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Biomedical subjects

G Walch

Publications and source records attributed to G Walch.

100 records · Page 6Linked to original sources
PubMedDate not supplied

Subluxations and dislocations of the tendon of the long head of the biceps.

Seventy-one cases of subluxation or dislocation of the long head of the biceps tendon (LHB) were retrospectively evaluated. Subluxation was observed in 25 (35%) cases combined with partial tearing of the subscapularis tendon and in 70% with tears of the supraspinatus tendon. Dislocation was defined as a permanent loss of contact between the tendon and the intertubercular groove; it was observed in 46 (65%) cases. Dislocation was associated with complete rupture of the subscapularis tendon in 23 cases, with partial tearing in 21 cases, and with an intact subscapularis tendon in 2 cases. Out of a series of 445 rotator cuff repairs, medial displacement of the LHB was found in 16%. In 70% of all cases dislocation of the long biceps tendon was associated with massive rotator cuff tears including the supraspinatus and infraspinatus tendons. Although "pseudoparalysis" of the shoulder (sudden loss of active elevation) was observed in 46% of all cases, no specific clinical test correlated to the presence of medial displacement of the LHB. Arthrography revealed displacement of the LHB in 28%, whereas arthro-computed tomography demonstrated lesions in 76%. The authors believe that medial displacement of the LHB can easily be overlooked during open surgery, and opening of the rotator interval is an essential part of rotator cuff repair.

Adult↗
PubMedDate not supplied

Critical analysis of the supraspinatus outlet view: rationale for a standard scapular Y-view.

The supraspinatus outlet view has been standardized under fluoroscopic control to become reproducible and comparable; it is the normalized scapular Y-view. Four hundred four healthy shoulders from patients 20 to 80 years old and 63 shoulders with rotator cuff tears underwent x-ray evaluation and were compared. A qualitative study was carried out on the shape of the acromion in relation to Bigliani's types (I, II, III and on the presence or absence of a bony spur on the anterior part of the acromion. Quantitative measurements were determined; the subacromial peak and the spinoacromial angle were assessed for a statistical comparison among the various populations. The acromions of healthy shoulders varied with age (8% type III in patients younger than 60 years, 27% in those older than 60 years), although not significantly. The dominant side and sex of the subjects had no effect. With 29% type III acromions the shoulders with cuff tears differed from those of the healthy shoulders (14% type III). No close correlation was seen between type III acromions and cuff ruptures. The quantitative values of the acromions had no predictive value for cuff rupture. Acromion typology failed to confirm that a type III acromion was responsible for rotator cuff rupture. Spurs are found in increasing incidence with age and in the presence of cuff rupture; whether they are caused by subacromial impingement or by natural aging of the acromion is uncertain.

Acromion↗
PubMedDate not supplied

Prosthetic adaptability: a new concept for shoulder arthroplasty.

An anatomic study of 65 cadaveric humeri allowed determination of the main features of the superior part of the humerus and design of a modular and adaptable humeral prosthesis. This cemented prosthesis is made in 3 different stem sizes, 7 humeral head sizes, and a variable humeral neck component. The 4 different humeral necks (125 degrees, 130 degrees, 135 degrees, and 140 degrees) allow the head to be cut at the level of the anatomic neck and adaptation of the prosthesis to the patient's anatomy with respect to the variable inclination and retroversion. An eccentric dial is located on the undersurface of the head; 8 positions are possible reproducing the posterior and medial offset of the humeral head with regard to the diaphysis. The large variety of components used for the first 101 implanted prostheses confirm the extreme variability of the anatomy and the need for a flexible shoulder prosthesis system. The glenoid component is made of polyethylene and is available in 3 different sizes to be used with a cemented keel. Eighty-six shoulders, which were monitored from 24 to 65 months, were evaluated with the Constant score. Primary glenohumeral arthritis (46 cases) and avascular necrosis (11 cases) yielded the best results, with scores of 95% and 86%. Rheumatoid arthritis (20 cases) scored 78%, although post-traumatic arthritis (11 cases) and cuff tear arthropathy (13 cases) had a less satisfactory result: 66% and 61%, respectively. Radiologic results showed 2 glenoids loosening and 48% of glenoids with radiolucent lines, with half of them being partial. An 8% complication rate has been observed, leading to 6 revisions (6%), in 2 cases for infection, 2 cases for secondary rupture of the subscapularis, and 2 cases for glenoid loosening.

Adult↗
PubMedDate not supplied

Arthroscopic release of the glenohumeral joint in shoulder stiffness: a review of 26 cases. French Society for Arthroscopy.

The purpose of this multicenter retrospective study of arthroscopic release of the glenohumeral joint was to evaluate the technical feasibility, the results, and the potential correlations between results and cause of the stiffness. Twenty-six shoulders in 25 patients (19 women and six men) were re-evaluated 3 to 72 months (mean, 21 months) after arthroscopic release of the glenohumeral joint. Diagnoses were primary frozen shoulder in 13 cases, bipolar stiffness (rotator cuff tear plus capsular contraction) in 3 cases, and postinjury or postsurgery stiffness in 10 cases. Results were evaluated on passive range of motion, Constant's score, and subjective assessment. Anterior or anterior inferior capsular release was done at the anterior rim of the glenoid fossa. Posterior capsule release was not performed in this series. There were no intraoperative complications. Mean range of motion gains were 86 degrees for forward elevation, 72 degrees for abduction, 34 degrees for external rotation, and 6 spinal processes for internal rotation. Constant's range of motion score increased from 12.9 out of 40 to 32 out of 40 points. Thirteen patients were very satisfied, 5 satisfied, 5 improved, and 3 unchanged. Range of motion gains were independent from the cause of shoulder stiffness, but global results were better in the primary frozen shoulder group in terms of pain and strength. Arthroscopic release of the glenohumeral joint is feasible and safe. For primary frozen shoulders, in case of failure of the functional treatment, arthroscopic release is a less traumatic alternative to manipulation under general anesthesia. For bipolar stiffness, arthroscopy provides the opportunity for treating concomitant lesions. For postsurgical stiffness, arthroscopic release improves range of motion, but the shoulder often remains painful.

Adult↗
PubMedDate not supplied

A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty.

We followed 210 cases of rotator cuff tears treated in four French centers by arthroscopic acromioplasty in 195 cases and by a tenotomy of the Long Head of Biceps (LHB) in 15 cases. All patients were evaluated by means of the Constant score (CS) and radiographic imaging. The mean age was 61 years and the mean follow-up period was 26.6 months (range, 12 to 93 months). The preoperative CS was 38.2 points; 41% were supraspinatus tears, 40.2% were supra and infraspinatus tears, 10.5% were three-tendon tears, and 8.1% were supraspinatus and subscapularis tears. The LHB was altered or disrupted in 77% of cases, dislocated or subluxated in 44% of cases. Acromioplasty was associated to tear debridement in 183 cases (88%) and to a tenotomy of the LHB in 38 cases (19%) of which 15 did not benefit from an associated acromioplasty. Global objective results shown by the corrected CS reached 79.7% and were satisfying in 73% of cases. Poor clinical factors were preoperative shoulder stiffness, postoperative painful crises, worker compensation, a preoperative history longer than 4 years, and young age. The poor anatomic factors were osteoarthritis, a lesion of the acromioclavicular joint or of the LHB tendon. An isolated supraspinatus tear will produce much better results than a triple-tendon tear. The persistence of an aggressive acromion was a prejudicial factor. The benefits of LHB tenotomy were evident and could be isolated in case of massive rotator tears. It seems that LHB tenotomy was particularly effective for massive tears of two or more tendons. Arthroscopic acromioplasty is an excellent indication for elderly patients without professional activity, functionally less demanding that a younger patient.

Acromion↗
PubMedDate not supplied

Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus.

The purpose of this multicenter study was to analyze the results of shoulder arthroplasty for the treatment of the sequelae of proximal humerus fractures and establish an updated classification system and treatment guidelines for these complex situations. Seventy-one sequelae of proximal humerus fractures were treated with shoulder replacement with the use of the same nonconstrained, modular, and adaptable prosthesis: the Aequalis prosthesis (Tornier Inc, St Ismier, France). The average time between initial fracture and shoulder arthroplasty was 5 years and 5 months. On the basis of anatomic classification schemes, sequelae were divided into 4 types: type 1, humeral head collapse or necrosis with minimal tuberosity malunion (40 cases); type 2, locked dislocations or fracture-dislocations (9 cases); type 3, nonunions of the surgical neck (6 cases); and type 4, severe malunions of the tuberosities (16 cases). The mean postoperative follow-up was 19 months (range, 12 to 48 months). Overall, the postoperative Constant score was excellent in 11 cases (16%), good in 19 cases (26%), fair in 18 cases (25%), and poor in 23 cases (33%). There were 18 complications (27%). Fifty-nine of 70 patients (81%) stated that they were satisfied with the result. The most significant factor affecting functional outcome was greater tuberosity osteotomy (P <.005). Regarding both surgical treatment and postoperative prognosis, we identify 2 categories of proximal humerus fracture sequelae: category 1, intracapsular/impacted fractures sequelae (associated with both cephalic collapse or necrosis [type 1] and chronic dislocation or fracture-dislocation [type 2]), in which an articulating joint can be reconstructed without a greater tuberosity osteotomy; and category 2, extracapsular/disimpacted fractures sequelae (associated with both surgical neck nonunions [type 3] and severe tuberosity malunions [type 4]) where the proximal humerus cannot be reconstructed without a greater tuberosity osteotomy. All of the excellent and good postoperative Constant scores were obtained in type 1 and 2, in which osteotomy of the greater tuberosity was not required. All patients in type 3 and 4, who underwent a greater tuberosity osteotomy, had either fair or poor results and did not regain active elevation above 90 degrees. We conclude that a greater tuberosity osteotomy is the most likely reason for poor and unpredictable results after shoulder replacement arthroplasty for the treatment of the complex sequelae of proximal humerus fractures. Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus should be performed without an osteotomy of the greater tuberosity when possible. If prosthetic replacement is possible without an osteotomy, surgeons should accept the distorted anatomy of the proximal humerus and adapt the prosthesis and their technique to the modified anatomy. A modular and adaptable prosthesis with both adjustable offsets and inclination may allow surgeons to adapt to a large number of malunions and may help to avoid the troublesome greater tuberosity osteotomy in a higher proportion of cases.

Adult↗
PubMedDate not supplied

Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus.

The purpose of this study was to evaluate the results of hemiarthroplasty for displaced proximal humeral fractures and to assess clinical and radiologic parameters that could explain unsatisfactory results. Sixty-six consecutive patients (45 women and 21 men) with a mean age of 66 years (range, 31-85 years) were followed up postoperatively for a mean of 27 months (range, 18-59 months), both clinically and radiologically. Subjectively, 29 patients were very satisfied, 9 were satisfied, and 28 were unsatisfied. Postoperative active elevation averaged 101 degrees +/- 33 degrees, external rotation averaged 18 degrees +/- 15 degrees, and internal rotation averaged the L3 level (+/-3 vertebrae). The absolute Constant score averaged 56 of 100 points (range, 20-95 points). Initial tuberosity malposition was present in 18 patients (27%). Tuberosity detachment and migration were noted in 15 patients (23%). Tuberosity migration could be observed after initial tuberosity malpositioning, as well as after initial correct positioning. Final tuberosity malposition occurred in 33 patients (50%) and correlated with an unsatisfactory result, superior migration of the prosthesis, stiffness or weakness, and persistent pain. Factors associated with failure of tuberosity osteosynthesis were poor initial position of the prosthesis (specifically, excessive height and/or retroversion), poor position of the greater tuberosity, and women over age 75 years (likely with osteopenic bone). Techniques to improve tuberosity osteosynthesis, including modifications to current prosthetic design and instrumentation to allow for a more anatomic reconstruction, should lead to more predictable and satisfactory results.

Adult↗
PubMedDate not supplied

Results of derotational humeral osteotomy in posterosuperior glenoid impingement.

We identified 20 throwing athletes who continued to have pain after articular debridement for posterosuperior impingement syndrome. These patients were unable to resume sports, and we subsequently performed a derotational humeral osteotomy with a myorraphy of the subscapularis muscle. Patients were observed for an average of 46 months (range, 12 to 69). Eleven patients were able to resume the same sport at the same level, five resumed the same sport at a lower level, three changed sport secondary to persistent pain, and the last patient did not resume any sport and was worse after surgery. Patients returned to sports at an average of 6 months postoperatively (range, 4 to 44) and to their previous level of sports at an average of 12 months (range, 8 to 18). The mean increase in humeral retroversion was 29 degrees (range, 18 degrees to 44 degrees) Three women with preoperative multidirectional hyperlaxity were considered to have failed results. Derotational humeral osteotomy can be considered in the throwing athlete with posterosuperior impingement after failure of all other means of treatment. Careful patient selection and preoperative evaluation of humeral retroversion is important. Best results can be achieved in a motivated patient with low retroversion (< 10 degrees). If retroversion is normal (20 degrees to 30 degrees), the surgical indication is unclear. We do not recommend this surgery for patients with hyperlaxity.

Adult↗
PubMedDate not supplied

[Posterosuperior glenoid rim impingement in athletes: the diagnostic value of traditional radiology and magnetic resonance].

First described by Walch in 1991, the posterosuperior glenoid rim impingement syndrome is a major condition in the differential diagnosis of shoulder pain occurring in the athletes engaged in repetitive and loading movements of abduction and extra-rotation of the dominant upper limb. Thirty-eight athletes with these dynamic athletic characteristics, referred for unexplained shoulder pain and with a clinical diagnosis of posterosuperior glenoid rim impingement syndrome, underwent radiography and MR examinations, with excellent final results. Radiography was capable of depicting the abnormal skeletal features of this kind of impingement, thus allowing a preliminary diagnosis to be made. MRI excelled in diagnosing the lesions in the deep surface of the supraspinatus tendon and in the posterior labrum secondary to impingement. The static and the kinematic sequences with the arm in abduction and extrarotation proved to be the best ones to define the physiopathologic phases of impingement. Thus, we conclude that invasive diagnostic procedures are not necessary for the correct and unquestionable diagnosis of posterosuperior glenoid rim impingement syndrome.

Adolescent↗