Biomedical subjects

L D Field

Publications and source records attributed to L D Field.

At least 37 records · Page 2Linked to original sources

PubMed1998

Common elbow injuries in sport.

Athletes of all ages and skill levels are increasingly participating in sports involving overhead arm motions, making elbow injuries more common. Among these injuries is lateral epicondylitis, which occurs in over 50% of athletes using overhead arm motions. Lateral epicondylitis is characterised by pain in the area where the common extensor muscles meet the lateral humeral epicondyle. The onset of this pathological condition begins with the excessive use of the wrist extensor musculature. Repetitive microtraumatic injury can lead to mucinoid degeneration of the extensor origin and subsequent failure of the tendon. Lateral epicondylitis can almost always be treated nonoperatively with activity modification and specific exercises. If the athlete fails to respond to nonoperative treatment after 6 months to 1 year, they are candidates for surgical intervention. Medial epicondylitis is characterised by pain and tenderness at the flexor-pronator tendinous origin with pathology commonly being located at the interface between the pronator teres and flexor carpi radialis origin. Golfers and tennis players often develop this condition because of the repetitive valgus stress placed on the medial elbow soft tissues. Careful evaluation is important to differentiate medial epicondylitis from other causes of medial elbow pain. As with lateral epicondylitis, patients with medial epicondylitis not responding to an extensive nonoperative programme are candidates for surgical intervention. A less common cause of medial elbow pain is medial ulnar collateral ligament injury. Repetitive valgus stress placed on the joint can lead to microtraumatic injury and valgus instability. When the medial ulnar collateral ligament is disrupted, abnormal stress is placed on the articular surfaces that can lead to degenerative changes with osteophyte formation. As with other elbow injuries, a strict rehabilitation regimen is first employed; ligament reconstruction is only recommended if the injury fails to improve and only in athletes requiring a high level of performance. Excessive valgus stress can also lead to posteromedial olecranon impingement on the olecranon fossa producing pain, osteophyte and loose body formation. Arthroscopic elbow debridement can often be helpful in improving motion and in reducing pain in such patients.

Athletic Injuries↗

PubMed1997

Massive rotator cuff tears: debridement versus repair.

In many studies, short-term and midterm results of debridement seem to show satisfactory results. However, the three long-term studies currently available all report that these initial results deteriorate significantly with time and are not acceptable. If debridement is considered, careful preoperative and intraoperative evaluation as discussed by Burkhart should be followed. We believe an adequate understanding of the anatomic subtleties, pathologic changes, biomechanical forces, and advanced reconstructive techniques allows repair to be performed in most, if not all, rotator cuff tears of the shoulder. The findings of the study described herein indicate that repair of these tears is the treatment of choice.

Adult↗

PubMed1997

Arthroscopic reconstruction of traumatic anterior instability of the shoulder: the Caspari technique.

In a prospective study, all patients with recurrent traumatic anterior instability of the shoulder were treated by an arthroscopic transglenoid suture reconstruction; 163 consecutive patients were treated during the 3-year period of the study. The average number of dislocations per patient was 11, average age 27 years, and the average preoperative Bankart score 15. All patients underwent reconstruction using the Caspari technique of arthroscopic suture reconstruction. Of the 163 patients, 161 were re-evaluated 36 to 72 months postoperatively. Overall, 147 (91%) of the patients rated as satisfactory and 14 (9%) rated as unsatisfactory. The average postoperative Bankart score for all patients was 89. Twenty of 27 patients (76%) younger than age 18 achieved a satisfactory result. Forty-nine of 54 college-age patients achieved a satisfactory result. In patients older than 22 years, 97.5% (78 of 80) achieved a satisfactory result. In this extensive study, it would appear that the success of this arthroscopic technique is age-related, with younger patients having a less successful result than older patients. Arthroscopic reconstruction with this technique provides results equal to those of the open procedure for patients age 22 years and older and would provide a success rate of 90% in patients age 18 to 22. However, it is effective only 74% of the time in patients younger than 18 and is not indicated for patients in this age range.

Adolescent↗

PubMed1997

Arthroscopic Bankart repair in a high demand patient population.

In this prospective study, 40 consecutive patients identified as high risk for recurrent instability were managed by an arthroscopic Bankart repair using nonabsorbable sutures and anchors. The technique employed is an arthroscopic modification of the capsulolabral repair described by Jobe. One-and-one-half to 3 years postoperatively (average 30 months), 37 of the 40 patients (93%) remained stable. The average Bankart score was 90. Thirty-seven of the 40 patients returned to normal activities, including sports, by 6 months postoperatively. Twenty-nine of the 32 patients involved in athletic activities returned to their respective sports at the same or higher level. Three patients had discontinued sporting activities due to graduation but felt as though they could resume their activities at the same level. Three patients developed recurrent instability, all of whom required surgical restabilization. Arthroscopic Bankart Repair using suture anchor technique in a high demand population provided results superior to those previously reported with the suture punch technique in our patient population. The results may be equivalent to open reconstruction in this high-risk patient population.

Adolescent↗

PubMed1997

Rotator interval capsule closure: an arthroscopic technique.

The importance of the rotator interval in glenohumeral instability has become increasingly apparent as anatomic studies have illustrated a significant increase in inferior and posterior translations after sectioning of the coracohumeral and superior glenohumeral ligaments. Limited reports of this lesion exist in the literature, and all such lesions have been treated with open procedures, with good clinical results. This report describes an arthroscopic technique for imbrication of the rotator interval in treating symptomatic defects and laxity in the anterosuperior shoulder capsule.

Arthroscopy↗

PubMed1997

Biomechanical evaluation of the medial collateral ligament of the elbow.

UNLABELLED: Anatomical dissection and biomechanical testing were used to study twenty-eight cadaveric elbows in order to determine the role of the medial collateral ligament under valgus loading. The medial collateral ligament was composed of anterior, posterior, and occasionally transverse bundles. The anterior bundle was, in turn, composed of anterior and posterior bands that tightened in reciprocal fashion as the elbow was flexed and extended. Sequential cutting of the ligament was performed while rotation caused by valgus torque was measured. The anterior band of the anterior bundle was the primary restraint to valgus rotation at 30, 60, and 90 degrees of flexion and was a co-primary restraint at 120 degrees of flexion. The posterior band of the anterior bundle was a co-primary restraint at 120 degrees of flexion and a secondary restraint at 30 and 90 degrees of flexion. The posterior bundle was a secondary restraint at 30 degrees only. The reciprocal anterior and posterior bands have distinct biomechanical roles and theoretically may be injured separately. The anterior band was more vulnerable to valgus overload when the elbow was extended, whereas the posterior band was more vulnerable when the elbow was flexed. The posterior bundle was not vulnerable to valgus overload unless the anterior bundle was completely disrupted. The intact elbows rotated a mean of 3.6 degrees between the neutral position and the two-newton-meter valgus torque position. Cutting of the entire anterior bundle caused an additional 3.2 degrees of rotation at 90 degrees of flexion, where the effect was greatest. CLINICAL RELEVANCE: Physical findings in a patient who has an injury of the anterior bundle may be subtle, and an examination should be performed with the elbow in 90 degrees of flexion for greatest sensitivity. As the anterior bundle is the major restraint to valgus rotation, reconstructive procedures should focus on anatomical reproduction of that structure. Parallel limbs of tendon graft placed from the inferior aspect of the medial epicondyle to the area of the sublimis tubercle will simulate the reciprocal bands of the anterior bundle. Temporary immobilization with the elbow in flexion may relax the critically important anterior band of the reconstruction during healing.

Biomechanical Phenomena↗

PubMed1996

Tennis elbow.

Explore the source record for details and available documents.

Adult↗

PubMed1995

Costs analysis of successful rotator cuff repair surgery: an outcome study. Comparison of gatekeeper system in surgical patients.

In an effort to determine the cost effectiveness of rotator cuff repair surgery in workers' compensation patients, a financial analysis of 50 consecutive patients with a "successful" result was performed. Treatment costs were analyzed from the date of initial injury through all evaluations, diagnostic studies, surgical reconstruction, physical therapy and work hardening. Additionally, all workers' compensation payments and the cost of settlement was analyzed. The average cost of medical care was $50,302.25 per patient. The average time to return to unrestricted duty from the date of injury was 11 months. However, patients referred to a specialist immediately following the diagnosis of a rotator cuff tear had total costs that averaged $25,870.64 and returned to work an average of 7 months postoperatively. Patients managed via a "gatekeeper" system averaged $100,280.10 in total costs and the average return to work was 18 months. These differences in cost and return to work were both statistically significant, P < .05. In conclusion, immediate referral of rotator cuff tears for specialized care results in decreased cost and earlier return to work.

Absenteeism↗

PubMed1995

Elbow injuries.

Injuries about the elbow are common in racquet sports. Lateral epicondylitis is seen most often, but symptoms can arise from other sources including the medial elbow and the articular surfaces themselves. Medial elbow symptoms can result from medial epicondylitis, medial collateral ligament injury, ulnar nerve trauma, or any combination of these injuries. Careful evaluation of medial elbow pain is required to define the causes. Proper technique, conditioning, and equipment are also important in reducing the risk of injury to the elbow.

Biomechanical Phenomena↗

PubMed1994

Arthroscopic anatomy of the lateral elbow: a comparison of three portals.

Ten fresh cadaveric elbows were used to evaluate the proximity of the radial nerve and its branches to three anterolateral portals. A proximal anterolateral portal used routinely at our institution and located 2 cm proximal and 1 cm anterior to the lateral epicondyle was compared with the distal anterolateral portal described by Andrews and with a mid-anterolateral portal. The three portals were initially established without joint distention while the elbows were flexed 90 degrees. Measurements were then obtained with and without joint distention at flexion angles of 0 degrees and 90 degrees. The radial nerve was found to be an average distance of 3.8 mm at extension and 7.2 mm at 90 degrees of flexion from the distal anterolateral portal, located 3 cm distal and 1 cm anterior to the lateral epicondyle. Conversely, the distance between the proximal anterolateral portal cannula and the nerve was statistically greater (p < 0.05), averaging 7.9 mm in extension and 13.7 mm in flexion. The remaining anterolateral portal, located 1 cm directly anterior to the lateral epicondyle, was found to be at a statistically greater average distance from the nerve than was the distal anterolateral portal but statistically closer than was the more proximal portal. The ability to visualize the joint arthroscopically was assessed using the three portals, and although the ulnohumeral joint could be adequately seen using all portals, radiohumeral joint visualization was most complete and technically easiest using the most proximal portal.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

PubMed1993

A 31P NMR study of the interaction of the antitumor active metallocene Cp2MoCl2 with calf thymus DNA.

Treatment of sonicated calf thymus DNA with the antitumor active metallocene Cp2MoCl2 afforded a metallocene-DNA complex which was characterized by 31P NMR spectroscopy. In addition to the resonance for the phosphate backbone (delta-1.6), the spectrum contained 2 signals assigned to a phosphate bound Mo-DNA complex(es) (delta 37.2, 36.5) and a broad signal at delta 6.2 ppm. This result suggests that covalent attachment of the metallocene Cp2MoCl2 occurs via phosphate(O) coordination and is accompanied by local distortion of the DNA backbone. This result supports recent ICP studies with Cp2TiCl2 that have DNA detected DNA-metallocene adducts.

Animals↗

PubMed1993

Comparison of patella tendon versus patella tendon/Kennedy ligament augmentation device for anterior cruciate ligament reconstruction: study of results, morbidity, and complications.

In a study designed to evaluate the efficacy of supplementing patellar tendon bone-tendon-bone intraarticular anterior cruciate ligament (ACL) reconstructions with the polypropylene braid ligament augmentation device (Kennedy LAD; 3M, Minneapolis, MN), 75 consecutive patients treated between July 1988 and January 1990 with isolated ACL disruptions in whom no associated ligament injury was present were offered the LAD as part of their preoperative consent. Interference screws at both bone plugs were used. Group I was composed of 25 patients (10 acute, 15 chronic) with ACL disruptions who had the LAD added to their reconstruction. Group II was composed of 50 patients (24 acute, 26 chronic) who underwent an identical surgical procedure except that the LAD was not used. Objective and subjective assessments were made throughout the postoperative course, with the longest follow-up an average of 24 months postoperatively. Statistical analysis of these findings failed to show any statistically significant differences between the groups. Complications that occurred among the augmented group included infection, synovitis, effusion, and recurrence of instability, intraarticular adhesions, hemarthrosis, and painful hardware. This study demonstrates that the LAD added to the morbidity and severity in this series. It does not seem to improve results and is therefore not recommended for use in this manner.

Adolescent↗

PubMedDate not supplied

The pain control infusion pump for postoperative pain control in shoulder surgery.

PURPOSE: This study was initiated to evaluate the effect of a pain control infusion catheter in managing postoperative pain. TYPE OF STUDY: In a prospective, randomized trial, 62 consecutive patients undergoing arthroscopic subacromial decompression had an indwelling pain control infusion catheter placed at the operative site. MATERIALS AND METHODS: Thirty-one patients received 0.25% bupivacaine and 31 patients received saline infusions, each at a constant rate of 2 mL per hour. Patients evaluated their pain by visual analog scale, and also tabulated the amount of narcotic and nonnarcotic medication used each day in the first week of surgery. RESULTS: There was a statistically significant difference in pain in all parameters tested in the bupivacaine group as compared with the saline control group (P <.05). CONCLUSIONS: The bupivacaine pain control infusion pump is an effective means of decreasing postoperative pain.

Adult↗

PubMedDate not supplied

Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: a cause of anterior shoulder instability.

Recurrent anterior unidirectional shoulder instability is most commonly associated with an avulsion of the glenoid attachment of the labroligamentous complex (Bankart lesion). However, additional capsular injury is often considered necessary to allow anterior dislocation. Five patients undergoing surgical stabilization for recurrent anterior instability were noted to have not only a classic Bankart lesion but also a complete disruption of the lateral capsule from the humeral neck. Repair of this "floating" anterior inferior glenohumeral ligament was accomplished by reattachment of the medial and lateral capsular disruptions and has led to excellent postoperative function in these patients. None of the patients has had instability after an average follow-up of 26 months. Identification and repair of this unusual anatomic lesion is important and if missed may have a significant negative effect on postoperative stability.

Adolescent↗

PubMedDate not supplied

Hemiarthroplasty of the shoulder for rotator cuff arthropathy.

Sixteen patients underwent hemiarthroplasty for rotator cuff arthropathy between June 1989 and March 1992, and evaluations obtained before and after surgery in all patients were compared. A modular head large enough to articulate with the coracoacromial arch but not so large as to prevent approximately 50% of humeral head translation on the glenoid was used in these cases. Each patient was evaluated with Neer's limited goals rating scale after an average follow-up of 33 months (24 to 55 months). Ten patients were rated as successful and six as unsuccessful. Four of the six unsuccessful patients had undergone at least one attempt at rotator cuff repair with acromioplasty before the index procedure, and two of these four patients had deficient deltoid function after this rotator cuff surgery as a result of postoperative deltoid detachment. Also, three of these four patients who had previously undergone acromioplasty subsequently had anterosuperior subluxation after hemiarthroplasty. Hemiarthroplasty did not provide for a successful outcome in all patients with rotator cuff arthropathy. However, 10 of the 12 patients in this series with good deltoid function and an adequate coracoacromial arch were rated as successful by Neer's limited goals criteria. In addition, this study illustrates that formal acromioplasty carried out during attempts at rotator cuff repair in such patients may jeopardize the subsequent success of hemiarthroplasty.

Aged↗

PubMedDate not supplied

Arthroscopic management of the arthritic elbow: indications, technique, and results.

Twenty-four patients with painful restricted motion of the elbow joint because of an arthritic process were treated with an arthroscopic modification of the open Outerbridge-Kashiwagi procedure. Average preoperative flexion was to 90 degrees (range 60 degrees to 140 degrees), and average extension loss was -40 degrees (range -5 degrees to -60 degrees). The average total arc of motion was 50 degrees. The procedure consisted of arthroscopic debridement, partial resection of the coronoid and olecranon processes, and fenestration of the olecranon fossa. The radial head was excised arthroscopically in 18 of the 24 patients. All patients were reexamined 24 to 60 months after operation (mean 32 months). All patients had a significant decrease in pain as described by a visual analog scale (preoperative 8.2; postoperative 2.2). Average flexion was to 139 degrees (range 95 degrees to 145 degrees), and average extension loss was -8 degrees (range 0 degree to 15 degrees). The average arc of motion was 131 degrees, an improvement of 81 degrees. Arthroscopic ulnohumeral arthroplasty provides satisfactory results in terms of pain control and improved motion. The complication rate is comparable to those reported in series of open ulnohumeral arthroplasties. This procedure seems to be a valuable adjunct in the management of the arthritic elbow, serving as an intermediate step between nonoperative management and elbow replacement surgery.

Adolescent↗

PubMedDate not supplied

Arthroscopic treatment of multidirectional instability.

Multidirectional instability of the shoulder, described by Neer and Foster, has been treated surgically with the inferior capsular shift procedure. The small number of reports on mid-term outcomes indicate that good to excellent results have been obtained in 75% to 100% of cases. Arthroscopic treatment of multidirectional instability has been previously described. The purpose of this study was to review the results of the arthroscopic capsular shift procedure with a minimum follow-up of 2 years. A retrospective study was performed on 25 patients who underwent an arthroscopic capsular shift performed with the transglenoid technique between January 1990 and December 1993. All patients had earlier not responded to an extensive course of physical therapy. Excluded from the study were patients who had undergone a previous arthroscopic capsular shift or any other procedure, arthroscopic or open, for the shoulder. Average patient age was 26.4 years. There were 20 male and 5 female patients. Sixteen of the affected shoulders involved the dominant extremity. All patients had a history of asymptomatic subluxation that slowly progressed to symptomatic subluxation. Eleven patients had a history of dislocation. Thirteen patients were athletes who were symptomatic in their chosen sport, whereas the other patients were symptomatic in activities of daily living. All patients were examined while they were under anesthesia and had positive results on the sulcus test in abduction with associated anterior instability, posterior instability, or both. Follow-up evaluation was performed with patient interview and examination. All 25 patients were available for follow-up, which occurred an average of 60 months (range 36 to 80 months) after operation. Three patients had episodes of instability after the operation. The average Bankart score was 95 (range of 50 to 100). All but 1 patient had regained full symmetric range of motion by follow-up. Twenty-one (88%) patients had a satisfactory result according to the Neer system. Results of treatment with the arthroscopic capsular shift procedure for multidirectional instability of the shoulder appear to be comparable to those of the open inferior capsular shift.

Adolescent↗

PubMedDate not supplied

Rotator cuff repairs in patients 62 years of age or older.

We retrospectively reviewed 105 consecutive patients aged 62 years and older who had undergone a repair of a rotator cuff tear to evaluate the efficacy of this surgery in patients in this age range. Six patients died, and 7 had less than 2 years of follow-up or were incapable of returning for examination. Ninety-two patients with 97 rotator cuff tears were re-examined. The average preoperative UCLA (University of California, Los Angeles) score was 12.9 (range 8 to 20), and the average postoperative score was 32.4 (range 12 to 35). Five patients (5%) had failure of the repair, accounting for the poor results. Severe complications included infection (1 patient) and brachial plexus stretch injury (1 patient). Four additional patients sustained minor complications, for an overall rate of 6%. Overall, 87% of patients had good or excellent results. Eight additional patients, while satisfied, were classified as fair. Of the 5 failures, 3 were revised to a satisfactory result. Thus 90 of the 92 patients in the study were satisfied with the result of the surgery at final follow-up. Rotator cuff repair in patients 62 years and older results in increased function, decreased pain, and satisfactory results.

Aged↗