A Modified Rotator Cuff Sparing Approach to the Proximal Humerus in Antegrade Nail Osteosynthesis with Transosseous Supraspinatus Tendon Refixation

2019 ◽  
Vol 157 (06) ◽  
pp. 706-714
Author(s):  
Atesch Ateschrang ◽  
Christoph Gratzer ◽  
Ulrich Stöckle ◽  
Anna Janine Schreiner
Keyword(s):  
Rotator Cuff ◽  
Proximal Humerus ◽  
Adhesive Capsulitis ◽  
Functional Results ◽  
Supraspinatus Tendon ◽  
Dash Score ◽  
Invasive Approach ◽  
Fracture Stabilization ◽  
Nail Osteosynthesis

Abstract Background Due to the approach within antegrade humerus nail osteosyntheses, lesions of the supraspinatus tendon with a consecutive functional limitation of the rotator cuff (RC), insufficiencies, adhesions and chronic shoulder pain in the long term can result. The evidence respectively the study data situation is limited regarding the evaluation of this issue. Patients/Material and Methods We are the first to present by means of a case report with a geriatric female patient and a dislocated diaphyseal humerus fracture a rotator cuff sparing osseous approach to the proximal humerus in antegrade nail osteosynthesis without harming the vulnerable supraspinatus tendon (SSP). This is possible through a limited osteotomy of the greater tubercle with the preparation of a 10 mm deep and 15 to 20 mm wide osseous SSP base. The medullary cavity is then opened for inserting the nail in an antegrade manner and closed after fracture stabilization through reposition of the attached osteotomy of the greater tubercle by means of a suture anchor, for example. The procedure also includes a biceps tenodesis. Besides the description of the intraoperative approach and procedure, the clinical and functional results were recorded by established scores as well as radiologically respectively sonographically 6 weeks (T1) and 3 months (T2) postoperatively. Results The patient was very satisfied regarding pain and function after the modified operative procedure. The rotator cuff tests were negative and there were no impingement like symptoms or indications for an adhesive capsulitis. Range of motion as well as the Constant and (Quick) DASH-Score showed a very good function in the course. The implant was located regularly in the radiological control and the fracture showed a good osseous consolidation. A bland joint without effusion or periarticular fluid and no adhesion with the delta fascia could be presented by sonography. The RC and especially the SSP showed a normal sonographic separation. The functional results are comparable to the other publications so far. Conclusion The described surgical technique shows a significantly less invasive approach for the implantation of an antegrade humerus nail in the case of a humerus shaft fracture with an excellent function of the affected shoulder in a short-term follow-up. This novel approach should be evaluated by means of prospective studies regarding the functional outcome to justify the establishment of this modified procedure in the long term. Other modified approaches have been depicted but are essentially differing from our described procedure with regards to the invasiveness of the vulnerable tendinous structure of the SSP respectively RC.

scholarly journals Dislocation of the Elbow: A Retrospective Multicentre Study of 86 Patients

2010 ◽  
Vol 4 (1) ◽  
pp. 76-79 ◽  
Author(s):  
Jeroen de Haan ◽  
Niels W.L Schep ◽  
Imme Zengerink ◽  
Jesse van Buijtenen ◽  
Wim E Tuinebreijer ◽  
...  
Keyword(s):  
Elbow Dislocation ◽  
Functional Results ◽  
Dash Score ◽  
Social Psychological ◽  
Mild Disease ◽  
Music Score ◽  
Multicentre Cohort Study ◽  
Quick Dash

The objective of this retrospective multicentre cohort study was to prospectively assess the long-term functional outcomes of simple and complex elbow dislocations. We analysed the hospital and outpatient records of 86 patients between 01.03.1999 and 25.02.2009 with an elbow dislocation. After a mean follow-up of 3.3 years, all patients were re-examined at the outpatient clinic for measurement of different outcomes. The mean range of motion was ROM 135.5°. The Mayo elbow performance index (MEPI) scored an average of 91.9 (87.5% of the patients were rated excellent or good). The average Quick disabilities of the arm, shoulder and hand (Quick- DASH) score was 9.7, the sports/music score 11.5 and work score 6.1. The Oxford function score was 75.7, Oxford pain score 75.2 and Oxford social-psychological score 73.9. Elbow dislocation is a mild disease and generally, the outcome is excellent. Functional results might improve with early active movements.

scholarly journals Management of Volkmann’s Ischemic Contracture: Case Series of 32 patients

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 56
Author(s):  
Otman Benabdallah ◽  
Mohamed Shimi ◽  
Hicham Ait Benali ◽  
Ahmed Khamlichi ◽  
Rania Benabdallah
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Wrist Fracture ◽  
Long Term Results ◽  
Dash Score ◽  
X Rays ◽  
Ischemic Contracture ◽  
Associated Lesions ◽  
Elbow Fractures

Introduction: Volkmann’s contracture condition is of high prevalence in our population and is linked to therapeutic faults. The treatment and its results are determined according to the severity of the lesions. Methods: This retrospective study was performed in three centers and was conducted over 30 years (1987–2018); it included 32 patients. The disabilities of the arm, shoulder and hand (DASH) score and the Weber test were used to evaluate the functional outcome looking at mid and long-term results. Results: Thirty-two patients were treated for Volkmann’s Ischemic Contracture (VIC). The age ranged from 4 to 58 years, with 19 patients aged under 15. Wrist fracture was the predominant cause in 16 cases. Fourteen patients obtained a completely functional hand, seven good functional results, four fair functional results, and seven poor results. Discussion: In comparison with other studies, we noticed significant differences: apart from the dominant male sex and right side, this is one large case series conducted over 30 years (1987–2018) looking at mid-and long-term results. All the patients presented with severe or moderate lesions on the first visit. In our study, the wrist fracture is predominant compared to elbow fractures and soft trauma. X-rays are especially helpful and are a first-line investigation for identifying displaced fractures and other associated lesions. Our study population is not large, and the treatment methods are varied, so it is impossible to provide statistically relevant correlations between the treatment method and outcome. But this work is based on the experience of more than 30 years, which makes it possible to help adequate decision making according to the state of the lesions. This study is a level IV case series.

scholarly journals Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score?

2021 ◽  
Vol 12 ◽  
pp. 204062232199026
Author(s):  
Jan Zabrzyński ◽  
Maciej Gagat ◽  
Łukasz Łapaj ◽  
Łukasz Paczesny ◽  
Alper Yataganbaba ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroscopy ◽  
Smoking Status ◽  
Biceps Tendon ◽  
Functional Results ◽  
Morphological Alterations ◽  
Histopathologic Evaluation ◽  
Long Head

Aim: The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results. Methods: This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. The follow-up examination was based on the American Shoulder and Elbow Surgeons Score (ASES). Results: A cohort of 32 patients was enrolled in the final follow-up examination; mean 37.56 months. Histopathological evaluation according to the classical Bonar score revealed degeneration of the tendinous tissue in each group but there was no correlation between the extent of degeneration, smoking indexes and the ASES. After revision of Bonar scale within the vascularity criterion, we found a correlation between the extent of degeneration of tendinous tissue, smoking data, ASES score, and the severity of rotator cuff injury. Conclusion: In this paper, we indicate the ambiguous role of the neovascularization in the biceps tendinopathy, and it was used for modification of the classical Bonar score. Consequently, recalculated, modified Bonar score was correlated positively with smoking indexes and functional outcomes. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration, measured according to the modified scoring system.

scholarly journals Does Conservative Rehabilitation Program Lead to Long-Term Stiffness after Arthroscopic Rotator Cuff Repair?

2018 ◽  
Vol 24 (1) ◽  
pp. 47-51
Author(s):  
Chan Chun Ming ◽  
Li Pang Hei
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Constant Score ◽  
Rehabilitation Program ◽  
Arthroscopic Rotator Cuff Repair ◽  
Dash Score ◽  
Power Deficit ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background Evidence on the ideal rehabilitation program for arthroscopic rotator cuff repair is lacking. Most data and results are conflicting with no consensus made. This study aims to compare between an early aggressive program with immediate postoperative range-of-motion (ROM) exercises and a more conservative program with early restriction of motion in Hong Kong Chinese population. Materials and Methods We retrospectively evaluated 37 arthroscopic rotator cuff repair cases who underwent a standardized delayed rehabilitation protocol of immobilization for 4 weeks to 6 weeks before formal passive ROM exercises. Patients were evaluated at 3 months, 6 months, and 12 months after the surgery, for which they would be tested on passive forward flexion (FF). They were categorized as “stiff if FF was less than 100°. Constant score, Disability of Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) score, and isometric abduction power deficit percentage were parameters to assess the functional outcome, and they were obtained in all of the patients’ last follow-up assessments. Results Two cases (5.4%) are considered “stiff 6 months after the surgery. At 1 year, the stiffness in both cases resolved, resulting in 0% rate of stiffness. The mean FF at 1 year was 153.33 ± 20.15, which is comparable to the literature. Two cases (5.4%) of clinical retear occurred. Mean Constant score at the latest follow-up was 62.4 ± 13.2. Mean VAS score was 1.1 ± 1.8 at rest and 2.8 ± 2.0 on exertion. Mean DASH score was 25.3 ± 21.9. Mean isometric abduction power deficit was 42.7% ± 0.2%. Discussion Historically, due to concerns on long-term stiffness, an early aggressive postoperative rehabilitation protocol was used. We found that an early restriction of ROM with 4 weeks to 6 weeks of immobilization did not lead to long-term stiffness and functional disadvantage. This includes patients with stiffness even before the operations. Conclusions Immobilization for 4 weeks to 6 weeks after arthroscopic rotator cuff repair does not result in long-term stiffness and may even be beneficial to cuff tendon healing.

A CASE REPORT ON IMPORTANCE OF SHOULDER PROPRIOCEPTIVE TRAINING AND PNF TECHNIQUES ALONG WITH CONVENTIONAL EXERCISES IN FUNCTIONAL RECOVERY OF THE INDIVIDUAL WITH ADHESIVE CAPSULITIS SECONDARY TO ROTATOR CUFF TENDINOSIS.

2021 ◽  
pp. 34-36
Author(s):  
Aishwarya Mhetras ◽  
Poorva Devi
Keyword(s):  
Case Report ◽  
Rotator Cuff ◽  
Medical History ◽  
Functional Recovery ◽  
Adhesive Capsulitis ◽  
Manual Muscle Testing ◽  
Dash Score ◽  
Past Medical History ◽  
Muscle Testing ◽  
Proprioceptive Training

BACKGROUND AND PURPOSE Adhesive capsulitis is a condition where there is inammation of shoulder capsule (capsulitis) which in turn causes bands of sticky connective tissue (adhesions) between the joint's surfaces. Due to this (1) shoulder movement becomes painful and often completely restricted .The purpose of this case report is to highlight Importance of Shoulder Proprioceptive training and shoulder PNF techniques using theraband and inatable ball (30 cm) along with Conventional exercises in Functional Recovery of the patient with adhesive capsulitis secondary to rotator cuff tendinosis. CASE DESCRIPTION A 66-year-old female who presented with right shoulder pain and neck pain and limited range of motion (ROM) since 1 month with a past medical history of type II diabetes mellitus, hypertension and hypothyroidism on medication was diagnosed with adhesive capsulitis secondary to rotator cuff tendinosis based on clinical examination, ROM assessment, Radiographical investigations-MRI and past medical history. INTERVENTION The patient was treated for a total of 10 physical therapy sessions over the span of 2 weeks. Interventions included were incorporating shoulder proprioceptive exercises with a help of inatable ball and textured towel, shoulder PNF patterns using Red theraband along with cryotherapy(icepacks),mobilizations (Maitland grade 2) with oscillatory techniques, therapeutic exercises, Active assisted ROM exercises with the help of a wooden wand, capsular stretching, myofascial trigger point release, postural correction exercises, strengthening and home exercise program. Outcome measures included ROM goniometric measurements, pain rating scale, Angle reproduction test for proprioception, Manual muscle testing and the Disabilities of the Arm, Shoulder and Hand (DASH) Score. DISCUSSION AND CONCLUSION This case report conclude that appropriate combinations of interventions including shoulder proprioceptive exercises with an inatable ball, shoulder pnf patterns(D1-D2) , stretching, mobilisations, MFR and strengthening exercises resulted in an improvement in overall functional performance of the patient with adhesive capsulitis secondary to rotator cuff tendinosis .An improvement in post-test scores of Manual Muscle Testing (MMT) , ROM , DASH scores was observed after 10 sessions. Rationale for treatment was based on various research articles. The treatment was altered based on patient's need and response.

scholarly journals Are the good functional results from arthroscopic repair of massive rotator cuff injuries maintained over the long term?

2016 ◽  
Vol 51 (1) ◽  
pp. 40-44
Author(s):  
Alberto Naoki Miyazaki ◽  
Pedro Doneux Santos ◽  
Luciana Andrade da Silva ◽  
Guilherme do Val Sella ◽  
Sérgio Luiz Checchia ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Functional Results ◽  
Arthroscopic Repair ◽  
Rotator Cuff Injuries

scholarly journals Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

2021 ◽  
Vol 73 (2) ◽  
pp. 495-502
Author(s):  
Francesco Bianco ◽  
Paola Incollingo ◽  
Armando Falato ◽  
Silvia De Franciscis ◽  
Andrea Belli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Coloanal Anastomosis ◽  
Functional Results ◽  
Anal Margin ◽  
Perioperative Mortality ◽  
The Mean ◽  
Pull Through ◽  
Protective Stoma

AbstractDespite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed ‘Short stump and High anastomosis Pull-through’ (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

scholarly journals Long-Term Results of a Standard Algorithm for Intravenous Port Implantation

2021 ◽  
Vol 11 (5) ◽  
pp. 344
Author(s):  
Ching-Feng Wu ◽  
Jui-Ying Fu ◽  
Chi-Tsung Wen ◽  
Chien-Hung Chiu ◽  
Ming-Ju Hsieh ◽  
...  
Keyword(s):  
Operative Time ◽  
Functional Results ◽  
Long Term Results ◽  
Related Complication ◽  
Standard Algorithm ◽  
Port Implantation ◽  
Male Patients ◽  
Catheter Fracture ◽  
Guided Puncture

Intravenous ports serve as vascular access and are indispensable in cancer treatment. Most studies are not based on a systematic and standardized approach. Hence, the aim of this study was to demonstrate long-term results of port implantation following a standard algorithm. A total of 2950 patients who underwent intravenous port implantation between March 2012 and December 2018 were included. Data of patients managed following a standard algorithm were analyzed for safety and long-term outcomes. The cephalic vein was the predominant choice of entry vessel. In female patients, wire assistance without use of puncture sheath was less likely and echo-guided puncture via internal jugular vein (IJV) with use of puncture sheath was more likely to be performed, compared to male patients (p < 0.0001). The procedure-related complication rate was 0.07%, and no pneumothorax, hematoma, catheter kinking, catheter fracture, or pocket erosion was reported. Catheter implantations by echo-guided puncture via IJV notably declined from 4.67% to 0.99% (p = 0.027). Mean operative time gradually declined from 37.88 min in 2012 to 23.20 min in 2018. The proposed standard algorithm for port implantation reduced the need for IJV echo-guided approach and eliminated procedure-related catastrophic complications. In addition, it shortened operative time and demonstrated good functional results.

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