Complications of endoscopic and open carpal tunnel release.

Separate questionnaires regarding surgically treated complications of endoscopic and open carpal tunnel release over a 5-year period were sent to members of the American Society for Surgery of the Hand to assess and compare major complications of the 2 procedures. Four hundred fifty-five major complications from endoscopic carpal tunnel release were treated by the 708 respondents. This included 100 median nerve lacerations, 88 ulnar nerve lacerations, 77 digital nerve lacerations, 121 vessel lacerations, and 69 tendon lacerations. There were 283 major complications from open carpal tunnel release treated by 616 respondents, including 147 median nerve lacerations, 29 ulnar nerve lacerations, 54 digital nerve lacerations, 34 vessel lacerations, and 19 tendon lacerations. Although this is a retrospective voluntary study with resultant methodologic flaws, the data support the conclusion that carpal tunnel release, be it endoscopic or open, is not a safe and simple procedure. Major, if not devastating, complications can and do occur with both procedures, of which surgeons should be ever cautious.

Acromial structure and tears of the rotator cuff.

Rotator cuff lesions have been related to the structure of the acromion. We report a clinical review of 56 shoulders and the analysis of their acromial structure as seen on the radiographic arch (outlet) view and magnetic resonance imaging. The shoulders were classified as acromial type I (flat), type II (curved), or type III (hooked). On plain radiographs 89% of type III acromions had tearing of the rotator cuff (p < 0.001). The association between acromial type as determined on magnetic resonance imaging and the presence of rotator cuff tearing was less significant. Magnetic resonance imaging offered no additional benefit over plain radiographs for determining acromial type. In addition, a method of quantitating acromial structure (the "acromial angle") was devised. This angle showed a significant association with acromial types (p < 0.0001) seen on plain radiographs and had good interobserver reproducibility (coefficient of variation, 0.1). With this measurement system a type I acromion had an acromial angle of 0 degrees to 12 degrees; a type II acromion, 13 degrees to 27 degrees; and a type III acromion, greater than 27 degrees.

Acromial angle on radiographs of the shoulder: correlation with the impingement syndrome and rotator cuff tears.

OBJECTIVE: This study was undertaken to determine the reproducibility of measurements of an acromial angle on radiographs and to correlate those measurements with the presence of the impingement syndrome and rotator cuff tears. MATERIALS AND METHODS: Ninety-nine shoulders in 95 patients who had an arch radiograph and had undergone shoulder arthroscopy were included in this retrospective study. The acromial angle was measured on the arch view of the shoulder independently by three observers who were blinded to the name, history, and arthroscopic results. The angle was measured at the intersection of lines drawn along the inferior cortex of the anterior and posterior portions of the acromion. Interobserver variability was determined by the intercorrelation coefficient (a test of reproducibility of quantitative measurements). The average of the three measurements for each patient was correlated with the preoperative diagnosis and the arthroscopic findings. RESULTS: A correlation was found between increasing severity of cuff disease as determined on arthroscopy and increasing acromial angle (p < .01). In 67 patients (70 shoulders) with impingement, patients with a full-thickness tear (29%) accounted for 43% of those with an angle of 30 degrees or greater. The average acromial angle for patients with impingement was greater than that for either patients with instability or patients with trauma (p < .05 for both). An angle of 25 degrees or greater was measured in 63% of patients with impingement but in only 18% of those with instability. The average acromial angle in patients with impingement and an intact rotator cuff was also greater than the average angle in patients with instability (p = .001). The interobserver variability had an intercorrelation coefficient of 0.90. CONCLUSION: The acromial angle is an objective and fairly reproducible measure of anterior acromial shape. The angle is useful in identifying patients with a greater likelihood of having a rotator cuff tear and in distinguishing patients with primary impingement from those with instability.