Ultrasonography of the rotator cuff: a comparison with arthroscopy in one-hundred-and-ninety consecutive cases.

PURPOSE: To evaluate the accuracy of high-resolution ultrasonography compared to arthroscopy in the detection of rotator cuff tears. MATERIAL AND METHODS: Preoperative ultrasonography (US) with a 10-MHz commercially available linear-array transducer and a standardized study protocol was performed in 190 consecutive shoulders in 185 patients with a history of shoulder pain for more than 3 months. The findings at US were classified into intact cuff, partial-thickness, and full-thickness rotator cuff tears, and correlated with findings at shoulder arthroscopy. RESULTS: US correctly depicted 118 of 124 rotator cuff tears with sensitivity 95%, specificity 94%, PPV 97%, NPV 91% and accuracy 95%, all 94 full-thickness tears (sensitivity 100%, specificity 91%, PPV 91%, NPV 100%, and accuracy 95%), 24 of 30 partial-thickness tears (sensitivity 80%, specificity 98%, PPV 86%, NPV 96%, and accuracy 95%). CONCLUSION: US is a highly accurate diagnostic method for detecting full-thickness rotator cuff tears, but is less sensitive in detecting partial-thickness rotator cuff tears.

Stability of cemented all-polyethylene keeled glenoid components. A radiostereometric study with a two-year follow-up.

We studied the stability of cemented all-polyethylene keeled glenoid components by radiostereometric analysis (RSA) in 16 shoulders which had received a total shoulder replacement. There were 14 women (one bilateral) and one man with a mean age of 64 years. The diagnosis was osteoarthritis in eight and rheumatoid arthritis in seven. Two of the shoulders were excluded from the RSA study because of loosening of the tantalum markers. Three tantalum markers were inserted in the glenoid socket, two in the coracoid process and two in the acromion. The polyethylene keeled glenoid component was marked with three to five tantalum markers. Conventional radiological and RSA examinations were carried out at five to seven days, at four months and at one and two years after operation. Radiolucent lines were found in all except three shoulders. Migration was most pronounced in the distal direction and exceeded 1 mm in four shoulders. In ten shoulders rotation exceeded 2 degrees in one or more axes with retroversion/anteversion being most common. No correlation was found between migration and the presence of radiolucencies on conventional radiographs.

Enhanced in situ bioremediation of BTEX-contaminated groundwater by combined injection of nitrate and sulfate.

Enhancement of in situ anaerobic biodegradation of BTEX compounds was demonstrated at a petroleum-contaminated aquifer in Seal Beach, CA. Specifically, combined injection of nitrate and sulfate into the contaminated aquifer was used to accelerate BTEX removal as compared to remediation by natural attenuation. An array of multi-level sampling wells was used to monitor the evolution of the in situ spatial distributions of the electron acceptors and the BTEX compounds. Nitrate was utilized preferentially over sulfate and was completely consumed within a horizontal distance of 4-6 m from the injection well; sulfate reduction occurred in the region outside the denitrifying zone. By combining injection of both nitrate and sulfate, the total electron acceptor capacity was enhanced without violating practical considerations that limit the amount of nitrate or sulfate that can be added individually. Degradation of total xylene appears linked to sulfate utilization, indicating another advantage of combined injection versus injection of nitrate alone. Benzene degradation also appears to have been stimulated by the nitrate and sulfate injection close to the injection well but only toward the end of the 15-month demonstration. The results are consistent with the hypothesis that benzene can be biodegraded anaerobically after other preferentially degraded hydrocarbons have been removed.

The Swedish Elbow Arthroplasty Register and the Swedish Shoulder Arthroplasty Register: two new Swedish arthroplasty registers.

Two new national orthopedic quality registers were started in Sweden in 1999, the Swedish Shoulder Arthroplasty Register and the Swedish Elbow Arthroplasty Register. Both are owned by the Swedish Shoulder and Elbow Section of the Swedish Orthopedic Association. The purpose of the registers is to improve surgical techniques and selection of implants and identify individual risk factors. Two of the main problems in starting a new national quality register involve inducing all centers in the country to participate and deciding on the data to register.

A prospective comparison between external fixation and plates for treatment of midshaft nonunions of the clavicle.

BACKGROUND AND AIMS: Several surgical techniques have been used to treat clavicular nonunions. The aim with this prospective study was to compare treatment of symptomatic midshaft clavicular nonunions with either external fixation or plating. PATIENTS AND METHODS: The study included two consecutive series where the first 11 patients (8 men and 3 women) were treated with external fixation (EF) while the following 13 patients (5 men and 8 women) were treated with internal fixation using a 3.5 mm reconstruction plate (RP). All patients had autologous cancellous bone graft. After on average 8.6 years (EF) and 5.4 years (RP), respectively, an independent observer evaluated the patients. RESULTS: In the EF-group 8/11 healed within 12 months while 3/11 healed after reoperation with a reconstruction plate and new bone grafting at 6-9 months. In the RP-group 12/13 healed within six months while 1/13 healed after two additional bone transplants. There was no hardware breakage. The healing time for the RP group was significant shorter when compared with the EF group even if the fractures that did not heal after the first operation were excluded. In 4 patients the plate was removed following healing. There was no significant difference in functional outcome between groups at follow up. CONCLUSION: The reconstruction plate was a better alternative than external fixation due to faster and more reliable healing. Patients commonly considered the external frame cumbersome.

Recovery of isometric grip strength after Colles' fracture: a prospective two-year study.

Grip strength during short and sustained maximal voluntary isometric contractions was measured in 28 females and 5 males with displaced Colles' fracture involving the distal radio-ulnar joint. The patients were randomized into two groups, treated either through immobilization with plaster cast or with external fixation. The recovery of isometric grip strength was followed over a two-year period. A significant difference was registered between women with plaster casts and women with external fixators six weeks after the fracture. Regaining of grip strength occurred up to one year after the fracture. The pattern of recovery was slower for women with primary external fixation. Neither the dominant nor the non-dominant injured side regained short or sustained maximal voluntary isometric contraction. The dominant injured side showed no significant difference between sides but the non-dominant injured side remained significantly weaker. It is thus important to identify hand dominance. Pain during measurements was reduced after two years, but about one-fifth of the patients still perceived pain. The present findings may serve as guidance in physiotherapy for these patients.

The subacromial impingement syndrome. A study of results of treatment with special emphasis on predictive factors and pain-generating mechanisms.

Forty-two patients with subacromial impingement syndrome entered a randomized prospective study comparing open anterior acromioplasty with a physiotherapy regime. The criterion for a successful outcome of treatment was a reduction of the initial pain score of more than 50% using the visual analogue scale (VAS) technique. The evaluation was performed by an independent observer. At the 6-month follow-up, treatment in the surgical group had been successful in 12/21 (57%) patients versus 6/18 (33%) in the physiotherapy group. A one-year evaluation revealed 16/21 (76%) "successes" in the surgical group. A direct and unbiased comparison with the physiotherapy group was not possible at one year, since 13 patients chose surgery after initial physiotherapy. However, in "an intention to treat" analysis outcome at one year was significantly better in those randomized to surgery. We found two standardized, composite, active movements--the "Pour out of a Pot" manoeuvre requiring the emptying of a pot of water, and the "Hand in Neck" manoeuvre--to be of predictive value for the outcome of surgery. When combining three pain-related variables into a criterion for prediction of success, a sensitivity of 78% (p < 0.02) and a specificity of 90% (p < 0.03) were attained. We advance the hypothesis that pain in the impingement syndrome is mainly elicited by comparison of the subacromial bursa. In some patients a traction-responsive pain generator in the supraspinatus tendon may be present as well.

A prospective, randomized study with an independent observer comparing open carpal tunnel release with endoscopic carpal tunnel release.

In order to define the role of two-portal endoscopic carpal tunnel release, a prospective randomised study with an independent observer was performed to compare endoscopic and open surgery. Thirty-two hands in 29 patients, with symptoms, clinical signs and EMG changes consistent with idiopathic carpal tunnel syndrome were randomised to either endoscopic carpal tunnel release or open release. No significant difference in sick leave between the two groups could be found, being a mean of 17 days (range 0-31 days) with endoscopic surgery, and 19 days (range 0-42 days) with open conventional surgery. No differences in surgical results were found, but three patients in the endoscopic group suffered transient numbness on the radial side of the ring finger.

Quantitative resistance to barley leaf stripe (Pyrenophora graminea) is dominated by one major locus.

A major gene underlying quantitative resistance of barley against Pyrenophora graminea, a seedborne pathogen causing leaf stripe, was mapped with molecular markers in a barley doubled haploid (DH) population derived from the cross 'Proctor' x 'Nudinka'. This quantitative trait locus (QTL) accounts for r (2)= 58.5% and was mapped on barley chromosome 1, tightly linked to the "naked" gene. A second resistance QTL accounting for 29.3% of the variation in the trait was identified on the P arm of barley chromosome 2. Another two minor QTLs were detected by further analysis. None of the QTLs was found in the barley chromosome 2 "Vada" region studied by Giese et al. (1993).

The hand in neck manoeuvre as a tool to analyze pain-generating mechanisms in the subacromial impingement syndrome.

A scoring system for a standardized composite movement of the shoulder--the Hand in Neck (HIN) manoeuvre--is presented. The EMG activity of the supraspinatus muscle was studied in 5 healthy subjects at different performance levels of this test. It is shown that the supraspinatus muscle is about four times more active during normal performance than at the subnormal levels, which among themselves do not differ. EMG activity was also studied during normal performance of another standardized manoeuvre--the Pour out of a Pot (POP) test. Based on a comparison of the EMG data with clinical data from patients with the subacromial impingement syndrome it is suggested that an abnormal HIN test indicates the presence of a traction responsive pain generator in the supraspinatus tendon. In the same patient group, the combination of a normal HIN test and an abnormal POP test indicates pain generated by compression of subacromial structures.

The subacromial bursa and the impingement syndrome. A clinical and histological study of 30 cases.

Biopsies from the subacromial bursa were obtained from 30 patients with an impingement syndrome and from an autopsy series of 13 "normal" shoulders. Bursal fibrosis seemed to be a characteristic of the patient group; inflammatory cells, found in 7/30 specimens from the patients, were not found in the autopsy series. The microscopic findings could not be predicted from peroperative observations. There was an association between a poor outcome of surgery and absence of bursal fibrosis.

Sonography for diagnosis of rotator cuff tear. Comparison with observations at surgery in 58 shoulders.

To investigate the correlation between ultrasonographic and anatomic changes of the rotator cuff of the shoulder, we studied the findings in 58 surgical cases. Fifteen cases had a full thickness tear, 10 of which had a positive and 5 a negative ultrasonogram. Nine cases had partial tears of the cuff on the bursal side. Ultrasonographically, 3 of these were normal. Among the 34 cases that proved to be normal at surgery, 9 had positive ultrasonograms. The predictive value of a negative examination was 0.8, whereas the predictive value of a positive examination was 0.6. A cautious attitude towards ultrasonography for evaluation of the rotator cuff seems appropriate.

Idiopathic avascular necrosis of the capitate bone--case report.

A carpenter and ice hockey player with wrist pain was found to have avascular necrosis of the proximal pole of the capitate bone.