ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Understanding the effect of superior labral lesions on the function of the shoulder is essential to successfully treating the overhead athlete. Recognizing the pseudolaxity due to SLAP lesions and the pathologic “peel-back” sign is critical in evaluating the injured shoulder and repairing the SLAP lesion. The mechanical characteristics of suture anchors are more favorable in resisting the pathologic forces responsible for the peel-back mechanism. The higher success rate of arthroscopic suture anchor repair of SLAP lesions compared with open capsulolabral reconstruction suggests that SLAP lesions are the usual cause of the “dead arm” syndrome. In our experience, arthroscopic repair of SLAP lesions can return the overhead athlete to pre-operative level of function in the vast majority of cases (87% return to pre-operative level for two or more seasons).

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

A subcoracoid pectoralis major muscle transfer is an option for the treatment of irreparable subscapularis deficiency. Subscapularis deficiency is a significant source of pain, reduced strength, and instability in the shoulder. A pectoralis major transfer may be indicated in patients with subscapularis deficiency in whom previous surgical repair has failed or who are deemed to have an irreparable tear, patients with recurrent glenohumeral instability and subscapularis deficiency after a failed instability repair, and patients with chronic anterosuperior instability after previous prosthetic replacement. The pectoralis major tendon is detached from its insertion on the humerus and transferred in the subcoracoid position. The musculocutaneous nerve is dissected free from the undersurface of the conjoined tendon. The pectoralis major is then transferred deep to the conjoined tendon and superficial to the musculocutaneous nerve. A pectoralis major transfer is then attached to the greater tuberosity of the humerus. This appears to be an effective option for patients with the difficult problem of irreparable subscapularis deficiency as well as anterosuperior instability. It has a low complication rate and a high degree of satisfaction.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Scapular winging secondary to serratus anterior palsy was first described nearly three centuries ago. Since that time numerous procedures, dynamic and static in design, have been developed for the treatment of this clinical entity. Recent clinical studies demonstrate excellent results with the use of a split pectoralis major transfer to the inferior angle of the scapula. Autologous tendon grafts such as fascia lata or semitendinosus/gracilis may be used to augment the transfer. Successful direct transfer of the pectoralis major tendon, which may lower donor site morbidity associated with graft harvest, has been recently described. Overall, the literature reports satisfactory outcomes in 81% to 100% of patients treated with the pectoralis major transfer.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

With the advent of magnetic resonance imaging, supraglenoid cyst identification has become more common. A high incidence of type II SLAP lesions has been described in association with these cysts, which are frequently located in the region of the suprascapular notch. Clinical evaluation frequently reveals posterolateral shoulder pain and infraspinatus weakness and atrophy. We have successfully treated patients with symptomatic cysts using diagnostic arthroscopy followed by arthroscopic cyst decompression. All patients in our study were identified with a superior labral pathology and subsequently went on to have arthroscopic superior labral stabilization. Open decompression is reserved for patients when an adequate arthroscopic decompression cannot be confirmed, or a large cyst is associated with significant neurologic involvement of the infraspinatus or supraspinatus muscle, or both.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Rotator cuff reconstruction associated with inferior acromioplasty is an effective treatment for the patient with a full-thickness rotator cuff tear. This article describes the author's technique of using multiple sutures to reconstruct the torn rotator cuff tendon. Intuitively, it is felt that this multi-suture technique will distribute forces across the tendon better than will fewer, larger sutures. The author has published a comprehensive review of 72 patients treated with this technique and evaluated at a minimum follow-up of 2 years (range, 24–102 months). The mean age was 58 years (range, 24–87 years). At follow-up 82% of the patients rated their pain as <2 on a 0—10 visual analog scale, with “0” representing no pain. Ninety-six percent of the patients had no pain or slight pain without restriction of their activities of daily living. Ninety-four percent of the patients were subjectively satisfied with their surgical result. The mean UCLA scoring scale was 32 (range, 7–35). The mean Hospital for Special Surgery Scale was 94 and the mean raw Constant–Murley Score was 78 points (range, 12–95). This modification of the “classic” rotator cuff reconstruction yields predictable results and can be adapted to mini-open rotator cuff reconstruction. Although marked technologic changes have enhanced our ability to address rotator cuff disease arthroscopically, open rotator cuff reconstruction should remain a choice of the shoulder surgeon.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Posterior elbow pain in the throwing athlete often requires surgical treatment. High valgus and extension forces at the elbow during the throwing motion may result in posteromedial olecranon hypertrophy, osteophyte formation, chondral damage to the trochlea, and loose bodies. With careful attention to detail and meticulous surgical technique, arthroscopic management of posterior elbow impingement may be performed with minimal risk of complications. This article discusses our technique in detail, with an emphasis on avoiding potential complications.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Osteochondritis dissecans (OCD) is an inflammatory process affecting the articular surface of the capitellum of the distal humerus. Preoperative evaluation consists of monitoring function, range of motion, and pain and obtaining a thorough history of the onset of symptoms. Plain radiographs are usually sufficient to delineate the lesion, but magnetic resonance imaging (MRI) can occasionally be helpful to further outline the nature and exact location of the pathology. With progression of symptoms and deterioration of function, surgery is indicated, because the natural history is one of continued elbow dysfunction and can ultimately result in permanent joint deformity. This chapter outlines surgical approach, with an emphasis on arthroscopy, technique, and results. Specific complications are also mentioned.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID