ABSTRACT
Total shoulder replacement is a successful procedure for degenerative or some inflammatory diseases of the shoulder. However, fixation of the glenoid seems to be the main weakness with a high rate of loosening. The results using all-polyethylene components have been better than those using metal-backed components. We describe our experience with 35 consecutive total shoulder replacements using a new metal-backed glenoid component with a mean follow-up of 75.4 months (48 to 154). Our implant differs from others because of its mechanism of fixation. It has a convex metal-backed bone interface and the main stabilising factor is a large hollow central peg. The patients were evaluated with standard radiographs and with the Constant Score, the Simple Shoulder Test and a visual analogue scale. All the scores improved and there was no loosening, no polyethylene-glenoid disassembly and no other implant-related complications. We conclude that a metal-backed glenoid component is a good option in total shoulder replacement with no worse results than of those using a cemented all-polyethylene prosthesis.
Subject(s)
Arthroplasty, Replacement/methods , Joint Prosthesis , Shoulder Joint/surgery , Aged , Arthritis, Rheumatoid/surgery , Arthroplasty, Replacement/instrumentation , Cementation , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis/surgery , Prosthesis Design , Radiography , Shoulder Joint/diagnostic imaging , Titanium , Treatment OutcomeABSTRACT
Recently the posterior humeral avulsion of the glenohumeral capsule (Reverse HAGL or RHAGL) has been reported in the orthopaedic literature as another possible cause of posterior traumatic shoulder instability. In the present paper we describe three patients in whom a RHAGL was probably a consequence of a tight open anterior shoulder stabilisation. The main complaint of these patients was a stiff shoulder after an open anterior stabilisation. A progressive and worsening discomfort was reported by patients in spite of an accurate rehabilitation program. At persistence of symptoms arthroscopy was performed with evidence of RHAGL that was repaired in association with an anterior release. Clinical and functional improvement was observed but the final outcome seems to be related to range of motion recovery and not only to the posterior repair.
Subject(s)
Joint Instability/etiology , Shoulder Dislocation/complications , Adult , Arthroscopy , Female , Humans , Joint Capsule/injuries , Joint Capsule/surgery , Joint Instability/physiopathology , Joint Instability/rehabilitation , Joint Instability/surgery , Ligaments, Articular/injuries , Ligaments, Articular/surgery , Male , Range of Motion, Articular , Reoperation , Shoulder Dislocation/physiopathology , Shoulder Dislocation/surgerySubject(s)
Intervertebral Disc/pathology , Magnetic Resonance Imaging , Spinal Diseases/diagnosis , Back Pain/diagnosis , Humans , Intervertebral Disc/diagnostic imaging , Intervertebral Disc Displacement/diagnosis , Intervertebral Disc Displacement/diagnostic imaging , Lumbosacral Region , Nerve Compression Syndromes/diagnostic imaging , Nerve Compression Syndromes/pathology , Osteoarthritis/diagnostic imaging , Osteoarthritis/pathology , Spinal Diseases/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Past radiologic and anthropometric studies report a high incidence of glenoid anteversion and increased humeral retrotorsion in patients with recurrent anterior dislocation (RAD) of the shoulder. However, recent radiologic studies do not demonstrate significant developmental variations between normal and unstable shoulders. To investigate these conditions, the authors used computed tomography (CT), which offered the advantage of permitting a transverse view at different levels of the glenohumeral joint. CT also avoided the typical distortion inherent in plain radiographs performed in the axial projection. No significant developmental differences in glenohumeral index, glenoid anteroposterior orientation, and humeral retrotorsion were found between 50 normal subjects and 40 patients with RAD. Only erosions and fractures of the glenoid may affect orientation and anteroposterior diameter of the glenoid. Mainly, traumatic lesions rather than developmental abnormalities seem to affect these parameters in RAD patients.
Subject(s)
Humerus/diagnostic imaging , Joint Instability/diagnostic imaging , Scapula/diagnostic imaging , Shoulder Joint/diagnostic imaging , Tomography, X-Ray Computed , Adult , Humans , Middle Aged , Reference Values , Shoulder Dislocation/diagnostic imaging , Tomography, X-Ray Computed/methodsABSTRACT
The authors discuss the value of computerised tomography combined with double contrast medium arthrography in the various pathological conditions associated with scapulohumeral instability. The results obtained in 18 patients with anterior instability and the findings reported in the literature indicate that arthro-C.T. is currently the simplest, most reliable and most comprehensive procedure for investigation of the lesions of the bones, joint capsule and glenoid labrum associated with instability of the shoulder. It is particularly indicated in the forms of instability in which there are no documented episodes of dislocation, while in cases of recurrent dislocation it provides a complete overview of the bone and capsule lesions that can be used as a basis for individually tailored surgical treatment.
Subject(s)
Joint Instability/diagnostic imaging , Shoulder Joint/diagnostic imaging , Tomography, X-Ray Computed , Adult , Contrast Media/administration & dosage , Evaluation Studies as Topic , Humans , Male , Methods , RecurrenceABSTRACT
Radiological investigation of the shoulder joint in articular instability syndromes often yields inadequate information. Computerised tomography, either with or without a contrast medium, can provide more precise information about the pathological anatomy of the bones and capsuloligamentous structures. The authors report their experience in 50 normal and 33 pathological shoulders.
Subject(s)
Joint Instability/diagnostic imaging , Shoulder Joint/diagnostic imaging , Tomography, X-Ray Computed , Arthrography , Contrast Media , Humans , Humerus/diagnostic imaging , Scapula/diagnostic imaging , Shoulder Dislocation/diagnostic imagingABSTRACT
The importance of instability in the determination of painful syndromes of the shoulder is examined, with particular reference to young people who engage in sport. The physiopathology and clinical features are described, and the importance of diagnostic tests is emphasized. These often disclose the underlying pathological anatomy. Surgical treatment, which is indicated whenever the lesion is well documented, follows the methods used in treating recurrent dislocation. The validity of the method of Latarjet and Bristow is emphasized.
Subject(s)
Joint Instability/surgery , Shoulder Joint , Adult , Biomechanical Phenomena , Diagnosis, Differential , Female , Humans , Joint Instability/diagnosis , Joint Instability/physiopathology , Male , Methods , Movement , Shoulder Dislocation/diagnosis , Shoulder Joint/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
In a double-blind study, indoprofen was superior to placebo in decreasing pain in patients with primary and metastatic cancer and with neuralgia. A single oral dose of 200 mg was more active than a 100-mg dose. The preferences of patients proved to be a more sensitive parameter in this study than scores of pain intensity, pain relief, and other related measurements (SPID, TOTPAR, and Peak PID).