ABSTRACT
One hundred fifty-six arthroscopic transglenoid multiple suture repairs were performed for chronic anterior shoulder instability. In 150 shoulders (96% follow-up), the outcome with respect to recurrence of instability and the Bankart Score was determined a minimum of 2 years and a mean of 4.1 years after surgery (range, 2 to 8.2 years). During the follow-up interval, 11 shoulders (7.3%) redislocated. Fourteen other shoulders (9.3%) had at least one episode that we interpreted as recurrent subluxation. Shoulders with a Bankart lesion and younger patients had a higher probability of recurrent instability (P < .05). We concluded that this method is most effective in shoulders without a Bankart lesion and in patients older than 25 years of age (regardless of pathology).
Subject(s)
Joint Instability/surgery , Shoulder Dislocation/surgery , Shoulder Joint/surgery , Suture Techniques , Adult , Female , Follow-Up Studies , Humans , Joint Capsule/surgery , Joint Instability/epidemiology , Joint Instability/physiopathology , Male , Recurrence , Shoulder Dislocation/epidemiology , Shoulder Dislocation/physiopathology , Sports , Survival Analysis , Time Factors , Treatment OutcomeABSTRACT
The etiology of rotator cuff disease is controversial, but is not always secondary to cuff impingement between the humeral head and the coracoacromial arch. Rotator cuff disease, and not impingement syndrome, more accurately describes this process. The spectrum of rotator cuff disease begins with rotator cuff inflammation (Stage I) and progresses to tendinitis (Stage II) and partial or full thickness tears (Stage III). Refractory Stage II and III disease without rotator cuff tears undergoes subacromial bursectomy and acromioplasty. Partial thickness tears are debrided with an acromioplasty, bursectomy, and removal of inferior clavicular osteophytes. Full thickness tears are treated arthroscopically or open, depending on the tear size and the patient expectations. In general, tears from 0 to 5 cm in active patients undergo subacromial decompression and a mini-open repair. Low demand patients with 0 to 5 cm tears or tears greater than 5 cm are treated with subacromial decompression and rotator cuff debridement.
Subject(s)
Arthroscopy/methods , Rotator Cuff/surgery , Acromion/surgery , Adult , Bursa, Synovial/surgery , Humans , Inflammation , Joint Diseases/surgery , Male , Rupture, Spontaneous , Tendinopathy/surgeryABSTRACT
Shoulder dislocation is a common cause of upper extremity disability. The recurrence rate is inversely proportional to the patient's age at the initial dislocation. There are several pathologic variations of anterior/inferior glenohumeral ligament laxity. The indications, contraindications, as well as the surgical procedure are reviewed in the following text. The postoperative rehabilitation program is briefly described.
ABSTRACT
We retrospectively reviewed Green procedures and transfer of the flexor carpi ulnaris (FCU) in treatment of spastic forearm pronation, wrist volarflexion, and ulnar deviation deformities. Patient's ages ranged from 3 years 5 months to 16 years 5 months. Surgically, a single volar incision was made and the extensor carpi radialis brevis and/or longus (ECRB, ECRL) were used for insertion. The FCU was tensioned at neutral against gravity and immobilized in 5 degrees of dorsiflexion and 45 degrees of supination. Arc of flexion (47 degrees) did not change but was centered about neutral. Supination improved markedly when operation included a pronator procedure. Quadraplegia athetosis and intellectual impairment did not affect the operative result adversely. Patients aged greater than 12 years showed less functional improvement. Eighty-eight percent had cosmetic improvement, and 79% improved functionally. None had a decreased functional rating.
