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1.
Orthopedics ; 38(7): e631-4, 2015 Jul 01.
Article in English | MEDLINE | ID: mdl-26186327

ABSTRACT

Traumatic rotator cuff tears in patients younger than 25 years are rare events, with few reports in the literature. When compared with the more mature shoulder, the young, healthy supraspinatus tendon is a robust tendon that is able to absorb a significant amount of energy before tendon failure. Therefore, the diagnosis of a rotator cuff tear can be often overlooked in this population due to the patient's age. This is a report of traumatic supraspinatus repairs in patients younger than 25 years. Nine patients younger than 25 years were identified with a posttraumatic supraspinatus tear as visualized during routine diagnostic shoulder arthroscopy. These 9 patients represented 0.33% of all rotator cuff repairs during a 9-year period. Average patient age was 19.1 years (±3.7 years; range, 13 to 25 years). Magnetic resonance imaging failed to diagnose a rotator cuff tear in 50% of the patients. Mean delay from injury to surgery was 6.6 months. All tears were arthroscopically repaired. Concomitant anterior instability pathology was demonstrated among 66.7% of the patients. No complications were reported. At latest follow-up, all patients reported minimal to no shoulder pain and were tolerating strenuous work, activities, and sports without significant complaints. Even with advanced imaging, the diagnosis of a rotator cuff tear can often be missed in this patient population. Although clinical outcomes can be good, care must be taken to broaden the diagnostic differential in young patients with posttraumatic shoulder pain.


Subject(s)
Rotator Cuff Injuries , Shoulder Injuries , Tendon Injuries/surgery , Adolescent , Adult , Arthroscopy , Female , Humans , Magnetic Resonance Imaging , Male , Retrospective Studies , Rotator Cuff/surgery , Rupture , Shoulder Joint/pathology , Shoulder Joint/surgery , Shoulder Pain/etiology , Tendon Injuries/pathology , Wound Healing , Young Adult
2.
Orthopedics ; 36(3): e377-80, 2013 Mar.
Article in English | MEDLINE | ID: mdl-23464961

ABSTRACT

Although postarthroscopic glenohumeral chondrolysis has become a well-known disastrous complication of arthroscopic shoulder surgery, little is known about postarthroscopic humeral head osteonecrosis. This article describes 3 patients who were referred to the authors' practice with end-stage osteonecrosis after an arthroscopic rotator cuff repair or debridement.Three patients (average age, 63.3 years) presented to the authors' practice reporting severe shoulder pain after a rotator cuff debridement or repair was performed at an outside facility. After an interval period of mild improvement, all patients experienced progressive pain and loss of shoulder range of motion at a mean of 4.8 months postoperatively. Plain radiographs and magnetic resonance imaging obtained prior to the index operation showed no evidence of osteonecrosis. Postoperatively, progressive clinical and radiographic evidence showed humeral head osteonecrosis and subsequent glenohumeral destruction with cuff tear arthropathy. The authors managed all patients with a reverse total shoulder arthroplasty due to severe glenohumeral arthrosis and massive rotator cuff tears not amendable to repair. Satisfactory results were achieved in all cases.Although many complications of arthroscopic shoulder surgery are documented, little is known about postarthroscopic humeral head osteonecrosis. Shoulder surgeons should be aware of this potential complication when performing arthroscopic rotator cuff surgery and when evaluating painful and stiff postarthroscopic shoulders.


Subject(s)
Arthroplasty, Replacement , Arthroscopy/adverse effects , Humeral Head/pathology , Osteonecrosis/surgery , Rotator Cuff/surgery , Shoulder Joint/surgery , Humans , Middle Aged , Osteonecrosis/etiology
3.
J Shoulder Elbow Surg ; 15(4): 440-4, 2006.
Article in English | MEDLINE | ID: mdl-16831648

ABSTRACT

We compared 2 groups of patients with chronic distal biceps tendon ruptures, 7 patients treated nonoperatively and 7 undergoing semitendinosus autograft tendon reconstruction. The mean time to surgery after the initial injury was 17 weeks. The mean clinical follow-up in the operative group was 63 months. Functional strength and endurance testing was measured at a mean of 30 months after injury in the nonoperative group and 26 months in the operative group. A 2-incision technique was used. In the allograft reconstruction group, flexion and supination strength was restored to the normal range. The nonoperative group lacked 20% of normal strength. Endurance in both groups was within the normal range. Autograft semitendinosus reconstruction in chronic distal biceps tendon ruptures improves flexion and supination strength when compared with nonoperative treatment. No radial nerve injuries or heterotopic ossification occurred, and all reconstructions remain intact.


Subject(s)
Tendon Injuries/surgery , Tendons/transplantation , Adult , Humans , Male , Middle Aged , Orthopedic Procedures/methods , Rupture , Time Factors
4.
Clin Sports Med ; 22(2): 407-22, ix, 2003 Apr.
Article in English | MEDLINE | ID: mdl-12825539

ABSTRACT

Symptomatic arthritic involvement of the sternoclavicular joint is relatively uncommon and can be a result of distant trauma, infection, and sternocostoclavicular hyperostosis, post-menopausal arthritis, condensing osteitis of the proximal clavicle, or secondary to an underlying arthropathy. Patients with degenerative osteoarthritis due to trauma most commonly have had either an anterior or posterior dislocation, subluxation, or periarticular fracture. Medical claviculectomy with or without ligamentous stabilization is indicated only in situations of painful primary and secondary rheumatoid arthritis, or in patients with neoplastic lesions. Numerous authors have recommended surgical reconstruction but few have reported series larger than two or three cases. This article reviews a few specific arthropathy conditions about the sternoclavicular joint and discusses their nonoperative and operative management.


Subject(s)
Hyperostosis/therapy , Osteoarthritis/therapy , Sternoclavicular Joint , Adult , Aged , Arthritis, Reactive/etiology , Arthritis, Reactive/therapy , Arthroplasty/methods , Clavicle/surgery , Female , Fractures, Bone/complications , Humans , Hyperostosis/diagnosis , Hyperostosis/etiology , Joint Dislocations/complications , Joint Instability/surgery , Male , Middle Aged , Osteitis/diagnosis , Osteitis/etiology , Osteoarthritis/diagnosis , Osteoarthritis/etiology , Postmenopause , Sternoclavicular Joint/injuries
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