Shoulder Surgery Research Papers - Academia.edu (original) (raw)

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in... more

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in different kinds of sports, and who have widely different expectations in terms of recovery of functions and pain relief. A large number of factors must be taken into account before implementing a rehabilita- tion protocol after rotator cuff surgery. These mainly include the technique (materials and procedure) used by the surgeon. Moreover, tissue quality, retraction, fatty infiltration and time from rupture are important biologi- cal factors while the patient’s work or sport or daily activities after surgery and expectations of recovery must also be assessed. A rehabilitation protocol should also take into account the timing of biological healing of bone to tendon or tendon to tendon interface, depending on the type of rupture and repair. This timing should direct the therapist’s choice of correct passive or assisted exercise and mobilisation manoeuvres and the teaching of correct active mobilisation movements the patient has to do. Following accepted knowledge about the time of biolog- ical tissue healing, surgical technique and focused reha- bilitation exercise, a conceptual protocol in four phases could be applied, tailoring the protocol for each patient. It starts with sling rest with passive small self-assisted arm motion in phase one, to prevent post-op stiffness. In phase two passive mobilisation by the patient dry or in water, integrated with scapular mobilisation and stabilis- er reinforcement, are done. Phase three consists of pro- gressive active arm mobilisation dry or in water integrat- ed with proprioceptive exercise and “core” stabilisation. In phase four full strength recovery integrated with the recovery of work or sports movements will complete the protocol. Because of the multi-factorial aspects of the problem, the best results can be obtained through a full transfer of information from the surgeon to the therapist to optimise timing and sizing of the individual rehabilita- tion protocol for each patient.

Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive rotator cuff tears that are not amendable to... more

Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive rotator cuff tears that are not amendable to primary repair due to fatty changes in the muscle tissue, or that have failed previous repair attempts. This procedure offers immediate and dramatic pain relief and is not as technically demanding as one might think. Understanding and respecting the principles of tendon transfer is a key to the success of this procedure.

Rotator cuff disease accounts for 10% of all shoulder pain and major shoulder disability, with limited information concerning the natural history and treatment approaches for the disorder. Our objective is to assess the available evidence... more

Rotator cuff disease accounts for 10% of all shoulder pain and major shoulder disability, with limited information concerning the natural history and treatment approaches for the disorder. Our objective is to assess the available evidence for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects. Although there is conflicting literature, there appears to be some consensus on the best indicators for choosing to treat a full-thickness tears (FTT) non-operatively to reduce pain and improve function. The risks associated with these tears include the potential of the progression of the tear, a diminished healing potential due to age or longer symptom duration, muscle atrophy, and fatty infiltration. The indications for surgery following conservative treatment are becoming more defined, and an outline regarding what scenarios warrant a transition from an initial conservative treatment plan has be...

This is a unique case of a female patient with features of classical and hypermobile types of Ehlers-Danlos syndrome (EDS) who developed complex scapular winging from spinal accessory and long thoracic neuropathies. These neurological... more

This is a unique case of a female patient with features of classical and hypermobile types of Ehlers-Danlos syndrome (EDS) who developed complex scapular winging from spinal accessory and long thoracic neuropathies. These neurological problems became manifest after an uncomplicated total shoulder arthroplasty (TSA). The patient had a complex postoperative course with extensive work-up in addition to revision shoulder surgery and manipulations to treat shoulder stiffness. It was eventually suspected that the periscapular nerve impairments occurred during physical therapy sessions after her TSA. This interpretation was further supported by genetic evidence that, in addition to EDS, the patient had an unrecognized genetic propensity for nerve palsies from stretch or pressure ("hereditary neuropathy with liability to pressure palsies" (HNPP)). By two years after the TSA the neuropathies had only partially improved, leaving the patient with persistent scapular winging and shoulder weakness. With this case we alert surgeons and physical therapists that patients with EDS can have not only a complicated course after TSA, but rare concurrent conditions that can further increase the propensity of neurological injuries that result in compromised shoulder function.

Purpose: The purpose of this study is to report the early and midterm functional outcomes and complications of a consecutive series of patients with primary adhesive capsulitis who were treated with isolated anteroinferior arthroscopic... more

Purpose: The purpose of this study is to report the early and midterm functional outcomes and complications of a consecutive series of patients with primary adhesive capsulitis who were treated with isolated anteroinferior arthroscopic capsular release after they did not respond to conservative treatment. Methods: Thirty-two consecutive patients with idiopathic adhesive capsulitis who did not respond to conservative physiotherapy were included in the study. Arthroscopic anteroinferior capsular release was performed in all cases. The primary outcome was improvement in range of motion in the short-and midterm follow-up. We also evaluated pain relief with the visual analog scale, functional outcomes with the ConstanteMurley score, and we registered postoperative complications. Results: The mean age was 49.6 years (range, 33-68 years) and the mean follow-up was 63 months (range, 18-84). Overall, there was significant improvement in the ConstanteMurley score from 42.4 to 86 points (P < .001). The visual analog scale decreased by approximately 6.3 points compared with the preoperative value (P < .001). All parameters improved significantly the first 6 months and then remained stable until the end of follow-up (P < .001). There was an additional minor improvement in both parameters between the sixth month and the final follow-up; however, this improvement was less than in the first 6 months and it was not statistically significant. Conclusions: In patients who don't respond to conservative treatment for primary adhesive capsulitis, isolated anteroinferior capsular release provides a reliable improvement in pain and range of motion that is maintained in the mid-term follow-up. Level of Evidence: Level IV, therapeutic, case series study.

In order to study the incidence of the axillary arch in the Bulgarian population, we examined the axillary regions of 56 formol–carbol fixed human cadavers and observed two cases with a unilateral axillary arch. In the first case, the... more

In order to study the incidence of the axillary arch in the Bulgarian population, we examined the axillary regions of 56 formol–carbol fixed human cadavers and observed two cases with a unilateral axillary arch. In the first case, the variant structure was situated on the right side of a 58-year-old female
cadaver. The axillary arch extended from the lateral border of the latissimus dorsi to the posterior layer of the pectoralis major tendon. In the second case, the axillary arch was found on the left side of a 63-year-old male cadaver and had the same attachment points as in the first case. The innervation and blood supply of the arches are discussed. We have also reviewed extensive information concerning the clinical importance of the axillary arch, and for the first time, it was summarized clearly for clinicians. The summary consists of three
parts: ‘‘diagnosis’’ of the axillary arch by physical investigation or imaging techniques; the axillary arch and surgical interventions in the region of the axilla; the axillary arch as an entrapment site for the axillary vessels and nerves.

There is no definite guideline concerning patient selection for operative intervention on rotator cuff tears in rheumatoid arthritis patients. This article presents a case of elderly patient with massive rotator cuff tear from rheumatoid... more

There is no definite guideline concerning patient selection for operative intervention on rotator cuff tears in rheumatoid arthritis patients.
This article presents a case of elderly patient with massive rotator cuff tear from rheumatoid arthritis. Physical examination and imaging showed that the supraspinatus and subscapularis tear were reparable. The arthroscopic synovectomy with supraspinatus and subscapularis repair were performed with excellent clinical outcome.

The aim of our study was to evaluate the shoulder function after clavicular hook plate fixation of acute acromioclavicular dislocations (Rockwood type III) in a population group consisting exclusively of high-demand military personnel.... more

The aim of our study was to evaluate the
shoulder function after clavicular hook plate fixation of
acute acromioclavicular dislocations (Rockwood type III)
in a population group consisting exclusively of high-demand
military personnel. This prospective study was carried
out at a tertiary care military orthopaedic centre during
2012–2013 using clavicular hook plate for management of
acromioclavicular injuries without coracoclavicular ligament
reconstruction in 33 patients. All patients underwent
routine implant removal after 16 weeks. The functional
outcome was assessed at 3, 6 and 12 months after hook
plate removal and 2 years from the initial surgery using the
Constant Murley and UCLA Scores. All the patients were
male serving soldiers and had sustained acromioclavicular
joint dislocation (Rockwood type III). Mean age of the
patient group was 34.24 years (21–55 years). The mean
follow-up period in this study was 23.5 months
(20–26 months) after hook plate fixation and an average of
19.9 months (17–22 months) after hook plate removal. The
average Constant Score at 3 months after hook plate
removal was 60.3 as compared to 83.7 and 90.3 at
6 months and 1 year, respectively, and an average of 91.8
at the last follow-up that was approximately 2 years after
initial surgery which was statistically significant (p value
\0.05). The UCLA Score was an average of 15.27, 25.9
and 30.1 at 3, 6 months and 1 year, respectively, after
removal of hook plate which improved further an average
of 32.3 at the last follow-up, which was also statistically
significant (p value\0.05). Clavicular hook plate fixation
without coracoclavicular ligament reconstruction is a good
option for acute acromioclavicular dislocations producing
excellent medium-term functional results in high-demand
soldiers.

Acromioclavicular dislocation associated with coracoid process fracture is a rare injury. Herein we reported two further cases with such combination of injuries and reviewed all previously published cases in current literature. In this... more

Acromioclavicular dislocation associated with coracoid process fracture is a rare injury. Herein we reported two further cases with
such combination of injuries and reviewed all previously published cases in current literature. In this review, we discussed the
demographic characteristics, mechanism of injury, diagnosis, and treatment options extensively.

Many US diagnosticians do not assess the posterior talofibular ligament on the assumption that visualizing this structure is difficult, and thus such examination will not be reliable. As with any anatomic structures, these... more

Many US diagnosticians do not assess the posterior talofibular ligament on the assumption that visualizing this structure is difficult, and thus such examination will not be reliable.
As with any anatomic structures, these challenges can
be overcome by understanding the anatomy of this area,
which would not only make the imaging of this structure
easier, but also repeatable, and most importantly – useful
in clinical practice.

This is a unique case of a female patient with features of classical and hypermobile types of Ehlers-Danlos syndrome (EDS) who developed complex scapular winging from spinal accessory and long thoracic neuropathies. These neurological... more

This is a unique case of a female patient with features of classical and hypermobile types of Ehlers-Danlos syndrome (EDS) who developed complex scapular winging from spinal accessory and long thoracic neuropathies. These neurological problems became manifest after an uncomplicated total shoulder arthroplasty (TSA). The patient had a complex postoperative course with extensive work-up in addition to revision shoulder surgery and manipulations to treat shoulder stiffness. It was eventually suspected that the periscapular nerve impairments occurred during physical therapy sessions after her TSA. This interpretation was further supported by genetic evidence that, in addition to EDS, the patient had an unrecognized genetic propensity for nerve palsies from stretch or pressure (“hereditary neuropathy with liability to pressure palsies” (HNPP)). By two years after the TSA the neuropathies had only partially improved, leaving the patient with persistent scapular winging and shoulder weakne...

We treated 32 shoulders in the period of 1993 to 2002 by the transfer of latissimus dorsi and teres mayor technic. We evaluate 29 shoulders in 26 patients with irreparable rotator-cuff, before and after surgery using the University of... more

We treated 32 shoulders in the period of 1993 to 2002 by the transfer of latissimus dorsi and teres mayor technic. We evaluate 29 shoulders in 26 patients with irreparable rotator-cuff, before and after surgery using the University of California at Los Angele (UCLA) protocol. There were 15 men and 11 women. The mean age was 62.8 years and the average follow-up was 58 months (14 to 114 months). The exclusion criteria were: follow-up less than 12 months (Two cases) and death (One case). The results were excellent in 10 shoulders, good in 11, fair in six and poor in only two shoulders. The active forward flexion increased 60 degrees at average. The group in which the biceps was not compromised showed better results than the group in which the biceps was absent when we evaluate about function, active forward flexion and strength. The authors concluded that the transfer of latissimus dorsi, with the bone insertion is a efficient technique in restoring the function of irreparable lesions of rotator-cuff.

A thromboelastometric profile and standard laboratory tests (hemoglobin, platelets count, PT, aPTT, fibrinogen) were performed in the same timeon patient venous blood and on unwashed salvaged blood in the PACU.Results. – Twenty patients... more

A thromboelastometric profile and standard laboratory tests (hemoglobin, platelets count, PT, aPTT, fibrinogen) were performed in the same timeon patient venous blood and on unwashed salvaged blood in the PACU.Results. – Twenty patients were included. The median duration of surgery was 93 minutes. Thirteen patients (65%) received tranexamic acid duringprocedure. The median volume of shed blood was 225 mL. Two patients (10%) received a reinfusion. Analysis of shed blood showed a majordeficiency of clotting factor in standard biology (PT < 10%) and an absence of clot formation in thromboelastometric test (In-tem®, Ex-tem®,Fib-tem®or Ap-tem®). Compared to venous blood, shed blood had significantly lower hemoglobin levels: 8.8 vs 13.5 g/dL (P < 0.0001). Allogenictransfusion concerned 5% of patients.Discussion. – In this work, we confirmed that shed blood was naturally uncoagulable probably due to a multifactorial mechanism involving a majorclot factor deficiency and an activation of fibrinolysis.

Bilateral posterior fracture-dislocation of the shoulder is a very rare injury. Almost 50% of bilateral posterior dislocations are due to a convulsive seizure, rising to 90% if the dislocations are associated with fractures. Electric... more

Bilateral posterior fracture-dislocation of the shoulder is a very rare injury. Almost 50% of bilateral posterior dislocations are due to a convulsive seizure, rising to 90% if the dislocations are associated with fractures. Electric shock accounts for less than 5% of bilateral posterior dislocations of the shoulder. A systematization of the clinical and radiological approach, followed by an early diagnosis and proper surgical treatment is essential. Authors report 2 cases of bilateral posterior fracture-dislocation of the shoulder, one caused by a convulsive seizure and the other by an electric shock. A review of literature and a treatment protocol are also presented.

The rotator cuff tears (RCT) are a well-known cause of shoulder pain and loss of upper extremity function. The purpose of this study was to evaluate the upper extremity function using two different methods in patients with RCT and to... more

The rotator cuff tears (RCT) are a well-known cause of shoulder pain and loss of upper extremity function. The purpose of this study was to evaluate the upper extremity function using two different methods in patients with RCT and to determine the parameters that influence the upper extremity function. A sample of 38 patients (27-76 years; 10 men and 28 women) who were diagnosed with a chronic full-thickness RCT, confirmed by magnetic resonance imaging (MRI), was studied. Upper extremity function was determined using Western Ontario Rotator Cuff Index (WORC) and 9 Hole Peg Test (9PEG). Other assessments included active range of motion (ROM), muscle strength, shoulder pain, and scapular dyskinesis. There was a weak association between WORC scores and 9PEG. A statistically significant, negative relationship was found between 9PEG and ROM in supination, as well as muscle strength of shoulder extensors, adductors, internal and external rotators. In addition to the weak association betwe...

With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT) to shoulder surgeons, illustrate the possible clinical value it may offer as... more

With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT) to shoulder surgeons, illustrate the possible clinical value it may offer as new ...

With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT) to shoulder surgeons, illustrate the possible clinical value it may offer as... more

With the cases described, we strive to introduce single photon emission computerized tomography in combination with conventional computer tomography (SPECT/CT) to shoulder surgeons, illustrate the possible clinical value it may offer as new ...

The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction. Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle... more

The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction. Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord(™) suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire(®) suture (FiberWire(®), Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper. The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord(™) suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire(®) suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, whic...