Results of nonoperative management of full-thickness tears of the rotator cuff.

The results of nonoperative management of 53 patients with full-thickness tears of the rotator cuff proven by arthroscopic examination was as follows. Patients were treated with nonsteroidal antiinflammatory medication, stretching, strengthening, and occasional steroid injections. Average age at presentation was 62.2 years. Patients were evaluated at an average of 7.6 years. Forty patients were male, and the dominant limb was involved in 40 cases. Thirty-four patients were reviewed by questionnaire and physical examination, whereas 19 patients were evaluated by telephone interview only. In 40 patients, the onset of symptoms was associated with an injury. In 12 patients, workmen's compensation was involved. At follow-up evaluation, the 34 shoulders that were available for examination were evaluated for pain, range of motion, strength, and function. Thirty-nine of the 53 patients (74%) assessed subjectively had only slight or no shoulder discomfort. Of the 28 shoulders presenting within three months of injury, 24 (86%) were rated as satisfactory at the time of latest evaluation. Of the 16 patients who initially had had shoulder pain for over 6 months, only nine (56%) were rated as satisfactory. Most patients showed improvement with regard to their ability to perform activities of daily living. Average active total elevation was 149 degrees compared with 121 degrees at initial presentation. Thirty-two of the 34 patients examined (94%) had evidence of weakness on muscle testing and 19 (56%) had demonstrable muscle atrophy.

Advances in elbow arthroscopy.

Arthroscopy of the elbow is a very precise and demanding technique. Because of the proximity of neurovascular structures to the recommended portals, a thorough knowledge of regional and intraarticular anatomy is essential. The high degree of congruency of the articular surfaces and the relatively small capsular volume make sound arthroscopic skills a necessity. With proper precautions, the technique is safe and affords the opportunity to obtain valuable diagnostic information and to perform selected procedures without the morbidity of an arthrotomy.

The profile view of the acromion.

A previously undescribed roentgenographic view shows the acromion in "profile." A sagittal view of the acromion outlines its bony architecture, specifically, the subacromial portion. This view is clinically useful in the perioperative evaluation of patients with impingement syndrome and can be especially revealing in some cases of persistent symptomatic impingement following previous acromioplasty. The view also provides an excellent perspective for roentgenographic examination of os acromiale. It is reproducible and relatively easy to obtain. The acromion is but one component of the subacromial arch, but this view is a valuable additional diagnostic tool to be used in evaluating the sometimes perplexing problem of impingement syndrome.

Glenohumeral osteoarthrosis. A late complication of the Putti-Platt repair.

Osteoarthrosis of the glenohumeral joint is a potential late complication of anterior Putti-Platt capsulorrhaphy. In ten patients (eleven shoulders), disabling pain in the shoulder began an average of 13.2 years after a Putti-Platt repair that had been done for recurrent anterior unidirectional instability. In all of the patients, the osteoarthrosis of the glenohumeral joint resulted in substantial limitation of motion. Seven shoulders were successfully treated non-operatively, and a technique of anterior release was successful in four shoulders.

Displaced proximal humeral fractures. Selecting treatment, avoiding pitfalls.

This article, based on years of modified classification of displaced proximal humeral fractures, presents the treatment alternative for each type of injury and the problems to be avoided with each method. The authors recommend reduction and fixation in active patients with displaced proximal humeral fractures. Percutaneous pin fixation for two-part fractures, tension band fixation for three-part fractures, and hemiarthroplasty for four-part fractures are advocated.

Suppression of precocial copulation by progesterone implants in the male chick forebrain.

Precocial copulation in 2-wk.-old male chicks, described behaviorally as free mount, tread, posterior contact, waggle, peek, and seize, was developed through hand-training experience and androgen treatment. Crystalline progesterone was then implanted in various forebrain or midbrain regions. Results indicated that progesterone inhibited copulatory behavior when placed in the periventricular areas of the preoptic-hypothalamic continuum. Progesterone implants in the preoptic lateral forebrain bundle regions also suppressed precocial copulation. Forebrain implants of cholesterol did not result in copulatory inhibition. The suppression of copulatory behavior was not accompanied by loss of weight or deficits in general activity or comb growth. These data indicate that brain regions responsible for progesterone-induced copulatory inhibition are similar in neuroanatomical distribution to those involved in testosterone-induced copulatory activation.