The surgical management of acute high-grade acromioclavicular (AC) joint (ACJ) injuries has evolved during the last decades. Numerous surgical techniques exist and recently arthroscopically assisted ...or all endoscopic techniques have gained popularity due to certain advantages. The goals of the new anatomic coracoclavicular ligament reconstruction techniques are to achieve anatomic reduction of the ACJ to allow and facilitate primary healing of AC and coracoclavicular (CC) ligaments, and also to minimize the risk of associated complications. We regularly use the open repair with double-loop sutures for the acute ACJ disruption, as described by Dimakopoulos et al. at 2006. In this surgical technique article, we present the arthroscopically assisted technique for the double-loop suture repair.
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The superior capsular reconstruction (SCR) is an arthroscopic surgical technique recently introduced as an effective solution to restore the defect of superior articular capsule in massive rotator ...cuff tears that cannot be repaired anatomically. The SCR retains static stability and inhibits the proximal humeral migration, thereby optimizing the force couples about the shoulder. In this surgical technique paper, we present our technique of SCR using a double bundle construct of long head of biceps tendon, called the “box” technique. It is always combined with partial rotator cuff repair.
The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, ...functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the “arm endurance” test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R2 = 0.33), functionality (model 2: p < 0.001, R = 0.50, R2 = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R2 = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R2 = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R2 = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP.
The aim of our study is to prove the validity and reliability of the Greek translated version of the self-report section of the American Shoulder and Elbow Surgeons (ASES) questionnaire.
A total of ...108 patients with various shoulder disorders were evaluated at two different orthopedic centers. All patients answered the Greek ASES questionnaire as well as the previously validated Greek version of the Disability Arm Shoulder and Hand score. Three days after the first evaluation, a subgroup of 40 individuals was randomly selected to complete again the Greek ASES text to prove its reliability, after the test-retest procedure. Reliability was tested with Cronbach’s alpha, stability by calculating the intraclass correlation coefficient and by Blant Altman plot and structural validity with the confirmatory factor analysis.
The internal consistency of the ASES functional score and the ASES total score was 0.925 and 0.750 respectively. The intraclass correlation coefficient between initial assessment and reassessment of the ASES functional and total score was 0.951 and 0.938 (P < .001), respectively. The correlation coefficients correlation between the ASES functional and total scores with DASH total score were −0.881 and −0.759 (P < .001), respectively.
The Greek ASES version proved to be equivalent to the English original version in evaluating different shoulder disorders in the Greek population.
Anterior shoulder dislocations following an epileptic event are considered rare. An extremely rare case of a 41 year old female suffering from bilateral anterior shoulder dislocation with concomitant ...greater tuberosities fractures after an epileptic seizure is presented. The patient presented to the out-patient orthopaedic clinic due to persistent pain and restriction of shoulders movement, 4 weeks after an epileptic seizure. Clinical examination and radiological evaluation established the diagnosis of bilateral anterior shoulder dislocation with concomitant greater tuberosities fractures. Closed reduction was performed under general anesthesia. There are 12 such cases in the literature, including the present one. Thirty percent of these cases had a delayed diagnosis. It is of paramount importance to have a high clinical suspicion for myoskeletal injuries and especially for shoulder dislocations following an epileptic episode, even in the absence of a traumatic event.
Background
Operative management of scapular body fractures, when indicated, typically involves extensive exposure through a posterior approach. We present our experience with a deltoid preserving ...approach that allows excellent exposure of the fracture lines for reduction and fixation while minimizing muscle detachment and overall tissue trauma.
Technique
Exposure of the scapula was obtained through a posterior incision. The posterior deltoid was exposed and retracted superiorly while the arm was abducted in accordance with Brodsky et al. The scapula was exposed in the interval between infraspinatus and teres minor.
Patients and methods
Six patients were treated using this approach and were retrospectively reviewed. All were men with a mean age of 34 years (range 24–45 ± 6.7 years). The injuries involved two 14-A3.1 and four 14-A3.2 AO/OTA types of fractures. The mean follow-up after surgery was 28 months (range 21–36 ± 4.93 months).
Results
All fractures could be anatomically reduced and healed without compromise. The mean Constant score was 93.8 (range 91–97 ± 2.13), while range of motion and strength returned to levels equal to the uninjured shoulder. All patients returned to their previous level of activity. We did not observe atrophy of the posterior muscles or hardware complications, and none required hardware removal.
Conclusion
The deltoid and external rotators preserving posterior approach permitted good visualization of the fractures while allowing reduction and fixation without extensive muscular dissection and provided excellent functional outcomes. We consider that it offers obvious advantages over more aggressive muscle detaching approaches.
Level of evidence
Therapeutic study, IV.
The aim of the study was to investigate whether subscapularis muscle atrophy is a negative prognostic factor leading to increased risk of retears in patients treated with an arthroscopic ...subscapularis tendon repair. We hypothesized that fatty infiltration of the subscapularis muscle deteriorates the clinical and sonographic outcome of the arthroscopic repair and inhibits reparability of the ruptured tendons. A double- center, multinational, retrospective, blind (in the follow-up) clinical study regarding 32 patients who underwent an arthroscopic subscapularis repair was conducted. Patients were divided into two groups according to the preoparative fatty infiltration grade of subscapularis muscle (group A: grade<II, group B: grade II or higher). Reparability was not influenced by the grade of preoperative fatty infiltration of subscapularis muscle. The preoperative MRI scans showed significantly higher grades of fatty infiltration (group B) in the subscapularis muscle of patients with clinical evidence of retear after the arthroscopic repair. Low grades of preoperative subscapularis muscle atrophy are significantly correlated with low clinical and sonographic retear's rate after subscapularis arthroscopic repair, while high grades were a clear negative prognostic factor for the clinical outcome of the aforementioned patients.
Abstract
We present a case of a closed distal-third forearm fracture, in which the flexor digitorum superficialis was found ruptured at its musculotendinous junction. We diagnosed the ruptured tendon ...during the exploration of the ulnar nerve for observed preoperative palsy. Although there are numerous reports about avulsions at the bony insertions, there are very few about avulsion at the musculotendinous junction in the literature. This consideration leads to the conclusion that this kind of rupture may be more frequent than recognized.
Trauma, infection, and posterior surgical approach are the most frequent causes of soft tissue defects of posterior elbow. The brachioradialis (BR) muscle flap is a rotational muscular pedicled flap, ...and the dominant vascular pedicle arises from the radial recurrent artery in the proximal portion of the muscle. The aim of the study was to present the BR muscle flap as a simple, safe, and effective solution for the treatment of soft tissue defects of the posterior elbow.
Five patients (3 males; mean age, 61.4 years; range, 40-73 years) with soft tissue defects of the posterior elbow underwent surgical treatment with the BR muscle flap. The causes of the defects were total elbow arthroplasty and postsurgical infection (n = 2), 1 patient with elbow arthrodesis due to neuropathic arthropathy, and postsurgical infection after open reduction and internal fixation of olecranon fractures (n = 2). All patients had a BR muscle flap and skin grafting. Orthopedic hardware was removed in 3 cases.
At the mean follow-up of 45 months (range, 26-61 months), all patients had viable and functional soft tissue coverage. All patients were free of infection, whereas 1 patient had a posterior elbow discomfort in daily activities. None of the patients reported wrist problems.
The BR muscle flap is a reliable solution, easy to harvest without requiring microsurgical expertise for small-size posterior elbow defects. It is a 1-stage procedure with no morbidity to the harvest site that provides stable and adequate coverage even in cases with postoperative infection.
Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while ...management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome.
Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported.
Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear.
Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component.
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