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Biomedical subjects

M J Moskal

Publications and source records attributed to M J Moskal.

11 recordsLinked to original sources
PubMed2001

Arthroscopic treatment of posterior impingement of the elbow in athletes.

Arthroscopic treatment of posterior impingement of the elbow in athletes consistently can improve comfort and function. Arthroscopic treatment is particularly valuable because of increased intra-articular visualization of the anterior and posterior compartments and diminished soft tissue trauma. Arthroscopic visualization also can help the surgeon assess small pathologic changes in joint congruity seen in subtle forms of ligamentous instability, which are often symptomatic in high-demand athletes. Treatment of these subtle instabilities can be individualized to the athlete. Most athletes are able to return to the same level of their sport after arthroscopic surgery for posterior impingement of the elbow. In certain athletes, however, depending on the position played, reoperation rates are high, and return rates to the same level of competition can be less than in other athletes with posterior impingement of the elbow. Patient selection, technical expertise, and familiarity with open and arthroscopic elbow surgery are all criteria for success.

Arthroscopy↗
PubMed2001

Arthroscopic capsulodesis of the lunotriquetral joint.

A case series consisting of 20 consecutive patients with persistent ulnar-sided mechanical wrist pain, lunotriquetral interosseous (LTIOL) ligament tears resulting in joint incongruity and increased laxity, and traumatic triangular fibrocartilage complex (TFCC) tears was reviewed. Each patient underwent an arthroscopic reduction and internal fixation (ARIF) of the lunotriquetral joint, arthroscopic disk-carpal (disklunate-ulnocapitate-disktriquetral, DL-UC-DT) ligament plication, and TFCC repair or débridement. There were 12 right wrists and 8 left wrists, of which 12 were dominant. The mean patient age was 33 years; 7 patients had workers' compensation claims and 2 had legal claims. Fourteen patients recalled a specific injury mechanism, such as hyperextension or rotation. The accompanying traumatic TFCC tears were peripheral in 15 and linear radial in 6 patients (one patient had concomitant peripheral and radial linear tears), and in 6 cases, the palmar ulnocarpal extrinsic ligaments were partially torn. The mean preoperative modified Mayo Wrist Score was 50, and at a mean of 3.1 years after surgery, the score had increased to 88. There were 13 excellent, 5 good, and 2 fair results. Four patients had complications, including transient tenderness along the extensor carpi ulnaris and persistent neuritis of a dorsal branch of the ulnar nerve. Overall wrist comfort and function, as indicated by the modified Mayo Wrist Scores, improved after arthroscopic stabilization of ulnar-sided wrist injuries (pinning of the lunotriquetral joint, disk-carpal ligament plication, and TFCC repair or débridement).

Adult↗
PubMed2001

Revision amputation achieving maximum function and minimizing problems.

Revision amputation is one of the most commonly performed operations in hand surgery. Despite being considered, a relatively straightforward procedure, it demands the full skills of the operating surgeon. Appropriate management is dependent upon a comprehensive understanding of hand anatomy and function, the ability to communicate clearly with the patient, and a repertoire of technical skills that allows the surgeon to select the most appropriate line of management.

Amputation, Surgical↗
PubMed1999

Elbow arthroscopy in trauma and reconstruction.

Arthroscopy of the elbow has become a valuable adjunct in the evaluation and treatment of elbow trauma and reconstruction. Arthroscopic visualization aids diagnosis and treatment while minimizing surgical trauma. The indications and techniques of elbow arthroscopy continue to expand and evolve. This article demonstrates the use of elbow arthroscopy as it relates to some of the topics in this volume. Arthroscopic setup, portal anatomy, technique, as well as an overview of trauma, loose bodies, bursitis, instability, arthrofibrosis, arthritis, and complications are discussed.

Arm Injuries↗
PubMed1999

Glenohumeral motion after complete capsular release.

The range of glenohumeral motion is primarily limited by the joint capsule. If the capsule is contracted, greater restriction in glenohumeral motion is exhibited. Release of a tight capsule has been an effective means of managing refractory stiffness of the glenohumeral joint. The effect of a complete capsular release on glenohumeral kinematics has not been previously studied in a cadaver model. Elevation, rotation, and translation of eight cadaveric glenohumeral preparations were studied before and after complete capsular release. As the intact joint was positioned near the limits of motion, glenohumeral torque rose rapidly with relatively small concomitant increases in elevation and rotational angles. Notable torque, due to tension in the capsule or cuff, ensued only after glenohumeral elevation reached approximately 80% of maximal range. After complete capsular release, maximal elevation increased on average 15%, yet retained definitive endpoints due to residual tension in the rotator cuff. Axial humeral rotation with an intact capsule decreased as maximum elevation approached, especially at elevation angles greater than 60 degrees. Maximum internal rotation was less than external, for all planes except +90 degrees. After complete capsular release, the greatest net gains for external rotation tended to be in the posterior scapular planes, whereas gains for internal rotation tended to be in the anterior scapular planes. Maximal translation in an intact vented capsule was 21 mm, 14 mm, and 15 mm in the anterior, posterior, and inferior directions, respectively. After complete capsular release, translation increased in all positions with maximal anterior, posterior, and inferior translations of 28 mm, 25 mm, and 28 mm, respectively. In general, relative gains in translation were greater in planes posterior to the scapula and at extremes of the range of motion. Although large glenohumeral translations were measured, no preparation could be dislocated before or after complete capsular release. Complete capsular release significantly increased glenohumeral range of motion and translation. The intact rotator cuff myotendinous units serves to limit the range of motion and translation after all capsuloligamentous attachments are rendered incompetent by complete capsular release.

Cadaver↗
PubMed1998

The correlation of comorbidity with function of the shoulder and health status of patients who have glenohumeral degenerative joint disease.

We studied the effect of comorbidities on function of the shoulder and health status in a group of eighty-five consecutive patients who had glenohumeral degenerative joint disease of sufficient severity to meet one surgeon's criteria for the performance of shoulder arthroplasty. A questionnaire was used to identify the comorbidities, such as other diseases, social factors, or a work-related injury, for each patient. The number of functions on the Simple Shoulder Test that the patient could perform had a significant negative correlation with the number of comorbidities (r = -0.32, intercept = 4.6 per cent, slope = -0.6, and p = 0.0031). Each parameter on the Short Form-36 (except for physical role function) had a significant negative correlation with the number of comorbidities (p < 0.05). This negative relationship was strongest for general health perception (r = -0.42) and vitality (r = -0.35). We concluded that the number of comorbidities has a quantitative effect on function of the shoulder. In the evaluation of the functional status of patients and the effectiveness of treatment, the effects of comorbidity must be controlled. The results of the present study demonstrate that the scores on the Short Form-36 are quantitatively related to the number of comorbidities. The six parameters that are unrelated to function of the shoulder (physical function, social function, emotional role function, mental health, vitality, and general health perception) may provide a practical way to integrate the effects of all potential comorbidities on individual patients. Future clinical research will be strengthened by efforts to measure the impact of comorbidities and by strategies to control for their effects.

Adult↗