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1.
Biomed J ; 46(1): 163-169, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35065282

RESUMO

BACKGROUND: Long head of the biceps tendon (LHBT) instability and biceps reflection pulley (BRP) lesions are common cause of refractory anterior shoulder pain. We described a technique using dynamic arthroscopy to determine associated intraarticular pathologies. METHODS: Patients with refractory anterior shoulder pain and arthroscopically-diagnosed LHBT instability were enrolled. LHBT instability and the integrity of BRP and concomitant intra-articular lesions were investigated by ramp test. Demographics and arthroscopic findings were compared between patients with and without BRP tear. RESULTS: Forty patients were enrolled. BRP tear was noted in 25 patients (group A) and superior glenohumeral ligament (SGHL) insufficiency through ramp test in 15 patients (group B). Concomitant intraarticular pathologies were noted in 27 patients, including 19 in group A (76%) and eight in group B (53%), without significant group-wise difference (p = 0.138). The incidence of articular-side subscapularis tear was significantly higher in group A (p = 0.021), and those of the other intraarticular pathologies were similar between groups A and B. Fraying at the articular side of the subscapularis and supraspinatus tendons was frequent in group B, without difference of incidence as compared to group A (p = 0.5 and p = 0.084, respectively). CONCLUSIONS: LHBT instability was a common disorder in patients with refractory shoulder pain. In those patients, dynamic assessment of BRP lesions and SGHL insufficiency and meticulous survey of associated intra-articular pathologies, including subscapularis tear are necessary for making accurate diagnosis and treatment decision.


Assuntos
Articulação do Ombro , Dor de Ombro , Humanos , Dor de Ombro/diagnóstico , Dor de Ombro/cirurgia , Dor de Ombro/etiologia , Tendões/cirurgia , Músculo Esquelético , Articulação do Ombro/cirurgia , Articulação do Ombro/patologia , Artroscopia/efeitos adversos , Artroscopia/métodos
2.
Arthrosc Tech ; 10(6): e1411-e1415, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34258184

RESUMO

Whereas arthroscopic superior capsule reconstruction has recently been introduced to treat irreparable rotator cuff tears with encouraging outcomes, graft options and fixation remain debated. The purpose of this article is to introduce a modified arthroscopic technique using the long head of the biceps tendon as augmentation for superior capsule reconstruction with fascia lata autograft.

3.
BMC Musculoskelet Disord ; 18(1): 495, 2017 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-29179714

RESUMO

BACKGROUND: The deltoid splitting approach has recently been widely adopted to facilitate less invasive procedures for proximal humerus fractures. However, there are still concerns regarding its effectiveness in aging people and in cases involving complex fractures. This study was conducted to evaluate the efficacy of a proximal humeral locking plate using the anterolateral deltoid splitting approach and to specifically examine the effect of patient age, gender, and fracture pattern on surgical outcomes. METHODS: Forty-two cases of proximal humeral fractures treated using the deltoid splitting approach and locking plate fixation were reviewed. Outcome differences were evaluated in terms of age, gender distribution, and radiographic analysis based on the Neer Classification. The influence of the surgical approach was further investigated by age-matched paired analysis after subdividing patients into two age groups (younger than 60 years vs. older than 60 years; N = 21, in each group). RESULTS: In total, 41 patients (98%) demonstrated fracture union. The average Constant score was 80.4. No significant differences were found between patients younger than 60 years, and the older patients. Higher mean scores were found in men than in women (p = 0.448) and in simple fractures than in complex fractures (p = 0.454), without any significant differences. Better postoperative functional outcomes were observed when the humeral head-neck angle was greater than 105°, with a significant difference (p = 0.000). Surgical complications were found in 16 patients (38%) without significant difference between two age groups (p = 0.268). The most common complication was screw penetration. CONCLUSIONS: Anterolateral deltoid splitting using locking plate fixation provided a feasible alternative for surgery of proximal humerus fractures in different age groups and yielded comparable outcomes when the neck-shaft angle was properly restored. Surgeons must be cautious regarding potential complications, especially with screw penetration when using the locking plate through a less invasive approach. TRIAL REGISTRATION: ISRCTN75494532 . Trial Date: 2017/01/31.


Assuntos
Fixação Interna de Fraturas/métodos , Posicionamento do Paciente/métodos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento
4.
Int Orthop ; 35(1): 61-5, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20442996

RESUMO

The purpose of our study is to make a follow-up evaluation of endoscopic carpal tunnel release under focal anesthesia using the Wolf single portal system. A total of 65 patients with a mean age of 50 years undergoing 79 procedures were retrospectively studied. Preoperative complaints, intraoperative findings, and postoperative results of all the patients were recorded. Follow-up was conducted at 1, 5, 12, and 24 weeks and at 1 year postoperatively. Wound pain, analysis of satisfaction, Levine functional status scales, and surgical complications were included. No patients sustained iatrogenic neurovascular injury or hematoma formation. The average Levine functional severity score decreased from 2.82 points preoperatively to 1.2 points at the most recent survey. One case recurred at 1 year after the surgery and subsequently underwent open release. Surgery using the Wolf single portal system under focal anesthesia is a safe and efficacious option for endoscopic carpal tunnel release.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Endoscopia/instrumentação , Endoscopia/métodos , Adulto , Idoso , Anestesia Local , Síndrome do Túnel Carpal/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
5.
J Trauma ; 69(2): 418-22, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20699752

RESUMO

BACKGROUND: Intra-articular malunion of the distal radius may be complicated with radiocarpal and radioulnar joint subluxation, which may result in joint stiffness and loss of function. Conventional corrective osteotomy emphasizes on the restoration of the articular step-off. However, little information is available concerning the restoration of a concentric functioning joint through osteotomy. METHODS: From 2002 to 2007, 12 patients with chronic intra-articular distal radius fractures were evaluated at an average follow-up of 33.6 months after repositioning osteotomy. The average time from initial injury to reconstructive operation was 11.3 months. The indication for osteotomy included dorsal or volar subluxation of the radiocarpal joint, distal radioulnar joint, or both in addition to articular incongruity. A preoperative computed tomography scan or rapid prototyping (RP) models were performed as part of the surgical planning. Operation was preceded by volar, dorsal, or both approaches. Repositioning osteotomy and internal fixation were also performed. Radiographic analysis and the Disability of Arm, Shoulder and Hand score were used for the outcome assessment. RESULTS: All osteotomy sites healed and all events of radiocarpal and radioulnar subluxation were corrected. The average correction was 13.8 degrees (palmar tilt of the radius) and 1.9 mm in ulnar variance. The mean Disability of Arm, Shoulder and Hand score improved from 64 to 18. DISCUSSION: Conventional corrective osteotomy via an extra-articular approach was favorably performed to correct an extra-articular malalignment or nascent intra-articular malunion. Problems of abnormal architecture after an intra-articular fracture of the radius are complicated with subluxation of carpus or distal radioulnar joint, which require repositioning via precise articular approach. Both reconstructed computed tomography images and rapid prototyping models are very useful tools in preoperative planning for intra-articular osteotomy. Simulated osteotomy and joint repositioning can be performed in solid models before commencement of actual operation. CONCLUSION: Repositioning osteotomy consistently restores joint alignment and achieves functional improvement either in cases of nascent simple malunion or complex intra-articular malunion.


Assuntos
Fraturas Mal-Unidas/cirurgia , Fraturas Intra-Articulares/cirurgia , Osteotomia/métodos , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Estudos de Coortes , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Fraturas Intra-Articulares/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Adulto Jovem
6.
Arthroscopy ; 26(5): 617-22, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20434658

RESUMO

PURPOSE: A retrospective study was conducted on arthroscopic ganglionectomy in wrists using a novel intrafocal cystic portal. The safety and efficacy of this technique were assessed by treatment of 15 wrists in 15 patients. METHODS: Arthroscopic ganglionectomy was performed by the same surgeon with the patient under general anesthesia or regional block. Preoperative complaints, intraoperative findings, and postoperative results of all the patients were reported. The mean follow-up was 15.3 months. Functional assessment by use of modified Mayo wrist scores, patient satisfaction, and recurrence were included in the follow-up evaluation. RESULTS: Two thirds of the patients acquired good to excellent results, whereas the results for the remaining third were fair. Complications included 1 recurrence and 1 case of transient paresthesia sensation. The most common arthroscopic findings were capsular and ligament lesions, rather than ganglionic stalks. CONCLUSIONS: Arthroscopic ganglionectomy through an intrafocal cystic portal is a safe and efficacious option for the treatment of painful wrist ganglia. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


Assuntos
Artroscópios , Artroscopia/métodos , Cistos Ósseos/cirurgia , Ganglionectomia/métodos , Articulação do Punho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Cistos Ósseos/complicações , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Arthroscopy ; 21(11): 1406, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16325103

RESUMO

Surgical repair of a Palmer type IB triangular fibrocartilage complex (TFCC) tear can be difficult using conventional dorsal portals and it may need special repair kits. The authors describe an arthroscopic technique using an additional volar portal that allows quick access and a secure purchase of peripheral TFCC tears as well as a distinct approach to dorsal wrist structures.


Assuntos
Artroscopia/métodos , Fibrocartilagem Triangular/cirurgia , Braquetes , Humanos , Imageamento por Ressonância Magnética , Cuidados Pós-Operatórios , Contenções , Técnicas de Sutura , Fibrocartilagem Triangular/lesões , Traumatismos do Punho/reabilitação
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