Reza Omid - Academia.edu (original) (raw)

Papers by Reza Omid

Research paper thumbnail of Percutaneous Pinning of Proximal Humeral Fractures: Is It Worth It?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of The Effect of Shoulder Immobilization on Rotator Cuff Repairs

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2013

Research paper thumbnail of All Shoulder Arthroplasties Are Not the Same

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2013

Research paper thumbnail of A SLAP Tear Epidemic?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of Frozen Shoulder in Diabetic Patients

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of The Acromial Index: Does It Matter?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of Are Fatty Infiltration and Muscle Atrophy Independent?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2013

Research paper thumbnail of How to minimize complications in shoulder instability and rotator cuff surgery

Instructional course lectures, 2012

Arthroscopic instability and rotator cuff repair techniques have rapidly evolved over the past de... more Arthroscopic instability and rotator cuff repair techniques have rapidly evolved over the past decade with expanding indications; however, there has been a corresponding increase in complications. Careful attention to detail and patient selection will result in satisfactory outcomes for most patients.

Research paper thumbnail of Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures

Journal of Shoulder and Elbow Surgery, 2016

Little is known about the perioperative complication rates of the surgical management of midshaft... more Little is known about the perioperative complication rates of the surgical management of midshaft clavicle nonunions. The purpose of the current study was to report on the perioperative complication rates after surgical management of nonunions and to compare them with complication rates of acute fractures using a population cohort. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who had undergone open reduction-internal fixation of midshaft clavicle fractures between 2007 and 2013. Patients were stratified by operative indication: acute fracture or nonunion. Patient characteristics and 30-day complication rates were compared between the 2 groups using univariate and multivariate analyses. A total of 1215 patients were included in our analysis. Of these, 1006 (82.8%) were acute midshaft clavicle fractures and 209 (17.2%) were midshaft nonunions. Patients undergoing surgical fixation for nonunion had a higher rate of total complications compared with the acute fracture group (5.26% vs. 2.28%; P = .034). On multivariate analysis, patients with a nonunion were at a >2-fold increased risk of any postsurgical complication (odds ratio, 2.29 [95% confidence interval, 1.05-5.00]; P = .037) and >3-fold increased risk of a wound complication (odds ratio, 3.22 [95% confidence interval, 1.02-10.20]; P = .046) compared with acute fractures. On the basis of these findings, patients undergoing surgical fixation for a midshaft clavicle nonunion are at an increased risk of short-term complications compared with acute fractures. This study provides additional information to consider in making management decisions for these common injuries.

Research paper thumbnail of Arthroscopic Decompression and Bone Grafting of Proximal Humeral Intraosseous Ganglion

Techniques in Shoulder & Elbow Surgery, 2015

ABSTRACT Intraosseous ganglia are rare lesions that can cause pain and leave patients susceptible... more ABSTRACT Intraosseous ganglia are rare lesions that can cause pain and leave patients susceptible to pathologic fracture. To date, these lesions have been treated with curettage and bone grafting through an open approach, although more recent techniques have allowed arthroscopic treatment of lesions located at the wrist, knee, and ankle. We present a novel, arthroscopic technique to treat intraosseous ganglion lesions of the proximal humerus. Using an arthroscopic approach, these lesions can be visualized, decompressed and curettage, with the ability to evaluate the extent of pathologic tissue remaining. This approach also allows for identification and treatment of additional glenohumeral pathology. Furthermore, we present a novel, completely arthroscopic technique of bone grafting and compaction to fill the resultant void.

Research paper thumbnail of Percutaneous Pinning of Proximal Humerus Fractures: A Technique

Seminars in Arthroplasty, 2011

Proximal humerus fractures are commonly seen, yet the treatment of many displaced fractures prese... more Proximal humerus fractures are commonly seen, yet the treatment of many displaced fractures presents significant challenges. Complications related to humeral head vascularity have caused a recent interest in minimally invasive techniques for fracture fixation. The technique of closed reduction and percutaneous fixation of proximal humerus fractures is difficult and demanding, and careful attention must be paid to appropriate indications and technical considerations. This article discusses the indications and techniques for percutaneous fixation of proximal humerus fractures. Semin Arthro 22:2-4

Research paper thumbnail of Lipoma arborescens of the biceps tendon sheath

Skeletal Radiology, 2013

Lipoma arborescens, described as lipomatous infiltration and distention of synovial villi resulti... more Lipoma arborescens, described as lipomatous infiltration and distention of synovial villi resulting in a frond-like appearance, most frequently affects the suprapatellar recess of the knee. While there have been reports of this entity involving the upper extremity joints, bursa, and tendon sheaths, we present the first reported case of lipoma arborescens isolated to the biceps tendon sheath. We describe imaging and histologic findings with clinical correlation.

Research paper thumbnail of Tendon Transfers for Irreparable Rotator Cuff Tears

Journal of the American Academy of Orthopaedic Surgeons, 2013

Tendon transfer is one treatment option for patients with massive irreparable rotator cuff tears.... more Tendon transfer is one treatment option for patients with massive irreparable rotator cuff tears. Although surgical indications are not clearly defined, the traditional thought is that the ideal candidate is young and lacks significant glenohumeral arthritis. The proposed benefits of tendon transfers are pain relief and potential increase in strength. The biomechanical rationale for the procedure is to restore the glenohumeral joint force couple and possibly to restore normal shoulder kinematics. The selection of donor tendon depends on the location of the rotator cuff deficiency. Transfers of latissimus dorsi and pectoralis major tendons have been shown to consistently improve pain; however, functional benefits are unpredictable. Trapezius tendon transfer may be an alternative in patients with massive posterosuperior rotator cuff tears, although longer-term follow-up is required.

Research paper thumbnail of Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], Jan 18, 2016

The use of reverse total shoulder arthroplasty (RTSA) has significantly increased in recent years... more The use of reverse total shoulder arthroplasty (RTSA) has significantly increased in recent years. However, there is large variance in reported complication rates and sparse data on implant survival. This study used a statewide patient database to investigate complication rates and implant survival for RTSA. All patients undergoing RTSA or total shoulder arthroplasty (TSA) from 2011 to 2013 were identified within a statewide database. The complication and revision rates at 30 days, 90 days, 1 year, and 2 years postoperatively were determined. Potential risk factors for complications were analyzed with logistic regression, and Kaplan-Meier survival curves were used to compare implant failure. During the 3-year period, 10,844 procedures (6,658 TSA; 4,186 RTSA) were found within the database. The all-cause complication rate at 90 days and 2 years postoperatively was significantly higher for RTSA (P < .001). RTSA patients had a significantly increased risk of infection (P < .05) a...

Research paper thumbnail of Biomechanical Comparison of the Lower Trapezius Transfer Versus Latissimus Dorsi Transfer for Irreparable Massive Posterosuperior Rotator Cuff Tears

Bone Joint Journal Orthopaedic Proceedings Supplement, Dec 1, 2013

Research paper thumbnail of Preoperative risk factors for discharge to a postacute care facility after shoulder arthroplasty

Journal of Shoulder and Elbow Surgery, 2015

Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to ... more Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to expanding indications and an aging population. Most patients are discharged home, but a subset of patients is discharged to a postacute care (PAC) facility. The purpose of this study was to identify the risk factors for discharge to a PAC facility after shoulder arthroplasty. The Nationwide Inpatient Sample discharge records from 2011 to 2012 were analyzed for patients who underwent a total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Patient and hospital characteristics were identified. Univariate and multivariate analysis were used to determine the statistically significant risk factors for discharge to a PAC facility while controlling for covariates. In 2011 and 2012, 103,798 patients underwent shoulder arthroplasty procedures: 58,937 TSAs and 44,893 RTSAs were identified. RTSA patients were 1.3 times as likely to be discharged to a PAC facility as TSA patients (P = .001). Medicare patients were 2 times as likely to be discharged to a PAC facility than those with private insurance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). In addition, women and patients presenting with a fracture, older age, or an increasing number of medical comorbidities were more likely to be discharged to a PAC facility (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The risk factors identified in our study can be used to stratify patients at high risk for postoperative discharge to PAC, allowing for greater improvement in overall care and the facilitation of postoperative discharge planning.

Research paper thumbnail of Biomechanical comparison between the trapezius transfer and latissimus transfer for irreparable posterosuperior rotator cuff tears

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], Jan 3, 2015

The purpose of this study was to characterize the biomechanical effects of the lower trapezius tr... more The purpose of this study was to characterize the biomechanical effects of the lower trapezius transfer and to compare it with the latissimus dorsi transfer in a cadaveric model of a massive posterosuperior rotator cuff tear. Eight cadaveric shoulders were tested at 0°, 30°, and 60° of shoulder abduction. Range of motion, humeral rotational position due to muscle loading, joint reaction forces, and kinematics were measured. All specimens were tested in 4 conditions: intact, massive posterosuperior cuff tear, lower trapezius transfer, and latissimus dorsi transfer. A repeated-measures analysis of variance was used for statistical analysis. Internal rotation due to muscle loading increased with massive cuff tear compared with the intact condition (P < .05). The latissimus transfer corrected this change at 0° abduction, whereas the trapezius transfer corrected this at all abduction angles. The massive cuff tear decreased glenohumeral joint compression forces at all abduction angles;...

Research paper thumbnail of Surgical anatomy of the lower trapezius tendon transfer

Journal of Shoulder and Elbow Surgery, 2015

The precise surgical anatomy of the lower trapezius tendon transfer has not been well described. ... more The precise surgical anatomy of the lower trapezius tendon transfer has not been well described. A precise anatomic description of the different trapezius segments and the associated neurovascular structures is crucial for operative planning and execution. We aimed (1) to establish a reliable demarcation between the middle and lower trapezius, (2) to establish the precise relationship of the main neurovascular pedicle to the muscle belly, and (3) to evaluate the utility of the relationships established in (1) and (2) by using the results of this study to perform cadaveric lower trapezius tendon harvest. In phase 1, a single surgeon performed all measurements using 10 cadavers. In phase 2, 10 cadaveric shoulders were used to harvest the tendon by using the relationships established in phase 1. We found anatomically distinct insertion sites for the lower and middle trapezius. The lower trapezius inserted at the scapular spine dorsum and the middle trapezius inserted broadly along the superior surface of the scapular spine. The distance from tip of tendon insertion to the nearest nerve at the most superior portion of the lower trapezius was 58 mm (standard deviation ± 18). By use of these relationships, there were no cases of neurovascular injury during our cadaveric tendon harvests. The lower trapezius can be reliably and consistently identified without violating fibers of the middle trapezius. Muscle splitting can be performed safely without encountering the spinal accessory nerve (approximately 2 cm medial to the medial scapular border).

Research paper thumbnail of Hemiarthroplasty for the Treatment of Distal Humerus Fractures: Short-term Clinical Results

Orthopedics, 2012

Total elbow arthroplasty is the current gold standard of treatment for unreconstructable distal h... more Total elbow arthroplasty is the current gold standard of treatment for unreconstructable distal humerus fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humerus hemiarthroplasty offers an alternative and may allow for more durable results. The authors retrospectively evaluated the short-term clinical outcomes of 10 patients who underwent elbow hemiarthroplasty for distal humerus fractures. This short-term review suggests that distal humerus hemiarthroplasty may be an effective treatment for certain distal humerus fractures. Additional studies must be conducted to further define the role of elbow hemiarthroplasty for the treatment of complex fractures of the distal humerus.

Research paper thumbnail of Anatomy and histology of the transverse humeral ligament

Orthopedics, 2013

The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic str... more The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic structure with a role in biceps tendon stability; however, recent literature suggests that it is not a distinct anatomic structure. The purpose of this study was to evaluate the gross and microscopic anatomy of the THL, including a specific investigation of the histology of this ligament. Thirty frozen, embalmed cadaveric specimens were dissected to determine the gross anatomy of the THL. Seven specimens were evaluated histologically for the presence of mechanoreceptors and free nerve endings. Two tissue layers were identified in the area described as the THL. In the deep layer, fibers of the subscapularis tendon were found to span the bicipital groove with contributions from the coracohumeral ligament and the supraspinatus tendon. Superficial to this layer was a fibrous fascial covering consisting of distinct bands of tissue. Neurohistology staining revealed the presence of free nerve endings but no mechanoreceptors. This study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s findings demonstrate that the THL is a distinct structure continuous with the rotator cuff tendons and the coracohumeral ligament. The finding of free nerve endings in the THL suggests a potential role as a shoulder pain generator.

Research paper thumbnail of Percutaneous Pinning of Proximal Humeral Fractures: Is It Worth It?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of The Effect of Shoulder Immobilization on Rotator Cuff Repairs

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2013

Research paper thumbnail of All Shoulder Arthroplasties Are Not the Same

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2013

Research paper thumbnail of A SLAP Tear Epidemic?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of Frozen Shoulder in Diabetic Patients

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of The Acromial Index: Does It Matter?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2012

Research paper thumbnail of Are Fatty Infiltration and Muscle Atrophy Independent?

JBJS Orthopaedic Highlights: Shoulder & Elbow, 2013

Research paper thumbnail of How to minimize complications in shoulder instability and rotator cuff surgery

Instructional course lectures, 2012

Arthroscopic instability and rotator cuff repair techniques have rapidly evolved over the past de... more Arthroscopic instability and rotator cuff repair techniques have rapidly evolved over the past decade with expanding indications; however, there has been a corresponding increase in complications. Careful attention to detail and patient selection will result in satisfactory outcomes for most patients.

Research paper thumbnail of Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures

Journal of Shoulder and Elbow Surgery, 2016

Little is known about the perioperative complication rates of the surgical management of midshaft... more Little is known about the perioperative complication rates of the surgical management of midshaft clavicle nonunions. The purpose of the current study was to report on the perioperative complication rates after surgical management of nonunions and to compare them with complication rates of acute fractures using a population cohort. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who had undergone open reduction-internal fixation of midshaft clavicle fractures between 2007 and 2013. Patients were stratified by operative indication: acute fracture or nonunion. Patient characteristics and 30-day complication rates were compared between the 2 groups using univariate and multivariate analyses. A total of 1215 patients were included in our analysis. Of these, 1006 (82.8%) were acute midshaft clavicle fractures and 209 (17.2%) were midshaft nonunions. Patients undergoing surgical fixation for nonunion had a higher rate of total complications compared with the acute fracture group (5.26% vs. 2.28%; P = .034). On multivariate analysis, patients with a nonunion were at a &amp;amp;amp;amp;amp;amp;amp;amp;gt;2-fold increased risk of any postsurgical complication (odds ratio, 2.29 [95% confidence interval, 1.05-5.00]; P = .037) and &amp;amp;amp;amp;amp;amp;amp;amp;gt;3-fold increased risk of a wound complication (odds ratio, 3.22 [95% confidence interval, 1.02-10.20]; P = .046) compared with acute fractures. On the basis of these findings, patients undergoing surgical fixation for a midshaft clavicle nonunion are at an increased risk of short-term complications compared with acute fractures. This study provides additional information to consider in making management decisions for these common injuries.

Research paper thumbnail of Arthroscopic Decompression and Bone Grafting of Proximal Humeral Intraosseous Ganglion

Techniques in Shoulder & Elbow Surgery, 2015

ABSTRACT Intraosseous ganglia are rare lesions that can cause pain and leave patients susceptible... more ABSTRACT Intraosseous ganglia are rare lesions that can cause pain and leave patients susceptible to pathologic fracture. To date, these lesions have been treated with curettage and bone grafting through an open approach, although more recent techniques have allowed arthroscopic treatment of lesions located at the wrist, knee, and ankle. We present a novel, arthroscopic technique to treat intraosseous ganglion lesions of the proximal humerus. Using an arthroscopic approach, these lesions can be visualized, decompressed and curettage, with the ability to evaluate the extent of pathologic tissue remaining. This approach also allows for identification and treatment of additional glenohumeral pathology. Furthermore, we present a novel, completely arthroscopic technique of bone grafting and compaction to fill the resultant void.

Research paper thumbnail of Percutaneous Pinning of Proximal Humerus Fractures: A Technique

Seminars in Arthroplasty, 2011

Proximal humerus fractures are commonly seen, yet the treatment of many displaced fractures prese... more Proximal humerus fractures are commonly seen, yet the treatment of many displaced fractures presents significant challenges. Complications related to humeral head vascularity have caused a recent interest in minimally invasive techniques for fracture fixation. The technique of closed reduction and percutaneous fixation of proximal humerus fractures is difficult and demanding, and careful attention must be paid to appropriate indications and technical considerations. This article discusses the indications and techniques for percutaneous fixation of proximal humerus fractures. Semin Arthro 22:2-4

Research paper thumbnail of Lipoma arborescens of the biceps tendon sheath

Skeletal Radiology, 2013

Lipoma arborescens, described as lipomatous infiltration and distention of synovial villi resulti... more Lipoma arborescens, described as lipomatous infiltration and distention of synovial villi resulting in a frond-like appearance, most frequently affects the suprapatellar recess of the knee. While there have been reports of this entity involving the upper extremity joints, bursa, and tendon sheaths, we present the first reported case of lipoma arborescens isolated to the biceps tendon sheath. We describe imaging and histologic findings with clinical correlation.

Research paper thumbnail of Tendon Transfers for Irreparable Rotator Cuff Tears

Journal of the American Academy of Orthopaedic Surgeons, 2013

Tendon transfer is one treatment option for patients with massive irreparable rotator cuff tears.... more Tendon transfer is one treatment option for patients with massive irreparable rotator cuff tears. Although surgical indications are not clearly defined, the traditional thought is that the ideal candidate is young and lacks significant glenohumeral arthritis. The proposed benefits of tendon transfers are pain relief and potential increase in strength. The biomechanical rationale for the procedure is to restore the glenohumeral joint force couple and possibly to restore normal shoulder kinematics. The selection of donor tendon depends on the location of the rotator cuff deficiency. Transfers of latissimus dorsi and pectoralis major tendons have been shown to consistently improve pain; however, functional benefits are unpredictable. Trapezius tendon transfer may be an alternative in patients with massive posterosuperior rotator cuff tears, although longer-term follow-up is required.

Research paper thumbnail of Complication rate and implant survival for reverse shoulder arthroplasty versus total shoulder arthroplasty: results during the initial 2 years

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], Jan 18, 2016

The use of reverse total shoulder arthroplasty (RTSA) has significantly increased in recent years... more The use of reverse total shoulder arthroplasty (RTSA) has significantly increased in recent years. However, there is large variance in reported complication rates and sparse data on implant survival. This study used a statewide patient database to investigate complication rates and implant survival for RTSA. All patients undergoing RTSA or total shoulder arthroplasty (TSA) from 2011 to 2013 were identified within a statewide database. The complication and revision rates at 30 days, 90 days, 1 year, and 2 years postoperatively were determined. Potential risk factors for complications were analyzed with logistic regression, and Kaplan-Meier survival curves were used to compare implant failure. During the 3-year period, 10,844 procedures (6,658 TSA; 4,186 RTSA) were found within the database. The all-cause complication rate at 90 days and 2 years postoperatively was significantly higher for RTSA (P < .001). RTSA patients had a significantly increased risk of infection (P < .05) a...

Research paper thumbnail of Biomechanical Comparison of the Lower Trapezius Transfer Versus Latissimus Dorsi Transfer for Irreparable Massive Posterosuperior Rotator Cuff Tears

Bone Joint Journal Orthopaedic Proceedings Supplement, Dec 1, 2013

Research paper thumbnail of Preoperative risk factors for discharge to a postacute care facility after shoulder arthroplasty

Journal of Shoulder and Elbow Surgery, 2015

Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to ... more Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to expanding indications and an aging population. Most patients are discharged home, but a subset of patients is discharged to a postacute care (PAC) facility. The purpose of this study was to identify the risk factors for discharge to a PAC facility after shoulder arthroplasty. The Nationwide Inpatient Sample discharge records from 2011 to 2012 were analyzed for patients who underwent a total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Patient and hospital characteristics were identified. Univariate and multivariate analysis were used to determine the statistically significant risk factors for discharge to a PAC facility while controlling for covariates. In 2011 and 2012, 103,798 patients underwent shoulder arthroplasty procedures: 58,937 TSAs and 44,893 RTSAs were identified. RTSA patients were 1.3 times as likely to be discharged to a PAC facility as TSA patients (P = .001). Medicare patients were 2 times as likely to be discharged to a PAC facility than those with private insurance (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). In addition, women and patients presenting with a fracture, older age, or an increasing number of medical comorbidities were more likely to be discharged to a PAC facility (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The risk factors identified in our study can be used to stratify patients at high risk for postoperative discharge to PAC, allowing for greater improvement in overall care and the facilitation of postoperative discharge planning.

Research paper thumbnail of Biomechanical comparison between the trapezius transfer and latissimus transfer for irreparable posterosuperior rotator cuff tears

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], Jan 3, 2015

The purpose of this study was to characterize the biomechanical effects of the lower trapezius tr... more The purpose of this study was to characterize the biomechanical effects of the lower trapezius transfer and to compare it with the latissimus dorsi transfer in a cadaveric model of a massive posterosuperior rotator cuff tear. Eight cadaveric shoulders were tested at 0°, 30°, and 60° of shoulder abduction. Range of motion, humeral rotational position due to muscle loading, joint reaction forces, and kinematics were measured. All specimens were tested in 4 conditions: intact, massive posterosuperior cuff tear, lower trapezius transfer, and latissimus dorsi transfer. A repeated-measures analysis of variance was used for statistical analysis. Internal rotation due to muscle loading increased with massive cuff tear compared with the intact condition (P < .05). The latissimus transfer corrected this change at 0° abduction, whereas the trapezius transfer corrected this at all abduction angles. The massive cuff tear decreased glenohumeral joint compression forces at all abduction angles;...

Research paper thumbnail of Surgical anatomy of the lower trapezius tendon transfer

Journal of Shoulder and Elbow Surgery, 2015

The precise surgical anatomy of the lower trapezius tendon transfer has not been well described. ... more The precise surgical anatomy of the lower trapezius tendon transfer has not been well described. A precise anatomic description of the different trapezius segments and the associated neurovascular structures is crucial for operative planning and execution. We aimed (1) to establish a reliable demarcation between the middle and lower trapezius, (2) to establish the precise relationship of the main neurovascular pedicle to the muscle belly, and (3) to evaluate the utility of the relationships established in (1) and (2) by using the results of this study to perform cadaveric lower trapezius tendon harvest. In phase 1, a single surgeon performed all measurements using 10 cadavers. In phase 2, 10 cadaveric shoulders were used to harvest the tendon by using the relationships established in phase 1. We found anatomically distinct insertion sites for the lower and middle trapezius. The lower trapezius inserted at the scapular spine dorsum and the middle trapezius inserted broadly along the superior surface of the scapular spine. The distance from tip of tendon insertion to the nearest nerve at the most superior portion of the lower trapezius was 58 mm (standard deviation ± 18). By use of these relationships, there were no cases of neurovascular injury during our cadaveric tendon harvests. The lower trapezius can be reliably and consistently identified without violating fibers of the middle trapezius. Muscle splitting can be performed safely without encountering the spinal accessory nerve (approximately 2 cm medial to the medial scapular border).

Research paper thumbnail of Hemiarthroplasty for the Treatment of Distal Humerus Fractures: Short-term Clinical Results

Orthopedics, 2012

Total elbow arthroplasty is the current gold standard of treatment for unreconstructable distal h... more Total elbow arthroplasty is the current gold standard of treatment for unreconstructable distal humerus fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humerus hemiarthroplasty offers an alternative and may allow for more durable results. The authors retrospectively evaluated the short-term clinical outcomes of 10 patients who underwent elbow hemiarthroplasty for distal humerus fractures. This short-term review suggests that distal humerus hemiarthroplasty may be an effective treatment for certain distal humerus fractures. Additional studies must be conducted to further define the role of elbow hemiarthroplasty for the treatment of complex fractures of the distal humerus.

Research paper thumbnail of Anatomy and histology of the transverse humeral ligament

Orthopedics, 2013

The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic str... more The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic structure with a role in biceps tendon stability; however, recent literature suggests that it is not a distinct anatomic structure. The purpose of this study was to evaluate the gross and microscopic anatomy of the THL, including a specific investigation of the histology of this ligament. Thirty frozen, embalmed cadaveric specimens were dissected to determine the gross anatomy of the THL. Seven specimens were evaluated histologically for the presence of mechanoreceptors and free nerve endings. Two tissue layers were identified in the area described as the THL. In the deep layer, fibers of the subscapularis tendon were found to span the bicipital groove with contributions from the coracohumeral ligament and the supraspinatus tendon. Superficial to this layer was a fibrous fascial covering consisting of distinct bands of tissue. Neurohistology staining revealed the presence of free nerve endings but no mechanoreceptors. This study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s findings demonstrate that the THL is a distinct structure continuous with the rotator cuff tendons and the coracohumeral ligament. The finding of free nerve endings in the THL suggests a potential role as a shoulder pain generator.