scholarly journals USING OF PERSONALIZED SCREW GUIDE FOR LATARGET PROCEDURE

2020 ◽  
Vol 76 (4) ◽  
pp. 160-164
Author(s):  
A.S. Tregubov ◽  
◽  
D.A. Malanin ◽  
L.L. Cherezov ◽  
◽  
...  
Keyword(s):  
Shoulder Joint ◽  
Articular Surface ◽  
Suprascapular Nerve ◽  
Multiplanar Reconstruction ◽  
Bone Block ◽  
Anterior Instability ◽  
Nerve Branch ◽  
Articular Process ◽  
Preoperative Ct

The advisability of using a personalized guide in patients with anterior instability of the shoulder joint during Latarget procedure is shown. A multiplanar reconstruction of postoperative CT was carried out and the position of the bone block of the graft in the sagittal and axial planes relative to the articular process of the scapula was assessed. The angle between the screws and the plane of the articular process of the scapula was also evaluated. The use of preoperative CT planning with the manufacture of a personalized guide for positioning and fixing the bone block of the graft during the Latargier operation allows to increase the accuracy of the restoration of the defect in the articular surface of the glenoid, to position the implants more correctly and thereby reduce the risks associated with damage to the suprascapular nerve branch.

scholarly journals Risk factors and preventive measures for C5 palsy after cervical open-door laminoplasty

2020 ◽  
Vol 32 (4) ◽  
pp. 592-599
Author(s):  
Hideaki Nakajima ◽  
Hiroyuki Kuroda ◽  
Shuji Watanabe ◽  
Kazuya Honjoh ◽  
Akihiko Matsumine
Keyword(s):  
Spinal Cord ◽  
High Speed ◽  
Facet Joint ◽  
Patient Characteristics ◽  
Lateral Side ◽  
Intervertebral Foramen ◽  
Open Door ◽  
C5 Palsy ◽  
Articular Process ◽  
Preoperative Ct

OBJECTIVEThe pathomechanism of C5 palsy after cervical open-door laminoplasty is unknown despite the relatively common occurrence of this condition postoperatively. The aim of this study was to review clinical and imaging findings in patients with C5 palsy and to propose countermeasures for prevention of this complication.METHODSBetween 2001 and 2018, 326 patients with cervical myelopathy underwent cervical laminoplasty at the authors’ hospital, 10 (3.1%) of whom developed C5 palsy. Clinical features and radiological findings of patients with and without C5 palsy were analyzed.RESULTSIn patients with C5 palsy, the width of the C5 intervertebral foramen was narrower and the position of the bony gutter was wider beyond the medial part of the C5 facet joint. The distance between the lateral side of the spinal cord and bony gutter was significantly greater in patients with C5 palsy. Patient characteristics, disease, cervical alignment, spinal canal expansion rate, anterior protrusion of the C5 superior articular process, high-intensity area in the spinal cord on T2-weighted MR images, posterior shift of the spinal cord, and operative time did not differ significantly between patients with and without C5 palsy.CONCLUSIONSThe position of the bony gutter may have a central role in the pathomechanism of postoperative C5 palsy, especially in patients with a narrow C5 intervertebral foramen. Making an excessively lateral bony gutter might be a cause of C5 nerve root kinking at the intervertebral foramen. To prevent the occurrence of C5 palsy, it is important to confirm the medial line of the facet joint on the preoperative CT scan, and a high-speed burr should be started from inside of the facet joint and manipulated in a direction that allows the ligamentum flavum to be identified.

scholarly journals Stress Distribution Patterns Across the Shoulder Joint in Gymnasts: A Computed Tomography Osteoabsorptiometry Study

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096210
Author(s):  
Daisuke Momma ◽  
Wataru Iwamoto ◽  
Kaori Endo ◽  
Kazuki Sato ◽  
Norimasa Iwasaki
Keyword(s):  
Bone Density ◽  
Stress Distribution ◽  
Distribution Pattern ◽  
Subchondral Bone ◽  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Articular Surface ◽  
Articular Surfaces ◽  
Subchondral Bone Density ◽  
Collegiate Gymnasts

Background: The distribution pattern of subchondral bone density is an indicator of stress distribution over a joint surface under long-term physiologic loading. The biomechanical characteristics of the articular surfaces of the shoulder joint in gymnasts can be determined by measuring this distribution pattern. Purpose: To evaluate the distribution of subchondral bone density across the shoulder joint in male collegiate gymnasts and to determine the effects of gymnastic activities on its articular surfaces under long-term loading conditions using computed tomography osteoabsorptiometry (CTOAM). Study Design: Descriptive laboratory study. Methods: CT image data were obtained from both shoulders of 12 asymptomatic male collegiate gymnasts (gymnast group; mean age, 19.4 years; range, 18-22 years) and 10 male collegiate volunteers (control group; mean age, 20.2 years; range, 18-22 years). The distribution pattern of subchondral bone density across the articular surfaces of each shoulder joint was assessed by CTOAM. Quantitative analysis was performed of the locations and percentages of high-density areas on the articular surface. Results: Stress distribution patterns over the articular surfaces differed between the gymnasts and the controls. In the gymnasts, high-density areas were detected on the posterosuperior articular surface of the humeral head and the anterosuperior and/or posterosuperior articular surface of the glenoid. Mean bone density was greater in the gymnasts than in the controls ( P < .0001). Conclusion: Stress distribution over the articular surfaces of the shoulder joint was affected by gymnastic activities. Stress was concentrated over the superior part of the glenohumeral joint in male collegiate gymnasts. Clinical Relevance: The present findings suggest that gymnastic activities increase stress to the articular surfaces of the superior glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the origin of disorders particular to gymnastic activities.

scholarly journals Shoulder Joint Dysfunction Following Injury to the Suprascapular Nerve

1965 ◽  
Vol 45 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Bernard R. Strohm ◽  
C. Colachis
Keyword(s):  
Shoulder Joint ◽  
Suprascapular Nerve

scholarly journals Features of Partial Rotator Cuff Tears Diagnostics

2019 ◽  
Vol 25 (2) ◽  
pp. 143-149 ◽  
Author(s):  
A. N. Logvinov ◽  
D. O. Ilyin ◽  
P. M. Kadantsev ◽  
O. V. Makarieva ◽  
M. E. Burtsev ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Articular Surface ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Joint Surface ◽  
Subacromial Space ◽  
Diagnostic Significance ◽  
Combined Application ◽  
Shoulder Range Of Motion

Partial rotator cuff tears are the most common pathology of the shoulder joint. Diagnostic of such conditions is a challenging problem for trauma surgeon.Purpose of the study is to analyze the diagnostic significance of manual tests and the standard MRI of the shoulder joint.Materials and Methods. The study is a retrospective analysis of disease history data of 25 patients (15 males, 10 females) treated at the authors’ hospital during the period from 2014 to 2017. Examination was performed according to a standard protocol: assessment of shoulder range of motion, palpation, manual examination, including “full/empty can” test, a painful arc symptom and the Hawkins – Kennedy test. All patients underwent MRI of the shoulder joint. The mean age of patients was 50.8 years. Shoulder joint arthroscopic inspection was considered the gold standard for diagnostics.Results. After data analysis, the following results were obtained: sensitivity of the “full can” test was 68%, the accuracy was 68%; “empty can” test sensitivity and accuracy were 76%, respectively. MRI sensitivity for diagnostics of supraspinatus tendon ruptures was 84% with the accuracy of 84%. The combination of the Hawkins – Kennedy test with the symptom of painful arch demonstrated accuracy and sensitivity of 64%. The study evaluated the effectiveness of MRI for diagnostic of the rupture type: sensitivity for injury from the joint surface — 80%, from the subacromial space — 70%; specificity for ruptures from the articular surface — 90% and from the subacromial space — 93%. The accuracy was 84% for both types of ruptures.Conclusions. Combined application of manual tests and MRI of the shoulder joint allows to diagnose partial rotator cuff tears in the majority of cases.

scholarly journals Neuromodulation of the Suprascapular Nerve

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. E769-E773
Author(s):  
Foad Elahi
Keyword(s):  
Peripheral Nerve ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Nerve Stimulation ◽  
Shoulder Joint ◽  
Adhesive Capsulitis ◽  
Suprascapular Nerve ◽  
Shoulder Range Of Motion ◽  
Shoulder Range ◽  
Chronic Shoulder Pain

The shoulder joint is an enarthrodial or ball-and-socket joint. A complex network of anatomic structures endows the human shoulder with tremendous mobility, greater than any other joint in the body. Many pathologies can been found in those patients with chronic shoulder pain. The painful limitation of shoulder motion affects hand and arm motion as well; therefore, it significantly influences work performance and everyday activities as well as the quality of life. Therefore, the treatment of patients with chronic shoulder pain has major social and health economic implications. In this article we present a patient with a complex history of shoulder pathology including 7 surgeries that left the patient with chronic debilitating shoulder pain. She was suffering from chronic pain and limited mobility of the shoulder joint due to adhesive shoulder capsulitis. She was treated with a multimodality approach with the goals of increasing shoulder range of motion and decreasing her pain. This did not provide significant improvement. The suprascapular nerve supplies motor and sensory innervation to the shoulder, and can be easily accessible in the supraspinatus fossa. A suprascapular nerve block dramatically decreased her pain. This clinical observation along with confirmatory nerve block play an important role during the decision-making process for a trial period of electrical neuromodulation. She was followed for 3 months after the permanent implantation of a suprascapular nerve stimulator. Her pain and shoulder range of motion in all planes improved dramatically. Peripheral nerve stimulation (PNS) of the suprascapular nerve, in addition to multimodality pain management, is one approach to the difficult task of treating adhesive capsulitis with accompanying pain and the inability to move the shoulder. We conducted a literature review on PubMed and found no case describing a similar patient to our knowledge. Key words: Suprascapular nerve, neuromodulation, peripheral nerve stimulation, adhesive capsulitis, chronic shoulder pain

scholarly journals Management of periarthritis of shoulder joint by suprascapular nerve block

2019 ◽  
Vol 11 (2) ◽  
pp. 109
Author(s):  
Buddhadeb Nayak ◽  
AlokChandra Agrawal ◽  
Mayank Kumar ◽  
Sharath Kowshik
Keyword(s):  
Nerve Block ◽  
Shoulder Joint ◽  
Suprascapular Nerve ◽  
Suprascapular Nerve Block

Morphological and Elastic Properties of the Glenoid Region of the Shoulder

2003 ◽  
Author(s):  
D. Lim ◽  
R. Seliktar ◽  
J. Wee ◽  
L. Nunes ◽  
E. Farrell
Keyword(s):  
Ct Scan ◽  
Young’S Modulus ◽  
Elastic Properties ◽  
Shoulder Joint ◽  
Mechanical Characteristics ◽  
Articular Surface ◽  
Morphological Properties ◽  
Limited Success ◽  
Proper Method

Researchers have tried to assess the morphological and mechanical characteristics of bone using various methods with a limited success (Mow and Hayes, 1997, and Cowin, 2001). This may be due to the complexity for documentation and characterization of architecture by the anisotropic and nonhomogeneous characteristic of the bone. The bones of the shoulder joint complex are particularly deprived of information on their mechanical and morphological properties. Very little is known for example on the mechanics and morphology of the glenoid of the shoulder. The present work presents an attempt to identify a proper method for the measurement and characterization of the morphology and mechanics of bone, particularly in the glenoid. Our results show that trabecular lines are directed at 82.15° ± 7.98° relative to the glenoid articular surface, young’s modulus obtained from CT scan was 230 ± 8 MP, and the elastic tensors obtained from cadaver were 326 ± 78 MPa for E2222, 144 ± 22 MPa for E1111=E3333, 49 ± 7 MPa for E3311, 59 ± 9 MPa for E1122=E2233, 51 ± 8 MPa for E1313, and 70 ± 10 MPa for E1212=E2323. These results were consistent with Wolf’s Law and were in agreement with results reported in literatures (Anglin et al., 1999, Frich et al., 1998, and Mansat et al., 1998).

scholarly journals Managing Bony Defects of the Shoulder Joint that Occur in Association with Dislocation

2017 ◽  
Vol 11 (1) ◽  
pp. 1245-1257 ◽  
Author(s):  
Jonathan Brian Yates ◽  
Muhammad Naghman Choudhry ◽  
Mohammad Waseem
Keyword(s):  
Patient Outcomes ◽  
Humeral Head ◽  
Shoulder Joint ◽  
Articular Surface ◽  
Compression Fracture ◽  
Optimal Method ◽  
Treatment Techniques ◽  
Surgical Options ◽  
Defect Filling ◽  
Improve Patient

Background: Defects to the articular surface of the humeral head have been known to be associated with shoulder dislocation since the 19th century. It wasn't until 1934 that the first description of the ubiquitous compression fracture of the posterolateral humeral head that occurs with traumatic anterior instability appeared. From 1940, this defect became referred to as a Hill-Sachs lesion after the investigators who reported the condition. The significance of, and therefore treatment of, these and other such bony defects around the shoulder joint has been hotly debated. Methods: We reviewed the available current literature to determine and report on the most up to date concepts and treatment techniques being used to manage bony defects of the shoulder. Results: Numerous surgical options have been proposed to manage bony defects of the shoulder, including a variety of defect-filling procedures, with good outcomes. However, the small numbers and diversity of case mix makes for difficult comparisons. Conclusion: We are currently developing a greater appreciation of how both the humeral and glenoid defects interact and therefore should be assessed and addressed simultaneously in order to improve patient outcomes. More research and collaboration is needed to determine the optimal method of assessing and managing these patients.

scholarly journals Open Latarjet-Patte Procedure for Anterior Shoulder Stabilization: Critical Steps and Pearls for the Walch Technique

2021 ◽  
Vol 1 (4) ◽  
pp. 263502542110142
Author(s):  
Stefan Bauer ◽  
Charline Coron ◽  
Xavier Lannes ◽  
Gilles Walch ◽  
William G. Blakeney
Keyword(s):  
External Rotation ◽  
Articular Surface ◽  
Constant Score ◽  
Severity Index ◽  
Drill Hole ◽  
Neurological Complications ◽  
Long Term Results ◽  
Bone Block ◽  
Direction Parallel ◽  
Coracoacromial Ligament

Background: Latarjet is a term used for different techniques and modifications to expose the glenoid and to transfer and fix the coracoid. The procedure is intricate and technically demanding. Outcomes and complications are heterogeneous in the literature. A master technique, the Walch technique, has been practiced for decades, with outstanding long-term results and patient satisfaction. Indications: Documented anterior dislocations with evidence for emergency reduction, with or without hyperlaxity and confirmation of a traumatic capsuloligamentous lesion. Contraindications include voluntary dislocations and multidirectional instability without these criteria. The Instability Severity Index Score can guide decision making on whether Bankart surgery is sufficient. Large Hill-Sachs lesions may be an indication for additional remplissage. Technique Description: Three key maneuvers and 6 surgical stages need to be mastered for consistent results. Key maneuvers include: (1) arm positioning for all stages, (2) retractor placement, and (3) safe conjoint tendon releases. Six key stages include: (1) coracoid exposure and initial release; (2) osteotomy and subsequent release; (3) bone preparation; (4) subscapularis split and arthrotomy; (5) 360° scapula neck exposure; and (6) cornerstone drill hole positioning, fixation, and simple capsuloplasty. Specific arm positioning facilitates coracoid exposure, releases, subscapularis split, arthrotomy, and retractor insertion, as well as capsular repair. A 360° anterior scapula neck exposure is crucial to drill the inferior cornerstone hole (2.5 for 4.0 partially threaded cancellous screw) 7 mm medial to the articular surface with mandatory direction parallel to the articular surface. The bone block can be dialed to the exact position, preventing lateral overhang. The capsule is closed to the coracoacromial ligament stump in 45° of external rotation. Results: A series of >80 cases with minimum 1-year follow-up (range: 1-5 years) demonstrated excellent results. Outcomes were good to excellent (small saphenous vein >80% in 95% of cases; Constant score >90% and Rowe score > 90%) in keeping with the Walch results (>1000 cases). The complication rate was low: 1 early coracoid fracture (1.3%), no dislocation and neurological complications, no new arthritis or progression, and good coracoid position without lateral overhang. Conclusion: The Walch technique, although technically demanding, provides excellent, consistently reproducible results once the 3 key surgical maneuvers and 6 stages of the procedure are mastered.

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