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At least 1,801 records · Page 100Linked to original sources
PubMed2006

Cartilage lesions of the glenohumeral joint: diagnostic effectiveness of multidetector spiral CT arthrography and comparison with arthroscopy.

This study assessed the diagnostic effectiveness of multidetector spiral CT arthrography (MDCTa) in detecting hyaline cartilage abnormalities of the shoulder joint, with correlation to arthroscopy. Shoulder MDCTa images prospectively obtained in 22 consecutive patients (mean age, 50 years; age range, 23-74 years; 12 female, 10 male) were evaluated for glenohumeral cartilage lesions. Two musculoskeletal radiologists independently analysed the cartilage surfaces of the humeral head and of the glenoid fossa in nine anatomical surface areas. Observations of MDCTa were compared to arthroscopic findings. The sensitivity and specificity of MDCTa for grade 2 (substance loss <50%) or higher and grade 3 (substance loss >or=50%) or higher cartilage lesions, the Spearman correlation coefficient between arthrographic and arthroscopic grading, and K statistics for assessing Intra and Interobserver reproducibility were determined. At MDCTa, sensitivities and specificities ranged between 80% and 94% for the detection of grade 2 or higher cartilage lesions, and between 88% and 98% for the detection of grade 3 or higher cartilage lesions. Spearman correlation coefficients between MDCTa and arthroscopic grading of articular surfaces ranged between 0.532 and 0.651. Interobserver agreement was moderate for grading all articular surfaces (kappa = 0.457), but substantial to almost perfect for detecting lesions with substance loss (kappa, 0.618-0.876). In conclusion, MDCTa is accurate for the study of cartilage surface in the entire shoulder joint. This technique may beneficially impact patient's management by means of selecting the proper treatment approach.

Adult↗
PubMed2002

Rationales of arthroscopic shoulder stabilization.

Arthroscopic reconstruction of glenohumeral instability has become more common during the past decade. Compared with open reconstruction, which is still the gold standard in the treatment of shoulder instability, arthroscopic techniques allow for improved diagnosis of numerous intraarticular findings. This review presents an appropriate system for the arthroscopic classification of most pathological findings in patients with anterior shoulder instability. Based on the presented classification, a rationale for arthroscopic reconstruction under special conditions is given. Several operative techniques and implants are discussed and their use in certain circumstances analyzed. Special emphasis is targeted on techniques of realizing sufficient capsular shift or plication. Arthroscopic procedures remain technically demanding and require skills to address the great variety of possible situations. On the other hand, arthroscopic techniques in shoulder reconstruction benefit patients by avoiding the morbidity of open surgery. However, the surgeon must be prepared to address numerous conditions beyond a mere Bankart lesion, especially those involving capsular laxity, rotator interval lesions, and SLAP (superior labrum lesions from anterior to posterior) lesions. Nowadays, considering all the new technical possibilities of arthroscopic shoulder reconstruction including capsular shift procedures, most cases of anterior shoulder instability are suitable for arthroscopic reconstruction. Further studies are necessary to validate the continued efficacy of arthroscopic stabilization.

Arthroscopy↗
PubMed2003

Postoperative functional outcome and stability in recurrent traumatic anteroinferior glenohumeral instability: comparison of two different surgical capsular reconstruction techniques.

INTRODUCTION: Patients (n=62) with recurrent traumatic anterior or anteroinferior glenohumeral instability were prospectively evaluated with reference to the surgical reconstruction technique performed. MATERIALS AND METHODS: Neer's T-plasty procedure was performed in group I (n=31) while a modified, anatomically orientated, anteroinferior capsular shift was performed in group II (n=31). All patients underwent an additional Bankart repair. After 18.1 (group II) and 22.2 (group I) months, patients were assessed in terms of subjective satisfaction, objective stability, range of motion, and functional outcome. RESULTS: No significant differences (91.5% group II, 87.8% group I) were noted between the study groups regarding the patient's subjective evaluation (p=0.17106). Results of Rowe's (93.1% group II, 87.9% group I; p=0.14419) and Constant's Score (96.5% group II, 93.8% group I; p=0.16582) showed no significant differences for both collectives. Postoperative lack of external rotation remained significantly smaller in group II (5.6 degrees +/-2.5 degrees ) compared with group I (9.8 degrees +/-2.5; p=0.00028). Although no significant differences (p=0.612) were found, the rate of recurrence was obviously smaller in group II (group II vs group I: 6 patients). CONCLUSIONS: Our results demonstrate no significant differences between the two capsular reconstruction techniques regarding patient's satisfaction, Rowe and Constant Scores. However, the anatomically orientated anteroinferior capsular shift leads to a significantly smaller external rotation deficit and seems to offer a more reliable postoperative stability.

Adolescent↗
PubMed2006

Long-term results after open Bankart operation for anterior shoulder instability. A 3- to 16-year follow-up.

The open Bankart procedure is still considered the gold standard for patients with recurrent posttraumatic anterior shoulder instability. The purpose of this retrospective study was to analyze long-term results after open Bankart procedure in 83 patients that were operated between 1987 and 2000 and to evaluate the rate of recurrent instability, level of function and range of motion. The mean follow-up time was 9 (3-16) years. The postoperative recurrence rate including subluxations was 12%. The mean Constant score was 77 and the mean Rowe score was 63. Average loss of external rotation in 90 degrees of abduction was 19 degrees . The results were disappointing in terms of stability and function. In the absence of longterm prospective studies on newer arthroscopic techniques, the decision on the reconstruction method must still be based on the surgeon's experience and the patient's choice.

Adolescent↗
PubMed1992

Operative management of lesions of the axillary nerve, isolated or combined with other nerve lesions.

Sixty-six surgically treated lesions of the axillary nerve were reviewed and 57 were followed up over 1 year. Patients were divided into 4 groups: isolated axillary nerve lesions (n = 23), axillary and suprascapular nerve lesions (n = 15), axillary and infraclavicular nerve/plexus lesions (n = 26), and axillary nerve lesions and lower root avulsions (n = 2). Of 34 patients operated upon within 6 months after the trauma, 24 (71%) recovered a force of M4 or M5. Of 17 patients operated upon within 1 year, 10 (59%) had M4 or M5. Of 6 patients operated upon after 1 year, only one had M4. Good shoulder function was only regained when the spinati muscles had recovered good force.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging of the shoulder.

The authors have reviewed the field of magnetic resonance imaging of the shoulder. This review includes abnormalities of the rotator cuff mechanism and glenoid labrum, and other disorders.

Arthritis↗
PubMed1990

Arthroscopic removal of painful Bristow hardware.

Complications of metallic hardware about the shoulder have been well documented in the literature. This case report presents a recreational athlete who presented to our office with a painful shoulder 4 years after a Bristow procedure. Radiographic imaging confirmed contact of the humeral head on the Bristow screw. In these unusual situations, arthroscopic evaluation, as this case suggests, should be considered. The patient's hardware was removed arthroscopically, obviating an open procedure and hospitalization.

Adult↗
PubMed1992

Arthroscopic-assisted glenohumeral arthrodesis.

A case of successful glenohumeral arthrodesis performed under arthroscopic control is presented. Clinical and radiographic fusion occurred by 6 weeks after the procedure. Salient features of the procedure include arthroscopic debridement of all hyaline cartilage and subchondral bone on both sides of the joint, reduction in a functional position, and internal fixation with percutaneously placed screws.

Adult↗
PubMed1995

Arthroscopic Bankart repair with the Suretac device. Part I: Clinical observations.

Although arthroscopic Bankart repair has become an accepted surgical stabilization technique for anterior shoulder instability, the failure rate remains unacceptably high. Little information is available concerning healing of the Bankart repair. The purpose of this article is to clarify this issue by analyzing a cohort of 15 patients who underwent a "second-look" arthroscopy to evaluate and treat pain or recurrent instability following arthroscopic Bankart repair with the Suretac device (Acufex Microsurgical, Mansfield, MA). "Second-look" arthroscopy was performed at an average of 9 months following the index surgical procedure. The reasons for this second surgery were recurrent instability in 7, pain in 6, and pain and stiffness in 2. In the 7 patients with recurrent instability, the Bankart repair was found to be completely healed in 3 (43%), partially healed in 1 (14%), and had recurred in 3 (43%); however, 6 of 7 were observed to have lax capsular tissue. In 4 of these cases, retrospective review of the index surgical procedure showed that a technical error had been made during the repair. Two cases had biopsy of the repair site on "second-look" at 6 to 8 months, and this showed residual polyglyconate polymer debris surrounded by a histiocytic infiltrate. In the remaining 8 cases with stable shoulders, the Bankart repair had completely healed in 5 cases (62.5%) and partially healed in 3 cases (37.5%). The higher failure rate with this approach compared with open approaches appears to result from improper patient selection and errors in surgical technique. There is some question concerning healing strength of the Bankart repair, although complete healing of the Bankart does not seem to be a prerequesite for shoulder stability. Success of the procedure might be expected to improve by selecting only patients with unidirectional, posttraumatic, anterior instability who are found to have a discrete Bankart lesion and well-developed ligamentous tissue.

Adult↗
PubMed1995

Arthroscopic Bankart repair with the Suretac device. Part II: Experimental observations.

Arthroscopic Bankart repair using the Suretac device (Acufex Microsurgical, Mansfield, MA) was developed as an alternative to both the staple and suture repair techniques. While offering some technical advantages compared with these other approaches, it's technical limitations and pitfalls have only been described anecdotally based on the clinical experience of several surgeons. The purpose of this study was to define these limitations and pitfalls. Eight cadaver shoulders underwent arthroscopic Bankart repair using the Suretac device after first arthroscopically creating a Bankart lesion. These shoulders were then dissected to reveal the placement of the Suretacs and the adequacy of the Bankart lesion repair. Glenoids were transected in the transverse plane and embedded in clear methylmethacrylate to show placement of the Suretac device relative to the articular surface. There were several technical errors that occurred: (1) Inadequate abrasion of the anterior and inferior juxta-articular scapular neck; (2) inadequate superior and medial shift of the inferior glenohumeral ligament before placement of the lowest Suretac, (3) medial placement of the Suretac relative to the articular margin; and (4) insufficient capture and compression of capsular tissue by the Suretac device. This procedure is technically difficult and careful attention must be paid to each step of preparation and repair. Recognition of the common errors may help the surgeon to avoid these pitfalls in the clinical situation.

Arthroscopy↗
PubMed1995

Arthroscopic debridement of glenoid labral tears in athletes.

UNLABELLED: This is a retrospective study of 46 patients who underwent arthroscopic glenoid labral debridement from June 1988 to June 1990. All patients complained of pain in the involved shoulder and all were active in sports involving overhead use of the shoulder, including 30 baseball players (16 professional, 14 collegiate/high school). The average age was 22 years (range 16 to 45) and the average follow-up was 2.7 years (range 18 to 50 months). At operation, 35 patients had posterior glenoid lesions, 9 had anterior-superior lesions, and 2 had anterior-inferior lesions. The posterior lesions were further divided into those that involved a horizontal flap tear (n = 19), and those that involved fraying (n = 16). Overall, at an average of 31 months follow-up. 54% (25 of 46) of patients had good to excellent results. Professional baseball players had a statistically significant enhanced outcome with 75% (12 of 16) good-excellent compared with the remaining nonprofessional group, with 43% (13 of 30) good-excellent results. Outcome did not correlate with shoulder laxity, labral lesion location, mechanism of injury, or the presence of a rotator cuff lesion. CONCLUSIONS: Arthroscopic debridement of glenoid labral lesions does not yield consistent long-term results. Aggressive, supervised physical therapy in highly motivated individuals may be the most important factors in influencing outcome in patients having arthroscopic labral debridement in the absence of overt shoulder instability.

Adult↗

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