The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2002
Randomized Controlled Trial Comparative Study Clinical TrialComparison of intra-articular lidocaine and intravenous sedation for reduction of shoulder dislocations: a randomized, prospective study.
Acute anterior glenohumeral dislocations have been commonly treated with closed reduction and the use of intravenous sedation. Recently, the use of intra-articular lidocaine has been advocated as an alternative to sedation, since intravenous access and patient monitoring are not required. The purpose of this study was to evaluate the value of local anesthesia compared with that of the commonly used intravenous sedation during the performance of a standardized reduction technique. ⋯ Use of intra-articular lidocaine to facilitate reduction with the Stimson technique is a safe and effective method for treating acute shoulder dislocations in an emergency room setting. Intra-articular lidocaine requires less money, time, and nursing resources than does intravenous sedation to facilitate reduction with the Stimson technique.
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J Bone Joint Surg Am · Dec 2002
The vascular anatomy of the glenohumeral capsule and ligaments: an anatomic study.
A detailed description of the vascular anatomy of the shoulder capsule is lacking, yet surgical procedures may put this capsular blood supply at risk. We hypothesized that a hypovascular area is present in the capsule. The purpose of the present study was to describe the vascular anatomy of the human glenohumeral capsule and ligaments and its relevance to surgical treatment of the shoulder. ⋯ The glenohumeral capsule is a well-vascularized structure with direct predictable contributions from four named arteries. These arteries send branches that enter the capsule superficially and from the periphery. These dominant vessels run horizontally toward the midcapsule and to deeper layers of the capsule. Vessels originating from the rotator cuff provide additional blood supply to the capsule.
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J Bone Joint Surg Am · Nov 2002
The association of lumbar disc disease with vitamin-D receptor gene polymorphism.
Although the etiology of lumbar disc disease is unknown, it has been suggested that a genetic factor contributes to its development. Recently, some genetic polymorphisms have been found to be related to clinical disorders. We investigated the association between vitamin-D receptor gene and estrogen receptor gene polymorphisms and lumbar disc disease in young adults. ⋯ This study revealed that the Tt allele of the vitamin-D receptor gene was more frequently associated with multilevel and severe disc degeneration and disc herniation than was the TT allele, pointing to an increased risk of disc disease at an early age in subjects with the Tt allele in the vitamin-D receptor gene.
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J Bone Joint Surg Am · Nov 2002
Randomized Controlled Trial Multicenter Study Clinical TrialExtracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial.
On the basis of observational trials, numerous investigators have recommended extracorporeal shock wave therapy as an alternative treatment for chronic lateral epicondylitis of the elbow. However, there has been no evidence of its efficacy from well-designed randomized clinical trials. The objective of this study was to find out whether extracorporeal shock wave therapy in combination with local anesthesia was superior to placebo therapy in combination with local anesthesia. ⋯ Extracorporeal shock wave therapy as applied in the present study was ineffective in the treatment of lateral epicondylitis. The previously reported success of this therapy appears to be attributable to inappropriate study designs. Different application protocols might improve clinical outcome. We recommend that extracorporeal shock wave therapy be applied only in high-quality clinical trials until it is proved to be effective.
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J Bone Joint Surg Am · Nov 2002
Comparative StudyPulley plasty versus resection of one slip of the flexor digitorum superficialis after repair of both flexor tendons in zone II: a biomechanical study.
The outcome of repair of zone-II lacerations of the flexor digitorum superficialis and flexor digitorum profundus tendons remains suboptimal. We investigated the effects of two strategies to improve postoperative gliding in a human cadaveric hand. ⋯ Both pulley plasty and resection of one slip of the flexor digitorum superficialis reduce gliding resistance after tendon repair in zone II of the hand.