scholarly journals The Injured Shoulder in High-Level Male Gymnasts, Part 2: Can Athletes Return to Competition After Surgery?

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110434 ◽  
Author(s):  
Patrick Gendre ◽  
Pascal Boileau
Keyword(s):  
Surgical Treatment ◽  
Recovery Period ◽  
Case Series ◽  
International Level ◽  
Shoulder Injuries ◽  
Biceps Tenodesis ◽  
Independent Observer ◽  
Previous Level ◽  
High Level ◽  
Return To Competition

Background: The results of surgical treatment of shoulder injuries in high-level male gymnasts have not yet been documented. Purpose: To evaluate the functional and subjective results after surgical treatment of shoulder injuries in high-level gymnasts and the possibilities to return to sport at the same level. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 23 high-level male gymnasts (26 shoulders) underwent surgery by a single experienced shoulder surgeon. At the time of surgery, 7 gymnasts competed at the international level, 12 at the national elite level, and 4 at the regional level. According to symptoms and anatomic lesions, the shoulders were classified into 2 groups: painful shoulders (n = 11) and unstable shoulders (n = 15). Fifteen capsulolabral repairs, 10 cuff debridements, 1 cuff repair, 4 SLAP (superior labral anterior and posterior) repairs, and 8 suprapectoral biceps tenodesis were performed. Twelve shoulders (46%) had >1 procedure performed. Outcomes assessment was performed by an independent observer at a mean of 5 years (range, 2-15 years) postoperatively. In addition, patients completed the Subjective Shoulder Value (range, 0%-100%). Results: After shoulder surgery, 21 (91%) of the 23 gymnasts returned to competitive gymnastics, and 20 gymnasts (87%) regained their preinjury level of sport. All international-level gymnasts returned to their preinjury level of sport. Three athletes (13%) underwent revision surgery, and 1 athlete (4%) ended his career without returning to competition. The postoperative period before resumption of competitive gymnastics was 9 ± 3.5 months (mean ± SD). Of the 15 gymnasts treated for shoulder instability with arthroscopic stabilization, 12 were able to return to their previous level of sport. All 8 gymnasts who had arthroscopic biceps tenodesis were able to return to their previous level of sport, as opposed to only 2 of 4 gymnasts treated with SLAP repair. The gymnastics-specific Subjective Shoulder Value score was 80% ± 11%. Conclusion: Most gymnasts who required surgical treatment for a shoulder injury were able to return to competition at their previous level, although there was a considerable postoperative recovery period. Current arthroscopic reconstruction techniques were effective for treating structural lesions and allowing return to high-level gymnastics.

scholarly journals SLAP lesions: current controversies

2019 ◽  
Vol 4 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Filippo Familiari ◽  
Gazi Huri ◽  
Roberto Simonetta ◽  
Edward G. McFarland
Keyword(s):  
Surgical Treatment ◽  
Physical Examination ◽  
Clinical Presentation ◽  
Patient Characteristics ◽  
Diagnostic Value ◽  
Shoulder Injuries ◽  
Biceps Tenodesis ◽  
Glenoid Labrum ◽  
Slap Lesions ◽  
Slap Tear

Knowledge of the pertinent anatomy, pathogenesis, clinical presentation and treatment of the spectrum of injuries involving the superior glenoid labrum and biceps origin is required in treating the patient with a superior labrum anterior and posterior (SLAP) tear. Despite the plethora of literature regarding SLAP lesions, their clinical diagnosis remains challenging for a number of reasons. First, the diagnostic value of many of the available physical examination tests is inconsistent and ambiguous. Second, SLAP lesions most commonly occur concomitantly with other shoulder injuries. Third, SLAP lesions have no specific associated pain pattern. Outcomes following surgical treatment of SLAP tears vary depending on the method of treatment, associated pathology and patient characteristics. Biceps tenodesis has been receiving increasing attention as a possible treatment for SLAP tears. Cite this article: EFORT Open Rev 2019;4:25-32. DOI: 10.1302/2058-5241.4.180033.

scholarly journals The Injured Shoulder in High-Level Male Gymnasts, Part 1: Epidemiology and Pathoanatomy of Surgically Treated Lesions

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110434
Author(s):  
Patrick Gendre ◽  
Pascal Boileau
Keyword(s):  
Case Series ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
Independent Observer ◽  
Presenting Symptoms ◽  
Isometric Muscle Contraction ◽  
Labral Tears ◽  
Biceps Anchor ◽  
Shoulder Region ◽  
High Level

Background: Weightbearing and traction-suspension movements with the upper limbs put considerable demands upon the shoulder region of high-level gymnasts. The diagnosis of instability in these gymnasts may be difficult because voluntary inferior shoulder subluxation is part of their training and is needed to perform some acrobatic figures. Purpose: To (1) assess the epidemiology of shoulder lesions requiring surgery, (2) describe the types of injuries and assess which maneuvers and equipment put the gymnast most at risk, and (3) present a pathoanatomic classification of the injured shoulder in high-level male gymnasts. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 26 high-level male gymnasts (30 shoulders; mean age, 22 years; range, 16-33 years) were referred to our surgical center for shoulder pain or instability. Four gymnasts underwent surgery on both shoulders. All shoulders were evaluated clinically, radiologically, and arthroscopically. An independent observer evaluated the circumstances in which these lesions occurred, including the apparatus used and the maneuvers performed. Results: The mean duration of symptoms before surgery was 8 months (range, 6-24 months). Eighteen injured shoulders (60%) had chronic overuse injuries. In 27 shoulders (90%), the mechanism of injury was traction of the arm in forced flexion-rotation while using suspension equipment with locked hands on the bars or the rings. In the remaining 3 shoulders, the traumatic position was one of an isometric muscle contraction against gravity, sustained while performing strength-and-hold positions on the rings. Based on the main presenting symptoms (pain and/or instability) and main anatomic lesions found during arthroscopy, the injured gymnasts’ shoulders were classified into 2 categories: painful shoulders (n = 13) with no clinical, radiological, or arthroscopic findings of instability (mainly superior cuff and biceps anchor lesions) and unstable shoulders (n = 17) with isolated inferior capsule labral tears or mixed lesions (tendinous and capsulolabral). Some gymnasts with inferior labral tears had no recall of having suffered a dislocation or subluxation. Conclusion: The majority of injuries requiring surgery in this population occurred during traction in forced flexion-rotation using suspension equipment. Injured shoulders were classified as either painful or unstable shoulders.

Transforaminal Endoscopic Surgical Treatment for Post-Laminectomy Lumbar Radiculopathy: Case Series

2021 ◽  
Author(s):  
Albert E. Telfeian ◽  
Adetokunbo Oyelese ◽  
Jared Fridley ◽  
Ziya L. Gokaslan
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Lumbar Radiculopathy

Midcarpal instability

2015 ◽  
Vol 41 (1) ◽  
pp. 86-93 ◽  
Author(s):  
D. G. Hargreaves
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Case Series ◽  
Definite Diagnosis ◽  
Stress Tests ◽  
Functional Instability ◽  
Painful Wrist ◽  
Relative Rarity ◽  
Passive Stress

Midcarpal instability is a collective term for a number of conditions where the instability of the wrist is predominantly between the proximal and distal carpal rows. It has been regarded as relatively rare and infrequently requires surgical treatment. Palmar midcarpal instability is the most commonly found type of midcarpal instability and can be responsible for causing a clunking and painful wrist. The diagnosis is made on clinical grounds using the midcarpal instability provocative tests. Standard imaging and arthroscopic inspection do not usually confirm a definite diagnosis, but are important in excluding other pathologies. The classification and staging has been described using the extent of palmar translocation of the distal carpal row, which is elicited on passive stress tests. As this is a functional instability, it may be that a functional staging description might be better, and a proposed scheme is described. Treatment options including partial wrist fusions, tenodesis stabilizations and arthroscopic capsular shrinkage have been described in small case series with limited follow-up. There are no comparative series or randomized studies because of the relative rarity of this condition.

Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures

2021 ◽  
Author(s):  
Ulrich Josef Albert Spiegl ◽  
Klaus J. Schnake ◽  
Bernhard Ullrich ◽  
Max J. Scheyerer ◽  
Georg Osterhoff ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Screw Fixation ◽  
Case Series ◽  
Fracture Morphology ◽  
Iliosacral Screw ◽  
Insufficiency Fractures ◽  
Minimally Invasive Surgical ◽  
Sacral Insufficiency Fractures ◽  
Non Surgical Treatment

AbstractAn increasing incidence of sacral insufficiency fractures in geriatric patients has been documented, representing a major challenge to our healthcare system. Determining the accurate diagnosis requires the use of sectional imaging, including computed tomography and magnetic resonance imaging. Initially, non-surgical treatment is indicated for the majority of patients. If non-surgical treatment fails, several minimally invasive therapeutic strategies can be used, which have shown promising results in small case series. These approaches are sacroplasty, percutaneous iliosacral screw fixation (S1 with or without S2), trans-sacral screw fixation or implantation of a trans-sacral bar, transiliac internal fixator stabilisation, and spinopelvic stabilisation. These surgical strategies and their indications are reported in detail. Generally, treatment-related decision making depends on the clinical presentation, fracture morphology, and attending surgeonʼs experience.

Surgical treatment of brainstem cavernous malformations: an international Delphi consensus

2021 ◽  
pp. 1-11
Author(s):  
Philipp Dammann ◽  
Adib A. Abla ◽  
Rustam Al-Shahi Salman ◽  
Hugo Andrade-Barazarte ◽  
Vladimir Benes ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Treatment Decision ◽  
Clinical Situation ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Cavernous Malformations ◽  
Clinical Scenarios ◽  
Developmental Venous Anomalies ◽  
Question Survey

OBJECTIVE Indication for surgery in brainstem cavernous malformations (BSCMs) is based on many case series, few comparative studies, and no randomized controlled trials. The objective of this study was to seek consensus about surgical management aspects of BSCM. METHODS A total of 29 experts were invited to participate in a multistep Delphi consensus process on the surgical treatment of BSCM. RESULTS Twenty-two (76%) of 29 experts participated in the consensus. Qualitative analysis (content analysis) of an initial open-ended question survey resulted in 99 statements regarding surgical treatment of BSCM. By using a multistep survey with 100% participation in each round, consensus was reached on 52 (53%) of 99 statements. These were grouped into 4 categories: 1) definitions and reporting standards (7/14, 50%); 2) general and patient-related aspects (11/16, 69%); 3) anatomical-, timing of surgery–, and BSCM-related aspects (22/37, 59%); and 4) clinical situation–based decision-making (12/32, 38%). Among other things, a consensus was reached for surgical timing, handling of associated developmental venous anomalies, handling of postoperative BSCM remnants, assessment of specific anatomical BSCM localizations, and treatment decisions in typical clinical BSCM scenarios. CONCLUSIONS A summary of typical clinical scenarios and a catalog of various BSCM- and patient-related aspects that influence the surgical treatment decision have been defined, rated, and interpreted.

Adjunctive use of antimicrobial photodynamic therapy in the surgical treatment of periapical lesions: a case series

2021 ◽  
pp. 102598
Author(s):  
Pier Paolo Poli ◽  
Francisley Ávila Souza ◽  
Giovanni Damiani ◽  
Henrique Hadad ◽  
Carlo Maiorana ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Surgical Treatment ◽  
Case Series ◽  
Antimicrobial Photodynamic Therapy ◽  
Periapical Lesions

Surgical Treatment of Cavernous Malformations Involving the Midbrain: A Single-Center Case Series of 34 Patients

2017 ◽  
Vol 107 ◽  
pp. 753-763 ◽  
Author(s):  
Yanming Ren ◽  
Jin Li ◽  
Chuanyuan Tao ◽  
Jun Zheng ◽  
Si Zhang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Single Center ◽  
Cavernous Malformations

Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm

2016 ◽  
Vol 41 (7) ◽  
pp. 732-738 ◽  
Author(s):  
J. K. Andersson ◽  
P. Axelsson ◽  
J. Strömberg ◽  
J. Karlsson ◽  
J. Fridén
Keyword(s):  
Joint Instability ◽  
Clinical Signs ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Level Of Evidence ◽  
Independent Observer ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Level of evidence: Case series, Level IV.

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