Posterior Glenohumeral Thermal Capsulorraphy, Capsular Imbrication, and Labral Repair With Complication of Adhesive Capsulitis: A Modified Rehabilitation Approach

2012 ◽  
Vol 21 (1) ◽  
pp. 69-78 ◽  
Author(s):  
Jeffery T. Podraza ◽  
Scott C. White
Keyword(s):  
Shoulder Arthroscopy ◽  
Adhesive Capsulitis ◽  
Treatment Protocol ◽  
Time Frame ◽  
Assessment Tools ◽  
Labral Repair ◽  
Case Description ◽  
Glenohumeral Instability ◽  
Subjective Report ◽  
Residual Symptoms

Background:Isolated atraumatic posterior glenohumeral instability is rare. Use of thermal capsulorraphy for glenohumeral instability is considered controversial. This case study describes a modified rehabilitation protocol for a patient who underwent a multistep arthroscopic procedure for isolated posterior glenohumeral instability with a postoperative complication of adhesive capsulitis.Case Description:A 30-y-old man with a 15-y history of bilateral posterior glenohumeral instability related to generalized hypermobility underwent right-shoulder arthroscopy consisting of a combined posterior labral repair, capsular imbrication, and thermal capsulorraphy. A gunslinger orthosis was prescribed for 6 wk of immobilization. Adhesive capsulitis was diagnosed at the 5-wk postoperative visit and immobilization was discontinued. A modified treatment protocol was devised to address both the surgical procedures performed and the adhesive capsulitis. Residual symptoms resolved with release of an adhesion while stretching 10 months postoperatively.Outcomes:Scores of 5 shoulder-assessment tools improved from poor to excellent/good with subjective report of a very good outcome.Discussion:The complication of adhesive capsulitis required an individualized treatment protocol. In contrast to the standard protocol, our modified approach allowed more time to be spent in each phase of the program, was aggressive with restoring range of motion (ROM) without excessively stressing the posterior capsule, and allowed the patient to progress to activities that were tolerated regardless of protocol phase. Shoulder stiffness or frank adhesive capsulitis after stabilization, as in this case, requires a more aggressive modification to prevent permanent ROM limitations. Conversely, patients with early rapid gains in ROM must be protected from overstretching the repaired tissue with a program that allows functional motion to be incorporated over a longer time frame. This study indicates the use of thermal capsulorraphy as a viable surgical modality when it is used judiciously with the proper postoperative restrictions and rehabilitation.

Beyond exposure therapy: formulation-based therapy treating a fear of urinary incontinence – a case study

2021 ◽  
pp. 1-5
Author(s):  
Torstein Stapley ◽  
Tracey Taylor ◽  
Victoria Bream
Keyword(s):  
Urinary Incontinence ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Specific Phobia ◽  
Behaviour Therapy ◽  
Behavioural Treatment ◽  
Subjective Report ◽  
Cognitive Behaviour ◽  
Behavioural Factors

Abstract Background: The current literature on the specific phobia of urinary incontinence is limited, with no specific empirically established model or treatment protocol. Aims: This article consists of a case study of formulation-driven cognitive behaviour therapy (CBT) for phobia of urinary incontinence. Method: Martin attended a total of 12 treatment sessions. The treatment included the development of an idiosyncratic formulation, and the use of well-established cognitive and behavioural treatment strategies from other anxiety disorders. Results: Both outcome measures and Martin’s subjective report indicate that the treatment was effective. Conclusion: This case study contributes to the current limited literature on this phobia, and emphasises the importance of formulation-driven CBT to map for idiosyncratic features and target cognitive and behavioural factors.

Lesions of the Biceps Tendon Diagnosis and Classification

1999 ◽  
Vol 12 (04) ◽  
pp. 188-195 ◽  
Author(s):  
J. F. Bardet
Keyword(s):  
Shoulder Joint ◽  
Biceps Brachii ◽  
Shoulder Arthroscopy ◽  
Case Reports ◽  
Biceps Tendon ◽  
Adhesive Capsulitis ◽  
Clinical Signs ◽  
Joint Disease ◽  
Response To Treatment ◽  
Biceps Tendon Rupture

SummaryThis paper presents the clinical signs, radiographic and arthroscopic findings in 23 dogs and a cat having a lesion of the biceps tendon. Several conditions were recognized: partial or complete rupture; avulsion of the biceps tendon from the supraglenoid tubercle, tendinitis, mid-substance tear, bipartite tendon, dislocations and tenosynovitis of the bicipital tendon. Osteoarthritis of the shoulder joint was seen in 84% of the cases and osteophytosis of the bicipital groove was recognized in 38%. Biceps tendon rupture was associated with shoulder joint instability 76% of the time. Shoulder arthroscopy is a very reliable diagnostic method allowing direct visualization of intra-articular pathologies.In man, the tendon of the biceps brachii is the proverbial stepchild of the shoulder. It has been blamed for numerous painful conditions of the shoulder from arthritis to adhesive capsulitis. Kessell described the tendon as “somewhat of a maverick, easy to inculpate but difficult to condemn (1). Its function has been often misunderstood. It has been tenodesed, translocated, pulled through drill holes in the humeral head, and debrided with an arthroscope, oftentimes with marginal results”. Lippmann likened the biceps tendon to the appendix: “An unimportant vestigial structure unless something goes wrong with it” (2). Neer II has stressed the fact that 95 to 98 per cent of patients with a diagnosis of biceps tendinitis have, in reality, a primary diagnosis of impingement syndrome with secondary involvement of the biceps tendon (3). He has condemned routine biceps tenodesis.The veterinary literature on the biceps tendon in dogs is sparse (4-8). Tenosynovitis of the biceps tendon is “a common cause of forelimb lameness in medium and large breed dogs” (7). “Definitive diagnosis of bicipital tenosynovitis is often not possible, and the diagnosis is backed into by eliminating other causes of lameness. Proof of the diagnosis often depends on response to treatment” (7). There are not any reviews of cases of rupture of the tendon of the biceps brachii muscle except for anecdotal case reports (7). Arthrography has been described as diagnostic of rupture (10, 11). Calcifying tendinopathy of the biceps tendon was seen on radiographic views of the scapulohumeral joint in four dogs (9). Twodimensional real-time ultrasonography was found helpful in the diagnosis of strain of the infraspinatus muscle in a dog (12).This paper reviews the pertinent anatomy, explains the function of the biceps tendon, and presents a review of current concepts on the diagnosis of lesions of the biceps tendon.The author presents the clinical signs, radiographic and arthroscopic finding of the disorders of the biceps tendon seen in 25 shoulders. All biceps tendon lesions may be classified in one of the six subtypes. Partial or complete tears are the most frequent pathology. Degenerative joint disease is seen in 84% of the shoulders.

Common upper limb musculoskeletal lesions

2018 ◽  
pp. 595-604
Author(s):  
Gavin Clunie ◽  
Nick Wilkinson ◽  
Elena Nikiphorou ◽  
Deepak R. Jadon
Keyword(s):  
Rotator Cuff ◽  
Upper Limb ◽  
Glenohumeral Joint ◽  
Tennis Elbow ◽  
Adhesive Capsulitis ◽  
Lateral Epicondylitis ◽  
Glenohumeral Instability ◽  
Suprascapular Notch ◽  
Long Head ◽  
Musculoskeletal Lesions

This chapter introduces readers to some common upper limb musculoskeletal lesions, including subacromial (shoulder) impingement syndrome, adhesive capsulitis, and lateral epicondylitis (tennis elbow). The epidemiology, aetiopathogenesis, clinical presentation, and management of these conditions are presented. Algorithms for their management are provided. Other disorders presenting with a subacromial impingement pattern of pain are detailed and optimal diagnostic imaging methods proposed. These include supraspinatus/cuff tendonitis, subacromial bursitis, rotator cuff tear, long head of biceps tendonitis, osteophyte impingement on the rotator cuff tendon, glenohumeral instability due to labral trauma (e.g. SLAP lesion), arthritis of the glenohumeral joint, enthesitis related to spondyloarthritis, and lesions at the suprascapular notch.

Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

2020 ◽  
Vol 48 (11) ◽  
pp. 2621-2627
Author(s):  
Jared A. Wolfe ◽  
Michael Elsenbeck ◽  
Kyle Nappo ◽  
Daniel Christensen ◽  
Robert Waltz ◽  
...  
Keyword(s):  
Bone Loss ◽  
Circle Method ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Bone Deficiency ◽  
Posterior Shoulder ◽  
Deficiency Group ◽  
Glenoid Retroversion

Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder instability, but little is known about the incidence or effect of posterior glenoid bone loss. Purpose: To determine the incidence, characteristics, and failure rate of posterior glenoid deficiency in shoulders undergoing isolated arthroscopic posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing isolated posterior labral repair and glenoid-based capsulorrhaphy with suture anchors between 2008 and 2016 at a single institution were identified. Posterior bone deficiency was calculated per the best-fit circle method along the inferior two-thirds of the glenoid by 2 independent observers. Patients were divided into 2 groups: minimal (0%-13.5%) and moderate (>13.5%) posterior bone loss. The primary outcome was reoperation for any reason. The secondary outcomes were military separation and placement on permanent restricted duty attributed to the operative shoulder. Results: A total of 66 shoulders met the inclusion criteria, with 10 going on to reoperation after a median follow-up of 16 months (range, 14-144 months). Of the total shoulders, 86% (57/66) had ≤13.5% bone loss and 14% (9/66) had >13.5%. Patients with moderate posterior glenoid bone loss had significantly greater retroversion (−11.5° vs −4.3°; P = .01). Clinical failure requiring reoperation was seen in 10.5% of patients in the minimal bone deficiency group and 44.4% in the moderate group ( P = .024). There was no difference between groups in rate of military separation or restricted duty. Patients with moderate posterior glenoid bone deficiency were more likely to be experiencing instability instead of pain on initial presentation ( P < .001), were more likely to have a positive Jerk test result ( P = .05), and had increased glenoid retroversion ( P = .01). Conclusion: In shoulders with moderate glenoid bone deficiency (>13.5%) and increased glenoid retroversion, posterior capsulolabral repair alone may result in higher reoperation rates than in shoulders without bone deficiency.

scholarly journals 4. Assessment Typologies Used Within the Discipline Theory, Solfeggio, Musical Dictation

2018 ◽  
Vol 15 (1) ◽  
pp. 37-43
Author(s):  
Luminiţa Duţică
Keyword(s):  
Time Frame ◽  
Assessment Methods ◽  
Assessment Tools ◽  
Teaching Process ◽  
Specific Assessment ◽  
Distinct Stage ◽  
Musical Dictation

Abstract Assessment is a distinct stage within the teaching process, aiming to measure the level of the knowledge, skills and competences acquired within a given time frame. The discipline Theory, Solfeggio, Musical Dictation involves a synthesis between the theoretical and the practical side of the matter, and, as a result, it uses specific assessment tools for each side. Modern assessment methods involve personalized systems based on the diversification of types of docimological tests, quizzes, practical tests, etc. In this study we will present a series of personal contributions referring to the contents specific to the discipline Theory, Solfeggio, Musical Dictation taught at university.

Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment

2018 ◽  
Vol 46 (5) ◽  
pp. 1053-1057 ◽  
Author(s):  
Adam Hines ◽  
Jay B. Cook ◽  
James S. Shaha ◽  
Kevin Krul ◽  
Steve H. Shaha ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Patient Reported Outcomes ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Arthroscopic Stabilization ◽  
Posterior Instability ◽  
Glenohumeral Instability ◽  
Patient Reported ◽  
Return To Duty

Background: Glenoid bone loss is a well-accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. Glenoid bone loss in posterior instability has been noted relative to its existence in posterior instability surgery. Its effect on outcomes after arthroscopic stabilization has not been specifically evaluated and reported. Purpose: The purpose was to evaluate the presence of posterior glenoid bone loss in a series of patients who had undergone arthroscopic isolated stabilization of the posterior labrum. Bone loss was then correlated to return-to-duty rates, complications, and validated patient-reported outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted at a single military treatment facility over a 4-year period (2010-2013). Patients with primary posterior instability who underwent arthroscopic isolated posterior labral repair were included. Preoperative magnetic resonance imaging was used to calculate posterior glenoid bone loss using a standardized “perfect circle” technique. Demographics, return to duty, complications, and reoperations, as well as outcomes scores including the Single Assessment Numeric Evaluation and the Western Ontario Shoulder Instability Index (WOSI) scores, were obtained. Outcomes were analyzed across all patients based on percentage of posterior glenoid bone loss. Bone loss was then categorized as below or above the subcritical threshold of 13.5% to determine if bone loss effected outcomes similar to what has been shown in anterior instability. Results: There were 43 consecutive patients with primary, isolated posterior instability, and 32 (74.4%) completed WOSI scoring. Mean follow-up was 53.7 months (range, 25-82 months) The mean posterior glenoid bone loss was 7.3% (0%-21.5%). Ten of 32 patients (31%) had no appreciable bone loss. Bone loss exceeded 13.5% in 7 of 32 patients (22%), and 2 patients (6%) exceeded 20% bone loss. Return to full duty or activity was nearly 90% overall. However, those with >13.5%, subcritical glenoid bone loss, were statistically less likely to return to full duty (relative risk = 1.8), but outcomes scores, complications, and revision rates were otherwise not different in those with no or minimal bone loss versus those with more significant amounts. Conclusion: Posterior glenoid bone loss has not previously been evaluated independently relative to patients with shoulder instability repairs. Sixty-nine percent of our patients had measurable bone loss, and 22% had greater than 13.5%, or above subcritical bone loss. While these patients were statistically less likely to return to full duty, the reoperation rate, complications, and patient-reported outcomes between groups were not different.

scholarly journals Incidence and Clinical Significance of Posterior Glenoid Deficiency in Patients with Posterior Glenohumeral Instability

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008
Author(s):  
Michael Elsenbeck ◽  
Jared Wolfe ◽  
Kyle E. Nappo ◽  
Daniel Christensen ◽  
Robert A. Waltz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Preoperative Evaluation ◽  
Circle Method ◽  
Labral Repair ◽  
Glenohumeral Instability ◽  
Bone Deficiency ◽  
Case Logs ◽  
Deficiency Group ◽  
Reoperation Rates

Objectives: Posterior glenohumeral instability accounts for 10-40% of instability repairs yet the degree posterior bone deficiency contributing to labral repair failure is unclear. The purpose of this study is to determine the incidence, characteristics, and clinical impact of posterior glenohumeral bone deficiency in patients undergoing posterior shoulder stabilization. Methods: All consecutive patients undergoing isolated soft tissue only posterior labral repairs from 2008-2016 at our institution were identified via review of surgical case logs. Posterior bone deficiency was calculated using the best fit circle method along the inferior 2/3 s of the glenoid by two independent observers. The intra-observer and inter-observe reliability ICC of this method was .96 and .86, respectively. Patients were divided into three groups, no bone loss (0-5%), minimal bone loss (5-13.5%) and moderate posterior bone deficit (>13.5%). Our primary outcome, was reoperation for any reason, secondary outcomes were military separation due to the operative shoulder, and placement on permanent restricted duty due to the operative shoulder. Additional comparisons between the groups were made on the basis of preoperative clinical and radiographic characteristics. Results: We identified 66 patients that met our inclusion and exclusion criteria. Our median follow up time was 22 months (range 7-144months). 39 of the 66 patients had no measureable bone deficiency while 18 patients had between 5 and 13.5%, and 9 patients had greater than 13.5%. The greatest amount of bone deficiency in a patient was 27%. The reoperation rates were 7.7% in the no bone deficiency group, 16% in the minimal bone deficiency group, and 33% in the moderate group, this difference was statistically significant (p=.036). There was no difference in rates of military separation, or restricted duty between groups. Additionally, patients with posterior glenoid bone deficiency, were more likely to complain of instability instead of pain on initial presentation (p=.002), and were more likely to have a positive posterior load shift test (p=.027). Conclusion: Posterior glenoid bone deficiency is common and potentially under recognized in patients undergoing surgery for posterior glenohumeral instability with over one-third of our patients having some degree of bone deficiency. In patients with moderate glenoid bone deficiency (>13.5%), soft tissue only stabilization procedures may have higher reoperation rates then in patients without bone deficiency. On preoperative evaluation the primary complaint of instability instead of pain and a positive posterior load shift were predictive of the presence of posterior glenoid bone deficiency.

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