ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Without a clear understanding of the functional role for the long head of the biceps tendon, treatment recommendations have remained the subject of controversy. Some investigators have suggested that the tendon has only a vestigial function; others believe that it may play a critical role in shoulder stability. More recently, previously accepted theories of the function of the long head of the biceps tendon have been re-examined because of increased awareness of the significance of a retained symptomatic tendon. This tendon can be an important source of shoulder pain and disability when not specifically addressed, and functional consequences more negative than loss of the tendon are likely. Disorders affecting the long head of the biceps tendon can be classified as inflammatory, instability related, or traumatic, on the basis of the original initiating event. However, because of the close association of biceps tendon lesions with other abnormalities, a thorough evaluation of the shoulder is essential. Our surgical approach has been to employ arthroscopy, with special emphasis on discovering and treating any associated disorders. A decision on appropriate surgical management for the long head of the biceps tendon is made at the time of arthroscopy. Tenotomy or tenodesis is recommended for irreversible structural changes in the tendon, such as significant atrophy or hypertrophy, partial tearing greater than 25% of the width of the tendon, any luxation of the tendon from the groove, and for certain disorders of the biceps origin. Tenodesis is preferred for the younger patient. An acceptable alternative in the older patient is tenotomy without tenodesis. It should be emphasized that routine tenotomy or tenodesis is not recommended.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Interference screw fixation has been used with success for hamstring anterior cruciate ligament reconstruction of the knee. We propose the same fixation principle for arthroscopic tenodesis of a pathologic long head of the biceps (LHB) using bioabsorbable interference screws. Forty-three patients underwent tenodesis of the LHB for a pathologic tendon (tenosynovitis, pre-rupture, subluxation, or dislocation) encountered in three clinical situations: 1) with arthroscopic or mini-open rotator cuff repair (n = 3); 2) with intact cuffs (n = 6); or 3) with massive, irreparable cuff tears (n = 34). Mean age was 63 years. Minimum clinical and radiographic follow-up was 2 years. Six steps were required: 1) glenohumeral exploration and tenotomy of LHB; 2) anterior bursectomy and opening of bicipital groove; 3) LHB exteriorization and preparation; 4) humeral socket preparation; 5) trans-humeral Beath pin “pull-through” technique; and 6) bioabsorbable interference screw fixation. Constant score averaged 43 points before surgery and 79 points at review (p < 0.05). No deficit in elbow flexion-extension was observed. Spring-balance strength of the tenodesed biceps averaged 90% of the contralateral side (range, 80%–100%). Two early patients demonstrated distal biceps retraction and failure of the tenodesis within 3 months. Magnetic resonance imaging at final review revealed tight fixation of the LHB in the humeral socket and no adverse tissue reaction to the screw. These short-term results compare favorably with both open and previously described arthroscopic tenodeses using sutures. This technique is advantageous for pathologic LHB with intact cuffs, associated arthroscopic cuff repairs, and irreparable cuff tears instead of simple tenotomy.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Techniques for placement and fixation of the humeral component in shoulder arthroplasty have evolved over the past 40 years. This article reviews the comparative advantages and disadvantages of three commonly used methods for humeral prosthetic fixation (porous in-growth, classic press-fit, and cementing) and compares them with our presented technique of conservative broaching and impaction grafting. In this presented method, morcellized cancellous bone from the resected humeral head is sequentially impacted into the metaphyseal and proximal diaphyseal regions of the proximal humerus. This graft serves to 1) fill voids between implant and bone to improve fixation, 2) preserve bone stock, 3) allow for optimization of implant position, 4) minimize the risk of fracture compared with the conventional press-fitting technique, and 5) minimize the need for complex prosthesis modularity.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Regaining stable glenohumeral range of motion is critically important for improved function after total shoulder arthroplasty. The surgeon's ability to significantly improve stable range of motion depends on the underlying pathologic condition of the bone and soft tissues, surgical technique, and postoperative rehabilitation. For this reason, patient selection and meticulous attention to surgical detail are the keys to success. This article outlines the important surgical techniques necessary to regain stable range of motion after total shoulder arthroplasty, with special emphasis on soft-tissue releases, reconstruction, and balancing.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Nonunions of the surgical neck of the proximal humerus are unusual, given the natural ability of these fractures to heal without surgical intervention. However, when they do occur, they can be quite difficult to treat because of the often poor bone quality and other associated factors. The keys to successful treatment of these nonunions are limited exposure and minimal hardware, which maximize the potential for obtaining bony union and a pain-free functional shoulder. This report describes a two-tension-band technique that combines both these factors.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Nonoperative management is the treatment of choice for the vast majority of humeral shaft fractures. Good or excellent outcomes are reported in 85% to 95% of patients. However, the superiority of operative treatment has been demonstrated in several clinical scenarios, including open fractures, pathologic fractures, fractures in multiple-trauma patients, and fractures with associated intra-articular extension or neurovascular injuries. Operative management of humeral shaft fractures is also a viable option after failure to obtain or maintain acceptable fracture alignment by closed means, in cases of associated ipsilateral or contralateral upper extremity fractures, and for treatment of malunited or nonunited fractures. Osteosynthesis with plates and intramedullary nailing have been advocated, and multiple devices and surgical approaches are available for both techniques—each with particular advantages and disadvantages. Although there are few controlled studies comparing the various surgical treatment options, most authors report that intramedullary nailing may be associated with slightly higher rates of complications, particularly postoperative shoulder pain and impingement when using the antegrade approach, and elbow dysfunction when using the retrograde approach. We recommend plate fixation for most operatively treated humeral shaft fractures, particularly those with distal extension, nerve injury, or vascular injury. Nailing is preferred for fractures with proximal extension, segmental or significantly comminuted fractures, pathologic fractures, and humeral shaft fractures associated with significant soft tissue compromise. Key areas for future studies include entry site morbidity associated with intramedullary nailing, patient-perceived impact on quality-of-life, economic impact of humeral shaft fractures, and treatment alternatives.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Recurrent anterior glenohumeral instability and particularly failed surgical repairs may be complicated by loss of anterior glenoid concavity. Patients with major defects of the anteroinferior glenoid are unlikely to respond to soft-tissue procedures alone. In these situations a bony reconstruction is considered. Extracapsular anatomically contoured anterior glenoid bone grafting, using autologous iliac crest, provides an excellent method of robustly reconstructing the anterior glenoid lip. The iliac crest bone graft is secured so that the capsule is interposed between it and the humeral head. The graft is contoured so that it extends the natural curvature of the glenoid. Immediate stability provided by the securely fixed graft allows motion to be started the day of surgery. This procedure has provided secure glenohumeral stability in situations where soft-tissue repairs proved inadequate. It is our procedure of choice when the anterior glenoid lip cannot be reconstructed by soft-tissue procedures.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Unstable symptomatic os acromiale is an unusual cause of impingement syndrome and rotator cuff pathology. Failure of nonoperative measures may require surgical intervention. Arthroscopic excision of the unstable bone fragment and treatment of any associated minor rotator cuff pathology have produced acceptable results.

ISSN:1523-9896    

出版商:OVID    

年代:2001

数据来源: OVID