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Biomedical subjects

H Ellman

Publications and source records attributed to H Ellman.

7 recordsLinked to original sources

Early degenerative joint disease simulating impingement syndrome: arthroscopic findings.

Eighteen patients who underwent shoulder arthroscopy for impingement syndrome were shown at operation to have coexisting glenohumeral degenerative joint disease (DJD) which was not apparent during preoperative clinical and radiographic evaluation. Because traditional ("open") techniques of anterior acromioplasty do not allow inspection of the glenohumeral joint, it is almost certain that this pathology would have been missed at operation if open acromioplasty had been performed. We conclude that arthroscopic subacromial decompression (ASD), by allowing easy inspection of the glenohumeral joint, offers a distinct advantage over traditional acromioplasty. Furthermore, arthroscopic evaluation of some of these patients' glenohumeral joints provided us with evidence supporting the existence of subluxation arthropathy. We have also developed a new clinical test, the "compression-rotation" test, which has been helpful in distinguishing patients with both impingement syndrome and early DJD syndrome from those with isolated impingement syndrome. Although patients in this study appeared to be doing well at short-term follow-up status post-ASD and glenohumeral debridement, no long-term results are yet available.

Adult

Arthroscopic subacromial decompression for chronic impingement. Two- to five-year results.

Subacromial decompression was performed arthroscopically on 65 patients who were evaluated two to five years after the procedure. None had full thickness rotator cuff tears. Patients with partial thickness cuff tears were included in this study in order to allow comparison of arthroscopic acromioplasty with open acromioplasty for stage II impingement. On the UCLA shoulder rating scale, 89% of the cases in this study achieved a satisfactory result. These results compare favourably with those reported following open acromioplasty. The arthroscopic procedure is technically demanding. When properly performed in patients with appropriate indications, hospitalisation is brief, return to activities is rapid, there is little risk of deltoid muscle complications, and the results are lasting.

Acromioclavicular Joint

Diagnosis and treatment of incomplete rotator cuff tears.

The histopathologic changes leading to rotator cuff rupture are gradual and progressive. Incomplete tears can be observed in the articular or bursal surface. These partial lesions are infrequently demonstrated with arthrography or bursography. Although structural variations in cuff integrity can be demonstrated with ultrasound or magnetic resonance imaging, precise definition of partial tears is difficult. The exact location and extent of incomplete tears can be documented with shoulder arthroscopy. Anterior acromioplasty, either open or arthroscopic, is indicated for the treatment of chronic mechanical impingement refractory to conservative management. When a sizable partial defect is identified at open surgery, the degenerated tissue is excised and the tendon is reattached to bone or repaired with side-to-side suture. Arthroscopic treatment consists of debridement of the torn cuff margins, followed by arthroscopic subacromial decompression (ASD). When the incomplete tear in an active individual involves more than one-half the cuff thickness, arthroscopic and open techniques can be combined. Twenty partial-thickness tears were encountered among 130 patients who had ASD for chronic impingement. Fifteen had a satisfactory result, but five required additional surgery. A system of grading partial-thickness tears based on location, depth, and area is presented in an effort to standardize the observations of various investigators and to permit comparison of the results of arthroscopic treatment.

Humans

Arthroscopic treatment of impingement of the shoulder.

Arthroscopic subacromial decompression is an alternative to open anterior acromioplasty in patients who have advanced stage II and selected stage III impingement syndromes. This procedure can be performed in an outpatient setting and postoperative morbidity is minimal; however, the procedure is technically demanding. Because the deltoid is not detached, immediate full range of active motion is possible, allowing an early return to activities of daily living. Substantial pain relief can be anticipated in a large majority of patients.

Arthroscopy

Pulmonary function in scleroderma.

Pulmonary function tests were performed in 45 patients with scleroderma. Thirteen patients (29%) were found to have restrictive disease, 12 patients (27%) were found to have obstructive disease, and 19 patients (42%) had small airway disease (SAD). Smoking did not seem to be a factor underlying either obstructive or small airway disease in these patients. A low diffusing capacity was most common in patients with restrictive disease and rarely the only abnormality in pulmonary function. SAD was usually found in patients who had normal chest radiographs and no pulmonary symptoms and was often the only abnormality. SAD is therefore an early and sensitive indicator of pulmonary involvement in scleroderma.

Adult

Anterior angulation deformity of the radial head. An unusual lesion occurring in juvenile baseball players.

Four cases of an unusual angulation deformity of the radial head were seen in juvenile baseball players, with or without associated lesions of osteochondritis in the contiguous capitellum of the humerus and loose-body formation. The established deformity did not show a tendency toward anatomical restitution. In each case, symptoms produced by this deformity were noted to appear in association with athletic activity.

Adolescent