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PubMed1980

[Alloarthroplasty, resection-arthroplasty and arthrodesis of the shoulder-joint--indications and technic (author's transl)].

Indications and operative technics of problematic situations in the shoulder region are discussed. Methods which are commonly used at the "BG"-Accident-Hospital, Duisburg, are described in detail. Operative methods under question are arthroplasty, resection-arthroplasty and arthrodesis. The indications for the individual operative procedures are presented. Particular emphasis is laid upon the faction are discussed. Methods which are commonly used at the "BG"-Accident-Hospital, Duisburg, are described in detail. Operative methods under question are arthroplasty, resection-arthroplasty and arthrodesis. The indications for the individual operative procedures are presented. Particular emphasis is laid upon the faction are discussed. Methods which are commonly used at the "BG"-Accident-Hospital, Duisburg, are described in detail. Operative methods under question are arthroplasty, resection-arthroplasty and arthrodesis. The indications for the individual operative procedures are presented. Particular emphasis is laid upon the fact that alloarthroplasty--because of still unsolved technical problems--retains only a very narrow indication. It should be limited exclusively to older patients. Details of the operative technic for various operations are described. Apart from the common resection of the humoral head these are technically difficult; they require a surgeon who is experienced in traumatology and orthopedics.

Arthrodesis↗
PubMed1992

Arthroscopy of the shoulder joint.

Arthroscopy is without doubt the most comprehensive procedure for shoulder lesions, providing even better inspection of the interior of the joint than conventional open procedures. In 174 diagnostic arthroscopies, it proved more reliable than the computed tomography scan, ultrasound, or arthrography. The results of ultrasonography proved disappointing despite the enthusiastic reports on this technique, probably due to imperfections of equipment and lack of expertise rather than any inherent defect in the method. Arthrography seems to have a high incidence of false results. Though an invasive method requiring anesthesia, arthroscopy offers many diagnostic advantages such as an assessment of the role of the long biceps tendon and glenohumeral ligaments in recurrent or ordinary dislocation and the recognition of rotator cuff lesions not detectable at arthrography. It is also possible to assess the nature of shoulder instability and so to plan the appropriate operative procedure. A major advantage of arthroscopy is the possibility of carrying out treatment in the same session, though many of the suggested procedures are very demanding in terms of technical skill and time; the complication rate is often excessive. It is therefore best to restrict operative arthroscopy to simpler procedures such as irrigation in joint infections, the trimming of infolded flaps of labrum or stubs of biceps tendon, and the removal of loose bodies, where results are excellent. Arthroscopic repair of the rotator cuff or stapling of the labrum are more questionable regarding successes, complications, and recurrence. The equipment for arthroscopic operations needs improvement. Perhaps the major advantage of arthroscopic diagnosis is that it directs open procedures to the essential, thus minimizing operative trauma.

Adult↗
PubMed1997

[MRI arthrography--improved diagnosis of shoulder joint instability].

In a prospective study, we examined 34 patients with shoulder instabilities and 5 patients with unclear chronic shoulder pain (4 females, 35 males; 18-56 years of age, median 28 years) by CT arthrography and MRT arthrography from August 1994 through December 1995. No complications were seen when gadolinium-DPTA was applied intra-articularly. Twenty-three patients were followed up by operation and/or arthroscopy; 20 patients underwent a modified, open Bankart operation. In this paper, we present a new classification for damage of the anterior capsule and labrum. MRT arthrography showed better results in judging the anterior labrum and in determining the degree of damage to the labrum (sensitivity, specificity and accuracy 100%) in comparison with CT arthrography (sensitivity 90%, specificity 100%, accuracy 91%). Furthermore, MRT arthrography gave clearer results than CT arthrography regarding SLAP and cartilage lesions. Thus, MRT arthrography has proved to be a very exact method for diagnosing shoulder instabilities and is superior to CT arthrography in diagnostic accuracy.

Adolescent↗