Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Nov 2003
Clinical outcome of the treatment of floating shoulder by osteosynthesis for clavicular fracture alone.
Floating shoulder is an unstable combination of fractures that involve the scapular neck and the ipsilateral midclavicle and require surgical treatment. The clinical outcome of the surgical treatment of floating shoulder for the clavicular fracture alone is reported. ⋯ According to the UCLA score, the mean score was 34.2 points during a mean follow-up period of 57.4 months. In patients with a floating shoulder, it is important to evaluate the severity of fracture displacement and coracoclavicular ligament rupture accurately, and on the basis of this evaluation, an appropriate treatment for both fractures that may lead to a satisfactory clinical outcome can be determined.
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Thirty-two patients with chronic dislocation of the shoulder were diagnosed over a 5-year period at King Edward VIII Hospital, Durban, South Africa. Thirty-one patients had an anterior subcoracoid dislocation. One patient had a chronic posterior dislocation. ⋯ All but one of the dislocations were anterior, the incidence of epilepsy was lower, and successful reduction by manipulation was rarely achieved. In all 10 cases in which the author performed the operation, the shoulder was successfully relocated without neurovascular complications. Dissection of the axillary vessels and nerves was never necessary.
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Eleven fresh-frozen cadaveric upper extremities were studied to determine the effect of intra-articular fluid volume on the range of motion of the elbow. The flexion arc of the cadaveric elbows was measured before and after incremental injections of saline solution. ⋯ A mean volume of 10.8 mL of saline solution decreased the flexion arc to the point where surgery has traditionally been recommended for type II radial head fractures. On the basis of these findings, the use of post-aspiration range of motion should be reconsidered as a criterion for surgical treatment of radial head fractures.
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J Shoulder Elbow Surg · Jul 2003
Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy.
The purpose of this study is to define the prevalence of peripheral nerve injury associated with full-thickness tears of the rotator cuff presenting with shoulder muscle atrophy. Twenty-five patients with the diagnosis of full-thickness rotator cuff tear were included. Electrodiagnostic testing, including nerve conduction studies and needle examination, was performed on all patients. ⋯ The prevalence of associated peripheral neuropathy was found to be 28%. Greater degrees of atrophy were significantly associated with the presence of neuropathy in these patients. Careful neurologic screening in all patients and electromyographic examination in clinically suspicious groups are recommended in patients with full-thickness cuff tears before surgical repair.
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J Shoulder Elbow Surg · May 2003
The course of the suprascapular nerve in the supraspinatus fossa and its vulnerability in muscle advancement.
Twenty-four cadaveric shoulders were evaluated to assess damage to the suprascapular nerve in relation to Debeyre's advancement of the supraspinatus muscle for rotator cuff repair. In all cases the neurovascular pedicle was tethered at the suprascapular notch and at the periosteum of the supraspinatus fossa. The medial motor branches were directed to the trigonum spinae or the superior angle of the scapula (group 1). ⋯ Branches of group 1 and the main nerve are at risk of injury when detaching muscle from bone. This risk is minimized by subperiosteal detachment. Branches of group 1 are tensioned when advancing the muscle 1 cm laterally.