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J W Thomas Byrd

Publications and source records attributed to J W Thomas Byrd.

15 recordsLinked to original sources
PubMed2006

Adhesive capsulitis of the hip.

PURPOSE: It is postulated that adhesive capsulitis of the hip is more common than suggested in the published literature, which recounts only a few isolated cases, and that this condition shares many of the same characteristics seen in the shoulder. The purpose of this study was to investigate and report the findings of the first clinical case series on this condition. TYPE OF STUDY: Clinical case series, retrospective review of prospectively collected data. METHODS: Since 1993, all hip arthroscopy cases have been prospectively assessed with a 100-point rating system. In 1999, adhesive capsulitis was first recognized as a causative factor. Since then, 9 patients have been identified with this condition with at least 1 year of follow-up. RESULTS: There was 100% follow-up at an average of 17.3 months. The average age was 43.7 years. There were 8 women and 1 man. Radiographs were normal in 8 cases and revealed mild degenerative disease in the 1 male patient. Magnetic resonance imaging/arthrography failed to reveal evidence of adhesive capsulitis. Examination under anesthesia revealed an average loss of 25 degrees of rotational motion (19.4 external, 5.6 degrees internal). Full range of motion was regained with manipulation. Arthroscopy revealed characteristic findings of adhesive capsulitis in all cases and coexistent pathology in 6 cases (5 articular lesions, 3 labral tears, and 1 ruptured ligamentum teres). The 8 women with normal radiographs all improved with an average of 32 points (preoperative, 56.4; postoperative, 88.4). The 1 man with degenerative changes showed negligible improvement. There were no complications. CONCLUSIONS: Adhesive capsulitis of the hip is not as rare as suggested by the paucity of available literature. The clinical characteristics are similar to the shoulder, principally consisting of painful restricted motion and a clear predilection for middle aged women. It may occur with or without associated intra-articular pathology. Arthroscopy can be beneficial in the treatment of recalcitrant cases, but may assume less of a role with improved diagnostic skills essential to implementing a proper management strategy. LEVEL OF EVIDENCE: Level IV.

Arthroscopy↗
PubMed2006

Hip arthroscopy: surgical indications.

Successful outcomes of hip arthroscopy are most clearly dependent on selecting appropriate patients. The indications are numerous and continue to evolve. These indications are summarized in this report. The anatomic architecture of the hip region imposes unique challenges to performing this procedure. As a surgeon's experience evolves, so will his or her indications for this operation. It is imperative to be knowledgeable about the technique, to exercise care with the procedure, and to be certain that it is being performed for proper reasons.

Arthroplasty, Replacement, Hip↗
PubMed2006

The role of hip arthroscopy in the athletic hip.

Hip joint problems in the athlete can be disabling, yet remain elusive to investigation. The arthroscope has proved essential in both the detection and treatment of many of these disorders. Less invasive methods with quicker return to safe competition has been a sine qua non of sports medicine. The incentive to return motivated athletes to a sport has proven fertile ground for advancement of arthroscopic techniques. This has been especially exemplified in the rapidly evolving field of hip arthroscopy, and has allowed these methodologies to find application in the management of patients of all levels of activity. As has been stated, the athletic field of competition represents one of the most fertile clinical laboratories in the world.

Adolescent↗
PubMed2006

Hip arthroscopy.

Explore the source record for details and available documents.

Arthroscopes↗
PubMed2006

Hip arthroscopy by the supine approach.

The supine approach to arthroscopy of the hip has been well described, and the safe zones for arthroscopy and the technique of precise portal placement necessary for optimal access have been well established. However, with a growing understanding of hip pathology and its etiology, additional methods have been devised to address this pathology. Thus, the technique of hip arthroscopy continues to evolve, including incorporation of the peripheral compartment evaluation as part of the routine procedure.

Arthroscopy↗
PubMed2006

Evaluation and management of the snapping iliopsoas tendon.

Snapping caused by the iliopsoas tendon ("internal coxa saltans") is a common incidental observation that often requires little treatment on the part of the clinician other than assurance to the patient that this finding is not a harbinger of future problems. Most symptomatic patients can be managed with a properly structured conservative treatment program. However, surgical intervention may be indicated for select recalcitrant painful snapping that is unresponsive to conservative treatment. Traditional literature has proposed open procedures with relaxation or release of the tendinous portion of the iliopsoas. Recent experience with endoscopic release of the iliopsoas has met with favorable results at least comparable to those reported for open techniques. An obvious advantage is the less invasive nature that facilitates rehabilitation and return to function. However, of equal importance, most patients with recalcitrant painful snapping of the iliopsoas tendon have been found to have associated intra-articular pathology. The endoscopic method allows concomitant arthroscopy of the joint to assess and address this coexistent damage that, if overlooked, could be a cause of poor results. A strategy for management of painful snapping caused by the iliopsoas tendon is detailed, including the technique for endoscopic release.

Arthroscopy↗
PubMed2004

Traumatic rupture of the ligamentum teres as a source of hip pain.

PURPOSE: Lesions of the ligamentum teres have only occasionally been reported in the literature. However, with arthroscopy, pathology of the ligamentum teres has been increasingly recognized. The purpose of this article is to report the clinical characteristics associated with rupture of the ligamentum teres and the results of arthroscopic treatment. TYPE OF STUDY: Case series study. METHODS: All patients undergoing hip arthroscopy have been prospectively assessed using a modified Harris Hip score (100 point maximum) obtained preoperatively and postoperatively at 3, 12, 24, and 60 months. In this study, 271 cases had at least 1 year of follow-up evaluation. From this population, 41 patients were identified with lesions of the ligamentum teres. Twenty-three of these were traumatic in origin and represent the substance of this study. The remainder (18) were hypertrophic or degenerative. RESULTS: We noted 100% follow-up at an average of 29.2 months. Patients included 14 women and 9 men with an average age of 28.3 years. Duration of symptoms before surgery averaged 28.5 months. All patients experienced deep anterior groin pain. Nineteen patients experienced mechanical symptoms (catching, popping, locking, giving way), and 4 patients described simply pain with activities. Fifteen patients sustained major trauma (7 motor vehicle accidents, 3 falls from a height, 3 football, 1 snow skiing, 1 ice hockey), including 6 dislocations. The remaining 8 patients sustained a twisting injury. Evaluation included 20 magnetic resonance imaging (MRI) scans, 7 MR arthrograms, 7 computed tomography (CT) scans, and 3 bone scans. The diagnosis of a lesion of the ligamentum teres was made preoperatively in only 2 cases. Rupture of the ligament was complete in 12 cases and partial in 11. Ligament injury was an isolated finding in 8 cases, and associated pathology was found in 15 cases (9 labral tears, 5 loose bodies, 5 chondral damage). The average preoperative score was 47, and postoperative score was 90. No statistical difference was seen based on type of injury, complete versus partial rupture, or presence of coexistent pathology. CONCLUSIONS: Rupture of the ligamentum teres is increasingly recognized as a source of persistent hip pain. The diagnosis remains elusive to various imaging techniques. An index of suspicion should be maintained, especially in the presence of mechanical symptoms and a history of significant trauma. However, rupture may occur simply from a twisting injury in absence of major trauma. These lesions can be diagnosed using arthroscopy and, based on these results, may respond remarkably well to arthroscopic debridement. LEVEL OF EVIDENCE: Level IV.

Accidental Falls↗
PubMed2003

Hip arthroscopy in the presence of dysplasia.

PURPOSE: Intra-articular pathology of the hip is often associated with dysplasia. The presence of dysplasia is often believed to be a harbinger of poor results for arthroscopy. The purpose of this study was to report the results of operative hip arthroscopy in conjunction with dysplastic disease of the hip. TYPE OF STUDY: Prospective clinical case series. METHODS: All patients undergoing hip arthroscopy are prospectively assessed with a modified Harris hip score performed preoperatively and postoperatively at 3, 12, 24, and 60 months. A minimum of 1-year follow-up has currently accumulated for 184 consecutive cases. The center edge (CE) angle of Wiberg is measured on the anteroposterior pelvis film and categorized as normal (> 25 degrees ), dysplastic (< 20 degrees ), or borderline dysplasia (20 degrees -25 degrees ). RESULTS: In this study, 48 patients were identified with either dysplasia (16) or borderline dysplasia (32). At an average of 27 months, 100% follow-up was noted. For the dysplastic group, the average preoperative score was 57 and postoperative score was 83. For borderline dysplasia, the average preoperative score was 50 and postoperative score was 77. Statistically, no difference was found between the 2 groups. Collectively, the average improvement was 27 points, with 79% (38 patients) of patients showing at least a 10-point improvement. CONCLUSIONS: The results of arthroscopy in the presence of dysplasia compare favorably with the general population previously reported. The response to treatment is probably dictated more by the nature of the intra-articular pathology rather than simply the presence or absence of radiographic evidence of dysplasia.

Adolescent↗
PubMed2003

Hip arthroscopy in athletes.

The hip has received relatively little attention as a recognized site of sports injuries. However, arthroscopy has been used to identify numerous treatable sources of intra-articular pathology with good results. Historically, athletes with hip injuries were simply resigned to living within the constraints of their symptoms, being diagnosed with an ill-defined chronic groin injury and often prematurely ending their competitive careers. Recognizing the presence of these problems has led to a better understanding of the mechanisms of hip injury (for example, macrotrauma, microtrauma, and degeneration) and an increased awareness of particular sports that increase the incidence of injury.

Arthroscopy↗
PubMed2003

Hip arthroscopy: patient assessment and indications.

Hip arthroscopy is often performed for disorders that in the past have gone unrecognized and untreated. The arthroscope has helped in the understanding of the nature of numerous intra-articular lesions, subsequently leading to improved assessment skills for these often elusive disorders, including interpretation of the history, examination findings, and technical advances in imaging studies. The indications for this procedure have been well defined but continue to evolve. Successful results from arthroscopy are most clearly linked to indications and proper patient selection.

Arthralgia↗
PubMed2003

Hip arthroscopy: the supine position.

Hip arthroscopy performed with the patient in the supine position is an effective, reproducible procedure. Advantages include ease and simplicity of patient positioning, use of a standard fracture table, operating room layout that is user friendly, familiar joint orientation, and optimal access for all portal placements. All technical aspects of performing the procedure are detailed, including necessary equipment, patient positioning, landmarks, portal placement, and arthroscopic anatomy. Effective and safe performance of this procedure is dependent on careful attention to every detail of the operation.

Arthroscopy↗
PubMed2002

Osteoarthritis caused by an inverted acetabular labrum: radiographic diagnosis and arthroscopic treatment.

PURPOSE: An inverted labrum is an acknowledged but often elusive cause of osteoarthritis. The study goals were to define the characteristic radiographic features of secondary osteoarthritis of the hip due to an inverted labrum and report the results of arthroscopic treatment. TYPE OF STUDY: This is a case series study. METHODS: From 220 consecutive arthroscopic hip procedures, 9 patients were identified who had had secondary osteoarthritis caused by an inverted labrum and who underwent a minimum 2 years follow-up. All were prospectively assessed with a modified Harris hip score. All patients underwent excision of a torn inverted labrum and chondroplasty. Three patients who had well- circumscribed grade IV acetabular lesions also underwent microfracture of the subchondral bone. RESULTS: Characteristic anteroposterior radiographic features included isolated narrowing of the superolateral joint space. This narrowing caused a lateral convergence in the normally parallel lines created by the radius of curvature of the subchondral bone of the acetabulum and the convex surface of the femoral head. These 2 features created a false appearance of dysplasia (pseudodysplasia), because the center edge angle of Weiberg was normal in 6 cases (range, 24 degrees to 41 degrees; average, 29 degrees ) and was indicative of true dysplasia in only 3 cases (17 degrees ). The median preoperative score was 51, and the postoperative hip score was 56. Only 4 patients showed significant improvement. The best results were in the group with microfracture; the average improvement in this group was 36. CONCLUSIONS: An inverted labrum is an occasionally encountered cause of osteoarthritis of the hip. The radiographic features seen with this disorder are quite characteristic and essentially pathognomonic. Recognizing these features in this population may help the physician avoid an unnecessarily extensive work-up for poorly explained hip pain. The 3 patients with microfracture responded well to the arthroscopic technique; otherwise the results of arthroscopic treatment were poor. The outcomes were no better than those previously reported for arthritis of all causes.

Acetabulum↗
PubMedDate not supplied

Arthroscopic surgery for isolated capitellar osteochondritis dissecans in adolescent baseball players: minimum three-year follow-up.

BACKGROUND: Osteochondritis dissecans of the capitellum of the humerus usually occurs in adolescence and is caused by the valgus forces associated with excessive throwing. HYPOTHESIS: Arthroscopic surgery is an appropriate procedure for this condition. STUDY DESIGN: Retrospective cohort study. METHODS: Arthroscopic surgery was performed on 10 baseball players (average age, 13.8 years) with osteochondritis dissecans whose symptoms had been apparent for an average of 9 months before the operation. Follow-up at an average of 3.9 years included use of a standard rating scale, radiographs, and a questionnaire regarding return to sport. RESULTS: There were two grade I, one grade II, two grade IV, and five grade V lesions. Symptoms and objective findings correlated poorly with the grade of the lesion. The postoperative score averaged 195, reflecting excellent results. Radiographically, the primary lesion was still apparent in one patient, secondary degenerative changes were evident in one patient, and, in one patient, the lesion was still evident and degenerative changes had occurred. Only four athletes returned to organized baseball. CONCLUSIONS: Arthroscopic surgery for symptomatic osteochondritis dissecans of the capitellum in adolescent baseball players can provide excellent rating scores with intermediate follow-up but does not assure return to baseball.

Adolescent↗
PubMedDate not supplied

Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients.

BACKGROUND: Hip arthroscopy has defined elusive causes of hip pain. HYPOTHESIS/PURPOSE: It is postulated that the reliability of various investigative methods is inconsistent. The purpose of this study is to evaluate the diagnostic accuracy of these methods. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Five parameters were assessed in 40 patients: clinical assessment, high-resolution magnetic resonance imaging, magnetic resonance imaging with gadolinium arthrography, intra-articular bupivacaine injection, and arthroscopy. Using arthroscopy as the definitive diagnosis, the other parameters were evaluated for reliability. RESULTS: Hip abnormality was clinically suspected in all cases with 98% accuracy (1 false positive). However, the nature of the abnormality was identified in only 13 cases with 92% accuracy. Magnetic resonance imaging variously demonstrated direct or indirect evidence of abnormality but overall demonstrated a 42% false-negative and a 10% false-positive interpretation. Magnetic resonance arthrography demonstrated an 8% false-negative and 20% false-positive interpretation. Response to the intra-articular injection of anesthetic was 90% accurate (3 false-negative and 1 false-positive responses) for detecting the presence of intra-articular abnormality. CONCLUSIONS: In this series, clinical assessment accurately determined the existence of intra-articular abnormality but was poor at defining its nature. Magnetic resonance arthrography was much more sensitive than magnetic resonance imaging at detecting various lesions but had twice as many false-positive interpretations. Response to an intra-articular injection of anesthetic was a 90% reliable indicator of intra-articular abnormality.

Arthrography↗