摘要:

The shoulder joint is perhaps the most complex joint in the body. Preserving function after a surgical procedure on the shoulder would seem to be difficult. For five common approaches to the shoulder, the application of priorities in shoulder surgery is discussed to illustrate how decisions have been made in the past and how new procedures should be designed. The priorities in shoulder surgery, in order of importance, are (1) to preserve tissue viability, (2) to preserve motor control of muscle tissue and maintain muscle geometry, (3) to achieve sufficient exposure, (4) to ensure postoperative cosmesis, and (5) to preserve skin sensations.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The modified Bristow-Latarjet procedure is described in detail. The pitfalls and potential problems are carefully outlined for each step of the procedure. A review of the past and current literature shows that the procedure continues to be reliable for restoring stability to the shoulder joint characterized by anterior instability in the abducted and externally rotated position. However, a full return to preinjury overhead athletic activities in the dominant extremities is usually not possible.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The Bankart procedure is an operation in which an avulsed anterior shoulder capsule is reattached to the anterior rim of the glenoid fossa. The Bankart procedure is indicated for the treatment of recurrent anterior-inferior glenohumeral instability. This article details the operative technique. An anterior deltopectoral approach is used. A coracoid osteotomy is optional. Three methods of dividing the subscapularis tendon and muscle are described. The capsule can be divided using either a vertical or a T-shaped incision. When reattaching the capsule to the rim, the capsule may be overlapped in a superior-inferior direction. If a Bankart lesion is present, holes are made in the anterior glenoid rim, and the capsule is sutured to the bone. The medial capsule is then sutured over the lateral capsule to reinforce the repair. If no Bankart lesion is present, the sutures are placed through the glenoid labrum rather than the bone.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The anterior capsulolabral reconstruction (ACLR) was developed in response to the increasing awareness of instability as the common underlying pathologic entity in the throwing shoulder. The ACLR creates a new capsulolabral complex by addressing the inferior glenohumeral ligament with sutures through the anterior glenoid. This is done without detaching, shortening, or transferring any muscle. The shoulder is mobilized immediately and splinted in abduction. A supervised rehabilitation program is incorporated to enhance the return of functional motion and sports-specific athletic activity.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

In multidirectional instability, glenohumeral subluxation or dislocation can occur in three different directions: anteriorly, posteriorly, or inferiorly. The primary abnormality is a loose, redundant inferior capsule. Standard repairs for glenohumeral instability have not been successful in correcting this problem, since these procedures do not correct the primary abnormality, the redundant inferior pouch. The inferior capsular shift procedure corrects inferior capsular and ligamentous redundancy. It is usually performed through one surgical approach either anteriorly or posteriorly, depending on the direction of greatest instability.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Posterior shoulder subluxation is common in an athletic population. Most of the patients respond to a conservative exercise program, however, some individuals need operative repair. Posterior capsulor-rhaphy has proven to be a reliable technique in an athletic population for providing stability to the shoulder joint. The procedure can be performed through intramuscular planes without detachment of any muscles. By developing inferior and superior flap, any posterior redundancy in the capsule can be eliminated. The shoulder is immobilized postoperatively for three weeks in an abduction type pillow in neutral rotation, and six months of rehabilitation is required for recovery. Results are good for providing stability for the shoulder, but are unpredictable in allowing an athlete to return to his former throwing status.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

This article describes the surgical technique for repairing a full-thickness tear of the rotator cuff utilizing a trough in bone. There are several important steps that will be described in detail. Adequate decompression, secure fixation of the rotator cuff to a trough in bone, and reattachment of the deltoid muscle to the acromion are essential for success.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

From 1983 to 1987, subscapularis tendon transposition was used in 50 of 197 shoulders (25%) as part of the repair of rotator-cuff tears. The technique is useful for certain large tears with area defects in which the subscapularis tendon itself is involved to a minor degree. Only standard surgical exposure is necessary. Preparation of the tissue to be transposed is precise and well defined. Examination of the rotator-cuff repair before suturing of the deltoid muscle directs the postoperative rehabilitation. Physiotherapy usually includes early passive motion within the prescribed limits.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The technique of shoulder arthrodesis utilizing plate osteosynthesis is discussed along with indications and clinical examples. The technique does not require spica casting and allows for elbow, wrist, and hand mobility in the first few weeks following surgery.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The indications for prosthetic replacement and proximal humeral fractures include those four-part fractures and fracture dislocations, head split fractures, fractures associated with an impression defect of more than 50% of the articular surface, and some three-part fractures in which the quality of bone is inadequate to permit rigid internal fixation for early motion. The technique for proximal humeral replacement arthroplasty emphasizes accurate identification of each displaced segment so the proper treatment method may be selected, and a technique which emphasizes maintaining the deltoid origin, utilization of the biceps tendon as a guide to the orientation and identification of fracture anatomy, proper prosthetic selection, maintaining proper tension in the cuff and deltoid musculature, secure tuberosity and rotator cuff repair, bone grafting at the tuberosity shaft junction, and careful attention to postoperative rehabilitation. Although a technically demanding procedure, careful attention to patient selection, the details of surgical technique, and postoperative rehabilitation often result in excellent pain relief and satisfactory strength and patient function.

ISSN:0885-9698    

出版商:OVID    

年代:1989

数据来源: OVID