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PubMedDate not supplied

Latissimus dorsi tendon transfer for massive rotator cuff tears: a cadaveric study.

Certain massive defects of the rotator cuff tendinous insertion cannot be repaired primarily to the greater tuberosity. If restoration of strength is an important treatment goal to the patient, then a tendon transfer may be considered. Ten cadaver shoulders were dissected to define the anatomy of the latissimus dorsi tendon (LDT) and its distance relationship to the axillary and radial nerves with the arm in various positions. The axillary nerve lies superior to the LDT insertion, and the radial nerve passes medial and inferior to the LDT insertion. With the arm internally rotated and the shoulder flexed, the distances from the axillary and radial nerves to the LDT insertion were 2.3 cm and 2.8 cm, respectively. With the arm internally rotated and the shoulder abducted, the distances from the axillary and radial nerves to the LDT insertion were 1.8 cm and 2.0 cm, respectively. Understanding specific anatomic relationships is one of the factors contributing to the safety of the LDT transfer procedure with respect to nerve injury.

Adult↗
PubMed2006

Clinical results of arthroscopic bankart repair with knot-tying and knotless suture anchors.

PURPOSE: To compare the results of arthroscopic Bankart repair completed with knot-tying with results of the procedure performed with knotless suture anchors. METHODS: We evaluated 82 patients who underwent arthroscopic Bankart repair. A total of 61 patients were treated with knot-tying suture anchors, and 21 patients were treated with knotless suture anchors during the same period. In all, 75 male and 7 female patients were studied. Mean patient age at the time of operation was 24 years (range, 16 to 42 years), and the mean follow-up period had a duration of 29 months (range, 24 to 41 months' duration). RESULTS: Shoulder scores improved in both groups (P < .05). Postoperative pain, patient satisfaction score, and redislocation rate were significantly different between the 2 groups, with the knot-tying suture anchor group showing better results (P = .007, P = .007, and P = .012, respectively). In the knot-tying suture anchor group, 4.9% (3 patients) experienced redislocation and 1 patient underwent revision surgery. The redislocation rate in the knotless suture anchor group was 23.8% (5 patients), and 4 patients underwent revision surgery. CONCLUSIONS: The knot-tying and knotless suture anchor groups showed improvement in postoperative shoulder scores after arthroscopic Bankart repair. However, results after the knotless technique was performed were unsatisfactory when compared with results in the standard suture anchor group, particularly in terms of redislocation rate. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic study.

Adolescent↗
PubMed2001

[What information do we need to treat the injured shoulder of a hockey player?].

Successful patient care of the injured shoulder of a hockey player involves interdisciplinary cupertino. Images allow an interpretation of a static dimension but may not be sufficient enough to develop a surgical treatment strategy, since all injuries to the shoulder have its origin in a dynamic pathology with some kind of external impact. This article classifies various traumatic shoulder problems and the mechanism of injury, it outlines clinical tests and stresses key facts an imaging report should include in order to plan conservative or surgical treatment. Basic treatment options as performed in our institution for the injured shoulder of a hockey player are summarised briefly.

Acromioclavicular Joint↗
PubMed1995

Type 4 acromion: a new classification.

The three types of acromial processes previously described in the literature include type 1, in which the undersurface is straight, and types 2 and 3, in which the undersurface is concave. In this report, a fourth type of acromion is described in which the undersurface is convex near its distal end. The frequency of a type 4 acromion in the normal population is discussed based on a retrospective review of the MR examinations of 30 patients that originally were read as normal.

Acromioclavicular Joint↗
PubMed2004

Therapeutic results of acromioclavicular joint dislocation complicated by rotator cuff tear.

PURPOSE: To evaluate the operative findings and postoperative results of one-stage repair on patients with acromioclavicular joint dislocation complicated by rotator cuff tear. METHODS: Between 1992 and 1999, one-stage repair was performed on 5 patients with acromioclavicular joint dislocation complicated by rotator cuff tears. Modified Cadenat procedure for acromioclavicular joint dislocation, and McLaughlin procedure for rotator cuff tear, were performed on these patients. Postoperative results at the final examination were assessed according to the criteria for therapeutic effects on shoulder joint disorders of the Japanese Orthopaedic Association. RESULTS: There was partial-thickness cuff tear in one patient, and full-thickness cuff tear in the remaining 4 patients. In all patients, tears were located only in the supraspinatus tendon, and were medium or small ones with maximal diameter of 3 cm or less. After a mean follow-up period of 56 months (range, 36-79 months), all patients were assessed to have excellent results. No patient showed a good reduction of the acromio-clavicular joint. CONCLUSION: For patients successfully treated by one-stage repair, satisfactory results were obtained without pain or disturbance in activities of daily living.

Acromioclavicular Joint↗
PubMed2000

Shoulder injuries in overhead athletes. The "dead arm" revisited.

The following statements summarize this article: Three distinct categories of Type 2 SLAP lesions exist: (1) anterior, (2) posterior, and (3) combined anteroposterior. Posterior Type 2 SLAP lesions have distinct clinical and anatomic features that distinguish them from anterior Type 2 SLAP lesions. Posterior and combined Type 2 SLAP lesions can be disabling to overhead-throwing athletes because of posterosuperior instability and anteroinferior pseudolaxity. The Jobe relocation test is positive with posterosuperior pain in patients with posterior or combined anterior-posterior Type 2 SLAP lesions and is negative in patients with anterior Type 2 SLAP lesions. Rotator cuff tears are frequently associated with posterior or combined anterior-posterior SLAP lesions, are lesion-location specific, and typically begin from inside the joint as undersurface tears. Repair of posterior SLAP lesions can return overhead-throwing athletes to full overhead athletic functioning. The peel-back mechanism is a likely cause of posterior Type 2 SLAP lesions. To securely repair the posterosuperior labrum to resist torsional peel-back, sulure anchors must be placed posterior to the biceps at the corner of the glenoid. The repair must be protected against external rotation past 0 degree for 3 weeks to avoid undue premature torsional stresses on the repair from the peel-back mechanism. A tight posteroinferior capsule predisposes to Type 2 SLAP lesions in overhead athletes. Shoulders at risk for the dead arm syndrome have a marked loss of internal rotation caused by contracture of the posteroinferior capsule such that less than a 180 degrees arc of rotation is achieved with the arm abducted 90 degrees (the 180 degrees rule). Type 2 SLAP lesions that cause the dead arm syndrome in overhead-throwing athletes are most likely acceleration injuries that occur in late cocking rather than deceleration injuries in follow-through. Rehabilitation of athletes with the dead arm syndrome must include the entire kinetic chain. The root cause of the dead arm syndrome is the Type 2 SLAP lesion.

Athletic Injuries↗
PubMed2001

Results of open repair of the rotator cuff--a long-term review of 79 shoulders.

In 72 patients with 79 tears of the rotator cuff that had been completely repaired by open surgery, the outcome was evaluated on the basis of history, Constant functional score and radiography. At a mean follow-up period of 6.75 years, the Constant score was 71.5 points on average, showing a high correlation with the patients' subjective satisfaction, but the score was not a reliable indicator of recurrence. The larger the cuff tear, the poorer the result was. However, deterioration was not related to the duration of follow-up or the patient's age. The presence of acromioclavicular arthrosis also had no influence on the overall result. A comparison of follow-up radiographs with those obtained immediately after surgery revealed (despite postoperative flat subacromial resection) evidence of heterotopic bone formations or ossifications in nearly half of the patients. However, except for individual cases, this had no significant influence on the clinical result or the Constant score.

Adult↗
PubMedDate not supplied

MR imaging of shoulder injuries in professional baseball players.

Magnetic resonance (MR) imaging was used to evaluate the shoulders of 10 symptomatic professional baseball players and one asymptomatic player, with surgical correlation in six cases and arthrographic correlation in two cases. Seven small rotator cuff tears measuring 0.5-1 cm were identified on MR images, with arthrographic and surgical confirmation of these findings in two patients and surgical confirmation only in three patients. Cortical irregularity and/or subchondral cyst formation at the posterior aspect of the greater tuberosity near the insertion site of the infraspinatus tendon was found in five of the seven players with rotator cuff tears. Similar findings were noted in the asymptomatic volunteer and in one of the three players without cuff tear, who also had irregular thickening of the posterior capsule. These findings are believed to represent chronic avulsive changes resulting from the deceleration stresses of the follow-through motion.

Adult↗
PubMedDate not supplied

Upper extremity weight-training modifications for the injured athlete. A clinical perspective.

The ability of the health care professional to make correct decisions about the progression of weight-training is critical to the rehabilitation process. The purpose of this article is to describe our approach to modification of weight-lifting techniques using the injured shoulder as a model. Additionally, the impact of various upper extremity weight-training techniques on healthy athletes is discussed. The effects of grip, hand spacing, bar trajectory, and start and finishing positions on microtraumatic injury and return to weight-training activities after injury are considered. Several weight-training functional progressions for common multijoint exercises (such as bench press, shoulder press, power clean) are presented. Adaptations for periodization are also presented for implementation in the rehabilitation sequence. The weight-training modifications described in this paper will assist the health professional to safely return athletes to the weight room after shoulder injury.

Adaptation, Physiological↗
PubMed1983

Prevention of injury to the shoulder through exercises and therapy.

An injury prevention program for the athlete combines conditioning and warm-up with appropriate stretching and strengthening exercises. Rehabilitation after injury is necessary and must include not only re-establishment of strength but also an aggressive program for restoring and maintaining muscle length.

Athletic Injuries↗
PubMed2006

Massive rotator cuff tears repaired on top of humeral head by McLaughlin's procedure.

The clinical and radiographic outcomes of McLaughlin's procedure for massive rotator cuff tears were investigated in 25 shoulders, in which the cuff tears were so severe that the tendons were sutured on the top of the humeral head. The mean age at surgery was 62.2 years (range, 39-74 years). The mean follow-up period was 50 months (range, 24-80 months). The University of California, Los Angeles score significantly improved from 10.9 to 31.8 points postoperatively; the postoperative result was classified as excellent in 11 shoulders, good in 11, and poor in 3. Osteoarthritis progressed postoperatively in 7 shoulders (28%), and upper migration of the humeral head progressed in 6 (24%), although both progression rates were no higher than those for other common procedures. When torn tendons reach over the top of the humeral head with the arm at the side in patients with massive tears that are not reparable to the greater tuberosity, satisfactory clinical outcomes can be expected.

Adult↗
PubMed2002

[Ruptures of the subscapular tendon. A diagnostic problem?].

Isolated ruptures of the subscapularis tendon are rare injuries which are often missed initially. After recent treatment of 3 patients treated in our clinic typical courses and pitfalls are demonstrated. Due to the traumatic genesis of subscapularis tendon ruptures, lesions of the rotator cuff must be excluded generally by an adequate diagnostic concept. Conventional x-rays of the shoulder in 2 views to exclude a bony lesion, clinical and ultrasound examination are seen as a standard because these methods will allow the correct diagnosis in most cases. Typical clinical signs for a subscapularis lesion are the "lift-off-test" and the "napoleon sign." The ultrasound examination should be done statically and dynamically by comparing the injured with the uninjured shoulder. The typical view in case of a subscapularis tendon rupture is a thinned tendon overlying the humeral head. In our opinion nuclear magnetic resonance imaging should not be the first diagnostic procedure. It should be reserved for such cases with unclear clinical and ultrasound results.

Adolescent↗
PubMed2003

Arthroscopic management of the thrower's shoulder: internal impingement.

Our understanding of internal impingement in the overhand athlete is an evolving body of knowledge. More recent improved understanding of the pathophysiology of events that leads to the spectrum of injury has caused us to refine our techniques of treatment. Improved surgical techniques and instrumentation have made refinement of our approach to treatment possible. Only time will tell whether the perceived understanding of these disorders, resulting in alteration of our treatment methods, is making our treatment outcomes more successful.

Arthroscopy↗