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W H Castro

Publications and source records attributed to W H Castro.

At least 55 records · Page 3Linked to original sources
PubMed1993

Does the glenohumeral joint capsule have proprioceptive capability?

We performed a clinical study examining 60 volunteers with stable shoulder joints randomized to two groups. In group 1 we injected 5 ml lidocaine intra-articularly. In group 2 we injected 5 ml saline with 5 ml contrast dye the same way. After the injection we measured the amount of passive anteroposterior translation that occurred during anterior and posterior drawer tests and the amount of inferior subluxation during downward stress. We documented the extent of the passive glenohumeral translation using ultrasound. We had no complications related to the intra-articular injection or to the stability measurement. After the injection neither group had significant pain, and the patients were not apprehensive about the ensuing stability test. In group 1 (lidocaine) anteroposterior translation of 13.2 +/- 6.3 mm was seen in the anterior and posterior drawer test, whereas in group 2 (no lidocaine) the anteroposterior translation was only 6.8 +/- 3.2 mm. The difference between the two groups was statistically significant (P < 0.05). With downward stress during the sulcus test the distance between the acromion and the humeral head increased by 5.6 mm (+/- 3.2) in group 1 and by 2.7 mm (+/- 2.1) in group 2. This difference was also statistically significant (P < 0.05). Clinical consequences: Taking our preliminary findings into account, the capsule of the glenohumeral joint seems to have proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism. If our conclusions proprioceptive capability. Nerve fibres and mechanoreceptors seem to be localized in the capsule tissue, being part of a physiological feedback mechanism.

Adolescent↗
PubMed1993

[Magnetic resonance morphologic changes in shoulder joints of world class water polo players].

UNLABELLED: In a prospective study we examined the dominant shoulder of 11 athletes from the 1992 German Olympic water polo team. Their mean age was 25.4 +/- 3.5 years. Water polo had been practised generally for 14.1 +/- 4.3 years and professionally for 11.6 +/- 3.9 years. The weekly training amounted to between 12.5 and 19.5 hours. All athletes were submitted to standardised clinical, sonographical and MRI tests. In 5 cases we found anamnestic and/or clinical indications of rotator cuff pathology. In all 5 cases the supraspinatus tendon was affected, and in three cases both the supra- and the infraspinatus tendon were involved. Sonographically, no specific pathology except a thickened rotator cuff was seen. Remarkable changes were revealed by magnetic resonance imaging. In 8 cases changes were present in the insertion of the rotator cuff at the humeral head. The subacromial bursa was not pathologic. The tendon of the long head of the biceps was pathologically changed in 9 cases. In 7 athletes a so-called biceps halo and in two an osteophyte in the area of the bicipital groove was visible. In all of the 11 dominant shoulder joints massive hypertrophy of the articular capsule and pathologic changes of the anterior glenoid labrum existed. Occult osseous lesions were detected in 5 athletes, and osseous lesions of the humeral head in 8 athletes. In all athletes we could document degenerative changes at the acromioclavicular joints such as effusion in 7 cases, arthritis in two cases, and evident synovitis in two cases. CLINICAL RELEVANCE: Many of the changes detected by MRI were not symptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromioclavicular Joint↗
PubMed1993

[Nuclear magnetic tomography of the meniscus in asymptomatic probands].

In 82 asymptomatic subjects aged 8-62 years we evaluated the menisci by MRI [1.0 tesla; SE (spin-echo) 700/20, PS (partial saturation) 500/10, STIR (Short-Time-Inversion-Recovery-Sequence) 1600/130/30]. The meniscus was graded by means of a standard classification (grades 0-4). In SE sequences we found grade 0 in 45.5% of all cases, grade 1 in 33.2%, grade 2 in 16.1%, grade 3 in 4.5%, and grade 4 in 0.7%. In PS sequences we found grade 0 in 23.9%, grade 1 in 27.5%, grade 2 in 31.5%, grade 3 in 15.9%, and grade 4 in 1.1%. In STIR sequences we found grade 0 in 56%, grade 1 in 25.4%, grade 2 in 11.1%, grade 3 in 6%, and grade 4 in 1.6%. Correlation of meniscus degeneration with subjects' age showed relation of meniscus degeneration with subjects' age showed relation of meniscus degeneration with subjects' age showed an increase of grade 3 and grade 4 lesions with advancing age. Subjects older than 50 years presented grade 3 and 4 lesions in the SE sequence in 28.5% of the cases, in PS sequences in 40.7% of the cases, and in STIR sequences in 25% of the cases. MRI shows meniscal lesions in a significant proportion of asymptomatic patients, especially among subjects older than 50 years. The orthopedic surgeon has to test whether the clinical findings in patients with knee complaints coincide with the results of MRI.

Adolescent↗
PubMed1992

[Ultrasound diagnosis of lumbar intervertebral disk displacement--a clinically relevant method?].

UNLABELLED: In a prospective clinical study, 102 patients suffering from low back pain were examined by ultrasound. In all patients the segments L3/4, L4/5, and L5/S1 were evaluated. We analysed a total of 306 lumbar disc segments. Ultrasound evaluation was transabdominally performed by using a 3,5 MHz scanner. The results of the ultrasound documentation were compared to MRI or if the patient was operated on with the intraoperative findings. In 25 disc the dorsal border of the disc could not be demonstrated by ultrasound. The statistical analysis resulted in the following values: [table: see text] Comparing these results with the results of other imaging modalities like myelography, CT, or MRI, ultrasound scores are significantly inferior. CLINICAL RELEVANCE: With the present technique ultrasound does not seem to be of diagnostic value for patients with herniated disk.

Adolescent↗
PubMed1992

[Possibilities of nuclear magnetic resonance tomography in diagnosis of osteochondrosis dissecans of the knee joint].

20 patients who suffered from osteochondrosis dissecans in the knee were examined by x-ray and MRI. Afterwards all joints were evaluated by arthroscopy. On plain x-ray the judgement of joint cartilage is not possible. With the use of MRI, the hyaline cartilage can be documented. Even without any visible changes on x-ray, MRI clearly reveals pathologic bone patterns. Comparing areas of sclerosis on x-ray with MRI changes, the real diameter of osteochondrosis dissecans can only be seen on MRI.

Arthroscopy↗
PubMed1992

[Nuclear magnetic resonance tomography diagnosis of changes in the glenoid process in patients with unstable shoulder joints].

UNLABELLED: In 4 fresh specimens and in 14 healthy volunteers we studied normal anatomy of the glenoid labrum by MRI. In a total of 124 patients we examined the shoulder joints by MRI. 69 patients had any kind of subacromial pathology. 55 patients showed a glenohumeral instability. All MRI findings were compared with the surgical findings during arthroscopy and during open surgery. 44 patients showed a recurrent anterior instability, 7 patients showed a multidirectional instability, 2 patients showed a posterior instability, and 2 patients presented acute anterior dislocation. We found significant variability in the labral shape as well as significant variability of anterior capsular attachment. The pathologic changes of the glenoid labrum were classified in four different types. In 78% we found a concomitant Hill-Sachs lesion of various diameter. 5 patients suffered from an additional complete rotator cuff tear. Compared to the intraoperative findings MRI had a sensitivity of 95%, a specificity of 94%, an accuracy of 94%, a positive predictive value of 91%, and a negative predictive value of 96% in detecting labral pathology. CLINICAL RELEVANCE: Presenting a high diagnostic value for detecting Bankart lesions, MRI may replace other diagnostic modalities like CT-arthrography.

Humans↗
PubMed1992

Restriction of indication for automated percutaneous lumbar discectomy based on computed tomographic discography.

This report details the authors' early experience using the automated percutaneous lumbar discectomy (APLD) procedure, developed by Onik et al., in 97 patients with a disc protrusion. In the evaluation of a herniated disc, we used computed tomography (CT) discography. According to the distribution of the dye inside the disc, five different disc types can be differentiated. With a follow-up after 3-7 months, the short-term outcomes of the first 40 APLD-treated patients varied, depending on the shape of the protruded nuclear material. Patients with a broad dye base on CT discography had better short-term outcomes than patients with a narrow dye base. In the next 57 patients we treated with APLD, this tendency was confirmed. The success rate of a consecutive group of patients with a disc protrusion with a broad dye base, treated with APLD, was 80%. In comparison, the patients with a disc protrusion with a narrow dye base had an overall success rate of only 53%. The difference is statistically significant (P < 0.05). The message of this report is that APLD is a useful invasive treatment for patients with a disc protrusion. The outcome depends, however, on the shape of the protruded nuclear material as shown by CT discography, which makes this examination as a conditio sine qua non before treating patients with a disc protrusion with APLD.

Adult↗
PubMed1992

The influence of automated percutaneous lumbar discectomy (APLD) on the biomechanics of the lumbar intervertebral disc. An experimental study.

Twenty human lumbar motion segments were prepared and tested in an electromechanical materials testing machine in order to investigate the biomechanical changes, i.e. intradiscal pressure, radial extension and height of the intervertebral disc, after automated percutaneous lumbar discectomy (APLD) developed by Onik. The biomechanical data were statistically analyzed with the Friedman test (significance level p < 0.05). The APLD lasted 45 minutes in every segment. The mean weight of material removed was 4.6 g. The removal of 4.6 gram of nucleus pulposus material reduced the height of the disc by an average of 1.42 mm. The intradiscal pressure also decreased by an average of 5.7 bar. The radial bulge increased by an average of 0.45 mm. Our results show that the mechanism improving radicular pain in patients with herniated disc after treatment with percutaneous nucleotomy is still in question. While clinical studies show an improvement of 70% to 85% of patients treated with APLD for herniated disc, this in vitro study showed clearly that radial bulge increases after removal of nuclear material. We postulate that loss of height of the disc and, as a consequence, reduction of tension in the affected nerve root, plays a major role with regard to this improvement.

Aged↗
PubMed1992

[Arthroscopy of the elbow joint. Long-term results, complications and indications].

UNLABELLED: Based on the results of a retrospective study of 67 patients who had diagnostic and surgical arthroscopy of the elbow from 1977 until 1990, we present the technique, results, complications, and indications for elbow arthroscopy. The average age of the patients was 26 years (range: 11-59). At follow-up, the patients were examined both clinically and radiologically. The results were scored according to Figgie's score, which contains the criteria of pain, function, power, and range of motion. The overall score increased significantly from 61.6 preoperatively to 85.3 postoperatively. The age of the patient did not influence the results. However, patients who were laborers had a poorer outcome than the others. Patients with a preoperative pain of 4 months to 2 years had better results than patients with a preoperative course of more than 2 years. With respect to the criteria (pain, function, power, range of motion), the pain improved significantly, whereas the other parameters showed no significant improvement. Breaking the diagnosis down into three categories (specific diagnosis, degeneration, unclear diagnosis), only patients with a specific and clear preoperative diagnosis showed significant improvement. The high number of neurological complications was especially striking. CLINICAL RELEVANCE: According to our results, patients with loose bodies, early rheumatoid arthritis, and joint infection seem to be good candidates for elbow arthroscopy. However, patients with severe degeneration or patients with unclear preoperative diagnosis will rarely benefit from this procedure. In general, the patients' pain can be treated effectively, but range of motion or power will not increase after elbow arthroscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Appearance of the femur head epiphysis in healthy children and in children with hip dysplasia].

In a retrospective study we evaluated 4341 sonographic examinations of 1160 healthy children and 209 children with congenital hip dysplasia with special reference to the appearance of the femoral head epiphysis. In healthy children the epiphysis appeared between the first and seventh month. In more than 95% of the children, the epiphysis was sonographically present after the seventh month. In children with congenital hip dysplasia the first appearance of the femoral hip epiphysis had a retardation of one to two months. In most of the healthy children the epiphysis appeared in the fourth month, and after the ninth month in almost all of the normal hip joints the epiphysis is present. In children with normal hip joint configuration and missing femoral head epiphysis at three months, the final ultrasound examination should not be done before the seventh month. Thus, clinically unnecessary ultrasound examination in 6-week intervals can be reduced.

Epiphyses↗
PubMed1991

[Concomitant occult osseous injuries in knee joint injuries].

In 28 patients with different knee injuries, we documented intraosseous lesions by MRI, although on plain X-rays no abnormality had been discovered. The intraosseous abnormalities seen by MRI were classified into four categories. 1. Cancellous bone oedema: this type of lesion showed a decrease of signal on T1 weighted images with irregular borders. These irregular areas were located in the epiphysis and sometimes even in the metaphysis. On T2 weighted images these areas showed an increased signal, which was even better visualised on short time recovery sequences. 2. Subchondral fracture with involvement of cortical bone: In these cases the involved area even reached the subchondral cortex. The fracture line could be visualised on T1- and T2-weighted images. 3. Osteochondral fractures: In two patients we found typical osteochondral fractures with a minimal displaced small fragment. 4. Subchondral sclerosis: In these cases there was a decrease of the signal on T1-weighted images, located directly adjacent to the subchondral cortical bone, without a fracture within the cortical bone and without any increase of signal on T2-weighted or STIR-images. According to our experience, isolated decrease in the signal within the subchondral cancellous bone adjacent to the knee joint, with an increased signal in STIR sequences can be taken as indirect signs for a traumatic lesion. These intraosseous lesions have a high coincidence with ligament injuries of the knee joint.

Adolescent↗
PubMed1991

[Proton spin and computerized tomography in ligament injuries of the knee joint].

UNLABELLED: In a prospective study we evaluated the use of cat-scan an MRI in 106 patients with chronic complaints and acute injuries of the knee joint. All patients went to surgery afterwards. A total of 30 patients suffered from acute or chronic ligament ruptures. There were 20 ACL ruptures, 2 PCL ruptures, 3 MCL ruptures, and 2 LCL ruptures. In patients with ACL ruptures the MRI had a sensitivity of 80%, a specificity value of 80%, and a negative predictive value of 95%; whereas cat-scan had a sensitivity of 90%, a specificity of 95%, an accuracy of 94%, a positive predictive value of 82%, and a negative predictive value of 98%. All complete ACL ruptures we correctly diagnosed. However, 4 partial ACL ruptures were missed by MRI and 2 partial ruptures were missed by cat-scan. All other ligament ruptures (PCL, MCL, LCL) except one MCL rupture were correctly diagnosed by MRI as well as by cat-scan. CLINICAL RELEVANCE: In this study cat-scan and MRI proved to have a very high negative predictive value. Having a negative result in one of these imaging techniques means that a rupture of a ligament is highly unlikely. This may have influence on the number of unnecessary invasive arthroscopic procedures.

Anterior Cruciate Ligament Injuries↗
PubMed1991

The incidence of rotator cuff rupture. An anatomic study.

To evaluate the incidence of rotator cuff ruptures, we examined 122 autopsy specimens of the shoulder and compared our results with those reported in the literature. The incidence of partial tears in our study was 28.7%; the incidence of complete rupture was 30.3%. The frequency increased with age. We found no cuff rupture without supraspinatus tendon involvement. Very often, the cuff tear was bilateral. We do not share the opinion that the rupture of the rotator cuff is primarily an injury of men. We found a higher incidence in female than in male shoulders.

Aged↗
PubMed1991

Intracompartmental pressure in the lower extremity after arthroscopic surgery.

We measured the intracompartmental pressure of 53 patients in the anterior, lateral, and dorsal compartments of the calf after arthroscopic procedures. Prior to making these measurements we established normative data in 80 healthy volunteers in a lying, sitting, and standing position. After short procedures like lavage, partial meniscectomy, removal of loose joint bodies, and shaving, we documented nearly normal pressures. We did the same in lateral release. In time consuming procedures like total synovectomy or ACL-reconstruction, especially if dorsal portals were used, we found a significant increase in intracompartmental pressure. In one patient the pressure even increased up to 55 mmHg.

Arthroscopy↗
PubMed1991

[Value of computerized tomography and nuclear magnetic resonance tomography in preoperative diagnosis of meniscus lesions and ligamentous lesions of the knee joint].

In a prospective study, 53 patients with chronic complaints and acute injuries of the knee joint, were evaluated by clinical examination, CT-scanning and magnetic resonance imaging (MRI). Subsequently, arthroscopy or an open surgical procedure was performed. A total of 21 patients suffered from meniscal lesions. There were 17 ruptures of the medial and 4 ruptures of the lateral meniscus. In patients with meniscus ruptures, the sensitivity of both MRI and CT-scan was 86%, whereas the specificity of MRI was slightly lower than that of CT-scan. The accuracy and the predictive value were also slightly lower, although the difference was not significant. Fifteen patients suffered from acute or chronic ligament ruptures. In patients with anterior cruciate ligament (ACL) ruptures, all complete ACL ruptures had correctly been diagnosed by CT and MRI. Two out of four partial ACL ruptures were missed by MRI; only one was missed by CT-scan. Three medial collateral ligament ruptures were documented by MRI and two by CT-scanning. The high negative predictive value of CT and MRI can realize a reduction of the amount of diagnostic arthroscopies.

Anterior Cruciate Ligament↗
PubMed1991

An unfused acromial epiphysis. A reason for chronic shoulder pain.

We report on a case of a 34 year-old female patient who had been suffering from chronic shoulder pain for 2 years although she received conservative treatment. The X-ray revealed a prominent distal clavicle and was interpreted as an old AC dislocation. An axillary view showed an os acromiale. The bone scintigraphy confirmed the clinical suspicion of reaction at the epiphysis. Local corticoid injections improved the patient's condition so that she refused further surgical treatment.

Acromion↗
PubMed1991

[Nuclear magnetic resonance and computerized tomography in meniscus injuries of the knee joint].

In a prospective study we evaluated the use of CAT scan and MRI in 53 patients with chronic symptoms and acute injuries of the knee joint. All these patients subsequently underwent surgery. A total of 21 patients had acute or chronic meniscus ruptures. The sensitivity of MRI was 86% (medial: 88%, lateral: 75%), its specificity, 95% (medial: 92%, lateral: 98%), its accuracy 93% (medial: 91%, lateral: 96%), its positive predictive value of 82% (medial: 83%, lateral: 75%), and its negative predictive value 96% (medial: 94%, lateral: 98%); CAT scan had a sensitivity of 86% (medial: 88%, lateral: 75%), a specificity of 97% (medial: 94%, lateral: 98%), an accuracy of 94% (medial: 93%, lateral: 96%), a positive predictive value of 86% (medial: 88%, lateral: 75%), and a negative predictive value of 97% (medial: 94%, lateral: 98%). In this study CAT scan and MRI proved to have a very high negative predictive value in the diagnostic of meniscal lesions. A negative result with one of these imaging techniques means that a rupture of a meniscus is highly unlikely. This may avoid unnecessary invasive procedures such as arthrotomies or arthroscopic examinations.

Arthroscopy↗