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Biomedical subjects

Matthew L Ramsey

Publications and source records attributed to Matthew L Ramsey.

15 recordsLinked to original sources
PubMed2006

Loss of passive external rotation at 90 degrees abduction is predictive of a medially healed Bankart lesion.

PURPOSE: This prospective study correlates passive range of external rotation with arthroscopic findings in patients with anterior instability for the purpose of defining criteria that can be used to detect a medially healed Bankart lesion. METHODS: External rotation at 90 degrees abduction (ER90) was assessed on examination with the patient under anesthesia in bilateral shoulders of 46 consecutive patients with unidirectional, anterior glenohumeral instability. Arthroscopy was used to identify 22 patients with a detached Bankart lesion (group I) and 24 patients with a medially healed Bankart lesion (group II). Differences in ER90 between symptomatic and asymptomatic shoulders for both groups were compared. The t test and the Wilcoxon rank-sum test measured significance. RESULTS: In group I, mean ER90 in the symptomatic shoulder was 5 degrees greater than in the asymptomatic shoulder; in group II, mean ER90 in the symptomatic shoulder was 7.4 degrees less than in the asymptomatic shoulder (P < .001). Loss of ER90 was highly sensitive (92%) and specific (95%), with a positive predictive value of 96% for detection of a medially healed Bankart lesion. CONCLUSIONS: If a loss of 5 degrees or more of ER90 in the affected shoulder is found on examination under anesthesia, one should have a high degree of suspicion for the presence of a medially healed Bankart lesion. LEVEL OF EVIDENCE: Level II, development of diagnostic criteria on basis of consecutive patients.

Adolescent↗
PubMed2006

Arthroscopy effectively treats ganglion cysts of the shoulder.

UNLABELLED: In the hands of an experienced arthroscopist, arthroscopic decompression of a spinoglenoid notch cyst can lead to resolution of a patient's symptoms and complete functional recovery. In our study, we hypothesized that patients with a spinoglenoid notch cyst who were treated arthroscopically would have return to near normal function of their shoulders and that the outcomes for patients with a spinoglenoid notch cyst and associated labral tears would be no different than the outcomes for patients with a spinoglenoid notch cyst without associated labral tears. We retrospectively evaluated 18 consecutive patients who were treated arthroscopically for a spinoglenoid notch cyst. Nine had isolated arthroscopic decompression, and nine arthroscopic decompression with a labral repair. We used the validated American Shoulder and Elbow Society (ASES) and University of Pennsylvania (Penn) shoulder scores to evaluate patients' outcomes. We found improvements in the postoperative ASES and Penn shoulder scores for all outcomes measured including pain, satisfaction, and function. However, there were no differences in outcome when comparing the group that had decompression with the group that had decompression and labral repair for an associated superior labral anterior posterior tear. LEVEL OF EVIDENCE: Therapeutic study, Level III (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

Arthroscopic and open Bankart repairs provide similar outcomes.

UNLABELLED: Recurrent instability after arthroscopic Bankart repair has decreased, largely because of improvements in surgical technique. We wanted to know whether there were differences in functional outcomes (using a validated outcomes measure) in patients who had arthroscopic Bankart repair or open Bankart repair for recurrent anterior glenohumeral instability. We retrospectively reviewed 106 patients who had a Bankart repair for recurrent anterior glenohumeral instability from 1998-2001. Of the 93 patients included, 69 patients had arthroscopic Bankart repair and 24 patients had open Bankart repair. The indications for surgery in the two groups were similar. The average age of the patients was 29.9 years (arthroscopic Bankart repair, 31 years; open Bankart repair, 28 years). The followup ranged from 24-77 months. The average modified American Shoulder and Elbow Surgeons score (PENN score) for pain, satisfaction, and function were 26.3, 8.5, and 55.1, respectively, in the arthroscopic Bankart repair group and 26.6, 8.8, and 54.2, respectively, in the open Bankart repair group. The total score was 90 in the arthroscopic Bankart repair group and 89.5 in the open Bankart repair group. Recurrent instability occurred in one patient in each group. We found no difference in outcomes between the arthroscopic and open Bankart repair groups using patient-assessed outcomes. LEVEL OF EVIDENCE: Therapeutic Study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Axillary nerve monitoring during arthroscopic shoulder stabilization.

PURPOSE: This study evaluated the ability of a novel intraoperative neurophysiologic monitoring method used to locate the axillary nerve, predict relative capsule thickness, and identify impending injury to the axillary nerve during arthroscopic thermal capsulorrhaphy of the shoulder. TYPE OF STUDY: Prospective cohort study. METHODS: Twenty consecutive patients with glenohumeral instability were monitored prospectively during arthroscopic shoulder surgery. Axillary nerve mapping and relative capsule thickness estimates were recorded before the stabilization portion of the procedure. During labral repair and/or thermal capsulorrhaphy, continuous and spontaneous electromyography recorded nerve activity. In addition, trans-spinal motor-evoked potentials of the fourth and fifth cervical roots and brachial plexus electrical stimulation, provided real-time information about nerve integrity. RESULTS: Axillary nerve mapping and relative capsule thickness were recorded in all patients. Continuous axillary nerve monitoring was successfully performed in all patients. Eleven of the 20 patients underwent thermal capsulorrhaphy alone or in combination with arthroscopic labral repair. Nine patients underwent arthroscopic labral repair alone. In 4 of the 11 patients who underwent thermal capsulorrhaphy, excessive spontaneous neurotonic electromyographic activity was noted, thereby altering the pattern of heat application by the surgeon. In 1 of these 4 patients, a small increase in the motor latency was noted after the procedure but no clinical deficit was observed. There were no neuromonitoring or clinical neurologic changes observed in the labral repair group without thermal application. At last follow-up, no patient in either group had any clinical evidence of nerve injury or complications from neurophysiologic monitoring. CONCLUSIONS: We successfully evaluated the use of intraoperative nerve monitoring to identify axillary nerve position, capsule thickness, and provide real-time identification of impending nerve injury and function during shoulder thermal capsulorrhaphy. The use of intraoperative nerve monitoring altered the heat application technique in 4 of 11 patients and may have prevented nerve injury. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Adolescent↗
PubMed2005

Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcome.

PURPOSE: To compare the outcome of patients who underwent rotator cuff repair using all arthroscopic or mini-open repair techniques. TYPE OF STUDY: Retrospective comparative study. METHODS: We retrospectively reviewed 54 patients who underwent either mini-open or arthroscopic rotator cuff repair. Twenty-six patients underwent mini-open repair and 28 patients had arthroscopic repair. Follow-up averaged 33 months (range, 18 to 48 months) for the mini-open group and 19 months (range, 13 to 26 months) for the arthroscopic group. The patient groups were similar with regard to age, activity level, mechanisms of injury, associated findings at surgery, and tear size measured in square centimeters. The outcome for the 2 groups was evaluated using a modified American Shoulder and Elbow Society (ASES) score. Statistical analysis was performed using Pearson correlations and the Student t test. RESULTS: The tear size averaged 2.7 cm2 for the mini-open group and 2.0 cm2 for the arthroscopic group (P = .754). All patients showed significant improvement in their scores for pain, satisfaction, and function at the time of follow-up. The average preoperative and postoperative scores for the mini-open group were as follows: pain 17 and 27 (30 possible points), satisfaction 3 and 9 (10 possible points), function 32 and 53 (60 possible points), and total 52 and 89 (100 possible points) (P < .05). For patients who underwent arthroscopic repair, average preoperative and postoperative scores were as follows: pain 12 and 26, satisfaction 2 and 9, function 28 and 51, and total, 42 and 86 (P < .05). Improvement in scores within each group was significant, but the difference in total scores between the 2 techniques was not statistically significant. CONCLUSIONS: This study confirms that short-term results for arthroscopic and mini-open rotator cuff repair are similar and supports continued use of arthroscopic repair techniques. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Adult↗
PubMed2005

Recalcitrant nonunion of the distal humerus: treatment with free vascularized bone grafting.

UNLABELLED: We sought to determine whether open reduction and internal fixation in combination with free vascularized bone grafting and elbow contracture release is an effective treatment for patients with recalcitrant distal humeral nonunions with segmental bone loss. In addition, we wondered whether this treatment strategy has an acceptable complication rate. Five patients, with an average age of 48 years, form the basis of our study. An average of 3.4 surgical procedures were done before the vascularized bone grafting for treatment of nonunion. The average time from injury until the index vascularized graft was 37.2 months. All patients had elbow pain at rest and had severe functional limitations related to the nonunion. There was segmental bone loss averaging 3.2 cm at the time of vascularized grafting. Four of the five patients with nonunions had clinical and radiographic union at the latest followup, and one patient required a total elbow arthroplasty because of articular collapse after the vascularized grafting procedure. The average time from vascularized grafting until bony union was 4.5 months (range, 3-6 months). There were no other complications in this patient group. Free vascularized bone grafting is a treatment alternative for distal humeral fracture nonunion, especially in younger patients who have nonunions with segmental bone loss that are refractory to conventional fixation and bone grafting techniques. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical, control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2004

Outcome of open reduction and internal fixation of surgical neck nonunions of the humerus.

OBJECTIVE: The purpose of this study was to evaluate the results of open reduction and internal fixation of nonunions of the surgical neck of the humerus. DESIGN: Retrospective review of patients who underwent operative treatment of a surgical neck of the humerus nonunion. SETTING: Shoulder and elbow service at two university centers. PATIENTS: Thirteen patients with a two-part nonunion of the surgical neck of the humerus who were treated with open reduction and internal fixation with bone graft with a minimum of 12 months' follow-up were included. Patients with avascular necrosis, posttraumatic arthritis, severe humeral head bone loss, or a nonunion of one of the two tuberosities were excluded. INTERVENTION: Open reduction and internal fixation with either a blade plate or a T-plate and autogenous bone graft. MAIN OUTCOME MEASURES: Medical records, operative reports, physical examination, and preoperative and postoperative radiographs were reviewed. Outcome was assessed using Neer's criteria for the evaluation of total shoulder arthroplasty, visual analogue pain scale, range of motion, and ability to perform activities of daily living.RESULTS The results were excellent in 11 patients, satisfactory in 1 patient, and poor in 1 patient. The 11 nonunions in patients with excellent results healed within 6 months. The patient with the poor result initially had a persistent nonunion and required revision, open reduction and internal fixation, and bone grafting. This patient healed and went on to have an excellent result at final follow-up. All fractures were healed at the time of this study. Pain scores decreased from an average of 4.2 preoperatively to 1.2 postoperatively on a 5-point pain scale. Forward elevation in the scapular plane improved from 24 degrees preoperatively to 144 degrees postoperatively. All patients but one were able to attain overhead elevation. All patients were able to perform activities of daily living, such as dressing, bathing, combing hair, and performing perineal care, at final follow-up. Overall satisfaction increased from an average of 1.0 to 9.4 on a 10-point visual analogue scale. CONCLUSIONS: Open reduction and internal fixation with autogenous bone graft results in excellent outcomes even in patients >65 years old and patients with significant medical problems. This treatment method offers predictable fracture healing and has a low complication rate.

Activities of Daily Living↗
PubMed2004

Nonprosthetic management of proximal humeral fractures.

Many proximal humeral fractures can be treated without the need for hemiarthroplasty. Treatment choice is affected by fracture location and pattern, as well as by patient factors including age, activity level, quality of bone, and ability to comply with a regimen of therapy. Successful diagnosis and treatment of proximal humeral fractures is dependent on good-quality radiographs, but in some cases, intraoperative assessment of the fracture pattern is required for a complete and accurate diagnosis of the fracture pattern and severity. A discussion of nonsurgical and surgical treatment options and techniques needed to achieve anatomic reduction and stable fixation is important.

Fracture Fixation, Internal↗
PubMed2002

Ipsilateral intercondylar distal humerus fracture and Monteggia fracture-dislocation in adults.

We present two cases of ipsilateral Monteggia fracture-dislocations and intercondylar distal humerus fractures in adults. To our knowledge, this combination of injuries has not been described in skeletally mature individuals. Both patients were treated with rigid internal fixation of the bony injuries as well as early rehabilitation protocols. Despite the severity of the injuries, both patients had satisfactory results. Adherence to established internal fixation protocols is critical in the treatment of complex upper extremity injuries.

Adolescent↗
PubMedDate not supplied

Surgical treatment of os acromiale with and without associated rotator cuff tears.

Nineteen consecutive patients treated surgically for meso-os acromiale and subacromial pathology were reviewed retrospectively, with a mean length of follow-up of 40 months (range, 24-94 months). Of the patients, 11 (58%) were treated with acromioplasty in the presence of a stable os acromiale; 8 patients (42%) underwent open reduction-internal fixation for an unstable and painful os fragment. Of the 19 patients, 8 (42%) with an os acromiale had an associated full-thickness rotator cuff tear. Overall, only 10 of 19 patients (53%) achieved a satisfactory result. All 8 patients (100%) treated with open reduction-internal fixation achieved union of the os fragment, although only 3 (37.5%) achieved a satisfactory result. Of the 11 patients who underwent acromioplasty, only 7 (64%) achieved a satisfactory result. The outcome of surgical management of symptomatic meso-os acromiale with concomitant rotator cuff pathology was satisfactory in 4 of 8 patients in our study group. The rate of satisfactory results was similar in patients with (50%) and without (55%) associated rotator cuff tears. When we analyzed our results to exclude workers' compensation patients, 80% achieved satisfactory results (compared with only 22% in our workers' compensation group).

Acromion↗
PubMedDate not supplied

Non-prosthetic management of grade IV osteochondral lesions of the glenohumeral joint.

Osteochondral lesions of the glenohumeral joint in early stages and in younger patients are an important problem and present a challenge during clinical decision making. Although prosthetic arthroplasty remains the gold standard for treatment in later stages of the disease, alternatives are desirable in the early stages and in young patients. The purposes of this study are to evaluate the results of arthroscopic debridement and capsular release in patients with grade IV osteochondral lesions of the glenohumeral joint and to determine the factors associated with their success. Sixty-one patients with grade IV osteochondral lesions of the glenohumeral articular surfaces were treated with arthroscopic debridement, with or without arthroscopic capsular release. Standardized data collection was performed at the initial office visit and at the time of final follow-up. Overall outcome was analyzed with regard to patients' self-assessment of pain, function, improvement, satisfaction, and duration of pain relief. Forty-five of the patients had a minimum follow-up of 2 years. Time-to-event analysis was used to evaluate the duration of pain relief. The mean patient satisfaction score (0 = not satisfied; 10 = completely satisfied) improved from 0.67 preoperatively to 6.28 at final follow-up (P <.0001), with 87% of patients indicating that they would have the surgery again. Although workers' compensation patients obtained inferior results, significant improvement in pain and function was obtained in 88% of all patients (P <.0001). Most patients noted the onset of pain relief within 5 weeks of surgery and obtained a duration of pain relief of 28 months or greater (P <.05). The addition of concomitant procedures, such as acromioplasty, distal clavicle resection, labral debridement, or labral repair, did not have a negative impact on the functional results after arthroscopic debridement and capsular release. In well-selected patients with grade IV osteochondral lesions of the glenohumeral joint, significant improvements in pain relief and function follow arthroscopic debridement of the glenohumeral joint. Arthroscopic capsular release can be added in patients with a loss of passive arcs of shoulder motion. Osteochondral lesions greater than 2 cm(2) appear to be associated with return of pain and failure of this procedure.

Adult↗
PubMedDate not supplied

Iliotibial band reconstruction for treatment of glenohumeral instability associated with irreparable capsular deficiency.

The surgical management of patients with recurrent anterior instability after failed surgery can be complicated by the loss of capsular tissue and, in some cases, irreparable tears of the subscapularis tendon. We describe a new surgical technique for reconstruction of the capsular ligaments using the iliotibial band (ITB) to reconstruct deficient capsular tissues, and we report the results of 7 patients. All patients had prior surgery, with a mean of 2.2 procedures, and recurrent instability as the primary indication for their index and revision surgeries. After ITB reconstruction, the patients demonstrated significant improvement in their American Shoulder and Elbow Surgeons (ASES) score (P =.0004), and no patient had any persistent symptoms of instability. Physiologic range of motion and function were maintained. We would recommend our method of ITB reconstruction for patients with instability and capsular deficiency after failed surgery and believe that this procedure has advantages over those previously described. Capsular deficiency and persistent instability after prior surgery can occur after prior open or arthroscopic surgery. Capsular deficiency has been described after thermal capsulorrhaphy and is thought to represent excessive thermal injury and tissue necrosis. After open capsulorrhaphy, capsular deficiency can be associated with subscapularis tendon deficiency.(4,6-8,12,13) Capsular deficiency occurring after either open or arthroscopic surgery presents a difficult surgical challenge. The purpose of this case series is to evaluate our experience in the surgical management of recurrent glenohumeral instability after surgery initially performed for treatment of glenohumeral instability that failed and is associated with irreparable tears of the subscapularis and capsular deficiency. The primary objectives of this study are to describe the surgical technique for capsular reconstruction with ITB and to report the clinical results in 7 patients.

Adult↗
PubMedDate not supplied

Intratendinous strain fields of the supraspinatus tendon: effect of a surgically created articular-surface rotator cuff tear.

Articular-surface partial-thickness rotator cuff tears play a significant role in shoulder pathology, but the role of the articular-surface tissue is poorly understood. This investigation assessed the effect of an articular-surface partial-thickness rotator cuff tear on intratendinous strain fields. A magnetic resonance imaging-based technique quantified intratendinous strains in healthy cadaveric shoulders at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of glenohumeral abduction. A second set of magnetic resonance images was acquired after an articular-surface partial-thickness tear was created arthroscopically. Measures of strain were grouped into 3 tendon regions. A 3-factor analysis of variance assessed the effects of joint position, tendon region, and tendon tear. Intratendinous strains were influenced significantly by joint position, but few differences existed between tendon regions. The articular-surface partial-thickness tear increased intratendinous strain for all joint positions except 15 degrees. The results lend insight into the mechanical behavior of the normal and pathologic rotator cuff.

Adult↗