Biomedical subjects

Julie Y Bishop

Publications and source records attributed to Julie Y Bishop.

8 recordsLinked to original sources

PubMed2006

Outcomes after arthroscopic rotator cuff repairs.

Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic.

Adult↗

PubMed2006

Treatment of the acute traumatic acromioclavicular separation.

Injuries to the acromioclavicular joint occur commonly in athletes, especially those involved in contact sports. The majority of these injuries are type I and II acromioclavicular joint separations and are treated nonoperatively with rehabilitation. A rapid and full return to play is expected. Acute types IV, V, and VI are less common and operative intervention is recommended. The type III injury is more controversial and current trends are towards initial nonoperative management. Operative treatment is sought only when the athlete remains symptomatic with painful instability. However, some do support early intervention in the overhead athlete. The goal of operative intervention is to create a stiff and strong repair/reconstruction of the coracoclavicular ligaments while providing stability in all planes. This will allow early and more aggressive rehabilitation. Surgical treatment includes reconstruction of the coracoclavicular ligaments with an augmented coracoacromial ligament transfer and more recently tendon graft reconstructions. Biomechanical research supports an anatomic reconstruction of the ligaments to confer the most function and stability.

Acromioclavicular Joint↗

PubMed2005

Pediatric shoulder trauma.

Pediatric shoulder trauma is relatively uncommon. Injuries requiring surgical intervention are even rarer. However, it is important for the practicing orthopaedic surgeon to differentiate nonoperative injuries from the urgent and potentially operative injuries. Missing such an injury in the pediatric population could be potentially life threatening or lead to long-term disability. Posterior sternoclavicular dislocations should be differentiated from medial clavicular physeal injuries and promptly reduced. Open fractures or neurovascular threatening fractures should be attended to immediately. Severely displaced proximal physeal humerus fractures in the older child often have a better long-term outcome after anatomic reduction. Finally, although glenohumeral dislocations, once reduced, are not life threatening or limb threatening, they do have a very high incidence of recurrence in adolescent patients. This should be kept in mind when formulating the treatment plan. If these overall treatment recommendations and plans are adhered to, the majority of pediatric shoulder trauma will result in a good outcome.

Adolescent↗

PubMed2005

Interscalene regional anesthesia for shoulder surgery.

BACKGROUND: Despite a trend toward the use of regional anesthesia for orthopaedic procedures, there has been resistance to the use of interscalene regional block for shoulder surgery because of concerns about failed blocks and potential complications. METHODS: We retrospectively reviewed the cases of 568 consecutive patients who had shoulder surgery under interscalene regional block in a tertiary-care, university-based practice with an anesthesiology residency program. The blocks were performed by a group of anesthesiologists who were dedicated to the concept of regional anesthesia in their practice. Complete anesthetic and orthopaedic records were available for 547 patients. The surgical procedure, planned type of anesthesia, occurrence of block failure, and the presence of complications were noted. RESULTS: Of the 547 patients, 295 underwent an arthroscopic procedure and 252 (including eighty who had an arthroplasty) underwent an open procedure. General anesthesia was the initial planned choice for sixty-nine patients because of the complexity or duration of the procedure, the anatomic location, or patient insistence. Thirty-four of the sixty-nine patients also received an interscalene regional block. Interscalene regional block alone was planned for 478 patients. A total of 462 patients (97%) had a successful block whereas sixteen required general anesthesia because the block was inadequate. The success of the block was independent of the type or length of the surgery. No patient had a seizure, pneumothorax, cardiac event, or other major complication. Twelve (2.3%) of the 512 patients who had a block had minor complications, which included sensory neuropathy in eleven patients and a complex regional pain syndrome that resolved at three months in one patient. For ten of the eleven patients, the neuropathy had resolved by six months. CONCLUSIONS: Interscalene regional block provides effective anesthesia for most types of shoulder surgery, including arthroplasty and fracture fixation. When administered by an anesthesiologist committed to and skilled in the technique, the block has an excellent rate of success and is associated with a relatively low complication rate.

Arthroplasty↗

PubMed2004

Multidirectional instability: surgical decision making.

Although previous authors have described multidirectional instability of the shoulder, it was not until 1980 that Neer and associates solidified the current understanding and treatment of inferior and multidirectional instability. They emphasized the importance of differentiating this condition from the more common unidirectional instabilities and introduced the concept of an inferior capsular shift to globally tension the capsule anteriorly, inferiorly, and posteriorly, while thickening and reinforcing it on the side of greatest instability (i.e., anterior or posterior). Since the time of this initial description, the diagnosis and treatment of multidirectional instability has been fraught with difficulty and confusion. More recently, the advent of shoulder arthroscopy has blazed the trail for minimally invasive techniques to correct multidirectional instability, including arthroscopic thermal capsulorrhaphy and suture plication. However, despite strong opinions regarding these surgical techniques, when comparing open approaches to arthroscopic techniques for the treatment of multidirectional instability, long-term outcomes of arthroscopic techniques have yet to replicate those of open surgery.

Arthroscopy↗

PubMed2003

Management of glenohumeral arthritis: a role for arthroscopy?

When nonoperative measures fail in the treatment of glenohumeral arthritis, arthroscopy has emerged as a viable therapeutic option. It is valuable as a diagnostic and therapeutic intervention and has a low morbidity and low complication rate. Arthroscopic techniques can be performed in the younger patient or athlete wishing to delay arthroplasty or in the elderly patient with associated comorbidities wishing to avoid a larger operation. In those with inflammatory arthropathies, arthroscopy with associated debridement and synovectomy can relieve pain, improve function, and delay progression of the disease. In the athlete and young patient with osteoarthritis, arthroscopy allows recognition and treatment of coexisting pathologies in which procedures such as subacromial decompression and capsular release have proven to be of benefit. Arthroscopic debridement, abrasion arthroplasty, and microfracture techniques seem to be of some benefit; however, it remains unclear who the ideal candidate is. Overall it is generally viewed that patients improve and benefit most when intervention is early in the course of the disease. Although the role of arthroscopy in the treatment of glenohumeral arthritis is evolving, in certain situations and patients it is thus a viable option and another tool in the armamentarium of the orthopedic surgeon.

Arthritis↗

PubMedDate not supplied

Humeral head replacement versus total shoulder arthroplasty: clinical outcomes--a review.

Total shoulder replacement (TSR) has been shown to provide predictable pain relief and functional improvement in patients with glenohumeral degenerative arthritis and an intact rotator cuff. When compared with patients with humeral head replacement (HHR), those with TSR have been reported to have more stability, less pain, and increased motion. However, concerns regarding glenoid loosening and the subsequent possibility of a difficult revision with bony deficits have led many to favor HHR alone. Proponents of HHR regard the glenoid as the "weak link" in TSR and, when weighing their options, consider glenoid resurfacing to be too great a risk. The literature suggests that TSR is the best form of treatment for glenohumeral osteoarthritis, except in certain cases of insufficient glenoid bone stock and irreparable rotator cuff tears. Several recent clinical outcomes studies support this, as they have shown better results after TSR in comparison to HHR. Although the fear of radiographic glenoid component loosening is appropriate, evidence of clinical glenoid loosening is not very common. Currently, glenoid component design, in relation to its articulation with the humeral head, continues to grow and evolve as efforts are focused on changes to decrease the incidence of loosening. In addition, improved surgical techniques of cement pressurization may help to minimize glenoid loosening as well. Thus, it is reasonable to expect that the excellent results currently attainable with TSR may improve.

Arthroplasty, Replacement↗

PubMedDate not supplied

Interscalene regional anesthesia for arthroscopic shoulder surgery: a safe and effective technique.

There has been resistance to the use of interscalene regional block for arthroscopic shoulder surgery because of concerns about potential complications and failed blocks with the subsequent need for general anesthesia. The purpose of this study was to assess whether interscalene regional block is safe and effective and offers many advantages over general anesthesia for outpatient arthroscopic shoulder surgery. Through a retrospective chart review of consecutive arthroscopic shoulder surgeries over a 2.5-year time period, in a tertiary university medical center with an anesthesiology residency, 277 interscalene blocks (96%) were successful; 12 (4%) required general anesthesia because of an inadequate block. There were no seizures, pneumothoraces, cardiac events, or other major complications. There was a 1% rate of minor complications, all of which were transient sensory neuropathies that resolved within 5 weeks on average. We conclude that interscalene block can provide effective anesthesia for arthroscopic shoulder surgery.

Adolescent↗