tear.

Arthroscopy↗
PubMed1997

Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression.

Thirty-three consecutive patients in whom an irreparable tear of the rotator cuff had been treated with operative debridement and subacromial decompression were evaluated both preoperatively and postoperatively with regard to pain, ability to perform activities of daily living, range of motion, strength, and satisfaction. The assessments were performed with the Shoulder Score Index of the American Shoulder and Elbow Surgeons and the scoring systems of the University of California at Los Angeles and Constant and Murley. At the time of follow-up, twenty-six patients thought that the condition of the shoulder was improved; three, that it was unchanged; and four, that it was worse after the operation. There was a significant decrease in pain (p = 0.001) and significant increases in the range of motion (p = 0.038) and the ability to perform activities of daily living (p = 0.016). However, these improvements were inferior to those in reported series in which torn rotator cuffs had been repaired. Strength with elevation was decreased after the operations in the present series (p = 0.0007).

Activities of Daily Living↗