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1

Rotator cuff exercises  

MedlinePLUS

... tendinitis, which is irritation and swelling of these tendons A rotator cuff tear, which occurs when one of the tendons is ... Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio ...

2

Rotator cuff - self-care  

MedlinePLUS

... the bursa (a normally smooth layer) lining these tendons A tear, which occurs when one of the tendons is ... Leggin BG, Williams GR. Rotator cuff tendinopathies and tears: surgery and therapy. In: Skirven TM, Osterman AL, Fedorczyk JM, Amadio ...

3

What Do the Patients Want and Worry in Korean Patients Who Undergo Arthroscopic Rotator Cuff Surgery?  

PubMed Central

Background To specify what patients want and worry preoperatively is important in orthopedic practice. The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery, and to evaluate the differences in expectations and concerns by age and gender. Methods We prospectively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008. Three questionnaires were completed before surgery: the first one addressing preoperative patient's expectation, the second one focusing on concerns by covering 64 items using a visual analogue scale, and the third one evaluating patient's demographic characteristics. The characteristics of preoperative expectation, concern, and demographic data were evaluated according to gender and age group. Results Female patients had lower level of sports activity (p = 0.007) and lower levels of information (p = 0.028). Gender specific worries are about a caregiver during hospital stay, operating on the working side, fear about ugly scars, postoperative pain, applying makeup or combing hair. The older group responded that they can't be willing to change activities of daily living (p = 0.001), are not living with a spouse (p = 0.002), had previous shoulder operation history (p = 0.008), and had a lower level of information (p = 0.007). They especially worried about medical bills, worried about the physician being too young and inexperienced, postoperative pain, loss of arm function, and hospital food. Conclusions Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery. This can empower patients to formulate realistic expectations and make informed decisions. We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively. PMID:23205237

Yoon, Jong Pil; Min, Woo-Kie; Kim, Joon Woo; Jeong, Won-Ju; Lee, Hyun-Joo

2012-01-01

4

[Rupture of the rotator cuff].  

PubMed

Reconstructive surgery of rotator cuff tears tries to restore a stable center of rotation in the shoulder joint. Both the classic technique of open surgery and the arthroscopic technique are employed to reconstruct the rotator cuff. This review tries to answer the question which of both surgical techniques is superior by a review of the literature. The recent literature demonstrates a shorter follow-up period for publications concerning arthroscopic reconstruction (mean 3 years) in comparison to open surgery, where follow-up is in mean 6.2 years. Overall arthroscopic surgery achieves good and excellent results between 68 to 96%, open reconstruction between 77 and 91%. Longevity of reconstructed rotator cuffs especially in large tears seems to be significantly shorter if an arthroscopic technique was used. Several authors mentioned size of tear as a major factor influencing longevity. However in patients treated arthroscopically despite rerupture of the rotor cuff patient's satisfaction and clinical outcome is still very good in short-term follow-up. In case of a complete tear of one tendon of the rotator cuff the arthroscopic technique seems to be superior. If large tears occur (two or three tendons) the open surgical technique may be more reliable with regard to longevity of the repair. For the future it seems necessary to obtain long-term results to be able to compare both principles of reconstruction of the rotator cuff. Furthermore these future studies should include quality of life scores as measurements tools besides the already employed parameters as size of the tear, age at surgery, patient satisfaction and outcome scores. PMID:17187328

Wurmig, C

2006-01-01

5

National Trends in Rotator Cuff Repair  

PubMed Central

Background: Recent publications suggest that arthroscopic and open rotator cuff repairs have had comparable clinical results, although each technique has distinct advantages and disadvantages. National hospital and ambulatory surgery databases were reviewed to identify practice patterns for rotator cuff repair. Methods: The rates of medical visits for rotator cuff pathology, and the rates of open and arthroscopic rotator cuff repair, were examined for the years 1996 and 2006 in the United States. The national incidence of rotator cuff repairs and related data were obtained from inpatient (National Hospital Discharge Survey, NHDS) and ambulatory surgery (National Survey of Ambulatory Surgery, NSAS) databases. These databases were queried with use of International Classification of Diseases, Ninth Revision (ICD-9) procedure codes for arthroscopic (ICD-9 codes 83.63 and 80.21) and open (code 83.63 without code 80.21) rotator cuff repair. We also examined where the surgery was performed (inpatient versus ambulatory surgery center) and characteristics of the patients, including age, sex, and comorbidities. Results: The unadjusted volume of all rotator cuff repairs increased 141% in the decade from 1996 to 2006. The unadjusted number of arthroscopic procedures increased by 600% while open repairs increased by only 34% during this time interval. There was a significant shift from inpatient to outpatient surgery (p < 0.001). Conclusions: The increase in national rates of rotator cuff repair over the last decade has been dramatic, particularly for arthroscopic assisted repair. PMID:22298054

Colvin, Alexis Chiang; Egorova, Natalia; Harrison, Alicia K.; Moskowitz, Alan; Flatow, Evan L.

2012-01-01

6

Rotator Cuff Repair Rehabilitation  

PubMed Central

Background There is no consensus for the optimal postoperative rehabilitation protocol after rotator cuff repairs. Objective To determine if there is sufficient level I or II evidence available in the literature for establishment of a uniform, optimal rotator cuff rehabilitation protocol. Data Sources A systematic review of level I and II English-language, prospective, randomized controlled trials published between 1966 and 2008 was performed. MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references were appraised for studies that met the inclusion criteria. Search terms included rotator cuff, supraspinatus, infraspinatus, subscapularis, teres minor, rehab, rehabilitation, physical therapy, and physiotherapy. Study Selection Inclusion criteria were English-language level I or level II studies, including randomized clinical trials involving the rehabilitation of rotator cuff repairs. Exclusion criteria were non-English language, level IV or V studies, or studies involving shoulder rehabilitation of diagnoses other than rotator cuff repairs. Three independent reviewers arrived at a consensus for including 4 studies in this review out of 12 studies identified by the literature search. Data Extraction Included studies underwent worksheet quality appraisal independently by each of the 3 authors identifying strengths, weaknesses, and biases. The quality appraisal was then discussed among the authors and consensus reached regarding the strengths, weaknesses, and value of the included studies. Results Two studies examined the use of continuous passive motion for rotator cuff rehabilitation, and 2 studies compared an unsupervised, standardized rehabilitation program to a supervised, individualized rehabilitation program. These studies did not support the use of continuous passive motion in rotator cuff rehabilitation, and no advantage was shown with a supervised, individualized rehabilitation protocol compared to an unsupervised, standardized home program. Each investigation had weaknesses in study design that decreased the validity of its findings. Conclusion There is not enough high-level evidence to develop an evidence-based medicine approach to rotator cuff rehabilitation. There is a need for well-designed level I and level II trials to elucidate the optimal rotator cuff repair rehabilitation protocol. PMID:23015863

Baumgarten, Keith M.; Vidal, Armando F.; Wright, Rick W.

2009-01-01

7

The behavior of rotator cuff tendon cells in three-dimensional culture  

E-print Network

The rotator cuff is composed of the supraspinatus, infraspinatus, subcapularis, and teres minor tendons. Rotator cuff injuries are common athletic and occupational injuries that surgery cannot fully repair. Therefore tendon ...

Gill, Harmeet (Harmeet Kaur)

2007-01-01

8

Biological Augmentation of Rotator Cuff Tendon Repair  

PubMed Central

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery. PMID:18264850

Kovacevic, David

2008-01-01

9

Rotator Cuff Tears  

MedlinePLUS

... cu? tear most o en occurs within the tendon. Rotator Cu? Tears cont. .org Page ( 3 ) AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information ...

10

Biomechanical evaluation of rotator cuff fixation methods  

Microsoft Academic Search

Initial fixation strength and failure mode for various rotator cuff reattachment techniques (variations of the McLaughlin technique) were evaluated. Repair methods included standard suture (control), reinforced suture [expanded polytetrafluoroethylene (PTFE) patch and polydioxanone (PDS) tape augmentation] and stapling (nonarthroscopic and arthroscopic soft-tissue staples). The average strength of intact rotator cuff tissue (su praspinatus tendon) was also determined. The different rotator

E. Paul France; Lonnie E. Paulos; Chris D. Harner; Chris B. Straight

1989-01-01

11

Ruptures of the rotator cuff.  

PubMed Central

Through the use of improved diagnostic techniques, including arthrography and arthroscopy, ruptures of the rotator cuff that previously might not have been recognized are now being identified more frequently. In most cases the symptoms are relatively mild and respond satisfactorily to rest and therapy. Occasionally, however, there is severe, persistent disability despite treatment. These ruptures require surgical repair. In such cases the data obtained from special investigations help the surgeon select the appropriate surgical approach and repair technique. An imaginative program of physiotherapy before and after the operation contributes greatly to a satisfactory result. Images FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 PMID:7437980

Ha'eri, G B

1980-01-01

12

Advances in biology and mechanics of rotator cuff repair.  

PubMed

High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair. Animal models are critical to ensure safety and efficacy of new treatment strategies; however, although rat shoulders as well as sheep and goats are considered the most appropriate models for studying rotator cuff pathology, no one of them can fully reproduce the human condition. Emerging therapies involve growth factors, stem cells and tissue engineering. Experimental application of growth factors and platelet-rich plasma demonstrated promising results, but has not yet been transferred into standardized clinical practice. Although preclinical animal studies showed promising results on the efficacy of enhanced biological approaches, application of these techniques in human rotator cuff repairs is still very limited. Randomized controlled clinical trials and post-marketing surveillance are needed to clearly prove the clinical efficacy and define proper indications for the use of combined biological approaches. The following review article outlines the state of the art of rotator cuff repair and the use of growth factors, scaffolds and stem cells therapy, providing future directions to improve tendon healing after rotator cuff repair. Level of evidence Expert opinion, Level V. PMID:25573661

Lorbach, Olaf; Baums, Mike H; Kostuj, Tanja; Pauly, Stephan; Scheibel, Markus; Carr, Andrew; Zargar, Nasim; Saccomanno, Maristella F; Milano, Giuseppe

2015-02-01

13

Current Biomechanical Concepts for Rotator Cuff Repair  

PubMed Central

For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed. PMID:23730471

2013-01-01

14

The Societal and Economic Value of Rotator Cuff Repair  

PubMed Central

Background: Although rotator cuff disease is a common musculoskeletal problem in the United States, the impact of this condition on earnings, missed workdays, and disability payments is largely unknown. This study examines the value of surgical treatment for full-thickness rotator cuff tears from a societal perspective. Methods: A Markov decision model was constructed to estimate lifetime direct and indirect costs associated with surgical and continued nonoperative treatment for symptomatic full-thickness rotator cuff tears. All patients were assumed to have been unresponsive to one six-week trial of nonoperative treatment prior to entering the model. Model assumptions were obtained from the literature and data analysis. We obtained estimates of indirect costs using national survey data and patient-reported outcomes. Four indirect costs were modeled: probability of employment, household income, missed workdays, and disability payments. Direct cost estimates were based on average Medicare reimbursements with adjustments to an all-payer population. Effectiveness was expressed in quality-adjusted life years (QALYs). Results: The age-weighted mean total societal savings from rotator cuff repair compared with nonoperative treatment was $13,771 over a patient’s lifetime. Savings ranged from $77,662 for patients who are thirty to thirty-nine years old to a net cost to society of $11,997 for those who are seventy to seventy-nine years old. In addition, surgical treatment results in an average improvement of 0.62 QALY. Societal savings were highly sensitive to age, with savings being positive at the age of sixty-one years and younger. The estimated lifetime societal savings of the approximately 250,000 rotator cuff repairs performed in the U.S. each year was $3.44 billion. Conclusions: Rotator cuff repair for full-thickness tears produces net societal cost savings for patients under the age of sixty-one years and greater QALYs for all patients. Rotator cuff repair is cost-effective for all populations. The results of this study should not be interpreted as suggesting that all rotator cuff tears require surgery. Rather, the results show that rotator cuff repair has an important role in minimizing the societal burden of rotator cuff disease. PMID:24257656

Mather, Richard C.; Koenig, Lane; Acevedo, Daniel; Dall, Timothy M.; Gallo, Paul; Romeo, Anthony; Tongue, John; Williams, Gerald

2013-01-01

15

Understanding and preventing complications in repairing rotator cuff tears.  

PubMed

Repair of rotator cuff tears is a common procedure. Prior to approaching this surgery, it should be realized that each surgical step can lead to complications, including those related to positioning and anaesthesia. Stiffness, infection and failure of repair are the more frequent complications reported. PMID:21986055

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

2012-01-01

16

Clinical Examination of the Rotator Cuff  

PubMed Central

Rotator cuff tears are the leading cause of shoulder pain and shoulder-related disability accounting for 4.5 million physician visits in the United States annually. A careful history and structured physical examination are often sufficient for diagnosing rotator cuff disorders. We are not aware of a clinical review article that presents a structured physical examination protocol of the rotator cuff for the interested clinician. To fill this void, we present a physical examination protocol developed on the basis of review of prior literature and our clinical experience from dedicated shoulder practices. Our protocol includes range of motion testing using a goniometer, strength testing using a dynamometer, and select special tests. Among the many tests for rotator cuff disorders that have been described, we chose ones that have been more thoroughly assessed for sensitivity and specificity. This protocol can be used to isolate the specific rotator cuff tendon involved. The protocol can be typically completed in 15 minutes. We also discuss the clinical implications and limitations of the physical examination maneuvers described in our protocol. This protocol is thorough yet time-efficient for a busy clinical practice. It is useful in diagnosis of rotator cuff tears, impingement syndrome, and biceps pathology. PMID:23332909

Jain, Nitin B.; Wilcox, Reginald; Katz, Jeffrey N.; Higgins, Laurence D.

2013-01-01

17

Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review  

Microsoft Academic Search

The authors conducted a systematic review to assess the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of calcific and noncalcific tendonitis of the rotator cuff. Conservative treatment for rotator cuff tendonitis includes physiotherapy, nonsteroidal antiinflammatory drugs, and corticosteroid injections. If symptoms persist with conservative treatment, surgery is often considered. Extracorporeal shock wave therapy has been suggested as

Dorcas Beaton

2004-01-01

18

Fatty infiltration and rotator cuff atrophy.  

PubMed

Moderate to severe fatty infiltration and rotator cuff atrophy are commonly associated with poor clinical outcomes and failed rotator cuff repair. Numerous animal and human studies have attempted to elucidate the etiology of fatty infiltration and rotator cuff atrophy. Mechanical detachment of the tendon in rotator cuff tears is primarily responsible. Suprascapular nerve injury may also play a role. CT, MRI, and ultrasonography are used to evaluate severity. The Goutallier staging system is most commonly used to evaluate fatty infiltration, and rotator cuff atrophy is measured using multiple techniques. The presence and severity of fatty infiltration have been associated with increasing age, tear size, degree of tendon retraction, number of tendons involved (ie, massive tears), suprascapular neuropathy, and traumatic tears. Fatty infiltration is irreversible and progressive if left untreated. Slight reversal of muscle atrophy has been noted after repair in some studies. Novel therapies are currently being evaluated that may eventually allow clinicians to alter the natural history and improve patient outcomes. PMID:24084435

Kuzel, Bradley R; Grindel, Steven; Papandrea, Rick; Ziegler, Dean

2013-10-01

19

Incidence of familial tendon dysfunction in patients with full-thickness rotator cuff tears  

PubMed Central

Background A familial predisposition to the development of rotator cuff tearing has been previously reported. Very little information exists on the development of global tendon dysfunction in patients with rotator cuff tears. The purpose of the current study was to determine the incidence of global tendon dysfunction as well as the need for surgery for tendon dysfunction in patients with rotator cuff tears and their family members and compare them to age-matched controls. Methods Ninety two patients with full-thickness rotator cuff tears and 92 age-matched controls with no history of shoulder dysfunction or surgery responded to several questions regarding tendon diseases in themselves as well as their family members. Individuals were queried regarding the presence of tendon diseases other than the rotator cuff, the need for surgery on these other tendinopathies, the presence of family members having tendinopathies including rotator cuff disease, and the need for family members to have surgery for these problems. Chi-square analysis was performed to compare the incidences between cases and controls (P<0.05 was considered significant). Results The average age of patients in the rotator cuff tear group and control groups were 58.24±7.4 and 58.42±8.5 years, respectively (P=0.876). Results showed 32.3% of patients in the rotator cuff tear group reported that family members had a history of rotator cuff problems or surgery compared to only 18.3% of the controls (P=0.035), and 38.7% of patients in the rotator cuff tear group reported they had a history of other tendon problems compared to only 19.3% of individuals in the control group (P=0.005). Conclusion Individuals with rotator cuff tears report a higher incidence of family members having rotator cuff problems or surgery as well as a higher incidence of other tendinopathies compared to controls. This data further supports a familial predilection for the development of rotator cuff tearing and generalized tendinopathies. PMID:24966704

Tashjian, Robert Z; Saltzman, Erik G; Granger, Erin K; Hung, Man

2014-01-01

20

Clinical and biological aspects of rotator cuff tears  

PubMed Central

Summary Rotator cuff tears are common and are a frequent source of shoulder pain and disability. A wide variation in the prevalence of rotator cuff tears has been reported. The etiology of rotator cuff tear remains multifactorial and attempts to unify intrinsic and extrinsic theories tried to explain the etiopathogenesis of rotator cuff tears. Knowledge of the etiopathogenesis of rotator cuff tears is important to improve our therapies, surgical techniques and promote tendon repair. Several strategies have been proposed to enhance tendon healing and recently research has focused on regenerative therapies, such as Growth Factors (GFs) and Plasma Rich Platelet (PRP), with high expectations of success. PMID:23888289

Giai Via, Alessio; De Cupis, Mauro; Spoliti, Marco; Oliva, Francesco

2013-01-01

21

Regenerative Medicine in Rotator Cuff Injuries  

PubMed Central

Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results. Platelet-rich plasma (PRP) is a whole blood fraction which contains several growth factors. Controlled clinical studies using different autologous PRP formulations have provided controversial results. However, favourable structural healing rates have been observed for surgical repair of small and medium rotator cuff tears. Cell-based approaches have also been suggested to enhance tendon healing. Bone marrow is a well known source of mesenchymal stem cells (MSCs). Recently, ex vivo human studies have isolated and cultured distinct populations of MSCs from rotator cuff tendons, long head of the biceps tendon, subacromial bursa, and glenohumeral synovia. Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research. PMID:25184132

Randelli, Pietro; Ragone, Vincenza; Menon, Alessandra; Cabitza, Paolo; Banfi, Giuseppe

2014-01-01

22

The Role of Acromioplasty for Management of Rotator Cuff Problems: Where Is the Evidence?  

PubMed Central

The incidence of acromioplasty has increased dramatically in recent decades, but its role in rotator cuff surgery has been debated. Neer popularized the extrinsic theory of rotator cuff pathology, where mechanical compression of the coracoacromial arch leads to tearing of the rotator cuff. Under this theory, acromioplasty is advocated to modify acromial morphology as an essential part of rotator cuff surgery. Proponents of the intrinsic theory suggest rotator cuff tendons undergo degeneration through aging and overuse, and that bursectomy alone without acromioplasty is sufficient. There exist cadaveric studies, expert opinions, and numerous case series espousing both sides of the argument. Recently, however, numerous high-quality prospective randomized controlled trials have been published examining the role of acromioplasty. They have similar study design and randomization protocols, including groups of arthroscopic rotator cuff repair with bursectomy and acromioplasty versus isolated bursectomy. The results have been consistent across all studies, with no difference in the outcomes of the acromioplasty and isolated bursectomy groups. Current evidence does not support the routine use of acromioplasty in the treatment of rotator cuff disease. PMID:23316375

Shi, Lewis L.; Edwards, T. Bradley

2012-01-01

23

Anomalous biceps origin from the rotator cuff  

PubMed Central

Variations in the origin of the long head of biceps tendon (LHBT) have been described in literature; however, its clinical significance remains uncertain. We describe in this report, the history, physical examination and the arthroscopic findings in a patient who had an anomalous origin of the LHBT from the rotator cuff, resulting in restriction of range of motion. This anomalous origin of the long head of biceps tendon causing capsular contracture and restriction of movements leading to secondary internal impingement, has not been extensively reported in the literature. Shoulder arthroscopists should be aware that, although, an uncommon clinical condition, the aberrant congenital origin of the LHBT from the rotator cuff can rarely become pathologic in middle age and lead to shoulder dysfunction. In such cases, release of the anomalous band may be required, along with the treatment of other concomitant intraarticular pathologies in the glenohumeral joint. PMID:25593361

Banerjee, Samik; Patel, Vipul R

2015-01-01

24

Impingement syndrome of the shoulder following double row suture anchor technique for arthroscopic rotator cuff repair: a case report  

Microsoft Academic Search

INTRODUCTION: Arthroscopic repair of the rotator cuff is a demanding surgery. Accurate placement of anchors is key to success. CASE PRESENTATION: A 38-year-old woman received arthroscopic repair of her rotator cuff using a double row suture anchor technique. Postoperatively, she developed impingement syndrome which resulted from vertical displacement of a suture anchor once the shoulder was mobilised. The anchor was

Rohit Rambani; Roger G Hackney

2009-01-01

25

Orthopaedic Surgery Sports Medicine  

E-print Network

Orthopaedic Surgery Sports Medicine How Does Arthroscopic Rotator Cuff Repair Surgery Work? Rev. 2 Surgical Illustrations (Pages 2-4) · Preparing for Rotator Cuff Surgery (Pages 5-6) · General Post Surgery to embark on the arthroscopic rotator cuff repair journey. The goal of rotator cuff repair surgery is create

Kim, Duck O.

26

Arthroscopic rotator cuff repair: 4- to 10-year results  

Microsoft Academic Search

Purpose: The purpose of this article is to report the 4- to 10-year results of arthroscopic repair of full- thickness rotator cuff tears. Type of Study: This is a retrospective study evaluating a series of arthroscopic rotator cuff repairs performed by a single surgeon from February 1990 to February 1996. Methods: Retrospective chart reviews and telephone interviews were performed to

Eugene M Wolf; William T Pennington; Vivek Agrawal

2004-01-01

27

Arthroscopic Rotator Cuff Repair: 4- to 10Year Results  

Microsoft Academic Search

Purpose: The purpose of this article is to report the 4- to 10-year results of arthroscopic repair of full- thickness rotator cuff tears. Type of Study: This is a retrospective study evaluating a series of arthroscopic rotator cuff repairs performed by a single surgeon from February 1990 to February 1996. Methods: Retrospective chart reviews and telephone interviews were performed to

Eugene M. Wolf; William T. Pennington; Vivek Agrawal

2004-01-01

28

Imaging Algorithms for Evaluating Suspected Rotator Cuff Disease: Society of Radiologists in Ultrasound Consensus Conference Statement  

PubMed Central

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. © RSNA, 2013 PMID:23401583

Jacobson, Jon A.; Benson, Carol B.; Bancroft, Laura W.; Bedi, Asheesh; McShane, John M.; Miller, Theodore T.; Parker, Laurence; Smith, Jay; Steinbach, Lynne S.; Teefey, Sharlene A.; Thiele, Ralf G.; Tuite, Michael J.; Wise, James N.; Yamaguchi, Ken

2013-01-01

29

Imaging algorithms for evaluating suspected rotator cuff disease: Society of Radiologists in Ultrasound consensus conference statement.  

PubMed

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. PMID:23401583

Nazarian, Levon N; Jacobson, Jon A; Benson, Carol B; Bancroft, Laura W; Bedi, Asheesh; McShane, John M; Miller, Theodore T; Parker, Laurence; Smith, Jay; Steinbach, Lynne S; Teefey, Sharlene A; Thiele, Ralf G; Tuite, Michael J; Wise, James N; Yamaguchi, Ken

2013-05-01

30

Calcific Tendinitis of the Rotator Cuff: A Review  

PubMed Central

Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non – operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non – steroidal anti – inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non – operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short – wave, and radiation therapy. Rest, immobilization with a sling, and oral non – steroidal and steroid anti – inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences. PMID:23998102

Kachewar, Sushil G; Kulkarni, Devidas S

2013-01-01

31

THE EFFECT OF TEAR SIZE AND NERVE INJURY ON ROTATOR CUFF MUSCLE FATTY DEGENERATION IN A RODENT ANIMAL MODEL  

PubMed Central

Background Irreversible muscle changes following rotator cuff tears is a well-known negative prognostic factor after shoulder surgery. Currently, little is known about the pathomechanism of fatty degeneration of the rotator cuff muscles after chronic cuff tears. Hypothesis/Purpose The purposes of this study were: 1) to develop a rodent animal model of chronic rotator cuff tears that can reproduce fatty degeneration of the cuff muscles seen clinically, 2) to describe the effects of tear size and concomitant nerve injury on muscle degeneration, and 3) to evaluate the changes in gene expression of relevant myogenic and adipogenic factors following rotator cuff tears using the animal model. Methods Rotator cuff tears were created in rodents with and without transection of the suprascapular nerve. The supraspinatus and infraspinatus muscles were examined 2, 8, and 16 weeks after injury for histological evidence of fatty degeneration and expression of myogenic and adipogenic genes. Results Histological analysis revealed adipocytes, intramuscular fat globules, and intramyocellular fat droplets in the tenotomized and neurotomized supraspinatus and infraspinatus muscles. Changes increased with time and were most severe in the muscles with combined tenotomy and neurotomy. Adipogenic and myogenic transcription factors and markers were upregulated in muscles treated with tenotomy or tenotomy combined with neurotomy compared to normal muscles. Conclusions The present study describes a rodent animal model that produces fatty degeneration of the rotator cuff muscles similar to human muscles after chronic cuff tears. The severity of changes was associated with tear size and concomitant nerve injury. PMID:21831663

Kim, H. Mike; Galatz, Leesa M.; Lim, Chanteak; Havlioglu, Necat; Thomopoulos, Stavros

2011-01-01

32

Management of Rotator Cuff and Impingement Injuries in the Athlete  

PubMed Central

Objective: To review current concepts of the pathophysiology, diagnosis, and treatment of rotator cuff and impingement injuries in the athlete. Data Sources: The information we present was compiled from a review of classic and recently published material regarding rotator cuff and impingement injuries. These materials were identified through a search of a personal literature database compiled by the authors, as well as by selective searching of the MEDLINE. In addition, much of the information presented represents observations and opinions of the authors developed over 8 to 10 years of treating shoulder injuries in athletes. Data Synthesis: Biomechanics of the normal shoulder and pathophysiology of rotator cuff injuries in the athletic population are discussed, followed by a summary of the important diagnostic features of rotator cuff and impingement injuries. The principles of rehabilitation are extensively presented, along with indications and important technical aspects of selected surgical procedures. General principles and specific protocols of postoperative rehabilitation are also summarized. Conclusions/Recommendations: Rotator cuff and impingement injuries in the athletic population are multifactorial in etiology, exhibiting significant overlap with glenohumeral instability. Nonoperative treatment is successful in most athletic patients with rotator cuff and impingement injuries. When nonoperative treatment fails, arthroscopic surgical techniques such as rotator cuff repair and subacromial decompression may be successful in returning the athlete to competition. ImagesFigure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10.Figure 11.Figure 12.Figure 13. PMID:16558644

Williams, Gerald R.; Kelley, Martin

2000-01-01

33

Rotator Cuff Repair: Published Evidence on Factors Associated With Repair Integrity and Clinical Outcome.  

PubMed

BACKGROUND:Rotator cuff tears are common, and rotator cuff repair represents a major health care expense. While patients often benefit from rotator cuff repair, anatomic failure of the repair is not unusual. PURPOSE:To identify the published evidence on the factors associated with retears and with suboptimal clinical outcomes of rotator cuff repairs. STUDY DESIGN:Systematic review and meta-analysis of articles with evidence levels 1-4. METHODS:A total of 2383 articles on rotator cuff repairs published between 1980 and 2012 were identified. Only 108 of these articles, reporting on over 8011 shoulders, met the inclusion criteria of reporting quantitative data on both imaging and clinical outcomes after rotator cuff repair. Factors related to the patients, their shoulders, the procedures, and the results were systematically categorized and submitted for meta-analysis. RESULTS:While the number of relevant articles published per year increased dramatically over the period of the study, the clinical and anatomic results did not show improvement over this period. The weighted mean retear rate was 26.6% at a mean of 23.7 months after surgery. Retears were associated with more fatty infiltration, larger tear size, advanced age, and double-row repairs. Clinical improvement averaged 72% of the maximum possible improvement. Patient-reported outcomes were generally improved whether or not the repair restored the integrity of the rotator cuff. The inconsistent and incomplete data in the published articles limited the meta-analysis of factors affecting the outcome of rotator cuff repair. CONCLUSION:In spite of a dramatic increase in the number of publications per year, there is little evidence that the results of rotator cuff repair are improving. The information needed to guide the management of this commonly treated and costly condition is seriously deficient. To accumulate the evidence necessary to inform practice, future clinical studies on the outcome of rotator cuff repair must report important data relating to each patient's condition, the surgical technique, the outcome in terms of integrity, and the change in patient self-assessed comfort and function. PMID:24753240

McElvany, Matthew D; McGoldrick, Erik; Gee, Albert O; Neradilek, Moni Blazej; Matsen, Frederick A

2014-04-21

34

Rotator Cuff Tendinitis and Tear (Beyond the Basics)  

MedlinePLUS

... article will be updated as needed on our web site ( www.uptodate.com/patients ). Related topics for ... a weight in your hand. Graphic 50148 Version 3.0 Wand exercises for rotator cuff Wand exercises such ...

35

Dual-Camera Technique for Arthroscopic Rotator Cuff Repair  

PubMed Central

An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications.

Tuttle, John R.; Ramos, Paul; DaSilva, Manuel F.

2014-01-01

36

Humeral head cysts: association with rotator cuff tears and age.  

PubMed

The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1% (60 patients) in the study population. Anterior GT cysts were found in 56% of patients and were strongly associated with full-thickness (p<.001) and articular-sided partial-thickness rotator cuff tears (p=.02). Posterior GT and lesser tuberosity cysts were found in 27 and 17% of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p=.09). A significant relation was found between patient age and the cyst size (p=.01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age. PMID:23748696

Suluova, Fatih; Kanatli, Ulunay; Ozturk, Burak Yagmur; Esen, Erdinc; Bolukbasi, Selcuk

2014-07-01

37

Improved apparatus for predictive diagnosis of rotator cuff disease  

NASA Astrophysics Data System (ADS)

Rotator cuff disease impacts over 50% of the population over 60, with reports of incidence being as high as 90% within this population, causing pain and possible loss of function. The rotator cuff is composed of muscles and tendons that work in tandem to support the shoulder. Heavy use of these muscles can lead to rotator cuff tear, with the most common causes is age-related degeneration or sport injuries, both being a function of overuse. Tears ranges in severity from partial thickness tear to total rupture. Diagnostic techniques are based on physical assessment, detailed patient history, and medical imaging; primarily X-ray, MRI and ultrasonography are the chosen modalities for assessment. The final treatment technique and imaging modality; however, is chosen by the clinician is at their discretion. Ultrasound has been shown to have good accuracy for identification and measurement of full-thickness and partial-thickness rotator cuff tears. In this study, we report on the progress and improvement of our method of transduction and analysis of in situ measurement of rotator cuff biomechanics. We have improved the ability of the clinician to apply a uniform force to the underlying musculotendentious tissues while simultaneously obtaining the ultrasound image. This measurement protocol combined with region of interest (ROI) based image processing will help in developing a predictive diagnostic model for treatment of rotator cuff disease and help the clinicians choose the best treatment technique.

Pillai, Anup; Hall, Brittany N.; Thigpen, Charles A.; Kwartowitz, David M.

2014-03-01

38

Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder.  

PubMed

The management of patients with irreparable rotator cuff tears remains a challenge for orthopaedic surgeons with the final treatment option in many algorithms being either a reverse shoulder arthroplasty or a tendon transfer. The long term results of these procedures are however still widely debated, especially in younger patients. A variety of arthroscopic treatment options have been proposed for patients with an irreparable rotator cuff tear without the presence of arthritis of the glenohumeral joint. These include a simple debridement with or without a biceps tenotomy, partial rotator cuff repair with or without an interval slide, tuberplasty, graft interposition of the rotator cuff, suprascapular nerve ablation, superior capsule reconstruction and insertion of a biodegradable spacer (Inspace) to depress the humeral head. These options should be considered as part of the treatment algorithm in patients with an irreparable rotator cuff and could be used as either as an interim procedure, delaying the need for more invasive surgery in the physiologically young and active, or as potential definitive procedures in the medically unfit. The aim of this review is to highlight and summarise arthroscopic procedures and the results thereof currently utilised in the management of these challenging patients. PMID:25405083

Anley, Cameron M; Chan, Samuel Kl; Snow, Martyn

2014-11-18

39

Shoulder labral pathomechanics with rotator cuff tears.  

PubMed

Rotator cuff tears (RCTs), the most common injury of the shoulder, are often accompanied by tears in the superior glenoid labrum. We evaluated whether superior humeral head (HH) motion secondary to RCTs and loading of the long head of the biceps tendon (LHBT) are implicated in the development of this associated superior labral pathology. Additionally, we determined the efficacy of a finite element model (FEM) for predicting the mechanics of the labrum. The HH was oriented at 30° of glenohumeral abduction and neutral rotation with 50N compressive force. Loads of 0N or 22N were applied to the LHBT. The HH was translated superiorly by 5mm to simulate superior instability caused by RCTs. Superior displacement of the labrum was affected by translation of the HH (P<0.0001), position along the labrum (P<0.0001), and interaction between the location on the labrum and LHBT tension (P<0.05). The displacements predicted by the FEM were compared with mechanical tests from 6 cadaveric specimens and all were within 1 SD of the mean. A hyperelastic constitutive law for the labrum was a better predictor of labral behavior than the elastic law and insensitive to ±1 SD variations in material properties. Peak strains were observed at the glenoid-labrum interface below the LHBT attachment consistent with the common location of labral pathology. These results suggest that pathomechanics of the shoulder secondary to RCTs (e.g., superior HH translation) and LHBT loading play significant roles in the pathologic changes seen in the superior labrum. PMID:24636720

Hwang, Eunjoo; Carpenter, James E; Hughes, Richard E; Palmer, Mark L

2014-05-01

40

Impingement is not impingement: the case for calling it “Rotator Cuff Disease”  

PubMed Central

Summary Historically, many causes have been proposed for rotator cuff conditions. The most prevalent theory is that the rotator cuff tendons, especially the supraspinatus, make contact with the acromion and coracoacromial ligament, resulting in pain and eventual tearing of the tendon. However, more recent evidence suggests that this concept does not explain the changes in rotator cuff tendons with age. The role of acromioplasty and coracoacromial ligament release in the treatment of rotator cuff disease has become questioned. Evidence now suggests that tendinopathy associated with aging may be a predominant factor in the development of rotator cuff degeneration. We propose that the overwhelming evidence favors factors other than “impingement” as the major cause of rotator cuff disease and that a paradigm shift in the way the development of rotator cuff pathology is conceptualized allows for a more comprehensive approach to the care of the patient with rotator cuff disease. PMID:24367779

McFarland, Edward G.; Maffulli, Nicola; Del Buono, Angelo; Murrell, George A. C.; Garzon-Muvdi, Juan; Petersen, Steve A.

2013-01-01

41

Development of Fatty Atrophy After Neurologic and Rotator Cuff Injuries in an Animal Model of Rotator Cuff Pathology  

PubMed Central

Background: Detachment of a tendon from its osseous insertion, as can be the case with severe rotator cuff injuries, leads to atrophy of and increased fat in the corresponding muscle. We sought to validate a rotator cuff injury model in the rabbit and to test the hypothesis that tenotomy of a rotator cuff tendon would consistently create muscle atrophy and fatty degeneration analogous to the changes that occur after injury to a nerve innervating the same muscle. Methods: New Zealand white rabbits were divided into three groups: (1) partial rotator cuff tear without retraction of the muscle, (2) complete rotator cuff tear with retraction of the muscle, and (3) nerve transection of the subscapular nerve. Animals were killed at two or six weeks after injury, and the muscles were analyzed for weight, cross-sectional area, myosin fiber-type composition, and fat content. In addition, the subscapular nerve was harvested at two weeks and evaluated for neuronal injury. Results: At six weeks after injury, the rabbit muscles in the complete tenotomy and nerve transection groups had significant decreases in wet mass and increases in fat content relative to the control groups. Fat accumulation had a similar spatial pattern at six weeks in both the nerve transection and complete tenotomy groups. Such changes were not seen in the partial tenotomy group. No change was found in muscle myosin fiber-type composition. At two weeks after injury, subscapular nerves in the complete tenotomy group showed gross evidence of neuronal injury. Conclusions: This study establishes the rabbit subscapularis muscle as a valid model to study the muscular changes associated with rotator cuff tears. Our data suggest that the muscular changes associated with complete tenotomy are comparable with those seen with denervation of the muscle and suggest that chronic rotator cuff tears may induce a neurologic injury. Clinical Relevance: Chronic rotator cuff injuries are associated with neuronal injury of the affected muscle. As such, neuronal injury may explain the histopathologic changes that have been observed following chronic rotator cuff tears. PMID:20926720

Rowshan, Kasra; Hadley, Scott; Pham, Khoa; Caiozzo, Vince; Lee, Thay Q.; Gupta, Ranjan

2010-01-01

42

Open versus Two Forms of Arthroscopic Rotator Cuff Repair  

PubMed Central

There have been technologic advances in the methods for repairing torn rotator cuffs. We compared the clinical and structural outcomes of three different forms of rotator cuff repair with up to 24 months’ followup. We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three cohorts of patients had repair of a symptomatic rotator cuff tear using (1) an open technique (n = 49); (2) arthroscopic knotted (n = 53); or (3) arthroscopic knotless (n = 57) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained preoperatively and at 6 weeks, 3 and 6 months, and 2 years postoperatively. Ultrasound studies were performed with a validated protocol at 6 months and 2 years postsurgery. Clinical outcomes were similar with the exception that the arthroscopic groups had, on average, 20% better American Shoulder and Elbow Surgeons scores than the open group at 6 months and 2 years. Retear correlated with tear size and operation time and occurred more frequently after open repair (39%) than after arthroscopic knotted (25%) and arthroscopic knotless (16%) repair. An intact cuff on ultrasound corresponded to better results for supraspinatus strength, patient outcomes, and rotator cuff functional ability. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:19184264

Millar, Neal L.; Wu, Xiao; Tantau, Robyn; Silverstone, Elizabeth

2009-01-01

43

Subacromial Spacer Placement for Protection of Rotator Cuff Repair  

PubMed Central

Rotator cuff repairs have a high failure rate proportional to the tear size. Various techniques have been described to improve the repair strength and failure rate. The described surgical technique uses a biodegradable subacromial balloon-shaped spacer (InSpace; OrthoSpace, Caesarea, Israel) that is implanted arthroscopically to protect our tendon repair. We describe the introduction technique and suggest some hints and tricks. The spacer is placed under direct vision in the subacromial space after the rotator cuff repair is finished. Correct placement is verified by moving the arm freely. The subacromial spacer may help to protect the rotator cuff repair by centering the humeral head and reducing friction between suture knots and the acromion. It may also help to flatten dog-ear formations. PMID:25473615

Szöllösy, Gregor; Rosso, Claudio; Fogerty, Simon; Petkin, Kalojan; Lafosse, Laurent

2014-01-01

44

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study  

Microsoft Academic Search

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or\\u000a an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff\\u000a repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair,\\u000a and 32 patients

Leonardo Osti; Rocco Papalia; Massimo Paganelli; Enzo Denaro; Nicola Maffulli

2010-01-01

45

Decision-making in massive rotator cuff tear.  

PubMed

Treatment of massive rotator cuff tears has developed over many years ranging from conservative treatment to open and arthroscopic repair, muscle transfers and reversed arthroplasty. The evolution of more advanced techniques in arthroscopic repair has changed the treatment approach and improved the prognosis for functional outcome despite low healing rates. Due to this rapid development, our evidence-based knowledge today is mainly founded in Level 3 and Level 4 studies. Based on the literature, the current knowledge on treatment of symptomatic massive rotator cuff tears is proposed in an algorithm. Level of evidence V. PMID:25502477

Thès, André; Hardy, Philippe; Bak, Klaus

2015-02-01

46

Rotator cuff strength weakness in recurrent anterior shoulder instability physiopathology  

Microsoft Academic Search

BackgroundAlthough rotator cuff contractions play an important role in stabilizing the glenohumeral joint, little is known about the role of these muscles in physiopathological recurrent anterior instability.ObjectiveTo analyze the association between isokinetic internal rotator (IR) and external rotator (ER) muscle strength and glenohumeral joint instability in patients with nonoperated recurrent anterior instability.DesignCase-control study.SettingDepartment of Physical Medicine and Rehabilitation, Laboratory setting.Participants48

P Edouard; L Beguin; F Farizon; P Calmels

2011-01-01

47

Effectiveness of Subacromial Anti-Adhesive Agent Injection after Arthroscopic Rotator Cuff Repair: Prospective Randomized Comparison Study  

PubMed Central

Background Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection. Methods Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery. Results The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections. Conclusions A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies. PMID:21369479

Oh, Chung Hee; Oh, Joo Han; Kim, Sae Hoon; Cho, Jae Hwan; Yoon, Jong Pil

2011-01-01

48

COMPREHENSIVE STRENGTH TRAINING PROGRAM FOR A RECREATIONAL SENIOR GOLFER 11-MONTHS AFTER A ROTATOR CUFF REPAIR  

PubMed Central

Background and Purpose: Golf is a popular sport played by hundreds of thousands of individuals of all ages and of varying skill levels. An orthopedic or sports-related injury and/or surgery may limit an individual's sport participation, require him/her to complete a course of rehabilitation, and initiate (or resume) a sport-specific training program. Unlike the availability of evidence to guide postsurgical rehabilitation and sport-specific training of athletes from sports other than golf, there have only been two reports describing outcomes after surgery and for golfers. The purpose of this case report is to present a post-rehabilitation return to sport-training program for a recreational golfer 11-months after a rotator cuff repair. Case Description: The subject, a 67-year old female, injured her right shoulder requiring a rotator cuff repair 11-months prior to her participation in a golf fitness training program. The subject participated in six training sessions over seven week period consisting of general strengthening exercises (including exercises for the rotator cuff), exercises for the core, plyometrics, and power exercises. Outcomes: The subject made improvements in power and muscular endurance of the core. She was able to resume golf at the completion of the training program. Discussion: The subject was able to make functional improvements and return to golf after participation in a comprehensive strength program. Additional studies are necessary to improve program design for golfers who wish to return to sport after shoulder surgery. PMID:22163096

Meira, Erik P.; En Gilpin, Hui; Brunette, Meredith

2011-01-01

49

Anatomical Considerations of the Suprascapular Nerve in Rotator Cuff Repairs  

PubMed Central

Introduction. When using the double interval slide technique for arthroscopic repair of chronic large or massive rotator cuff tears, the posterior interval release is directed toward the scapular spine until the fat pad that protects the suprascapular nerve is reached. Injury to the suprascapular nerve can occur due to the nerve's proximity to the operative field. This study aimed to identify safe margins for avoiding injury to the suprascapular nerve. Materials and Methods. For 20 shoulders in ten cadavers, the distance was measured from the suprascapular notch to the glenoid rim, the articular margin of the rotator cuff footprint, and the lateral border of the acromion. Results. From the suprascapular notch, the suprascapular nerve coursed an average of 3.42?cm to the glenoid rim, 5.34?cm to the articular margin of the rotator cuff footprint, and 6.09?cm to the lateral border of the acromion. Conclusions. The results of this study define a safe zone, using anatomic landmarks, to help surgeons avoid iatrogenic injury to the suprascapular nerve when employing the double interval slide technique in arthroscopic repair of the rotator cuff. PMID:24724030

Tom, James A.; Shah, Mitesh P.; Lee, Dan J.; Cerynik, Douglas L.; Amin, Nirav H.

2014-01-01

50

Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review  

PubMed Central

Purpose: To review the evidence for the effectiveness of therapeutic exercise for the treatment of full thickness (including massive and inoperable) tears of the rotator cuff. Relevance: There is little consensus as to the most effective treatment of full thickness and massive tears of the rotator cuff. There is consensus that the outcome of rotator cuff tendon surgery in the elderly is generally very poor. As such, exercise therapy is usually recommended for this patient group. Although commonly prescribed, the evidence to support this approach is equivocal. The aim of this study was to conduct a systematic review of the literature to determine the efficacy of exercise therapy for the management of full thickness rotator cuff tears. Methods: A systematic review was conducted to synthesise the available research literature on the effectiveness of exercise therapy for full thickness tears of the rotator cuff. Data source: Reports up to and including September 2006 were located from MEDLINE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), AMED, EMBASE, the Cochrane Database of Systematic Reviews and the Physiotherapy Evidence Database (PEDro) using the terms “rotator cuff” and “tear/s” and “exercise” or “physiotherapy” or “physical therapy” or “rehabilitation”. Study selection: Studies were included if they related to full thickness rotator cuff tears and exercise. Data extraction: Two independent reviewers assessed the methodological quality of the studies. Differences were resolved by consensus. Analysis/Data synthesis: Ten studies met the inclusion criteria: eight were observational case series and two were single case studies. There were no randomised clinical trials. Results: Four studies were specific to massive rotator cuff tears. One study had a sub?group with massive cuff tears and five studies were not specific as to the size of the full thickness tear. Due to the heterogeneity of outcome measures used, it was not possible to combine results. In all studies an improvement in outcome scores was reported. Exercise programmes were well documented in five studies. Conclusions: No randomised controlled trials met the inclusion criteria and the evaluation has been based on observational studies of lower scientific merit. The findings suggest that some evidence exists to support the use of exercise in the management of full thickness rotator cuff tears. There is a definite need for well?planned randomised controlled trials investigating the efficacy of exercise in the management of full thickness and massive rotator cuff tears. PMID:17264144

Ainsworth, Roberta; Lewis, Jeremy S

2007-01-01

51

Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: A randomised controlled study of 103 patients with one-year follow-up.  

PubMed

In order to compare the outcome from surgical repair and physiotherapy, 103 patients with symptomatic small and medium-sized tears of the rotator cuff were randomly allocated to one of the two approaches. The primary outcome measure was the Constant score, and secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score, the Short Form 36 Health Survey and subscores for shoulder movement, pain, strength and patient satisfaction. Scores were taken at baseline and after six and 12 months by a blinded assessor. Nine patients (18%) with insufficient benefit from physiotherapy after at least 15 treatment sessions underwent secondary surgical treatment. Analysis of between-group differences showed better results for the surgery group on the Constant scale (difference 13.0 points, p - 0.002), on the American Shoulder and Elbow surgeons scale (difference 16.1 points, p < 0.0005), for pain-free abduction (difference 28.8 degrees , p = 0.003) and for reduction in pain (difference on a visual analogue scale -1.7 cm, p < 0.0005). PMID:20044684

Moosmayer, S; Lund, G; Seljom, U; Svege, I; Hennig, T; Tariq, R; Smith, H-J

2010-01-01

52

Platelet-rich plasma for rotator cuff repair.  

PubMed

Rotator cuff tears are a common cause of shoulder pain and disability. Because they combine both traumatic and degenerative elements, the surgical repair can be challenging. Even after surgical intervention, tendon residual defects or "retears" often develop. Risk factors for tendon "retears" include patient age, number of tendons involved, tear size, and smoking. Platelet-rich plasma (PRP) is a supraphysiological concentration of platelets, which may be able to positively augment rotator cuff tendon healing. Not all PRPs are the same and those containing higher leukocyte levels may be detrimental to tendon healing. Thrombin activation triggers an immediate release of growth factors from the PRP and may actually inhibit some parts of the healing response. As yet, the clinical data does not conclusively prove a benefit from PRP, but discernment is required in evaluating the published results. As different PRPs may act differently and the results may be dose dependent requiring more PRP to achieve a beneficial threshold. How success is measured (clinical outcomes vs. intact cuff tendons) and how long the patients are followed are also critical items. Currently, the PRP fibrin matrix version holds the greatest promise for improving clinical success after rotator cuff tendon repair. PMID:24212367

Barber, F Alan

2013-12-01

53

Isolated subscapularis repair for massive rotator cuff tear.  

PubMed

The best surgical treatment for an irreparable rotator cuff tear is controversial. In such cases, partial rotator cuff repair, primarily involving the posterior cuff in most reports, has been shown to be beneficial. The authors retrospectively investigated 41 patients who underwent arthroscopic subscapularis-only repair and greater tuberoplasty between April 2003 and August 2009 for massive 3-tendon cuff tears with irreparable supraspinatus and infraspinatus tendons after 3 months of conservative management was unsuccessful. Twenty-five patients (61%) underwent biceps tenotomy, and the remaining 39% had preexisting biceps tenotomy or rupture. The patients were assessed with American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Of the 41 patients, 34 (83%) were available for a follow-up telephone questionnaire after a minimum of 12 months (mean, 35 months; range, 12-84 months). Mean ASES and SANE scores were 76% and 63%, respectively. Mean postoperative passive range of motion was 156° of forward flexion and 39° of external rotation. Of the patients queried, 74% (25 of 34) were able to actively raise their arms above shoulder level. For those with a positive belly-press test result preoperatively, 22 of 27 patients had a negative test result postoperatively. A total of 3 complications (7.3%) occurred. Workers' compensation claim was a strong predictor of lower shoulder scores. Arthroscopic subscapularis-only repair and greater tuberoplasty may offer a promising and safe method for treating massive rotator cuff tears when the supra-spinatus and infraspinatus tendons are irreparable. Workers' compensation claim may predict lower outcome scores. PMID:25361371

Austin, Luke; Chang, Edward S; Zmistowski, Benjamin; Nydick, Jason; Lazarus, Mark

2014-11-01

54

Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure  

PubMed Central

Purpose The purpose of this study was to evaluate clinical and anatomic outcomes of patients following transtendon rotator-cuff repair of partial articular supraspinatus tendon avulsion (PASTA) lesions. Patients and methods Patients in the senior author’s practice who had isolated PASTA lesions treated by transtendon rotator-cuff repair were included (n=8) and retrospectively reviewed. All patients were evaluated preoperatively and at a mean of 21.2 months (±9.7 months) postoperatively using standardized clinical evaluation (physical exam, American Shoulder and Elbow Surgeons, and Simple Shoulder Test). All patients underwent postoperative imaging with a magnetic resonance imaging arthrogram. Results There was a significant improvement in American Shoulder and Elbow Surgeons (42.7±17.5 to 86.9±25.2) and Simple Shoulder Test (4.6±3.2 to 10.1±3.8) scores from pre- to postoperative, respectively. Postoperative imaging demonstrated full-thickness medial cuff tearing in seven patients, and one patient with a persistent partial articular surface defect. Conclusion Transtendon repair of PASTA lesions may lead to improvements in clinical outcome. However, postoperative imaging demonstrated a high incidence of full-thickness rotator-cuff defects following repair. PMID:25114604

Woods, Tom C; Carroll, Michael J; Nelson, Atiba A; More, Kristie D; Berdusco, Randa; Sohmer, Stephen; Boorman, Richard S; Lo, Ian KY

2014-01-01

55

Arthroscopic management of recalcitrant stiffness following rotator cuff repair: A retrospective analysis  

PubMed Central

Background: Rotator cuff repair surgery is one of the most commonly performed procedures in the world but limited literature exists for guidance of optimal management of post-operative arthrofibrosis following cuff repair. The purpose of this study is to report the results of arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy in patients with recalcitrant postoperative stiffness after rotator cuff repair. Materials and Methods: Twenty-nine patients who had recalcitrant arthrofibrosis following either an arthroscopic (62%), open (28%), or mini-open (10%) rotator cuff repair were included in study. The average age at the time of index cuff repair surgery was 49.8 years (range 24?70 years). Sixteen patients (55%) were involved in worker's compensation claims. The mean time from the date of index operation to lysis of adhesions was 9.7 months (range 4.2?36.2 months), and the mean time from lysis of adhesion to most recent follow-up 18.2 months (range 4.1?43.7 months). Post-operative evaluation was performed using American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Score (VAS), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) on 18 (62%), while range of motion (ROM), dynamometer strength testing, and Constant-Murley Scoring were performed on 13 (45%). Statistical analysis was performed using a Student's t-test. Results: Prior to arthroscopic lysis of adhesions, mean forward active elevation (FE) was 103.8°, (range 60-145° (SD 26.3) and external rotation at the side (ERS) was 25.3°, (range 5-70° SD 15.1°). Post-operatively, at the most recent follow-up, FE was significantly improved to 158.3°, (range 110?180° SD 22.3°), and ERS improved to 58.9°, (range 15?90° SD 18.6°) in both cases. Involvement in a worker's compensation claim resulted in a lower ASES, VAS, and SANE score, but there was no statistically significant difference in motion. Conclusion: Arthroscopic capsular release, lysis of adhesions, and manipulation under anesthesia is a safe, reliable method of treating persistent stiffness following rotator cuff repair. PMID:23682175

Bhatia, Sanjeev; Mather, Richard C; Hsu, Andrew R; Ferry, Amon T; Romeo, Anthony A; Nicholson, Gregory P; Cole, Brian J; Verma, Nikhil N

2013-01-01

56

Calcific Tendinitis of the Rotator Cuff: Management Options.  

PubMed

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. PMID:25344596

Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

2014-11-01

57

Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures  

Microsoft Academic Search

BACKGROUND: Disease-specific Quality Of Life (QOL) measures are devised to assess the impact of a specific disease across a spectrum of important domains of life. The purpose of this study was to examine the cross-sectional and longitudinal construct validity (sensitivity to change) of two rotator cuff disease-specific measures, the Rotator Cuff-Quality Of Life (RC-QOL) and the Western Ontario Rotator Cuff

Helen Razmjou; Andrea Bean; Varda van Osnabrugge; Joy C MacDermid; Richard Holtby

2006-01-01

58

All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique  

PubMed Central

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation. PMID:24400198

Chalmers, Peter N.; Frank, Rachel M.; Gupta, Anil K.; Yanke, Adam B.; Trenhaile, Scott W.; Romeo, Anthony A.; Bach, Bernard R.; Verma, Nikhil N.

2013-01-01

59

Human dermal allograft for massive rotator cuff tears.  

PubMed

Previously published studies reported variable results using various suture techniques and reconstruction options for massive rotator cuff tears. Therefore, the current authors retrospectively studied 21 consecutive patients/shoulders with massive rotator cuff tears treated from January 2005 to October 2011 with a human dermal allograft through a mini-open approach. Mean patient age was 58 years (range, 33-72 years). Mean follow-up was 29 months (range, 18-52 months). Ten patients underwent revision repair for a failed rotator cuff repair. The authors measured the tendon gap (mean, 1.7 cm) and acromiohumeral interval (mean, 6.5 mm). They evaluated pain, shoulder range of motion (ROM) and function, patient satisfaction with the operation and outcome, and complications. At last follow-up, all patients experienced significant pain relief (P=.001) and improved ROM (P=.001) and American Shoulder and Elbow Surgeons (ASES) score (P=.001). Eighteen patients reported that they were satisfied or very satisfied and 3 reported that they were not satisfied with the operation and outcome. Comparison of outcomes between patients who underwent primary repair and those who underwent revision repair and between patients who had muscle atrophy and fatty infiltration grades 0 to II and those who had grades III to IV showed no statistically significant differences. A statistically significant correlation was observed between the size of the tendon gap and postoperative pain, ROM (except external rotation), and ASES score (P<.050). No significant correlation was observed between postoperative pain, ROM, and ASES score and the acromiohumeral interval (P>.050). Complications related to the dermal human allograft were not observed. PMID:25437086

Kokkalis, Zinon T; Mavrogenis, Andreas F; Scarlat, Marius; Christodoulou, Michael; Vottis, Christos; Papagelopoulos, Panayiotis J; Sotereanos, Dean G

2014-12-01

60

Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios  

PubMed Central

Objectives Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. Methods In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree) and a statistical method (logistic regression) to classify the rotator cuff diagnosis into “tear” and “no tear” groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. Results Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear). Conclusions Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears. PMID:24733553

Lu, Hsueh-Yi; Huang, Chen-Yuan; Su, Chwen-Tzeng; Lin, Chen-Chiang

2014-01-01

61

Classification of rotator cuff tendinopathy using high definition ultrasound  

PubMed Central

Summary Background: ultrasound is a valid cost effective tool in screening for rotator cuff pathology with high levels of accuracy in detecting full-thickness tears. To date there is no rotator cuff tendinopathy classification using ultrasound. The aims of this study are to define a valid high-definition ultrasound rotator cuff tendinopathy classification, which has discriminate validity between groups based upon anatomical principles. Methods: 464 women, aged 65–87, from an established general population cohort underwent bilateral shoulder ultrasound and musculoskeletal assessment. Sonographer accuracy was established in a separate study by comparing ultrasound findings to the gold standard intra-operative findings. Results: there were 510 normal tendons, 217 abnormal tendons, 77 partial tears, and 124 full-thickness tears. There was no statistical difference in age or the proportion with pain between the abnormal enthesis and partial tear groups, however both groups were statistically older (p<0.001) and had a greater proportion with pain (p<0.001 & p=0.050) than normal tendons. The full-thickness tears were statistically older than normal tendons (p<0.001), but not abnormal/partially torn tendons. The proportion with pain was significantly greater than both groups (p<0.001 & p=0.006). Symptomatic shoulders had a larger median tear size than asymptomatic shoulders (p=0.006). Using tear size as a predictor of pain likelihood, optimum sensitivity and specificity occurred when dividing tears into groups up to 2.5cm and >2.5cm, which corresponds with anatomical descriptions of the width of the supraspinatus tendon. Conclusion: the classification system is as follows: Normal Tendons; Abnormal enthesis/Partial-thickness tear; Single tendon full-thickness tears (0–2.5cm); Multi-tendon full-thickness tears (>2.5cm). PMID:25489559

Hinsley, Hannah; Nicholls, Alex; Daines, Michael; Wallace, Gemma; Arden, Nigel; Carr, Andrew

2014-01-01

62

Comma Sign–Directed Repair of Anterosuperior Rotator Cuff Tears  

PubMed Central

The comma sign was described as an arthroscopic landmark to identify the torn subscapularis stump to mobilize and repair the tendon in anterosuperior rotator cuff tears. It was hypothesized that it is composed of the humeral attachments of the superior glenohumeral and coracohumeral ligaments. This arthroscopic finding has since become accepted orthopaedic nomenclature pathognomonic for subscapularis tears and a key component of subscapularis tear classification. We propose an alternative theory of the pathoanatomy of the comma sign in anterosuperior rotator cuff tears and present the technique of comma sign–directed repairs of combined subscapularis and supraspinatus lesions. After appropriate releases, tendon-to-tendon repair of the distal-superior aspect of the comma sign to the upper border of the remnant subscapularis results in anatomic re-creation of the intra-articular portion of the torn subscapularis with concomitant reduction of the anterior leading edge of the supraspinatus and reconstitution of the rotator cable complex. A tension-free, single-anchor subscapularis repair is then performed to secure the tendon to the lesser tuberosity. After subscapularis repair, the supraspinatus that was previously retracted to the glenoid rim takes the appearance of a crescent-type tear that is easily approximated to its anatomic insertion.

Dilisio, Matthew F.; Neyton, Lionel

2014-01-01

63

REHABILITATION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR: CURRENT CONCEPTS REVIEW AND EVIDENCE-BASED GUIDELINES  

PubMed Central

Purpose: To provide an overview of the characteristics and timing of rotator cuff healing and provide an update on treatments used in rehabilitation of rotator cuff repairs. The authors' protocol of choice, used within a large sports medicine rehabilitation center, is presented and the rationale behind its implementation is discussed. Background: If initial nonsurgical treatment of a rotator cuff tear fails, surgical repair is often the next line of treatment. It is evident that a successful outcome after surgical rotator cuff repair is as much dependent on surgical technique as it is on rehabilitation. To this end, rehabilitation protocols have proven challenging to both the orthopaedic surgeon and the involved physical therapist. Instead of being based on scientific rationale, traditionally most rehabilitation protocols are solely based on clinical experience and expert opinion. Methods: A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair on PUBMED / MEDLINE and EMBASE databases was performed to illustrate the available evidence behind various postoperative treatment modalities. Results: There is little high-level scientific evidence available to support or contest current postoperative rotator cuff rehabilitation protocols. Most existing protocols are based on clinical experience with modest incorporation of scientific data. Conclusion: Little scientific evidence is available to guide the timing of postsurgical rotator cuff rehabilitation. To this end, expert opinion and clinical experience remains a large facet of rehabilitation protocols. This review describes a rotator cuff rehabilitation protocol that incorporates currently available scientific literature guiding rehabilitation. PMID:22530194

Westgard, Paul; Chandler, Zachary; Gaskill, Trevor R.; Kokmeyer, Dirk; Millett, Peter J.

2012-01-01

64

Posterosuperior rotator cuff tears: classification, pattern recognition, and treatment.  

PubMed

The posterosuperior rotator cuff, composed of the supraspinatus and infraspinatus tendons, is the most common site for full-thickness rotator cuff tears and represents a significant source of shoulder disability worldwide. Recognition of and classification of full-thickness tear patterns are essential in order to optimize surgical treatment and to improve prognosis. Until recently, tear patterns have been described using one- or two-dimensional classification systems. Three-dimensional pattern recognition is critical to achieving the most successful outcome possible. For more complex patterns, a combination of side-to-side stitching, margin convergence, and interval slide techniques may be needed to achieve a tension-free tendon-bone repair. Biomechanical and anatomic evidence supports the use of linked double-row repairs for most full-thickness tears. Although double-row repairs seem to result in improved structural outcomes, clinical evidence has not shown differences in outcomes scores between single-row and double-row repairs. Single-row repair may be performed in partial-thickness, small full-thickness, or very massive, immobile tears, whereas double-row repair may be performed in most other cases. PMID:25063750

Millett, Peter J; Warth, Ryan J

2014-08-01

65

Complications associated with arthroscopic rotator cuff repair: a literature review.  

PubMed

The aim of this literature review was to report complications associated with arthroscopic rotator cuff repair (RCR). A computerized search of articles published between 200 and 2009 was performed using MEDLINE and PubMed. We included clinical studies (Level 1-4): (a) investigating patients with rotator cuff tears, managed by a completely arthroscopic RCR technique; (b) reported data about complications. Data about arthroscopic-assisted techniques were excluded. Articles that meet criteria inclusion were analytically examined. Complications were classified into general complications and specific complications related to arthroscopic RCR. We found 414 complications in 2,890 patients; most of them were specific complications related to arthroscopic RCR. Re-rupture was the most frequently encountered complication: re-tear rate ranged between 11.4 and 94%. Stiffness and hardware-related complications were observed in 74 and 12 patients, respectively. Eleven less common complications were also reported: 5 neurovascular, 3 septic, 2 thromboembolic events, and 1 anesthesiological complication. This review stated that arthroscopic RCR is a low-risk surgical procedure. Anatomical failure of the repair is the most common complication encountered in the literature. PMID:22205384

Randelli, P; Spennacchio, P; Ragone, V; Arrigoni, P; Casella, A; Cabitza, P

2012-06-01

66

Clinic and electromyographic results of latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears.  

PubMed

BackgroundThis study examines the clinical and electromyographic results of latissimus dorsi transfer (LDT) using a combined open and arthroscopic technique for the treatment of symptomatic irreparable posterosuperior rotator cuff tears.MethodsBetween 2006 and 2009, LDT was performed in 14 patients (mean age 59 years) with massive and symptomatic irreparable posterosuperior rotator cuff tear. The patients were examined preoperatively and postoperatively with mean follow-up of 52 months using the Constant score, and the integrity of the latissimus dorsi (LD) transfer was assessed by ultrasound in all cases and by MRI in ten cases. The functional activity of the LD transfer was compared to the non-operated side using surface electromyography.ResultsAll patients demonstrated a significant improvement in the Constant score (p =0.001), from a preoperative score of 33 points (range 10¿55 points) to a postoperative score of 59 points (range 13¿80 points). The subjective assessment score was good to excellent in 12 patients (85%), and 11 patients (78%) would be willing to undergo surgery again. Integrity of the transferred tissue was confirmed in 13 of the 14 cases using ultrasound and MRI. Surface electromyographic signal showed increased activation of the transferred latissimus dorsi when performing active movements of external rotation (p =0.002) and abduction-elevation (p =0.009).ConclusionsOur results indicate that LDT significantly improves function and diminishes pain in patients with a massive posterosuperior rotator cuff tear. The combined open and arthroscopic technique preserves the deltoid muscle and controls the LD tendon reinsertion. Surface electromyographic signal confirms the active function of the transferred muscle. PMID:25380558

De Casas, Ricardo; Lois, Matías; Cidoncha, Myriam; Valadron, Miguel

2014-11-01

67

Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion - dynamic sonographic evaluation  

PubMed Central

Background Clavicular hook plates are effective fixation devices for distal clavicle fractures and severe acromioclavicular joint dislocations. However, increasing number of studies has revealed that subacromial portion of the hook may induce acromial bony erosion, shoulder impingement, or even rotator cuff damage. By sonographic evaluation, we thus intended to determine whether the presence of hook plate may induce subacromial shoulder impingement and its relationship relative to surrounding subacromial structures. Methods We prospectively followed 40 patients with either distal clavicle fracture or acromioclavicular joint dislocation that had surgery using the Arbeitsgemeinschaft für Osteosynthesefragen (AO) clavicular hook plate. All patients were evaluated by monthly clinical and radiographic examinations. Static and dynamic musculoskeletal sonography examinations were performed at final follow-up before implant removal. Clinical results for pain, shoulder function, and range of motion were evaluated using Constant-Murley and Disability of Arm, Shoulder, and Hand (DASH) scores. Results Clinically, 15 out of 40 patients (37.5%) presented with subacromial impingement syndrome and their functional scores were poorer than the non-impinged patients. Among them, six patients were noted to have rotator cuff lesion. Acromial erosion caused by hook pressure developed in 20 patients (50%). Conclusions We demonstrated by musculoskeletal sonography that clavicular hook plate caused subacromial shoulder impingement and rotator cuff lesion. The data also suggest an association between hardware-induced impingement and poorer functional scores. To our knowledge, the only solution is removal of the implant after bony consolidation/ligamentous healing has taken place. Thus, we advocate the removal of the implant as soon as bony union and/or ligamentous healing is achieved. PMID:24502688

2014-01-01

68

Tissue Engineering for Rotator Cuff Repair: An Evidence-Based Systematic Review  

PubMed Central

The purpose of this systematic review was to address the treatment of rotator cuff tears by applying tissue engineering approaches to improve tendon healing, specifically platelet rich plasma (PRP) augmentation, stem cells, and scaffolds. Our systematic search was performed using the combination of the following terms: “rotator cuff”, “shoulder”, “PRP”, “platelet rich plasma”, “stemcells”, “scaffold”, “growth factors”, and “tissue engineering”. No level I or II studies were found on the use of scaffolds and stem cells for rotator cuff repair. Three studies compared rotator cuff repair with or without PRP augmentation. All authors performed arthroscopic rotator cuff repair with different techniques of suture anchor fixation and different PRP augmentation. The three studies found no difference in clinical rating scales and functional outcomes between PRP and control groups. Only one study showed clinical statistically significant difference between the two groups at the 3-month follow up. Any statistically significant difference in the rates of tendon rerupture between the control group and the PRP group was found using the magnetic resonance imaging. The current literature on tissue engineering application for rotator cuff repair is scanty. Comparative studies included in this review suggest that PRP augmented repair of a rotator cuff does not yield improved functional and clinical outcome compared with non-augmented repair at a medium and long-term followup. PMID:25098365

Maffulli, Nicola; Longo, Umile Giuseppe; Loppini, Mattia; Berton, Alessandra; Spiezia, Filippo; Denaro, Vincenzo

2012-01-01

69

QUANTIFICATION OF THE DYNAMIC GLENOHUMERAL STABILITY PROVIDED BY THE ROTATOR CUFF MUSCLES IN THE LATE COCKING PHASE OF THROWING  

Microsoft Academic Search

The purpose of this study was to investigate quantitatively the dynamic glenohumeral stability provided by the rotator cuff muscles in the late-cocking phase of throwing. Using ten cadaveric shoulders, a new biomechanical parameter (dynamic stability index) was calculated considering compressive and shear forces to the glenoid provided by each cuff muscle. The rotator cuff muscles provided the joint with significant

Seok-Beom Lee; Shawn W. O'Driscoll; Bernard F. Morrey; Kai-Nan An

70

The Global Percutaneous Shuttling Technique Tip for Arthroscopic Rotator Cuff Repair  

PubMed Central

Most arthroscopic rotator cuff repairs utilize suture passing devices placed through arthroscopic cannulas. These devices are limited by the size of the passing device where the suture is passed through the tendon. An alternative technique has been used in the senior author’s practice for the past ten years, where sutures are placed through the rotator cuff tendon using percutaneous passing devices. This technique, dubbed the global percutaneous shuttling technique of rotator cuff repair, affords the placement of sutures from nearly any angle and location in the shoulder, and has the potential advantage of larger suture bites through the tendon edge. These advantages may increase the area of tendon available to compress to the rotator cuff footprint and improve tendon healing and outcomes. The aim of this study is to describe the global percutaneous shuttling (GPS) technique and report our results using this method. The GPS technique can be used for any full thickness rotator cuff tear and is particularly useful for massive cuff tears with poor tissue quality. We recently followed up 22 patients with an average follow up of 32 months to validate its usefulness. American Shoulder and Elbow Surgeons scores improved significantly from 37 preoperatively to 90 postoperatively (P<0.0001). This data supports the use of the GPS technique for arthroscopic rotator cuff repair. Further biomechanical studies are currently being performed to assess the improvements in tendon footprint area with this technique. PMID:25002932

Vopat, Bryan G.; Murali, Jothi; Gowda, Ashok L.; Kaback, Lee; Blaine, Theodore

2014-01-01

71

Assessment of the canine model of rotator cuff injury and repair  

PubMed Central

Animal shoulder models are used to systematically investigate the factors influencing rotator cuff injury and repair. Each model has advantages and disadvantages that must be considered in the context of the specific research questions being asked. Herein we evaluate the utility of the canine model for studies of acute, full-thickness rotator cuff tendon injury and repair. We found that time zero failure load is dependent on the suture type and configuration used for repair. Acute, full-width tendon repairs fail anatomically within the first days after surgery in the canine model, regardless of suture type, suture configuration or post-operative protocol. Robust scar tissue forms in the gap between the failed tendon end and the humerus, which can be visually, mechanically and histologically misconstrued as tendon if an objective test of repair connectivity is not performed. We conclude that a full-width injury and repair model in the canine will provide a rigorous test of whether a new repair strategy or post-operative protocol (such as casting or temporary muscle paralysis) can maintain repair integrity in a high load environment. Alternatively, a partial-width tendon injury model allows loads to be shared between the tendon repair and the remaining intact portion of the infraspinatus tendon and prohibits complete tendon retraction. Thus a partial-width injury in the canine may model the mechanical environment of many single tendon tears in the human injury condition and warrants further investigation. PMID:17560802

Derwin, Kathleen A; Baker, Andrew R; Codsi, Michael J; Iannotti, Joseph P

2007-01-01

72

Acromio-clavicular joint cyst associated with a complete rotator cuff tear - a case report.  

PubMed

This case report describes a patient with an acromio-clavicular joint (ACJ) cyst, associated with a complete tear of the supraspinatus tendon, and the related arthropathy. Ultrasound was a suitable imaging modality to make the diagnosis, and rule out other pathologies. Full assessment of the rotator cuff must be carried out in the presence of ACJ cysts due to their common co-existence with large cuff tears. Cyst aspiration is not a suitable treatment, due to the high likelihood of recurrence. Optimal treatment requires management of the underlying rotator cuff tear. PMID:24331701

McCreesh, Karen M; Riley, Sara J; Crotty, James M

2014-10-01

73

Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?  

Microsoft Academic Search

Background: Early passive motion exercise has been the standard rehabilitation protocol after rotator cuff repair for preventing postoperative stiffness. However, recent approaches show that longer immobilization may enhance tendon healing and quality.Purpose: To elucidate whether early passive motion exercise affects functional outcome and tendon healing after arthroscopic rotator cuff repair.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: One hundred

Yang-Soo Kim; Seok Won Chung; Joon Yub Kim; Ji-Hoon Ok; Joo Han Oh

2012-01-01

74

Rotator Cuff Tears in Middle-Aged Tennis Players: Results of Surgical Treatment  

Microsoft Academic Search

Background: Tennis players, like participants in other overhead sports, are vulnerable to rotator cuff tears. In players who continue to play into their middle-age years, the incidence of such injury increases.Hypothesis: Surgical treatment of rotator cuff tears in middle-aged tennis players is largely successful in allowing return to tennis.Study Design: Retrospective review.Methods: We evaluated the results of surgical treatment of

Bertrand Sonnery-Cottet; T. Bradley Edwards; Eric Noel; Gilles Walch

2002-01-01

75

Contrast-enhanced MRI of the subdeltoid, subacromial bursa in painful and painless rotator cuff tears  

PubMed Central

Objective Although shoulder pain is often associated with rotator cuff tears, many tears are asymptomatic and are not the cause of the patient's pain. This may explain the persistence of symptoms in some patients despite technically successful rotator cuff repair. It has been proposed that rotator cuff tears cause pain through subdeltoid/subacromial bursal inflammation. The aim of this study was to determine whether bursal inflammation seen on MRI is associated with pain in patients with rotator cuff tears of the shoulder. Methods The shoulders of 255 patients were screened with ultrasound. 33 full-thickness rotator cuff tears (18 with shoulder pain and 15 without pain) were identified and subsequently studied using contrast-enhanced MRI of the shoulder. Enhancement of the subacromial bursa was scored independently by two musculoskeletal radiologists. Logistic regression was used to determine whether bursal enhancement was independently associated with pain. Results There was a significant association between pain and age, with greater likelihood of pain in younger patients. Bursal enhancement was common in both painful and painless tears. No statistically significant link between pain and bursal enhancement was seen, even after accounting for age. Conclusion Although enhancement of the subdeltoid/subacromial bursa was common, no evidence was found to support the hypothesis that bursal enhancement is associated with pain in rotator cuff tears. It is therefore unlikely to determine reliably which patients would benefit from rotator cuff repair. Advances in knowledge Bursal enhancement and thickening does not reliably correlate with symptoms or presence of rotator cuff tear. PMID:23091289

Hodgson, R J; O'Connor, P J; Hensor, E M A; Barron, D; Robinson, P

2012-01-01

76

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study.  

PubMed

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P > 0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P < 0.05). No statistically significant difference in the total UCLA scores was found when comparing the two repair techniques (P > 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo; Maffulli, Nicola

2010-03-01

77

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study  

PubMed Central

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P?>?0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P? 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm. PMID:19424692

Osti, Leonardo; Papalia, Rocco; Paganelli, Massimo; Denaro, Enzo

2009-01-01

78

Electromyographic assessment of muscle fatigue in massive rotator cuff tear.  

PubMed

Shoulder muscle fatigue has not been assessed in massive rotator cuff tear (MRCT). This study used EMG to measure fatigability of 13 shoulder muscles in 14 healthy controls and 11 patients with MRCT. A hand grip protocol was applied to minimise artifacts due to pain experience during measurement. The fatigue index (median frequency slope) was significantly non-zero (negative) for anterior, middle, and posterior parts of deltoid, supraspinatus and subscapularis muscles in the controls, and for anterior, middle, and posterior parts of deltoid, and pectoralis major in patients (p?0.001). Fatigue was significantly greater in patients compared to the controls for anterior and middle parts of deltoid and pectoralis major (p?0.001). A submaximal grip task provided a feasible way to assess shoulder muscle fatigue in MRCT patients, however with some limitations. The results suggest increased activation of deltoid is required to compensate for lost supraspinatus abduction torque. Increased pectoralis major fatigue in patients (adduction torque) likely reflected strategy to stabilise the humeral head against superior subluxing force of the deltoid. Considering physiotherapy as a primary or adjunct intervention for the management of MRCT, the findings of this study generate a base for future clinical studies aiming at the development of evidence-based protocols. PMID:25301260

Hawkes, D H; Alizadehkhaiyat, O; Kemp, G J; Fisher, A C; Roebuck, M M; Frostick, S P

2015-02-01

79

Assessment and characterization of in situ rotator cuff biomechanics  

NASA Astrophysics Data System (ADS)

Rotator cuff disease is a degenerative disorder that is a common, costly, and often debilitating, ranging in severity from partial thickness tear, which may cause pain, to total rupture, leading to loss in function. Currently, clinical diagnosis and determination of disease extent relies primarily on subjective assessment of pain, range of motion, and possibly X-ray or ultrasound images. The final treatment plan however is at the discretion of the clinician, who often bases their decision on personal experiences, and not quantitative standards. The use of ultrasound for the assessment of tissue biomechanics is established, such as in ultrasound elastography, where soft tissue biomechanics are measured. Few studies have investigated the use of ultrasound elastography in the characterization of musculoskeletal biomechanics. To assess tissue biomechanics we have developed a device, which measures the force applied to the underlying musculotendentious tissue while simultaneously obtaining the related ultrasound images. In this work, the musculotendinous region of the infraspinatus of twenty asymptomatic male organized baseball players was examined to access the variability in tissue properties within a single patient and across a normal population. Elastic moduli at percent strains less than 15 were significantly different than those above 15 percent strain within the normal population. No significant difference in tissue properties was demonstrated within a single patient. This analysis demonstrated elastic moduli are variable across individuals and incidence. Therefore threshold elastic moduli will likely be a function of variation in local-tissue moduli as opposed to a specific global value.

Trent, Erika A.; Bailey, Lane; Mefleh, Fuad N.; Raikar, Vipul P.; Shanley, Ellen; Thigpen, Charles A.; Dean, Delphine; Kwartowitz, David M.

2013-03-01

80

Reusing Cadaveric Humeri for Fracture Testing After Testing Simulated Rotator Cuff Tendon Repairs  

PubMed Central

Abstract The financial cost of using human tissues in biomedical testing and surgical reconstruction is predicted to increase at a rate that is disproportionately greater than other materials used in biomechanical testing. Our first hypothesis is that cadaveric proximal humeri that had undergone monotonic failure testing of simulated rotator cuff repairs would not differ in ultimate fracture loads or in energy absorbed to fracture when compared to controls (i.e., bones without cuff repairs). Our second hypothesis is that there can be substantial cost savings if these cadaveric proximal humeri, with simulated cuff repairs, can be re-used for fracture testing. Results of fracture tests (conducted in a backwards fall configuration) and cost analysis support both hypotheses. Hence, the bones that had undergone monotonic failure tests of various rotator cuff repair techniques can be re-used in fracture tests because their load-carrying capacity is not significantly reduced. PMID:25371862

Pitts, Todd C.; Knight, Alex N.; Burkhead, Wayne Z.

2014-01-01

81

Reusing cadaveric humeri for fracture testing after testing simulated rotator cuff tendon repairs.  

PubMed

The financial cost of using human tissues in biomedical testing and surgical reconstruction is predicted to increase at a rate that is disproportionately greater than other materials used in biomechanical testing. Our first hypothesis is that cadaveric proximal humeri that had undergone monotonic failure testing of simulated rotator cuff repairs would not differ in ultimate fracture loads or in energy absorbed to fracture when compared to controls (i.e., bones without cuff repairs). Our second hypothesis is that there can be substantial cost savings if these cadaveric proximal humeri, with simulated cuff repairs, can be re-used for fracture testing. Results of fracture tests (conducted in a backwards fall configuration) and cost analysis support both hypotheses. Hence, the bones that had undergone monotonic failure tests of various rotator cuff repair techniques can be re-used in fracture tests because their load-carrying capacity is not significantly reduced. PMID:25371862

Skedros, John G; Pitts, Todd C; Knight, Alex N; Burkhead, Wayne Z

2014-10-01

82

Is the Supraspinatus Muscle Atrophy Truly Irreversible after Surgical Repair of Rotator Cuff Tears?  

PubMed Central

Background Atrophy of rotator cuff muscles has been considered an irreversible phenomenon. The purpose of this study is to evaluate whether atrophy is truly irreversible after rotator cuff repair. Methods We measured supraspinatus muscle atrophy of 191 patients with full-thickness rotator cuff tears on preoperative magnetic resonance imaging and postoperative multidetector computed tomography images, taken at least 1 year after operation. The occupation ratio was calculated using Photoshop CS3 software. We compared the change between pre- and postoperative occupation ratios after modifying the preoperative occupation ratio. In addition, possible relationship between various clinical factors and the change of atrophy, and between the change of atrophy and cuff integrity after surgical repair were evaluated. Results The mean occupation ratio was significantly increased postoperatively from 0.44 ± 0.17 to 0.52 ± 0.17 (p < 0.001). Among 191 patients, 81 (42.4%) showed improvement of atrophy (more than a 10% increase in occupation ratio) and 33 (17.3%) worsening (more than a 10% decrease). Various clinical factors such as age tear size, or initial degree of atrophy did not affect the change of atrophy. However, the change of atrophy was related to repair integrity: cuff healing failure rate of 48.5% (16 of 33) in worsened atrophy; and 22.2% (18 of 81) in improved atrophy (p = 0.007). Conclusions The supraspinatus muscle atrophy as measured by occupation ratio could be improved postoperatively in case of successful cuff repair. PMID:23467404

Chung, Seok Won; Kim, Sae Hoon; Tae, Suk-Kee; Yoon, Jong Pil; Choi, Jung-Ah

2013-01-01

83

Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease  

PubMed Central

Summary Background: in the last years the incidence of rotator cuff tears increased and one main cause still waiting to be clarified. Receptors for thyroid hormones in rotator cuff tendons suggest possible effects on tendons metabolism and status. We undertook a retrospective, observational cohort study of 441 patients who underwent arthroscopic and mini-open repair for non traumatic degenerative rotator cuff tears. Methods: all the patients, predominantly females (63%), were interview to assess the relationship (frequency for class age “20 yrs” and factor analysis) between lesions of the rotator cuff with the following variables: gender, thyroid disease, smoker, taking medications for diabetes, hypertension or high cholesterol; presence of associated conditions (diabetes, hypertension, hypercholesterolemia). Results: thyroid disease is highly frequently (until 63% for 60<80 yrs) in females group independent to the age. Conversely, males showed a high frequency for smoker 37<62% until 80 yrs and 50% hypercholesterolemia over 80 yrs for the clinical variable studied. Conclusions: this is the first clinical report that shown a relationship between thyroid pathologies and non-traumatic rotator cuff tear as increased risk factors. PMID:25489548

Oliva, Francesco; Osti, Leonardo; Padulo, Johnny; Maffulli, Nicola

2014-01-01

84

Glenoid Cartilage Mechanical Properties Decrease after Rotator Cuff Tears in a Rat Model  

PubMed Central

Summary Rotator cuff repairs are commonly performed to reduce pain and restore function. Tears are also treated successfully without surgical intervention; however, the effect that a torn tendon has on the glenohumeral cartilage remains unknown. Clinically, a correlation between massive rotator cuff tears and glenohumeral arthritis has often been observed. This may be due to a disruption in the balance of forces at the shoulder, resulting in migration of the humeral head and subsequently, abnormal loading of the glenoid. Our lab previously demonstrated changes in ambulation and intact tendon mechanical properties following supraspinatus and infraspinatus rotator cuff tendon tears in a rat model. Therefore, the purpose of this study was to investigate the effects of supraspinatus and infraspinatus rotator cuff tears on the glenoid cartilage. Nine rats underwent unilateral detachment of the supraspinatus and infraspinatus tendons and were sacrificed after four weeks. Cartilage thickness significantly decreased in the antero-inferior region of injured shoulders. In addition, equilibrium elastic modulus significantly decreased in the center, antero-superior, antero-inferior, and superior regions. These results suggest that altered loading after rotator cuff injury may lead to damage to the joint with significant pain and dysfunction. Clinically, understanding the mechanical processes involved with joint damage will allow physicians to better advise patients. PMID:22407524

Reuther, Katherine E.; Sarver, Joseph J.; Schultz, Susan M.; Lee, Chang Soo; Sehgal, Chandra M.; Glaser, David L.; Soslowsky, Louis J.

2012-01-01

85

Shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears  

PubMed Central

Background Complex regional pain syndrome (CRPS) is one of the serious complications after surgical treatment of a rotator cuff tear. Both a measurement of body surface temperature and bone scintigraphy have been used as diagnostic tools for the early phase of CRPS.Unfortunately, few studies have been carried out that applied these methods to the patients after rotator cuff repair. Purposes To clarify both shoulder surface temperature and bone scintigraphy findings in patients with rotator cuff tears. Subjects and methods Subjects comprised patients with unilateral rotator cuff tears (five men and five women, mean age 61 years). For measurements of shoulder surface temperature, a Thermochron was attached to both shoulders. As for bone scintigraphy, intravenous injection of technetium-labelled hydroxymethylenebisphosphonic acid (99mTc-HMDP)was performed, and then images were taken with a gamma camera. Results During the measurements, the changes in body surface temperature for the affected and healthy shoulders remained within the standard deviation of the reference group. The intensity of radioisotope (RI) uptake for the affected shoulder joint was significantly increased compared to that for the healthy shoulder joint (P < 0.05). Conclusion RI uptake is increased in shoulders with rotator cuff tears, whereas shoulder surface temperature shows no differences on the affected and unaffected sides. PMID:21323485

2011-01-01

86

Fluoroscopy-guided implantation of subacromial "biodegradable spacer" using local anesthesia in patients with irreparable rotator cuff tear.  

PubMed

Treatment of massive rotator cuff tears can be challenging, especially when tears are considered irreparable or, when repaired, at significant risk of retear. A surgical technique is described using a biodegradable subacromial balloon-shaped spacer (InSpace; Ortho-Space, Caesarea, Israel) that, when implanted between the humeral head and acromion, permits smooth, frictionless gliding, supporting shoulder biomechanics. The specific insertion technique described herein is a simple procedure that can be performed in a day-care or outpatient setting with patients under local anesthesia, thus providing a treatment option for patients with multiple comorbidities complicating or contraindicating surgery, such as reverse arthroplasty under general anesthesia. PMID:25264508

Gervasi, Enrico; Cautero, Enrico; Dekel, Assaf

2014-08-01

87

Fluoroscopy-Guided Implantation of Subacromial “Biodegradable Spacer” Using Local Anesthesia in Patients With Irreparable Rotator Cuff Tear  

PubMed Central

Treatment of massive rotator cuff tears can be challenging, especially when tears are considered irreparable or, when repaired, at significant risk of retear. A surgical technique is described using a biodegradable subacromial balloon-shaped spacer (InSpace; Ortho-Space, Caesarea, Israel) that, when implanted between the humeral head and acromion, permits smooth, frictionless gliding, supporting shoulder biomechanics. The specific insertion technique described herein is a simple procedure that can be performed in a day-care or outpatient setting with patients under local anesthesia, thus providing a treatment option for patients with multiple comorbidities complicating or contraindicating surgery, such as reverse arthroplasty under general anesthesia. PMID:25264508

Gervasi, Enrico; Cautero, Enrico; Dekel, Assaf

2014-01-01

88

Rotator cuff biology and biomechanics: a review of normal and pathological conditions.  

PubMed

The glenohumeral joint is a complex anatomic structure commonly affected by injury such as tendinopathy and rotator cuff tears. This review presents an up-to-date overview of research on tendon biology and structure, shoulder joint motion and stability, tendon healing, and current and potential future repair strategies. Recent studies have provided information demonstrating the serious impact on uninjured tissues after a rotator cuff tear or other cause of altered shoulder joint mechanics. Another major focus of recent research is biological augmentation of rotator cuff repair with the goal of successfully reinstating normal tendon-to-bone structure. To effectively treat shoulder pathologies, clinicians need to understand normal tendon biology, the healing process and environment, and whole shoulder stability and function. PMID:25475598

Huegel, Julianne; Williams, Alexis A; Soslowsky, Louis J

2015-01-01

89

Correlation between Rotator Cuff Tears and Repeated Subacromial Steroid Injections: A Case-Controlled Study  

PubMed Central

INTRODUCTION Concern exists regarding potential damage to the rotator cuff from repeated corticosteroid injections into the subacromial space. PATIENTS AND METHODS In this retrospective, case-controlled study, 230 consecutive patients presenting to three orthopaedic units with subacromial impingement and investigated as an end-point with magnetic resonance imaging (MRI) of the shoulder were divided into groups having received less than three or three or more subacromial injections of corticosteroids. RESULTS With no significant difference in age and sex distribution, analysis by MRI showed no significant difference between the two groups in the incidence of rotator cuff tear (P < 1.0). CONCLUSIONS This suggests that corticosteroid use in patients with subacromial impingement should not be considered a causative factor in rotator cuff tears. PMID:19409148

Bhatia, M; Singh, B; Nicolaou, N; Ravikumar, KJ

2009-01-01

90

Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?  

PubMed Central

Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report. PMID:24976930

Tawfik, Ahmed M; El-Morsy, Ahmad; Badran, Mohamed Aboelnour

2014-01-01

91

The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study.  

PubMed

Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness. The aim of the study was to examine the effects of endotracheal tube cuff pressure changes during gynecological laparoscopic surgery on postoperative sore throat rates. Thirty patients who underwent gynecological laparoscopic surgery and 30 patients who underwent laparotomy under general anesthesia with endotracheal intubation were included. After induction of general anesthesia and endotracheal intubation, the cuff was inflated to 25 mmHg. At 5, 15, 30, 45 and 60 min after endotracheal intubation, cuff pressure and peak airway pressure were recorded. At 2 and 24 h after surgery, the patients were assessed for complaints of a sore throat. In patients who underwent laparotomy, cuff pressure and peak airway pressure did not change significantly at different time points after intubation. In patients who received laparoscopic surgery, cuff pressure and peak airway pressure were significantly increased compared to initial pressure at all examined time points. In both groups, the endotracheal tube cuff pressure and peak airway pressure were significantly correlated (R = 0.9431, P < 0.01; R = 0.8468, P < 0.01). Compared to patients who had undergone laparotomy, patients who had undergone laparoscopic surgery showed significantly higher sore throat scores at both 2 and 24 h after surgery (P < 0.01). Pneumoperitoneum and Trendelenburg position may increase airway pressure and cuff pressure, resulting in increased incidence of postoperative sore throat. PMID:24748551

Geng, Guiqi; Hu, Jingyi; Huang, Shaoqiang

2015-02-01

92

Fatal pulmonary embolism after arthroscopic rotator cuff repair: a case series  

PubMed Central

Summary Background: pulmonary embolism (PE) is a rare and serious complication of arthroscopic orthopaedic surgery. Currently there is great paucity in the literature regarding PE events following arthroscopic rotator cuff (ARCR) surgery. The purpose of this case series was to (1) report our known incidence rate of symptomatic PE following ARCR for a single surgeon and (2) describe five cases of pulmonary embolism following ARCR, detailing patient medical history and potential perioperative risk factors. Methods: the number of PE events were queried retrospectively from the institutional database with the ICD-9 code 415.1 within a 10 year time frame (2003–2013). Cases of PE identified by ICD-9 query were reviewed for type of procedure, postoperative day of event, and surgeon. Only patients with a confirmed diagnosis by computed tomography (CT) scan or post-mortem exam, were included in this study. Patient medical records belonging to affected patients were ordered and reviewed by a single investigator. Pre, intra, and postoperative information was obtained and summarized. Results: 5 cases of PE were identified, two of which were fatal. All events occurred in the perioperative period following ARCR. The 10 year incidence rate for PE following ARCR was 0.89%. Medical record review revealed significant risk factors for these patients when compared to current VTE prophylactic guidelines. Conclusions: our ten year incidence rate of PE following arthroscopic shoulder surgery and ARCR was 0.25 and 0.89% respectively. These rates were found to be considerably higher than reported rates of PE in the general population and following arthroscopic shoulder surgery. In addition, our methods failed to detect subclinical PE events, resulting in the likelihood of this value to be an underestimate of the true incidence. Medical record review revealed risk factors which would qualify patients for chemoprophylaxis under certain guidelines, however, the validity of available risk stratification methods continue to be a topic of debate. Level of Evidence: Level IV; case series. PMID:25332941

Durant, Thomas J.S.; Cote, Mark P.; Arciero, Robert A.; Mazzocca, Augustus D.

2014-01-01

93

Prevalence of peripheral neurologic injuries in rotator cuff tears with atrophy.  

PubMed

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. There were 7 abnormal electromyographic examinations. The most common diagnosis was upper trunk brachial plexopathy severely affecting the axillary nerve (4/7), followed by suprascapular neuropathy (2/7) and cervical radiculopathy (1/7). 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. PMID:12934025

Vad, Vijay B; Southern, Daniel; Warren, Russell F; Altchek, David W; Dines, David

2003-01-01

94

Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age.  

PubMed

We compared the outcomes of arthroscopically repaired rotator cuff tears in 28 patients older than 65 years (the over 65 group: median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years). The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but different in age. After careful arthroscopic evaluation of the full-thickness rotator cuff tear, rotator cuff repair and biceps tenotomy were performed in all patients. Pre- and post-operatively, each patient was evaluated for range of motion, shoulder score (UCLA), and SF-36 self-administered questionnaire. Comparing pre- versus post-operative status at a minimum 24 months follow-up, forward elevation, internal and external rotation, modified UCLA rating system scores, and SF-36 scores improved significantly in both groups, with no significant difference between the groups. At the last follow-up, strength improved significantly in both groups, with non-significant intergroup difference. The Popeye sign was detected in 13/28 (46%) of the patients in the over 65 group and in 11/28 (39%) in the under 65 group (? = 0.29) with non-significant difference between the two groups. In selected active patients older than 65, arthroscopic rotator cuff repair associated with biceps tenotomy (when necessary) can yield clinical and related quality of life outcomes similar to those of patients younger than 65 years. PMID:20182868

Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

2010-12-01

95

Evidence for effectiveness of Extracorporal Shock-Wave Therapy (ESWT) to treat calcific and non-calcific rotator cuff tendinosis – A systematic review  

Microsoft Academic Search

Extracorporeal shock-wave therapy (ESWT) is suggested as a treatment alternative for calcific and non-calcific rotator cuff tendinosis (RC-tendinosis), which may decrease the need for surgery. In this study we assessed the evidence for effectiveness of ESWT for these disorders. The Cochrane Library, PubMed, Embase, Pedro, and Cinahl were searched for relevant systematic reviews and RCTs. Two reviewers independently extracted data

Bionka M. A. Huisstede; Lukas Gebremariam; Renske van der Sande; Elaine M. Hay; Bart W. Koes

2011-01-01

96

Suprascapular nerve rotator cuff compression syndrome in volleyball players.  

PubMed

Selective denervation of the infraspinatus muscle producing weakness and wasting has been reported in certain sports (eg, volleyball and baseball). Nerve kinking or friction caused by excessive infraspinatus motion and compression by superior or inferior transverse scapular ligament or ganglions have been proposed as possible causes. However, in extreme abduction with full external rotation of the shoulder, the medial tendinous margin between the infraspinatus and supraspinatus muscles impinges strongly against the lateral edge of scapular spine, compressing the intervening infraspinatus branch of the suprascapular nerve. Spinaglenoid notchplasty has been performed in 5 elite volleyball players with infraspinatus neuropathy, allowing recovery of shoulder function in all patients and correction of infraspinatus muscle wasting. All returned to the same or higher level of volleyball by 8 months after surgery. An alternative cause of infraspinatus compromise in volleyball players is proposed and has been treated surgically with satisfactory outcome. PMID:9814933

Sandow, M J; Ilic, J

1998-01-01

97

Ultrasound detection of rotator cuff tears: observer agreement related to increasing experience  

Microsoft Academic Search

OBJECTIVE: Ultrasound of the rotator cuff is considered to be operator-dependent with its accuracy being related to the operator's level of experience. This study was conducted to test the hypothesis that ultrasound performed by operators with different levels of experience will give nonreproducible results. SUBJECTS AND METHODS: Two radiologists, one general radiologist with no experience in musculoskeletal ultrasound and one

M. J. Rutten; G. J. Jager; L. A. L. M. Kiemeney

2010-01-01

98

A new technique for patch augmentation of rotator cuff repairs.  

PubMed

Massive rotator cuff tears defying primary repair have been treated with debridement, arthroscopic subacromial decompression, partial repair, muscle-tendon transfer, and joint prosthesis, among other techniques. However, the treatment results have not been satisfactory compared with those of small- to medium-sized rotator cuff tears; each procedure has its merits and demerits, and currently, there is no single established method. For massive rotator cuff tears defying primary repair, the arthroscopic patch graft procedure has been reported as an effective surgical procedure, and this procedure is chosen as the first-line treatment in our department. In this procedure, suture anchors are generally used to fix the patch graft to the footprint on the side of the greater tuberosity. However, tendon-to-bone healing is frequently difficult to achieve, and bone-to-bone healing seems more advantageous for the repair of the rotator cuff attachment site. To improve the results of treatment, a new patch graft procedure was developed, in which the iliotibial ligament with bone was collected at Gerdy's tubercle and the bone was anchored to the footprint on the side of the greater tuberosity. With this procedure, excellent results were obtained, although only short-term results are available at present. The technique and its results so far are reported. PMID:25126505

Mihara, Shuzou; Ono, Teruyasu; Inoue, Hirofumi; Kisimoto, Tetsurou

2014-06-01

99

Tissue Fixation Security in Transosseous Rotator Cuff Repairs: A Mechanical Comparison of Simple Versus Mattress Sutures  

Microsoft Academic Search

Summary: The primary purpose of this investigation was to compare tissue fixa- tion security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair

Stephen S. Burkhart; Scott P. Fischer; Wesley M. Nottage; James C. Esch; F. Alan Barber; James Ferrier

1996-01-01

100

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives.  

PubMed

Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

2014-11-18

101

RC-QOL score for rotator cuff pathology: adaptation to Italian.  

PubMed

We translated and adapted the English RC-QOL (rotator cuff quality of life) questionnaire into Italian and performed reliability and validity evaluations of the Italian RC-QOL version in patients with rotator cuff tears. The RC-QOL English version was translated into Italian by a bilingual orthopaedic surgeon. The back translation of the Italian version into English was performed by another bilingual orthopaedic surgeon. The original version was compared with the back translation. The RC-QOL questionnaire was then administered to 22 subjects (range 45-74 years) with a diagnosis of rotator cuff tears. For test-retest evaluation, the 22 patients were asked to complete the questionnaire at first examination, and 30 min following the end of this examination. The intraclass correlation coefficient for the 22 patients was 0.94 (95% CI = 0.85-0.98), indicating a high reliability. There were no significant differences between the scores immediately after the consultation and 30 min later. The Italian and the English versions of the RC-QOL questionnaire evaluate the same aspects of clinical severity in patients with rotator cuff tears. PMID:19838675

Papalia, Rocco; Osti, Leonardo; Leonardi, Francesco; Denaro, Vincenzo; Maffulli, Nicola

2010-10-01

102

Differential ubiquitin-proteasome and autophagy signaling following rotator cuff tears and suprascapular nerve injury  

PubMed Central

Previous studies have evaluated role of Akt/mTOR signaling in rotator cuff muscle atrophy and determined that there was differential in signaling following tendon transection (TT) and suprascapular nerve (SSN) denervation (DN), suggesting that atrophy following TT and DN was modulated by different protein degradation pathways. In this study, two muscle proteolytic systems that have been shown to be potent regulators of muscle atrophy in other injury models, the ubiquitin-proteasome pathway and autophagy, were evaluated following TT and DN. In addition to examining protein degradation, this study assessed protein synthesis rate following these two surgical models to understand how the balance between protein degradation and synthesis results in atrophy following rotator cuff injury. In contrast to the traditional theory that protein synthesis is decreased during muscle atrophy, this study suggests that protein synthesis is up-regulated in rotator cuff muscle atrophy following both surgical models. While the ubiquitin-proteasome pathway was a major contributor to the atrophy seen following DN, autophagy was a major contributor following TT. The findings of this study suggest that protein degradation is the primary factor contributing to atrophy following rotator cuff injury. However, different proteolytic pathways are activated if SSN injury is involved. PMID:24018537

Joshi, Sunil K.; Kim, Hubert T.; Feeley, Brian T.; Liu, Xuhui

2013-01-01

103

Distribution and expression of type VI collagen and elastic fibers in human rotator cuff tendon tears.  

PubMed

There is increasing evidence for a progressive extracellular matrix change in rotator cuff disease progression. Directly surrounding the cell is the pericellular matrix, where assembly of matrix aggregates typically occurs making it critical in the response of tendon cells to pathological conditions. Studies in animal models have identified type VI collagen, fibrillin-1 and elastin to be located in the pericellular matrix of tendon and contribute in maintaining the structural and biomechanical integrity of tendon. However, there have been no reports on the localization of these proteins in human tendon biopsies. This study aimed to characterize the distribution of these ECM components in human rotator cuffs and gain greater insight into the relationship of pathology to tear size by analyzing the distribution and expression profiles of these ECM components. Confocal microscopy confirmed the localization of these structural molecules in the pericellular matrix of the human rotator cuff. Tendon degeneration led to an increased visibility of these components with a significant disorganization in the distribution of type VI collagen. At the genetic level, an increase in tear size was linked to an increased transcription of type VI collagen and fibrillin-1 with no significant alteration in the elastin levels. This is the first study to confirm the localization of type VI collagen, elastin and fibrillin-1 in the pericellular region of human supraspinatus tendon and assesses the effect of tendon degeneration on these structures, thus providing a useful insight into the composition of human rotator cuff tears which can be instrumental in predicting disease prognosis. PMID:25166893

Thakkar, Dipti; Grant, Tyler M; Hakimi, Osnat; Carr, Andrew J

2014-01-01

104

Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives  

PubMed Central

Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

2014-01-01

105

T lymphocytes are not required for the development of fatty degeneration after rotator cuff tear  

PubMed Central

Objectives Rotator cuff tears are among the most common and debilitating upper extremity injuries. Chronic cuff tears result in atrophy and an infiltration of fat into the muscle, a condition commonly referred to as ‘fatty degeneration’. While stem cell therapies hold promise for the treatment of cuff tears, a suitable immunodeficient animal model that could be used to study human or other xenograft-based therapies for the treatment of rotator cuff injuries had not previously been identified. Methods A full-thickness, massive supraspinatus and infraspinatus tear was induced in adult T-cell deficient rats. We hypothesised that, compared with controls, 28 days after inducing a tear we would observe a decrease in muscle force production, an accumulation of type IIB fibres, and an upregulation in the expression of genes involved with muscle atrophy, fibrosis and inflammation. Results Chronic cuff tears in nude rats resulted in a 30% to 40% decrease in muscle mass, a 23% reduction in production of muscle force, and an induction of genes that regulate atrophy, fibrosis, lipid accumulation, inflammation and macrophage recruitment. Marked large lipid droplet accumulation was also present. Conclusions The extent of degenerative changes in nude rats was similar to what was observed in T-cell competent rats. T cells may not play an important role in regulating muscle degeneration following chronic muscle unloading. The general similarities between nude and T-cell competent rats suggest the nude rat is likely an appropriate preclinical model for the study of xenografts that have the potential to enhance the treatment of chronically torn rotator cuff muscles. Cite this article: Bone Joint Res 2014;3:262–72. PMID:25185444

Gumucio, J.; Flood, M.; Harning, J.; Phan, A.; Roche, S.; Lynch, E.; Bedi, A.; Mendias, C.

2014-01-01

106

Synthetic and degradable patches: an emerging solution for rotator cuff repair.  

PubMed

The use of rotator cuff augmentation has increased dramatically over the last 10 years in response to the high rate of failure observed after non-augmented surgery. However, although augmentations have been shown to reduce shoulder pain, there is no consensus or clear guideline as to what is the safest or most efficacious material. Current augmentations, either available commercially or in development, can be classified into three categories: non-degradable structures, extra cellular matrix (ECM)-based patches and degradable synthetic scaffolds. Non-degradable structures have excellent mechanical properties, but can cause problems of infection and loss of integrity in the long-term. ECM-based patches usually demonstrate excellent biological properties in vitro, but studies have highlighted complications in vivo due to poor mechanical support and to infection or inflammation. Degradable synthetic scaffolds represent the new generation of implants. It is proposed that a combination of good mechanical properties, active promotion of biological healing, low infection risk and bio-absorption are the ideal characteristics of an augmentation material. Among the materials with these features, those processed by electrospinning have shown great promis. However, their clinical effectiveness has yet to be proven and well conducted clinical trials are urgently required. PMID:23837794

Hakimi, Osnat; Mouthuy, Pierre-Alexis; Carr, Andrew

2013-08-01

107

Recurrent anterior shoulder dislocation with glenoid bone loss and concurrent irreparable rotator cuff tear in a young patient: case report  

PubMed Central

Full-thickness rotator cuff tear associated with gleno-humeral anterior dislocation is a rare injury in patients younger than 40 years of age. We here report a case of recurrent anterior shoulder dislocation with glenoid bone loss and concurrent irreparable rotator cuff tear in a young patient. This is, to the best of our knowledge, the first such case reported in the literature. We also discuss the type of surgical treatment adopted and the measures that can be undertaken to address both instability and massive rotator cuff tear.

PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

2013-01-01

108

A Probabilistic Model of Glenohumeral External Rotation Strength for Healthy Normals and Rotator Cuff Tear Cases  

PubMed Central

The reigning paradigm of musculoskeletal modeling is to construct deterministic models from parameters of an “average” subject and make predictions for muscle forces and joint torques with this model. This approach is limited because it does not perform well for outliers, and it does not model the effects of population parameter variability. The purpose of this study was to simulate variability in musculoskeletal parameters on glenohumeral external rotation strength in healthy normals, and in rotator cuff tear cases using a Monte Carlo model. The goal was to determine if variability in musculoskeletal parameters could quantifiably explain variability in glenohumeral external rotation strength. Multivariate Gamma distributions for musculoskeletal architecture and moment arm were constructed from empirical data. Gamma distributions of measured joint strength were constructed. Parameters were sampled from the distributions and input to the model to predict muscle forces and joint torques. The model predicted measured joint torques for healthy normals, subjects with supraspinatus tears, and subjects with infraspinatus–supraspinatus tears with small error. Muscle forces for the three conditions were predicted and compared. Variability in measured torques can be explained by differences in parameter variability. PMID:16474916

Langenderfer, Joseph E.; Carpenter, James E.; Johnson, Marjorie E.; An, Kai-nan; Hughes, Richard E.

2006-01-01

109

[Ultrasonography of the shoulder in subacromial syndromes with disorders and injuries of the rotator cuff].  

PubMed

Shoulder sonography was performed prospectively in 4172 patients with 4588 shoulders affected with pathology of the subacromial space, among them 1227 operated cases with 425 rotator cuff tears (292 total tears and 133 partial tears). A two-criterion model with formal as well as echogenic and dynamic criteria was used for the diagnosis of cuff tears. The overall sensitivity in diagnosing rotator cuff tears was 95.3% (97.3% in total tears and 91.0% in partial tears). False-negative results were found overall in 1.6% of cases. Overall accuracy for all defects was 94.9%. Involvement of the supraspinatus tendon was found in 95.8%, of the infraspinatus in 39.3% and of the subscapularis in 10.1%. In 33.6% of cases, involvement of the long head of biceps was found. It was clearly correlated with the size of the tears: 25.9% in isolated supraspinatus tears and 68.8% in three-tendon tears of subscapularis, supraspinatus and infraspinatus. Differentiation between fresh, traumatic tears and degenerative tears is possible by means of measuring retraction, determining the length of the distal cuff stump and by formal criteria of the stump configuration as well as by bursal criteria. Differentiation of old tears of suspected traumatic origin from those with degenerative causes is impossible. PMID:8532336

Hedtmann, A; Fett, H

1995-11-01

110

Rotator cuff muscle function and its relation to scapular morphology in apes.  

PubMed

It is widely held that many differences among primate species in scapular morphology can be functionally related to differing demands on the shoulder associated with particular locomotor habits. This perspective is largely based on broad scale studies, while more narrow comparisons of scapular form often fail to follow predictions based on inferred differences in shoulder function. For example, the ratio of supraspinous fossa/infraspinous fossa size in apes is commonly viewed as an indicator of the importance of overhead use of the forelimb, yet paradoxically, the African apes, the most terrestrial of the great apes, have higher scapular fossa ratios than the more suspensory orangutan. The recent discovery of several nearly complete early hominin scapular specimens, and their apparent morphological affinities to scapulae of orangutans and gorillas rather than chimpanzees, has led to renewed interest in the comparative analysis of human and extant ape scapular form. To facilitate the functional interpretation of differences in ape scapulae, particularly in regard to relative scapular fossa size, we used electromyography (EMG) to document the activity patterns in all four rotator cuff muscles in orangutans and gibbons, comparing the results with previously published data for chimpanzees. The EMG results indicate that the distinctive contributions of each cuff muscle to locomotion are the same in the three ape species, failing to support inferences of differences in rotator cuff function based on relative scapular fossa size comparisons. It is also shown that relative scapular fossa size is not in fact a good predictor of either the relative masses or cross-sectional areas of the rotator cuff muscles in apes, and relative fossa size gives a false impression of the importance of individual cuff muscles to locomotor differences among apes. A possible explanation for the disparity between fossa and muscle size relates to the underappreciated role of the scapular spine in structural reinforcement of the blade. PMID:23968682

Larson, Susan G; Stern, Jack T

2013-10-01

111

Changes in endotracheal tube cuff pressure during laparoscopic surgery in head-up or head-down position  

PubMed Central

Background The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. Methods 70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n?=?38) and laparoscopic cholecystecomy (head-up position, n?=?32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared. Results There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26?±?3 to 32?±?6 and 27?±?3 to 33?±?5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p?cuff pressure from 33?±?5 to 35?±?5 cmH2O (p?cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery. Conclusions An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position. PMID:25210501

2014-01-01

112

Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial  

Microsoft Academic Search

Objective To investigate the efficacy of a programme of manual therapy and exercise treatment compared with placebo treatment delivered by physiotherapists for people with chronic rotator cuff disease.Design Randomised, participant and single assessor blinded, placebo controlled trial.Setting Metropolitan region of Melbourne, Victoria, Australia.Participants 120 participants with chronic (>3 months) rotator cuff disease recruited through medical practitioners and from the community.Interventions

Kim Bennell; Elin Wee; Sally Coburn; Sally Green; Anthony Harris; Margaret Staples; Andrew Forbes; Rachelle Buchbinder

2010-01-01

113

Intratendinous strain fields of the supraspinatus tendon: Effect of a surgically created articular-surface rotator cuff tear  

Microsoft Academic Search

Articular-surface partial-thickness rotator cuff tears play a significant role in shoulder pathology, but the role of the articular-surface tissue is poorly understood. This investigation assessed the effect of an articular-surface partial-thickness rotator cuff tear on intratendinous strain fields. A magnetic resonance imaging–based technique quantified intratendinous strains in healthy cadaveric shoulders at 15°, 30°, 45°, and 60° of glenohumeral abduction. A

Michael J Bey; Matthew L Ramsey; Louis J Soslowsky

2002-01-01

114

Long Head of the Biceps Pathology Combined with Rotator Cuff Tears  

PubMed Central

The long head of the biceps tendon (LHBT) is an anatomic structure commonly involved in painful shoulder conditions as a result of trauma, degeneration, or overuse. Recent studies have pointed out the close correlation between LHBT lesions and rotator cuff (RCT) tears. Clinicians need to take into account the importance of the LHBT in the presence of other shoulder pathologies. This paper provides an up-to-date overview of recent publications on anatomy, pathophysiology, diagnosis, classification, and current treatment strategies. PMID:23209915

Ditsios, Konstantinos; Agathangelidis, Filon; Boutsiadis, Achilleas; Karataglis, Dimitrios; Papadopoulos, Pericles

2012-01-01

115

Comparison of rotator cuff muscle architecture between humans and other selected vertebrate species  

PubMed Central

In this study, we compare rotator cuff muscle architecture of typically used animal models with that of humans and quantify the scaling relationships of these muscles across mammals. The four muscles that correspond to the human rotator cuff – supraspinatus, infraspinatus, subscapularis and teres minor – of 10 commonly studied animals were excised and subjected to a series of comparative measurements. When body mass among animals was regressed against physiological cross-sectional area, muscle mass and normalized fiber length, the confidence intervals suggested geometric scaling but did not exclude other scaling relationships. Based on the architectural difference index (ADI), a combined measure of fiber length-to-moment arm ratio, fiber length-to-muscle length ratio and the fraction of the total rotator cuff physiological cross-sectional area contributed by each muscle, chimpanzees were found to be the most similar to humans (ADI=2.15), followed closely by capuchins (ADI=2.16). Interestingly, of the eight non-primates studied, smaller mammals such as mice, rats and dogs were more similar to humans in architectural parameters compared with larger mammals such as sheep, pigs or cows. The force production versus velocity trade-off (indicated by fiber length-to-moment arm ratio) and the excursion ability (indicated by fiber length-to-muscle length ratio) of humans were also most similar to those of primates, followed by the small mammals. Overall, primates provide the best architectural representation of human muscle architecture. However, based on the muscle architectural parameters of non-primates, smaller rather than larger mammals may be better models for studying muscles related to the human rotator cuff. PMID:24072803

Mathewson, Margie A.; Kwan, Alan; Eng, Carolyn M.; Lieber, Richard L.; Ward, Samuel R.

2014-01-01

116

The Biomechanical and Histologic Effects of Platelet-Rich Plasma on Rat Rotator Cuff Repairs  

PubMed Central

Background Rotator cuff tears are common injuries that are often treated with surgical repair. Because of the high concentration of growth factors within platelets, platelet-rich plasma (PRP) has the potential to enhance healing in rotator cuff repairs. Hypothesis Platelet-rich plasma would alter the biomechanical and histologic properties of rotator cuff repair during an acute injury response. Study Design Controlled laboratory study. Methods Platelet-rich plasma was produced from inbred donor rats. A tendon-from-bone supraspinatus tear was created surgically and an immediate transosseous repair performed. The control group underwent repair only. The PRP group underwent a repair with PRP augmentation. Rats in each group were sacrificed at 7, 14, and 21 days. The surgically repaired tendons underwent biomechanical testing, including failure load, stiffness, failure strain, and stress relaxation characteristics. Histological analysis evaluated the cellular characteristics of the repair tissue. Results At 7- and 21-day periods, augmentation with PRP showed statistically significant effects on the biomechanical properties of the repaired rat supraspinatus tear, but failure load was not increased at the 7-, 14-, or 21-day periods (P = .688, .209, and .477, respectively). The control group had significantly higher stiffness at 21 days (P = .006). The control group had higher failure strain at 7 days (P = .02), whereas the PRP group had higher failure strain at 21 days (P = .008). Histologically, the PRP group showed increased fibroblastic response and vascular proliferation at each time point. At 21 days, the collagen fibers in the PRP group were oriented in a more linear fashion toward the tendon footprint. Conclusion In this controlled, rat model study, PRP altered the tissue properties of the supraspinatus tendon without affecting the construct’s failure load. Clinical Relevance The decreased tendon tissue stiffness acutely and failure to enhance tendon-to-bone healing of repairs should be considered before augmenting rotator cuff repairs with PRP. Further studies will be necessary to determine the role of PRP in clinical practice. PMID:22822177

Beck, Jennifer; Evans, Douglas; Tonino, Pietro M.; Yong, Sherri; Callaci, John J.

2013-01-01

117

Extracorporeal Shock Wave Therapy in the Treatment of Calcific Tendinitis of the Rotator Cuff  

Microsoft Academic Search

Background: Low-energy extracorporeal shock wave therapy is an alternative treatment, with limited evidence for effectiveness, for calcific tendinitis of the rotator cuff.Hypothesis: Objective localization of the calcium deposit by 3-dimensional, computer-assisted navigation reveals superior clinical and radiographic outcomes compared to localization through patient-to-therapist feedback.Study Design: Randomized controlled clinical trial; Level of evidence, 1.Methods: A prospective, randomized, single-blind study was carried

Manuel Sabeti-Aschraf; Ronald Dorotka; Alexandra Goll; Klemens Trieb

2005-01-01

118

Advantages and techniques of utilizing anterolateral portal in delaminated rotator cuff repair.  

PubMed

Typically, rotator cuff repair is performed two-dimensionally while visualizing the subacromial space. To achieve a more complete repair, sutures can be retrieved from inside the joint utilizing a penetrating suture device through the anterolateral portal, which permits visualization of the articular side and bursal side of the rotator cuff tear. Utilizing other portals can leave the sutures out of sight and reach. The anterolateral portal helps capture both leaves of a delaminated tear and places the sutures in the center of the field for retrieval and tying. The anterolateral portal is located with a spinal needle just off the anterolateral corner of the acromion, and the suture anchor is inserted into the greater tuberosity through this portal. The sutures are passed into the joint through the tear in the rotator cuff with a suture grasper. The scope is redirected intraarticularly, and the suture is visualized. The sutures are positioned, and the penetrator is passed through the tendon. The scope is placed back in the bursa for tying sutures and capturing both leaves of a delaminated tear. It works equally well for simple complete tears and partial articular-sided supraspinatus tendon avulsion lesions. PMID:25153817

Chavan, Prithviraj; Gothelf, Todd K; Nord, Keith M; Garrett, William H; Nord, Keith D

2014-01-01

119

Degenerative disease in rotator cuff tears: what are the biochemical and histological changes?  

PubMed Central

The histopathological changes associated with rotator cuff tears include thinning and disorganization of collagen fibers, the presence of granulation tissue, increased levels of glycosaminoglycans, fibrocartilaginous metaplasia, calcification, fatty infiltration, and necrosis of the tendon margin with cell apoptosis. The biochemical changes include an increase in the expression of matrix metalloproteinases (MMPs) and a decrease in tissue inhibitor of metalloproteinases (TIMP) messenger ribonucleic acid expression. Histological evidence of tendinopathy has been found in patients with rotator cuff tear. Biochemical changes include significant increases in MMP1, MMP2, MMP3, and in TIMP1 and TIMP2 levels, not only at the lateral supraspinatus edge, but also in the macroscopically intact portion of the supraspinatus tendon and in the intact subscapularis. The tissue in the ruptured area of the supraspinatus tendon undergoes marked rearrangement at molecular levels. This involves the activity of MMP1, 2, and 3 and supports a critical role of MMPs in tendon physiology. Intact parts of the torn supraspinatus tendon can present the histopathological changes associated with rotator cuff tears. These findings suggest that biochemical changes can already occur in a macroscopically intact tendon and seem to point to a global degenerative process in the shoulder. PMID:25606538

DE GIORGI, SILVANA; SARACINO, MICHELE; CASTAGNA, ALESSANDRO

2014-01-01

120

Arthroscopic Lamina-Specific Double-Row Fixation for Large Delaminated Rotator Cuff Tears  

PubMed Central

Delamination is a commonly observed finding at the time of rotator cuff repair, but few studies have described the surgical techniques used for delaminated rotator cuff tears (RCTs) or their clinical outcomes. We developed a technique using a combination of a double row and an additional row, which we call lamina-specific double-row fixation, for large delaminated RCTs. The lamina-specific double-row technique is performed using an additional row (lamina-specific lateral row) of suture anchors placed between the typical medial and lateral rows of suture anchors. The technique is performed as follows: (1) medial-row sutures are passed through the inferior (articular-side) and superior (bursal-side) layers in a mattress fashion; (2) lamina-specific lateral-row simple sutures are passed through the inferior layer; and (3) lateral-row simple sutures are passed through the superior layer. We believe that this technique offers the following advantages: (1) creation of a larger area of contact between the inferior layer and the footprint, (2) higher initial fixation strength of the articular-side components of the repaired rotator cuff tendon, and (3) an adaptation between the superficial and inferior layers. This technique represents an alternative option in the operative treatment of large delaminated RCTs.

Mori, Daisuke; Funakoshi, Noboru; Yamashita, Fumiharu

2014-01-01

121

The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report.  

PubMed

We studied a prospective, consecutive series of 8 patients presenting with massive rotator cuff tears (>5 cm. in maximum dimension), all associated with severe retraction and fatty infiltration of the supraspinatus muscle on magnetic resonance imaging studies. All 8 patients had suprascapular neuropathy shown by electromyography (EMG) findings of denervation in the supraspinatus and/or infraspinatus muscles. Clinically, all patients had severe limitation of active motion, with no patient able to elevate their affected arm actively >40 degrees . Four patients elected débridement and partial surgical repair using margin convergence principles via a mini-open approach. Follow-up of these patients averaged 24 months. All 4 patients regained the ability to elevate their affected arm to >90 degrees , and to place their hand actively behind their head without assistance. Two of the 4 surgical patients consented to follow-up EMG studies that demonstrated, in both cases, that the suprascapular nerve had significant renervation potentials, with almost complete recovery of the nerve in 1 case. We conclude that suprascapular neuropathy may be associated with massive rotator cuff tears, and that partial rotator cuff repair may allow recovery of the nerve and improvement of function. PMID:16831639

Mallon, William J; Wilson, Robert J; Basamania, Carl J

2006-01-01

122

The effect of unloading on gene expression of healthy and injured rotator cuffs  

PubMed Central

Little is known about the effects of muscle and tendon unloading on the molecular response of the rotator cuff. Tendon unloading following rupture of one of the rotator cuff tendons can induce alterations in muscle physiology and tendon structure, which can subsequently affect reparability and healing potential. The goals of the current study were to determine the effect of mechanical unloading on gene expression and morphology of (1) healthy supraspinatus tendons and muscles, and (2) supraspinatus tendons and muscles after acute injury and repair. Mechanical unloading was achieved by tenotomy and/or botulinum toxin A (BTX) chemical denervation in a rat rotator cuff model of injury and repair. Gene expression profiles varied across regions of the muscle, with the greatest changes seen in the distal aspect of the muscle for most genes. Myogenic and adipogenic genes were upregulated in muscle when unloaded (tenotomy and BTX). Tendon injury, with and without repair, resulted in upregulation of fibrosis- and tendon-specific gene expression. The expression of scleraxis, a transcription factor necessary for tendon development, was upregulated in response to injury and repair. In summary, tendon detachment and repair had the greatest effect on tendon gene expression, while unloading had the greatest effect on muscle gene expression. PMID:23508698

Killian, ML; Lim, CT; Thomopoulos, S; Charlton, N; Kim, HM; Galatz, LM

2013-01-01

123

Intraosseous foreign body granuloma in rotator cuff repair with bioabsorbable suture anchor  

PubMed Central

Biodegradable implants lead to problems such as cyst formation, soft-tissue inflammation, loose implant fragments or local osteolysis. This report represents the first published case of an intraosseous foreign body granuloma in the humeral head after arthroscopic rotator cuff tear fixation with a poly-l-lactide (PLLA) suture anchor. A 48-year-old female patient presented with pain in her right shoulder. A refixation of her right supraspinatus tendon with a biodegradable suture anchor was performed 11 months ago at an external hospital. Laboratory tests showed normal values for C-reactive protein, leukocytes and the erythrocyte sedimentation rate. No signs of infection or instability were noted. The visual analogue scale (VAS) was 8, the simple shoulder test (SST) was 4 and the American shoulder and elbow surgeons score (ASES) was 44. Plain radiographs showed high lucency in the area of the tuberculum majus. MRI showed an intra- and extraosseous mass surrounded by fluid in this area. Surgical care involved arthroscopic debridement and removal of the suture anchor. Histological examination revealed a foreign body granuloma. At the 18-month follow-up the patient was nearly pain-free. The VAS was 2, SST was 10 and ASES was 88. Foreign body granulomas are a well known but rarely described complication that arises after the use of biodegradable suture anchors in shoulder surgery. Every patient presenting with shoulder pain after usage of a biodegradable fixation material should be evaluated closely. Orthopaedic surgeons should be aware of the possibility of delayed foreign body reactions, especially after using PLLA anchors. PMID:20526849

Nusselt, T.; Freche, S.; Klinger, H.-M.

2010-01-01

124

Effects of humeral head compression taping on the isokinetic strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis  

PubMed Central

[Purpose] The purpose of this study was to examine the effects of humeral head compression taping (HHCT) on the strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis. [Subjects and Methods] Twenty patients with rotator cuff tendinitis were recruited. The shoulder external rotator strength was measured using a Biodex isokinetic dynamometer system. A paired t-test was performed to evaluate within-group differences in the strength of the shoulder external rotator muscle. [Results] Significantly higher shoulder external rotator peak torque and peak torque per body weight were found in the HHCT condition than in the no-taping condition. [Conclusion] HHCT may effectively increase the shoulder external rotator muscle strength in patients with rotator cuff tendinitis.

Kim, Moon-Hwan; Oh, Jae-Seop

2015-01-01

125

Magnetic Resonance Imaging of Rotator Cuff Tears in Shoulder Impingement Syndrome  

PubMed Central

Summary Background Shoulder joint is a common site of musculoskeletal pain caused, among other things, by rotator cuff tears due to narrowing of subacromial space, acute trauma or chronic shoulder overload. Magnetic resonance imaging (MRI) is an excellent modality for imaging of soft tissues of the shoulder joint considering a possibility of multiplanar image acquisition and non-invasive nature of the study. The aim of this study was to evaluate the prevalence of partial and complete rotator cuff tears in magnetic resonance images of patients with shoulder impingement syndrome and to review the literature on the causes and classification of rotator cuff tears. Material/Methods We retrospectively analyzed the results of 137 shoulder MRI examinations performed in 57 women and 72 men in Magnetic Resonance facility of the Department of Radiology and Diagnostic Imaging at the St. Jadwiga the Queen Regional Hospital No. 2 in Rzeszow between June 2010 and February 2013. Examinations were performed using Philips Achieva 1.5T device, including spin echo and gradient echo sequences with T1-, T2- and PD-weighted as well as fat saturation sequences in transverse, frontal and sagittal oblique planes. Patients were referred from hospital wards as well as from outpatient clinics of the subcarpathian province. Results The most frequently reported injuries included partial supraspinatus tendon tear and complete tearing most commonly involved the supraspinatus muscle tendon. The smallest group comprised patients with complete tear of subscapularis muscle tendon. Among 137 patients in the study population, 129 patients suffered from shoulder pain, including 57 patients who reported a history of trauma. There was 44% women and 56% men in a group of patients with shoulder pain. Posttraumatic shoulder pain was predominantly reported by men, while women comprised a larger group of patients with shoulder pain not preceded by injury. Conclusions Rotator cuff injury is a very common pathology in patients with shoulder impingement syndrome. Isolated supraspinatus tendon injury or complete tearing is most frequent, rather than in conjunction with injuries to other rotator cuff tendons. We did not observe isolated complete tears of infraspinatus and subscapular muscle tendons. PMID:25374626

Freygant, Magdalena; Dziurzy?ska-Bia?ek, Ewa; Guz, Wies?aw; Samojedny, Antoni; Go?ofit, Andrzej; Kostkiewicz, Agnieszka; Terpin, Krzysztof

2014-01-01

126

Mini-Open Suture Bridge Repair with Porcine Dermal Patch Augmentation for Massive Rotator Cuff Tear: Surgical Technique and Preliminary Results  

PubMed Central

Background The aim of this study was to describe the mini-open suture bridge technique with porcine dermal patch augmentation for massive rotator cuff tear and to assess preliminary clinical and radiological results. Methods Five patients with massive rotator cuff tear for which it was not possible to restore the anatomical footprint underwent mini-open suture bridge repair using a porcine dermal patch. The patients' average age was 53.4 years (range, 45 to 57 years), and the average duration of follow-up was 20.6 months (range, 14 to 26 months). Patients were evaluated with preoperative and postoperative outcome measures, including a visual analog scale (VAS) for pain, the University of California Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score. The structural integrity of repaired rotator cuffs was assessed by magnetic resonance imaging 6 months postoperatively. Results The average VAS pain score, UCLA score, and ASES score improved from 6.8, 15.4, and 39.4 preoperatively to 0.8, 31.2, and 86.4 postoperatively (p = 0.041, 0.042, and 0.043, respectively). Magnetic resonance images obtained at an average of 8 months after surgery showed that four patients had intact repair integrity with graft incorporation. One patient had a re-tear with partial healing but still had a satisfactory clinical outcome. There was no intraoperative or postoperative complication in any patient. Conclusions Mini-open suture bridge repair with porcine dermal patch augmentation can be an option in young patients with high physical demands and massive rotator cuff tears for which it is not possible to restore the anatomical footprint. PMID:25177460

Lee, Sung-Moon; Lee, Young-Kuk; Shin, Hong-Kwan

2014-01-01

127

The relative strengths of the rotator cuff muscles. A cadaver study.  

PubMed

We studied five cadaver shoulders to determine the strength relationship of the four rotator cuff muscles. The mean fibre length and volume of each muscle were measured, from which the physiological cross-sectional area was calculated. This value was used to estimate the force which each muscle was capable of generating. The lever arm of each muscle about the humeral head was then measured and the moment exerted was calculated. The strength ratios between the muscles were more or less constant in the five specimens. Subscapularis was the most powerful muscle and contributed 53% of the cuff moment; supraspinatus contributed 14%, infraspinatus 22% and teres minor 10%. The force-generating capacity of the subscapularis was equal to that of the other three muscles combined. PMID:8421011

Keating, J F; Waterworth, P; Shaw-Dunn, J; Crossan, J

1993-01-01

128

Biological augmentation of rotator cuff repair using bFGF-loaded electrospun poly(lactide-co-glycolide) fibrous membranes  

PubMed Central

Clinically, rotator cuff tear (RCT) is among the most common shoulder pathologies. Despite significant advances in surgical techniques, the re-tear rate after rotator cuff (RC) repair remains high. Insufficient healing capacity is likely the main factor for reconstruction failure. This study reports on a basic fibroblast growth factor (bFGF)-loaded electrospun poly(lactide-co-glycolide) (PLGA) fibrous membrane for repairing RCT. Implantable biodegradable bFGF–PLGA fibrous membranes were successfully fabricated using emulsion electrospinning technology and then characterized and evaluated with in vitro and in vivo cell proliferation assays and repairs of rat chronic RCTs. Emulsion electrospinning fabricated ultrafine fibers with a core-sheath structure which secured the bioactivity of bFGF in a sustained manner for 3 weeks. Histological observations showed that electrospun fibrous membranes have excellent biocompatibility and biodegradability. At 2, 4, and 8 weeks after in vivo RCT repair surgery, electrospun fibrous membranes significantly increased the area of glycosaminoglycan staining at the tendon–bone interface compared with the control group, and bFGF–PLGA significantly improved collagen organization, as measured by birefringence under polarized light at the healing enthesis compared with the control and PLGA groups. Biomechanical testing showed that the electrospun fibrous membrane groups had a greater ultimate load-to-failure and stiffness than the control group at 4 and 8 weeks. The bFGF–PLGA membranes had the highest ultimate load-to-failure, stiffness, and stress of the healing enthesis, and their superiority compared to PLGA alone was significant. These results demonstrated that electrospun fibrous membranes aid in cell attachment and proliferation, as well as accelerating tendon–bone remodeling, and bFGF-loaded PLGA fibrous membranes have a more pronounced effect on tendon–bone healing. Therefore, augmentation using bFGF–PLGA electrospun fibrous membranes is a promising treatment for RCT. PMID:24868155

Zhao, Song; Zhao, Jingwen; Dong, Shikui; Huangfu, Xiaoqiao; Li, Bin; Yang, Huilin; Zhao, Jinzhong; Cui, Wenguo

2014-01-01

129

Effect of subacromial sodium hyaluronate injection on rotator cuff disease: A double-blind placebo-controlled clinical trial  

PubMed Central

Background: Rotator cuff disease is a common cause of shoulder pain. There are studies about the effectiveness of sodium hyaluronate injection on shoulder and knee pain, but few studies demonstrating the efficacy of sodium hyaluronate ultrasonography guided injection for rotator cuff disease. This study evaluates effectiveness of ultrasonography guided subacromial sodium hyaluronate injection in patients with impingment syndrome without rotator cuff complete tear. Materials and Methods: This prospective, double-blind, placebo controlled clinical trial study was performed among 40 patients with subacromial impingement syndrome without complete tear of rotator cuff. Patients randomly injected ultrasonography guided in 2 groups: Case group by 20 mg of sodium hyaluronate (Fermathron™) and control group by 0.9% normal saline. Both groups received 3 weekly injections. The pain score (100 mm visual analogue score [VAS]) was evaluated before first injection and one week after each injection. The constant score was evaluated before first and 12 week after last injection. Data was analyzed statistically by Independent t-test. Results: In both groups mean VAS has decreased, but more significantly in case group (P < 0.001). Mean constant score was significantly higher in case group 12 weeks after last injection (P < 0.001). The constant score improved 12 weeks after the last injection in both groups with a significantly better result in case group (P < 0.001). Conclusion: Subacromial injections of sodium hyaluronate are effective in treating rotator cuff disease without complete tears. PMID:24524035

Moghtaderi, Alireza; Sajadiyeh, Sepideh; Khosrawi, Saeid; Dehghan, Farnaz; Bateni, Vahid

2013-01-01

130

Rotator cuff healing after continuous subacromial bupivacaine infusion: an in vivo rabbit study  

PubMed Central

Background The objective of this study was to evaluate the effects of continuous subacromial bupivacaine infusion on supraspinatus muscle and rotator cuff tendon healing via gross, biomechanical, and histologic analyses. Methods Thirty-three New Zealand White rabbits underwent unilateral supraspinatus transection and rotator cuff repair (RCR). Rabbits were assigned to 1 of 3 groups: (1)RCR only, (2)RCR with continuous saline infusion for 48 hours, or (3)RCR with continuous 0.25% bupivacaine with epinephrine (1:200,000) infusion for 48 hours. Rabbits were sacrificed at either 2 (for histologic assessment) or 8 weeks post-operatively (for biomechanical and histologic assessment). Results Tensile testing showed significantly higher load to failure in intact tendons compared to repaired tendons (p<0.01); however, no statistical differences were detected among RCR only, RCR Saline, and RCR Bupivacaine groups. Histologically, the enthesis of repaired tendons showed increased cellularity and disorganized collagen fibers compared to intact tendons, with no differences between treatment groups. Muscle histology demonstrated scattered degenerative muscle fibers at 2 weeks in both RCR Saline and RCR Bupivacaine, but no degeneration was noted at 8 weeks. Conclusions The healing supraspinatus tendons exposed to bupivacaine infusion showed similar histologic and biomechanical characteristics compared to untreated and saline infused RCR groups. Muscle histology showed fiber damage at 2 weeks for both the saline and bupivacaine treated groups, with no apparent disruption at 8 weeks, suggesting a recovery process. Therefore, subacromial bupivacaine infusion in this rabbit rotator cuff model does not appear to impair muscle or tendon following acute injury and repair. Level Of Evidence Basic science study PMID:22818894

FRIEL, NICOLE A.; WANG, VINCENT M.; SLABAUGH, MARK A.; WANG, FANCHIA; CHUBINSKAYA, SUSAN; COLE, BRIAN J.

2013-01-01

131

Complete Fatty infiltration of intact rotator cuffs caused by suprascapular neuropathy.  

PubMed

Suprascapular neuropathy is generally considered to be a diagnosis of exclusion, although it has been described in association with several activities and conditions. To our knowledge, this is the first description of suprascapular neuropathy with complete neurogenic fatty replacement in patients with intact rotator cuff tendons in the absence of traction or compression mechanisms. We present 4 cases of patients who presented with complete fatty infiltration of the supraspinatus (1 patient), infraspinatus (2 patients), and both (1 patient) resulting from suprascapular neuropathy. Each of these patients underwent arthroscopic suprascapular nerve decompression and subsequently had immediate improvement in pain and subjective shoulder value. PMID:24630957

Leclere, Lance E; Shi, Lewis L; Lin, Albert; Yannopoulos, Paul; Higgins, Laurence D; Warner, Jon J P

2014-05-01

132

Hybrid Repair of Large Crescent Rotator Cuff Tears Using a Modified SpeedBridge and Double-Pulley Technique  

PubMed Central

An ideal rotator cuff repair maximizes the tendon-bone interface and has adequate biomechanical strength that can withstand a high level of demand. Arthroscopic transosseous-equivalent rotator cuff repairs have become popular and have been shown to be superior to many other methods of fixation. We present an alternative method of repair for large crescent rotator cuff tears that combines 2 well-known methods of fixation: modified SpeedBridge (Arthrex, Naples, FL) and double-pulley techniques. These 2 repair constructs were combined to provide the greatest amount of compression across the footprint while also providing rigid fixation. Ultimately, this can provide an optimal environment for healing in otherwise significant injuries. PMID:25126513

Chauhan, Aakash; Regal, Steven; Frank, Darren A.

2014-01-01

133

Hybrid Repair of Large Crescent Rotator Cuff Tears Using a Modified SpeedBridge and Double-Pulley Technique.  

PubMed

An ideal rotator cuff repair maximizes the tendon-bone interface and has adequate biomechanical strength that can withstand a high level of demand. Arthroscopic transosseous-equivalent rotator cuff repairs have become popular and have been shown to be superior to many other methods of fixation. We present an alternative method of repair for large crescent rotator cuff tears that combines 2 well-known methods of fixation: modified SpeedBridge (Arthrex, Naples, FL) and double-pulley techniques. These 2 repair constructs were combined to provide the greatest amount of compression across the footprint while also providing rigid fixation. Ultimately, this can provide an optimal environment for healing in otherwise significant injuries. PMID:25126513

Chauhan, Aakash; Regal, Steven; Frank, Darren A

2014-06-01

134

Effects of Preoperative Non-Steroidal Anti-Inflammatory Drugs on Pain Mitigation and Patients' Shoulder Performance Following Rotator Cuff Repair  

PubMed Central

Purpose: Pain is one of the most important factors adversely affecting clinical outcomes of operated patients. The present study aims at evaluating effects of preoperative COX2 non-steroidal anti-inflammatory inhibitors on pain mitigation and performance of patients with shoulder rotator cuff tear. Methods: This case-control study was conducted on 60 patients suffering from rotator cuff injury candidate for arthroscopic repair. The patients were classified in two parallel and matched groups. One group (case group) was treated using Celecoxib (200mg/12h) started 48 hours before surgery and continued for 10 days after operation. In the control group, the placebo was prescribed in the same way. Postoperative pain, side effects, sleep disturbance, and short-term outcomes were compared between two groups using DASH questionnaire. Results: Postoperative pain in the Celecoxib group significantly decreased in comparison with the control one. The difference was statistically meaningful (P<0.001). Well motion ability was seen in 80% of patients of the Celecoxib group. It was 26.6% in the placebo group since pain inhibited them from exercising more motions. In this regard, there was a statistically meaningful difference between these two groups (P=0.02). Sleep disturbance was meaningfully at higher levels in the placebo group (P=0.001). Following up the patients for three months, it was made clear that performance of the Celecoxib group was better than that of the placebo one. Conclusion: COX2 inhibitors are well efficient in patients' pain management after arthroscopic rotator cuff repair surgery. It results in less life complications, less sleep disturbances, improvement of patients' short-term clinical outcome, and more quick recovery. PMID:25436192

Rouhani, Alireza; Tabrizi, Ali; Elmi, Asghar; Abedini, Naghi; Mirza Tolouei, Fardin

2014-01-01

135

PARot – assessing platelet-rich plasma plus arthroscopic subacromial decompression in the treatment of rotator cuff tendinopathy: study protocol for a randomized controlled trial  

PubMed Central

Background Platelet-rich plasma (PRP) is an autologous platelet concentrate. It is prepared by separating the platelet fraction of whole blood from patients and mixing it with an agent to activate the platelets. In a clinical setting, PRP may be reapplied to the patient to improve and hasten the healing of tissue. The therapeutic effect is based on the presence of growth factors stored in the platelets. Current evidence in orthopedics shows that PRP applications can be used to accelerate bone and soft tissue regeneration following tendon injuries and arthroplasty. Outcomes include decreased inflammation, reduced blood loss and post-treatment pain relief. Recent shoulder research indicates there is poor vascularization present in the area around tendinopathies and this possibly prevents full healing capacity post surgery (Am J Sports Med36(6):1171–1178, 2008). Although it is becoming popular in other areas of orthopedics there is little evidence regarding the use of PRP for shoulder pathologies. The application of PRP may help to revascularize the area and consequently promote tendon healing. Such evidence highlights an opportunity to explore the efficacy of PRP use during arthroscopic shoulder surgery for rotator cuff pathologies. Methods/Design PARot is a single center, blinded superiority-type randomized controlled trial assessing the clinical outcomes of PRP applications in patients who undergo shoulder surgery for rotator cuff disease. Patients will be randomized to one of the following treatment groups: arthroscopic subacromial decompression surgery or arthroscopic subacromial decompression surgery with application of PRP. The study will run for 3 years and aims to randomize 40 patients. Recruitment will be for 24 months with final follow-up at 1 year post surgery. The third year will also involve collation and analysis of the data. This study will be funded through the NIHR Biomedical Research Unit at the Oxford University Hospitals NHS Trust. Trial registration Current Controlled Trials: ISRCTN10464365 PMID:23758981

2013-01-01

136

Rotator Cuff Metastases: A Report of Two Cases with Literature Review  

PubMed Central

Context: Distant metastases of primary malignancies to the skeletal muscle tissue are a very rare event. Distant metastases that affect the rotator cuff are even rarer, and only a few of cases have been reported so far. Case Report: The present article reports two cases that presented to our hospital with the complaint of shoulder pain and had a soft tissue mass affecting the muscles of the rotator cuff and invading the neighboring bone compartments. One of the patients developed mucoepidermoid cancer metastasis of the submandibular gland, and the other was found to have a malignant epithelial tumor metastasized from the lower lobe of the right lung, whose primary origin could not be diagnosed until the imaging examinations were employed. Ultrasound and magnetic resonance imaging findings are presented in this paper. Conclusion: Metastases to the muscle tissues could be misdiagnosed as primary sarcomas. Because the therapy regiments and prognoses are fairly different for these two entities, the possibility of a metastasis to the muscle tissue must be considered as a differential diagnosis for case of painful soft tissue mass. Ultrasound is very useful in detection of the lesion and acts as a very important tool during guidance for biopsy. Magnetic resonance imaging, however, is a very valuable asset in the evaluation of the borders of the soft tissue mass and its invasive effect on the bony tissues. Particularly when the features such as lobulated contours, peripheral edema, and intratumoral necrosis exist, the possibility of metastases must be considered. PMID:25599056

Soker, Gokhan; Soker, Eda; Gulek, Bozkurt; Acikalin, Arbil; Asut, Elife; Kaya, Omer; Dilek, Okan; Yilmaz, Cengiz

2014-01-01

137

The Effect of Corticosteroid on Collagen Expression in Injured Rotator Cuff Tendon  

PubMed Central

Background Subacromial corticosteroid injections are commonly used in the nonoperative management of rotator cuff disease. The effects of corticosteroid injection on injured rotator cuff tendons have not been studied. Our aims were to characterize the acute response of rotator cuff tendons to injury through the analysis of the type-III to type-I collagen expression ratio, a tendon injury marker, and to examine the effects of corticosteroid on this response. Methods Sixty Sprague-Dawley rats were randomly assigned to four groups: control, tendon injury, steroid treatment, and tendon injury and steroid treatment. Six rats served as sham controls. Unilateral tendon injuries were created with full-thickness defects across 50% of the total width of the infraspinatus tendon, 5 mm from its humeral insertion. Steroid treatment with a single dose of methylprednisolone (0.6 mg/kg), equivalent to that given to humans, was injected into the subacromial space under direct visualization. Steroid treatment followed the creation of an injury in the rats in the injury and steroid treatment group. At one, three, and five weeks after the injury, the total RNA isolated from tendons was quantified with real-time polymerase chain reaction with use of primers for type-I and type-III collagen and ribosomal 18s RNA. Results The type-III to type-I collagen expression ratio remained at baseline at all time-points in the control and sham groups. At one week, the type-III to type-I collagen expression ratio increased more than fourfold above the control level in the tendon injury group (p = 0.017) and the tendon injury and steroid treatment group (p = 0.003). The ratio remained greater than twofold above the control at three weeks in both groups (p = 0.003 and p = 0.037) and returned to baseline at five weeks. Interestingly, the group that had steroid treatment only showed an increase of >4.5-fold (p = 0.001) in the type-III to type-I collagen expression ratio, without structural injury to the tendon. This ratio returned to baseline levels by three weeks. Conclusions A single dose of corticosteroid does not alter the acute phase response of an injured rotator cuff tendon in the rat. However, the same steroid dose in uninjured tendons initiates a short-term response equivalent to that of structural injury. Clinical Relevance These findings suggest that while a single corticosteroid dose may have no long-term effects on tendon collagen gene expression, collagen composition may be acutely altered by the injection. Therapy and activity recommendations following subacromial corticosteroid exposure should be made with the awareness of possible compromised rotator cuff tendon properties. PMID:16757768

Wei, Anthony S.; Callaci, John J.; Juknelis, Dainius; Marra, Guido; Tonino, Pietro; Freedman, Kevin B.; Wezeman, Frederick H.

2011-01-01

138

Evaluation and management of adult shoulder pain: a focus on rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral arthritis.  

PubMed

Shoulder pain is a common reason for a patient to see their primary care physician. This article focuses on the evaluation and management of 3 common shoulder disorders; rotator cuff disorders, acromioclavicular joint arthritis, and glenohumeral joint arthritis. The typical history and physical examination findings for each of these entities are highlighted, in addition to treatment options. PMID:24994050

Armstrong, April

2014-07-01

139

Extracting Information about the Rotator Cuff from Magnetic Resonance Images Using Deterministic and Random Techniques  

PubMed Central

We consider some methods to extract information about the rotator cuff based on magnetic resonance images; the study aims to define an alternative method of display that might facilitate the detection of partial tears in the supraspinatus tendon. Specifically, we are going to use families of ellipsoidal triangular patches to cover the humerus head near the affected area. These patches are going to be textured and displayed with the information of the magnetic resonance images using the trilinear interpolation technique. For the generation of points to texture each patch, we propose a new method that guarantees the uniform distribution of its points using a random statistical method. Its computational cost, defined as the average computing time to generate a fixed number of points, is significantly lower as compared with deterministic and other standard statistical techniques. PMID:25650281

De Los Ríos, F. A.; Paluszny, M.

2015-01-01

140

"V"ictory transosseous equivalent suture configuration for arthroscopic rotator cuff tear repairs of iatrogenically completed PASTA lesions and full-thickness "U"-shaped tears.  

PubMed

The cost of numerous anchors in rotator cuff surgery is high from both an economic standpoint as well as a physiologic one. More anchors means increased cost and increased surgical time; additionally, the greater number of anchors placed, the greater the expense on the native bone that they inevitably replace. It is therefore in the surgeon's and patient's best interest to use the appropriate number of anchors, no more and no less, with the appropriate number being that which allows for strong, stable fixation with minimal gap formation and maximal healing potential and recovery. The transosseous equivalent repair technique described herein uses a single double-loaded bioabsorbable suture anchor placed along the medial border of the rotator cuff foot print and the humeral head articular cartilage margin followed by 1 pushlock (Arthrex, Naples, Florida) anchor placed laterally on the vertical aspect of the greater tuberosity. It is designed for small to medium "U"-shaped tears and for iatrogenically completed partial articular supraspinatus tendon avulsions of moderate to large size, the so-called PASTA lesion. The use of selective knot placement allows for the conversion of a linear construct into a "V" configuration, optimizing repair strength and allowing for earlier rehabilitation while maximizing the healing biology seen with increased footprint contact dimensions and less repair gap formation. PMID:19824586

Lewicky, Yuri M

2009-10-01

141

Efficacy of arthroscopically placed pain catheter adjacent to the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block) following arthroscopic rotator-cuff repair  

PubMed Central

Background Rotator-cuff surgery is well recognized to be a painful procedure. Objectives The purpose of this study was to examine the effectiveness of an arthroscopically placed perineural catheter at the scapular notch to provide a continuous block of the suprascapular nerve (continuous arthroscopically assisted suprascapular nerve block [ca-SSNB]) following arthroscopic rotator-cuff repair (ARCR). Materials and methods This level II, prospective, randomized, controlled trial without postoperative blinding included 40 patients, who had a 48-hour pain pump, with 0.2% ropivacaine infusion and a continuous rate of 3 mL/hour, placed via an arthroscopically placed catheter following ARCR with arthroscopic release of the superior transverse ligament: 21 patients had a ca-SSNB, and 19 patients had a continuous subacromial bursal block (SAB). The visual analog scale (at 6 hours and on the first, second, and third postoperative days) and the total number of additional pain-reduction attempts during the 3 postoperative days were calculated. Results The respective visual analog scale scores (mm) obtained from the ca-SSNB and SAB groups were 62.4 and 67.6 (P=0.73) before surgery, 9.1 and 19.4 (P=0.12) at 6 hours after surgery, 24.4 and 44.6 (P=0.019) on the first postoperative day, 19.4 and 40.4 (P=0.0060) on the second postoperative day, and 18.5 and 27.8 (P=0.21) on the third postoperative day. Total additional pain-reduction attempts recorded for the ca-SSNB and SAB groups during the 3 postoperative days were 0.3 times and 1.2 times (P=0.0020), respectively. Conclusion ca-SSNB was highly effective in controlling postoperative pain after ARCR. PMID:24982592

Yamakado, Kotaro

2014-01-01

142

An in-vitro study of rotator cuff tear and repair kinematics using single- and double-row suture anchor fixation  

PubMed Central

Purpose: Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder. Materials and Methods: Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device. Results: Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen. Conclusions: This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ? 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs. Clinical Relevance: Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease. PMID:23960362

Kedgley, Angela E.; Shore, Benjamin J.; Athwal, George S.; Johnson, James A.; Faber, Kenneth J.

2013-01-01

143

Effects of 8 Weeks’ Specific Physical Training on the Rotator Cuff Muscle Strength and Technique of Javelin Throwers  

PubMed Central

[Purpose] For maximum efficiency and to prevent injury during javelin throwing, it is critical to maintain muscle balance and coordination of the rotator cuff and the glenohumeral joint. In this study, we investigated the change in the rotator cuff muscle strength, throw distance and technique of javelin throwers after they had performed a specific physical training that combined elements of weight training, function movement screen training, and core training. [Subjects] Ten javelin throwers participated in this study: six university athletes in the experimental group and four national-level athletes in the control group. [Methods] The experimental group performed 8 weeks of the specific physical training. To evaluate the effects of the training, measurements were performed before and after the training for the experimental group. Measurements comprised anthropometry, isokinetic muscle strength measurements, the function movement screen test, and movement analysis. [Results] After the specific physical training, the function movement screen score and external and internal rotator muscle strength showed statistically significant increases. Among kinematic factors, only pull distance showed improvement after training. [Conclusion] Eight weeks of specific physical training for dynamic stabilizer muscles enhanced the rotator cuff muscle strength, core stability, throw distance, and flexibility of javelin throwers. These results suggest that specific physical training can be useful for preventing shoulder injuries and improving the performance for javelin throwers. PMID:25364111

Kim, Hyeyoung; Lee, Youngsun; Shin, Insik; Kim, Kitae; Moon, Jeheon

2014-01-01

144

Autologous tenocyte implantation, a novel treatment for partial-thickness rotator cuff tear and tendinopathy in an elite athlete  

PubMed Central

Tendinopathy and small partial-thickness tears of the rotator cuff tendon are common presentations in sports medicine. No promising treatment has yet been established. Corticosteroid injections may improve symptoms in the short term but do not primarily treat the tendon pathology. Ultrasound-guided autologous tenocyte implantation (ATI) is a novel bioengineered treatment approach for treating tendinopathy. We report the first clinical case of ATI in a 20-year-old elite gymnast with a rotator cuff tendon injury. The patient presented with 12?months of increasing pain during gymnastics being unable to perform most skills. At 1?year after ATI the patient reported substantial improvement of clinical symptoms. Pretreatment and follow-up MRIs were reported and scored independently by two experienced musculoskeletal radiologists. Tendinopathy was improved and the partial-thickness tear healed on 3?T MRI. The patient was able to return to national-level competition. PMID:23314880

Wang, Allan W; Bauer, Stefan; Goonatillake, Matthew; Breidahl, William; Zheng, Ming-Hao

2013-01-01

145

Magnetic resonance imaging appearance of the shoulder after subacromial injection with corticosteroids can mimic a rotator cuff tear.  

PubMed

Subacromial injections have been used to treat rotator cuff problems. Previous studies have noted the difficulty in performing accurate injections into this area. In addition, one must also question the effects that misplaced corticosteroids could have on the surrounding tissues. In this case, a 51-year-old woman presented with several weeks of left shoulder pain and was diagnosed with rotator cuff tendonitis. After a subacromial injection with betamethasone and lidocaine, the patient noted 3 weeks of near complete pain relief, followed by a return of her symptoms. A magnetic resonance imaging scan obtained 7 weeks after the injection showed a full-thickness tear of the supraspinatus tendon. Five weeks later, the patient underwent arthroscopic evaluation of the shoulder and subacromial decompression. The rotator cuff tendons were noted to be intact and normal in appearance. The patient eventually had full resolution of her symptoms. Six months postoperatively, she underwent a new scan that showed a normal supraspinatus tendon. Apparently, the subacromial injection penetrated the anterior half of the supraspinatus tendon, causing a transient effect and signal change. One should use caution in the interpretation of magnetic resonance imaging scans of the shoulder soon after the injection of corticosteroids. PMID:18589276

Borick, Jay M; Kurzweil, Peter R

2008-07-01

146

Fascia lata allograft bridging of a rotator cuff tear in a rabbit animal model  

PubMed Central

Purpose: Despite advances in surgical treatment options, large rotator cuff (r-c) tears still represent a challenge for orthopedic surgeons. The purpose of this study was to evaluate the temporary and spatial histological incorporation of fascia lata allografts, used for bridging artificially created defects of the r-c. Materials and Methods: Seventy-two rabbits were divided into two groups and a supraspinatus tendinous defect was created. Half of the rabbit population underwent repair only, while in the other half, the defect was bridged utilizing fascia lata allograft. The animals were euthanized at 2, 4, and 6 weeks postoperative. Half of the specimens were evaluated histologically and the other half underwent mechanical testing. Results: There was an increased remodeling activity, fibroblastic in growth and strong presence of collagen fibers observed at 6 weeks on both groups. A gradually increasing mechanical strength was noticed by week 6 and increased toughness was also found at the same time period. There was no significant difference observed between the two groups regarding their histological and mechanical properties. Conclusions: In the difficult scenario of a large irreparable tear where the simple suture of the remaining r-c is impossible, allograft bridging, could be used with satisfactory results. Clinical Relevance: Treatment Study, Level 1. PMID:25114414

Varvitsiotis, Dimitrios; Papaspiliopoulos, Athanasios; Vlachou, Vasiliki; Feroussis, John; Papalois, Apostolos; Papacharalampous, Xenofon; Soucacos, Panayotis N.; Zoubos, Aristides

2014-01-01

147

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears  

PubMed Central

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success. PMID:19533125

Circi, Esra; Akgun, Rahmi Can; Tarhan, Nefise Cagla; Cetin, Nuri; Akpinar, Sercan; Tuncay, Ismail Cengiz

2009-01-01

148

Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup  

PubMed Central

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P < 0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P < 0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity. PMID:23533788

Carbonel, Ignacio; Martínez, Angel A.; Aldea, Elisa; Ripalda, Jorge

2013-01-01

149

Comparison of Three-Dimensional Isotropic and Two-Dimensional Conventional Indirect MR Arthrography for the Diagnosis of Rotator Cuff Tears  

PubMed Central

Objective To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. Materials and Methods The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). Results Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. Conclusion 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears. PMID:25469089

Lee, Ji Hyun; Jee, Sukkyung; Kwon, Jong Won; Cha, Jang Gyu; Yoo, Jae Chul

2014-01-01

150

Are occupational repetitive movements of the upper arm associated with rotator cuff calcific tendinopathies?  

PubMed

Calcifying tendinopathy (CT) of the shoulder is a common painful disorder, although the etiology and pathogenesis remain largely unknown. Recent theories about the role of excessive mechanical load in the genesis of CT have been proposed. Driven by the interest for these new theories, we investigated the hypothesis of a relationship between work-related repetitive movements of the upper arm, considered a potential cause of shoulder overload, and the presence of shoulder CT. A secondary aim was to obtain data on CT prevalence in a female sample from the working-age general population, as little data currently exist. 199 supermarket cashiers and 304 female volunteers recruited from the general population underwent a high-resolution ultrasonography of the rotator cuffs of both shoulders, and the presence of tendinopathies, with or without calcification, was recorded. The prevalence of calcific tendinopathy was 22.6 % in the cashiers group and 24.4 % in the control group. There were no statistically significant differences in the prevalence of calcifications between the two groups (p = 0.585), either for the dominant shoulder [OR = 0.841 (95 % CI 0.534-1.326)] or for the non-dominant shoulder [OR = 0.988 (95 % CI 0.582-1.326)]. We observed bilateral calcifications in 8.5 % of cashiers, and 9.6 % of controls, and an increase in prevalence of CT with age in both groups. Work-related repetitive movements of the upper arm did not induce a higher prevalence of shoulder CT compared with the female sample from the general population. If CT etiopathogenesis is related to mechanical load, CT onset may be influenced not only by loading history, but also by individual factors. Level of evidence Prognosis study, Level II. PMID:25000922

Sansone, Valerio C; Meroni, Roberto; Boria, Paola; Pisani, Salvatore; Maiorano, Emanuele

2014-07-01

151

Prevalence of the Rotator Cuff Tear Increases With Weakness in Hemiplegic Shoulder  

PubMed Central

Objective To investigate the relationship between the rotator cuff tear (RCT) and the muscle strength in hemiplegic side, and the effects of paralysis on the affected shoulders in hemiplegic patients. Methods A cross-sectional observational study performed in a university hospital was presented. The study enrolled 55 participants with hemiplegia of diverse degree of motor paresis, excluding those with bilateral lesions, history of major trauma or other co-existing musculoskeletal disorders of the shoulder. The main outcome measurements were muscle strength of the affected upper extremity (based on Medical Research Council scale), RCTs of the bilateral shoulders (by ultrasonography), and presence of shoulder pain, subluxation of the glenohumeral joint, passive range of motions, and subacromial spurs. Results Comparing each side of the shoulders, the prevalence of shoulder pain and supraspinatus muscle tear was higher (p<0.0001, p=0.007), and the range of motion was restricted (p<0.0001, p<0.0001, p<0.0001, p<0.0001) in the affected side. There was a significant trend toward higher prevalence of RCT and shoulder subluxation in the weaker shoulder (p=0.019, p<0.0001). In a multivariate analysis, Manual Muscle Test grade of less than three was an independent risk factor for RCT (p=0.025). Conclusion RCT in hemiplegia had a linear trend with muscle weakness in the affected side and the degree of weakness was an independent risk factor for the occurrence of RCT. In addition, shoulder pain, limitation of range of motions, and RCT were more frequent on the hemiplegic side of the shoulders. It is the first study to reveal a linear trend between RCT and upper extremity weakness and will provide physicians an insight to the management of RCTs in hemiplegic patients. PMID:24020027

Yi, Youbin; Shim, Jae Seong; Kim, Keewon; Baek, So-Ra; Jung, Se Hee; Kim, Won

2013-01-01

152

Outcome of arthroscopic rotator cuff repair in large tears: the exposed footprint.  

PubMed

The purpose of this retrospective study was to evaluate the clinical results of arthroscopic single-row repair in large rotator cuff tears. Selection was based on the extent of the "exposed footprint" (EFP) obtained by adding up the width of the subscapularis tear and the width of the supra/infraspinatus tear. Three groups were studied: Type I had an EFP of less than 5 cm; Type II had an EFP of 5 cm or more; tears allowing only partial repair were studied separately. During a period of nearly three years (in 2002-04) 49 shoulders complied with our selection. There were 25 type I and 24 type II tears. Subscapularis tears were found in 32/49 shoulders (65%); 10 shoulders (20%) had only partial repair. At an average follow-up of 33 months, all patients were subjected to an outcome assessment using the VAS, the Simple Shoulder Test (SST), Constant score (CS) and strength measurement. A near normal shoulder function (11-12 Yes-answers in the SST) was obtained in 68% of the patients with type I tears, compared to 33% of type II tears (p = 0.02). The adjusted CS for patients with a type I tear was 88%, compared to 77% for patients with a type II (p = 0.01); strength was 69% for type I and 36% for type II shoulders (p = 0.001). After arthroscopic single-row and margin-convergence repair, a near normal shoulder function was obtained in two-thirds of the shoulders with an EFP of up to 5 cm. When the EFP was larger, this outcome was achieved in only one-third of the shoulders. PMID:22308618

Buess, Eduard; Waibl, Bernhard; Seidner, Robert; Werlen, Stefan

2011-12-01

153

Dose- and time-dependent effects of triamcinolone acetonide on human rotator cuff-derived cells  

PubMed Central

Objectives To investigate the appropriate dose and interval for the administration of triamcinolone acetonide (TA) in treating tendinopathy to avoid adverse effects such as tendon degeneration and rupture. Methods Human rotator cuff-derived cells were cultured using three media: regular medium (control), regular medium with 0.1 mg/mL of TA (low TA group), and with 1.0 mg/mL of TA (high TA group). The cell morphology, apoptosis, and viability were assessed at designated time points. Results In the low TA group, the cells became flattened and polygonal at seven days then returned to normal at 21 days. The cell apoptosis ratio and messenger ribonucleic acid expression of caspase-3, 7, 8, and 9 increased, and viability was reduced in the low and high groups at seven days. In the low TA group, apoptosis and viability returned to normal at 21 days, however, in the high TA group, the cell morphology, apoptosis ratio, caspase-3, 7, 8, and 9 and viability did not return by day 21. Re-administration was performed in the low TA group at 7-, 14-, and 21-day intervals, and cell viability did not return to the control level at the 7- and 14-day intervals. Conclusion A 0.1 mg/mL dose of TA temporarily decreased cell viability and increased cell apoptosis, which was recovered at 21 days, however, 1 mg/mL of TA caused irreversible damage to cell morphology and viability. An interval > three weeks was needed to safely re-administer TA. These findings may help determine the appropriate dose and interval for TA injection therapy. Cite this article: Bone Joint Res 2014;3:328–34. PMID:25477418

Harada, Y.; Kokubu, T.; Mifune, Y.; Inui, A.; Sakata, R.; Muto, T.; Takase, F.; Kurosaka, M.

2014-01-01

154

LeBonheur Children's Hospital/Aesthetic Surgery Plastic Surgery Rotation  

E-print Network

LeBonheur Children's Hospital/Aesthetic Surgery Plastic Surgery Rotation PGY-7 (2nd year Resident) By the end of the Plastic Surgery Rotation at LeBonheur Children's Hospital and Aesthetic Surgery, the PGY-7 congenital disorders of the head and neck · Primary and secondary surgery on patients with common congenital

Cui, Yan

155

Arthroscopic Percutaneous Repair of Anterosuperior Rotator Cuff Tear Including Biceps Long Head: A 2-Year Follow-up  

PubMed Central

Background To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion. Methods The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed. Results The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%). Conclusions The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction. PMID:23205238

Kim, Do-Young; Lee, Sang-Soo; Seo, Eun-Min; Hwang, Jung-Taek; Kwon, Sun-Chang; Lee, Jae-Won

2012-01-01

156

Matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact portion of those tendons  

PubMed Central

Summary We evaluated whether matrix metalloproteases and their inhibitors are involved in extracellular matrix remodelling and degradation of chronic rotator cuff tears. Tendon samples were harvested from 13 patients who underwent arthroscopic repair of a rotator cuff tear. Supraspinatus specimens were harvested en bloc from the arthroscopically intact middle portion of the tendon, more than 1 cm lateral to the torn edge, from the lateral edge of the tear, and from the superior margin of the macroscopically intact subscapularis tendon, used as control. The collagenases, the stromelysins, and the tissue inhibitors of metalloprotease arrays were analyzed blindly by multiplex sandwich ELISA in each specimen. Histological evidence of tendinopathy was present in all patients with a rotator cuff tear, but not in the macroscopically intact subscapularis tendon. There were significantly increased levels of MMP 1, MMP 2, MMP 3, TIMP-1, and TIMP-2 in all specimens examined, including the macroscopically intact portion of the supraspinatus tendon and the subscapularis (control specimens). The levels of specific matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact tendons. These changes extended medially to the site of tendon tear, and to other tendons. PMID:24367772

Castagna, Alessandro; Cesari, Eugenio; Garofalo, Raffaele; Gigante, Antonio; Conti, Marco; Markopoulos, Nikolaos; Maffulli, Nicola

2013-01-01

157

Efficacy and cost-effectiveness of a physiotherapy program for chronic rotator cuff pathology: A protocol for a randomised, double-blind, placebo-controlled trial  

Microsoft Academic Search

BACKGROUND: Chronic rotator cuff pathology (CRCP) is a common shoulder condition causing pain and disability. Physiotherapy is often the first line of management for CRCP yet there is little conclusive evidence to support or refute its effectiveness and no formal evaluation of its cost-effectiveness. METHODS\\/DESIGN: This randomised, double-blind, placebo-controlled trial will involve 200 participants with CRCP recruited from medical practices,

Kim Bennell; Sally Coburn; Elin Wee; Sally Green; Anthony Harris; Andrew Forbes; Rachelle Buchbinder

2007-01-01

158

Disruption of the Anterior–Posterior Rotator Cuff Force Balance Alters Joint Function and Leads to Joint Damage in a Rat Model  

PubMed Central

The rotator cuff assists in shoulder movement and provides dynamic stability to the glenohumeral joint. Specifically, the anterior–posterior (AP) force balance, provided by the subscapularis anteriorly and the infraspinatus and teres minor posteriorly, is critical for joint stability and concentric rotation of the humeral head on the glenoid. However, limited understanding exists of the consequences associated with disruption of the AP force balance (due to tears of both the supraspinatus and infraspinatus tendons) on joint function and joint damage. We investigated the effect of disrupting the APforce balance on joint function and joint damage in an overuse rat model. Twenty-eight rats underwent 4 weeks of overuse to produce a tendinopathic condition and were then randomized into two surgical groups: Detachment of the supraspinatus only or detachment of the supraspinatus and infraspinatus tendons. Rats were then gradually returned to their overuse protocol. Quantitative ambulatory measures including medial/lateral, propulsion, braking, and vertical forces were significantly different between groups. Additionally, cartilage and adjacent tendon properties were significantly altered. These results identify joint imbalance as a mechanical mechanism for joint damage and demonstrate the importance of preserving rotator cuff balance when treating active cuff tear patients. PMID:24464961

Reuther, Katherine E.; Thomas, Stephen J.; Tucker, Jennica J.; Sarver, Joseph J.; Gray, Chancellor F.; Rooney, Sarah I.; Glaser, David L.; Soslowsky, Louis J.

2014-01-01

159

Ultrasound-Guided Myofascial Trigger Point Injection Into Brachialis Muscle for Rotator Cuff Disease Patients With Upper Arm Pain: A Pilot Study  

PubMed Central

Objective To assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain. Methods A prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS). Results US-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (?VAS=-2.8) was significantly larger than caused by oral NSAID (?VAS=-1.5) (p<0.05). Conclusion In patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle. PMID:25379497

Suh, Mi Ri; Chang, Won Hyuk; Choi, Hyo Seon

2014-01-01

160

Short-term results after reversed shoulder arthroplasty (Delta III) in patients with rheumatoid arthritis and irreparable rotator cuff tear  

PubMed Central

The purpose of this study was to describe the outcome after reversed Delta III shoulder prosthesis in patients with rheumatoid arthritis (RA) and irreparable rotator cuff tear. Fifteen patients (17 joints) were prospectively analysed using the Constant-Murley score (CS). Comprehensive outcome measure was carried out by means of four widely used questionnaires as well as clinical and radiographic examinations at an average of 24.3 months postoperatively. The CS improved significantly from 19 to 59.5 points. The mental (MSC) and physical (PCS) component summary score of the Short Form 36 (SF-36) reached 108% and 77%, respectively, while the DASH (Disabilities of the Arm, Shoulder, and Hand) was 58% of a comparative norm population. Remaining deficits were documented by SPADI (Shoulder Pain and Disability; 54.4 points) and ASES (clinical and patient-orientated American Shoulder and Elbow Surgeons; 84.3 and 61.3 points, respectively). No radiological signs of loosening were found, but scapular notching occurred in four cases. Reversed arthroplasty provides a substantial improvement of shoulder function in patients with RA. The high incidence of notching is of concern. PMID:19221749

Pap, Géza; Angst, Felix; Flury, Matthias P.; Lieske, Sebastian; Schwyzer, Hans-Kaspar; Simmen, Beat Rene

2009-01-01

161

High-resolution ultrasound of rotator cuff and biceps reflection pulley in non-elite junior tennis players: anatomical study  

PubMed Central

Background Tennis is believed to be potentially harmful for the shoulder, therefore the purpose of this study is to evaluate the anatomy of the rotator cuff and the coraco-humeral ligament (CHL) in a-symptomatic non-elite junior tennis players with high-resolution ultrasound (US). Methods From August 2009 to September 2010 n?=?90 a-symptomatic non-elite junior tennis players (mean age?±?standard deviation: 15?±?3) and a control group of age- and sex- matched subjects were included. Shoulder assessment with a customized standardized protocol was performed. Body mass index, dominant arm, years of practice, weekly hours of training, racket weight, grip (Eastern, Western and semi-Western), kind of strings were recorded. Results Abnormalities were found at ultrasound in 14/90 (15%) players. Two players had supraspinatus tendinosis, two had subacromial impingement and ten had subacromial bursitis. CHL thickness resulted comparable in the dominant and non-dominant arms (11.3?±?4.4 mm vs. 13?±?4.2, p?>?0.05). Multivariate analysis demonstrated that no association was present among CHL thickness and the variables evaluated. In the control group, abnormalities were found at ultrasound in 6/60 (10%) subjects (sub-acromial bursitis). No statistically significant differences between players and control group were found (p?=?0.71). Conclusion In a-symptomatic non-elite junior tennis players only minor shoulder abnormalities were found. PMID:25034864

2014-01-01

162

Characteristics and Stimulation Potential with BMP-2 and BMP-7 of Tenocyte-Like Cells Isolated from the Rotator Cuff of Female Donors  

PubMed Central

Tendon bone healing of the rotator cuff is often associated with non-healing or recurrent defects, which seems to be influenced by the patient’s age and sex. The present study aims to examine cellular biological characteristics of tenocyte-like cells that may contribute to this impaired rotator cuff healing. Moreover, a therapeutic approach using growth factors could possibly stimulate tendon bone healing. Therefore, our second aim was to identify patient groups who would particularly benefit from growth factor stimulation. Tenocyte-like cells isolated from supraspinatus tendons of female donors younger and older than 65 years of age were characterized with respect to different cellular biological parameters, such as cell density, cell count, marker expression, collagen-I protein synthesis, and stem cell potential. Furthermore, cells of the donor groups were stimulated with BMP-2 and BMP-7 (200 and 1000 ng/ml) in 3D-culture and analyzed for cell count, marker expression and collagen-I protein synthesis. Female donors older than 65 years of age showed significantly decreased cell count and collagen-I protein synthesis compared to cells from donors younger than 65 years. Cellular biological parameters including cell count, collagen-I and –III expression, and collagen-I protein synthesis of cells from both donor groups were stimulated with BMP-2 and BMP-7. The cells from donors older than 65 years revealed a decreased stimulation potential for cell count compared to the younger group. Cells from female donors older than 65 years of age showed inferior cellular biological characteristics. This may be one reason for a weaker healing potential observed in older female patients and should be taken into consideration for tendon bone healing of the rotator cuff. PMID:23825642

Klatte-Schulz, Franka; Pauly, Stephan; Scheibel, Markus; Greiner, Stefan; Gerhardt, Christian; Hartwig, Jelka; Schmidmaier, Gerhard; Wildemann, Britt

2013-01-01

163

Lysylhydroxylation and non-reducible crosslinking of human supraspinatus tendon collagen: changes with age and in chronic rotator cuff tendinitis  

PubMed Central

OBJECTIVES—To investigate age related and site specific variations in turnover and chemistry of the collagen network in healthy tendons as well as the role of collagen remodelling in the degeneration of the supraspinatus tendon (ST-D) in rotator cuff tendinitis.?METHODS—Collagen content and the amount of hydroxylysine (Hyl), hydroxylysylpyridinoline (HP), lysylpyridinoline (LP), and the degree of non-enzymatic glycation (pentosidine) were investigated in ST-D and in normal human supraspinatus (ST-N) and biceps brachii tendons (BT-N) by high-performance liquid chromatography.?RESULTS—In BT-N, tendons that served as control tissue as it shows rarely matrix abnormalities, pentosidine levels rise linearly with age (20-90 years), indicating little tissue remodelling (resulting in an undisturbed accumulation of pentosidine). A similar accumulation was observed in ST-N up to 50 years. At older ages, little pentosidine accumulation was observed and pentosidine levels showed large interindividual variability. This was interpreted as remodelling of collagen in normal ST after age 50 years because of microruptures (thus diluting old collagen with newly synthesised collagen). All degenerate ST samples showed decreased pentosidine levels compared with age matched controls, indicating extensive remodelling in an attempt to repair the tendon defect. Collagen content and the amount of Hyl, HP, and LP of ST-N and BT-N did not change with age. With the exception of collagen content, which did not differ, all parameters were significantly (p<0.001) lower in BT-N. The ST-D samples had a reduced collagen content and had higher Hyl, HP, and LP levels than ST-N (p<0.001).?CONCLUSIONS—Inasmuch as Hyl, HP, and LP levels in ST-N did not change with age, tissue remodelling as a consequence of microruptures does not seem to affect the quality of the tendon collagen. On the other hand, the clearly different profile of post-translational modifications in ST-D indicates that the newly deposited collagen network in degenerated tendons is qualitatively different. It is concluded that in ST-D the previously functional and carefully constructed matrix is replaced by aberrant collagen. This may result in a mechanically less stable tendon; as the supraspinatus is constantly subjected to considerable forces this could explain why tendinitis is mostly of a chronic nature.?? Keywords: collagen; tendons; crosslinks; pentosidine PMID:10343538

Bank, R.; TeKoppele, J.; Oostingh, G.; Hazleman, B.; Riley, G.

1999-01-01

164

Radial extracorporeal shock-wave therapy in patients with chronic rotator cuff tendinitis: a prospective randomised double-blind placebo-controlled multicentre trial.  

PubMed

The aim of this study was to determine the effect of radial extracorporeal shock-wave therapy (rESWT) on patients with chronic tendinitis of the rotator cuff. This was a randomised controlled trial in which 82 patients (mean age 47 years (24 to 67)) with chronic tendinitis diagnosed clinically were randomly allocated to a treatment group who received low-dose rESWT (three sessions at an interval 10 to 14 days, 2000 pulses, 0.11 mJ/mm(2), 8 Hz) or to a placebo group, with a follow-up of six months. The patients and the treating orthopaedic surgeon, who were both blinded to the treatment, evaluated the results. A total of 44 patients were allocated to the rESWT group and 38 patients to the placebo group. A visual analogue scale (VAS) score for pain, a Constant-Murley (CMS) score and a simple shoulder test (SST) score significantly improved in both groups at three and six months compared with baseline (all p ? 0.012). The mean VAS was similar in both groups at three (p = 0.43) and six months (p = 0.262). Also, the mean CMS and SST scores were similar in both groups at six months (p = 0.815 and p = 0.834, respectively). It would thus seem that low-dose rESWT does not reduce pain or improve function in patients chronic rotator cuff tendinitis compared with placebo treatment. PMID:24151273

Kolk, A; Yang, K G Auw; Tamminga, R; van der Hoeven, H

2013-11-01

165

Rotator cuff problems  

MedlinePLUS

... the pain goes down the arm to the elbow and hand, this may indicate a pinched nerve. There may also be pain with lowering the shoulder from a raised position. Over time, pain may be present at rest or at night, such as when lying ...

166

Rotator Cuff Pathology  

MedlinePLUS

... Safety Snowblower Safety Pumpkin Carving Safety Gardening Safety Turkey Carving Safety Removing a Ring News and Updates ... Safety Snowblower Safety Pumpkin Carving Safety Gardening Safety Turkey Carving Safety Removing a Ring News and Updates ...

167

Rotator Cuff Exercises  

MedlinePLUS

... up, stretch your arms and shoulders, and do pendulum exercises. To do pendulum exercises, bend from the waist, letting your arms ... your shoulder. (Hint: This is like the backhand swing in tennis.) Lower the arm slowly. Repeat the ...

168

Rotator Cuff Injuries  

MedlinePLUS Videos and Cool Tools

... the towel with your right hand, behind your back. Pull tightly on the towel and creep your thumb up as far as you can get it. Applying a cold pack or a heating pad to the shoulder is a good way to reduce inflammation and pain. Alternating heat and cold sometimes soothes pain also. ...

169

Effect of platelet-rich plasma and bioactive glass powder for the improvement of rotator cuff tendon-to-bone healing in a rabbit model.  

PubMed

To test the hypothesis that a platelet-rich plasma (PRP) plus bioactive glass (BG) mixture could shorten the tendon-bone healing process in rotator cuff tendon repair, thirty mature male New Zealand white rabbits were randomly divided into three groups, Control, PRP, and PRP + BG. All groups underwent a surgical procedure to establish a rotator cuff tendon healing model. Mechanical examinations and histological assays were taken to verify the adhesion of the tendon-bone. Real-time PCR was adopted to analyze Bone Morphogenetic Protein-2 (BMP-2). The maximum load-to-failure value in mechanical examinations was significantly higher in the PRP + BG group than that in the control group after six weeks (Control 38.73 ± 8.58, PRP 54.49 ± 8.72, PRP + BG 79.15 ± 7.62, p < 0.001), but it was not significantly different at 12 weeks (PRP 74.27 ± 7.74, PRP + BG 82.57 ± 6.63, p = 0.145). In histological assays, H&E (hematoxylin-eosin) staining showed that the interface between the tendon-bone integration was much sturdier in the PRP + BG group compared to the other two groups at each time point, and more ordered arranged tendon fibers can be seen at 12 weeks. At six weeks, the mRNA expression levels of BMP-2 in the PRP + BG group were higher than those in the other groups (PRP + BG 0.65 ± 0.11, PRP 2.284 ± 0.07, Control 0.12 ± 0.05, p < 0.05). However, there was no significant difference in the mRNA expression levels of BMP-2 among the three groups at 12 weeks (p = 0.922, 0.067, 0.056). BMP-2 levels in PRP and PRP+BG groups were significantly lower at 12 weeks compared to six weeks (p = 0.006, <0.001).We found that the PRP + BG mixture could enhance tendon-bone healing in rotator cuff tendon repair. PMID:25464384

Wu, Yang; Dong, Yu; Chen, Shiyi; Li, Yunxia

2014-01-01

170

Effect of Platelet-Rich Plasma and Bioactive Glass Powder for the Improvement of Rotator Cuff Tendon-to-Bone Healing in a Rabbit Model  

PubMed Central

To test the hypothesis that a platelet-rich plasma (PRP) plus bioactive glass (BG) mixture could shorten the tendon-bone healing process in rotator cuff tendon repair, thirty mature male New Zealand white rabbits were randomly divided into three groups, Control, PRP, and PRP + BG. All groups underwent a surgical procedure to establish a rotator cuff tendon healing model. Mechanical examinations and histological assays were taken to verify the adhesion of the tendon-bone. Real-time PCR was adopted to analyze Bone Morphogenetic Protein-2 (BMP-2). The maximum load-to-failure value in mechanical examinations was significantly higher in the PRP + BG group than that in the control group after six weeks (Control 38.73 ± 8.58, PRP 54.49 ± 8.72, PRP + BG 79.15 ± 7.62, p < 0.001), but it was not significantly different at 12 weeks (PRP 74.27 ± 7.74, PRP + BG 82.57 ± 6.63, p = 0.145). In histological assays, H&E (hematoxylin-eosin) staining showed that the interface between the tendon-bone integration was much sturdier in the PRP + BG group compared to the other two groups at each time point, and more ordered arranged tendon fibers can be seen at 12 weeks. At six weeks, the mRNA expression levels of BMP-2 in the PRP + BG group were higher than those in the other groups (PRP + BG 0.65 ± 0.11, PRP 2.284 ± 0.07, Control 0.12 ± 0.05, p < 0.05). However, there was no significant difference in the mRNA expression levels of BMP-2 among the three groups at 12 weeks (p = 0.922, 0.067, 0.056). BMP-2 levels in PRP and PRP+BG groups were significantly lower at 12 weeks compared to six weeks (p = 0.006, <0.001).We found that the PRP + BG mixture could enhance tendon-bone healing in rotator cuff tendon repair. PMID:25464384

Wu, Yang; Dong, Yu; Chen, Shiyi; Li, Yunxia

2014-01-01

171

The central nervous system--an additional consideration in 'rotator cuff tendinopathy' and a potential basis for understanding response to loaded therapeutic exercise.  

PubMed

Tendinopathy is a term used to describe a painful tendon disorder but despite being a well-recognised clinical presentation, a definitive understanding of the pathoaetiology of rotator cuff tendinopathy remains elusive. Current explanatory models, which relate to peripherally driven nocioceptive mechanisms secondary to structural abnormality, or failed healing, appear inadequate on their own in the context of current literature. In light of these limitations this paper presents an extension to current models that incorporates the integral role of the central nervous system in the pain experience. The role of the central nervous system (CNS) is described and justified along with a potential rationale to explain the favourable response to loaded therapeutic exercises demonstrated by previous studies. This additional consideration has the potential to offer a useful way to explain pain to patients, for clinicians to prescribe appropriate therapeutic management strategies and for researchers to advance knowledge in relation to this clinically challenging problem. PMID:23932100

Littlewood, Chris; Malliaras, Peter; Bateman, Marcus; Stace, Richmond; May, Stephen; Walters, Stephen

2013-12-01

172

Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: Part 2 - Muscle activity.  

PubMed

This study aimed to compare muscle activity in individuals with isolated acromioclavicular osteoarthritis (ACO), ACO associated with rotator cuff disease (ACO+RCD), and controls. Seventy-four participants (23 isolated ACO, 25 ACO+RCD, 26 controls) took part in this study. Disability was assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Muscle activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and anterior deltoid (AD) was collected during arm elevation in the sagittal and scapular planes. Pain during motion was assessed with the numerical pain rating scale. Analysis of the DASH, pain and kinematics were reported in part 1 of this study. For each muscle, separate 2-way linear mixed-model ANOVAs were performed to compare groups. ACO+RCD group had more UT and AD activity than the the isolated ACO and control other groups, more AD activity than the isolated ACO group during the ascending phase, and more AD activity than the ACO and control groups during the descending phase in both planes. Isolated ACO group had less SA activity than the control group only in the sagittal plane. Alterations in shoulder muscle activity are present in individuals with isolated ACO and with ACO+RCD and should be considered in rehabilitation. PMID:24928470

Sousa, Catarina de Oliveira; Michener, Lori Ann; Ribeiro, Ivana Leão; Reiff, Rodrigo Bezerra de Menezes; Camargo, Paula Rezende; Salvini, Tania Fátima

2015-02-01

173

Repetitive H-Wave® device stimulation and program induces significant increases in the range of motion of post operative rotator cuff reconstruction in a double-blinded randomized placebo controlled human study  

PubMed Central

Background Albeit other prospective randomized controlled clinical trials on H-Wave Device Stimulation (HWDS), this is the first randomized double-blind Placebo controlled prospective study that assessed the effects of HWDS on range of motion and strength testing in patients who underwent rotator cuff reconstruction. Methods Twenty-two patients were randomly assigned into one of two groups: 1) H-Wave device stimulation (HWDS); 2) Sham-Placebo Device (PLACEBO). All groups received the same postoperative dressing and the same device treatment instructions. Group I was given HWDS which they were to utilize for one hour twice a day for 90 days postoperatively. Group II was given the same instructions with a Placebo device (PLACEBO). Range of motion was assessed by using one-way ANOVA with a Duncan Multiple Range Test for differences between the groups preoperatively, 45 days postoperatively, and 90 days postoperatively by using an active/passive scale for five basic ranges of motions: Forward Elevation, External Rotation (arm at side), External Rotation (arm at 90 degrees abduction), Internal Rotation (arm at side), and Internal Rotation (arm at 90 degrees abduction). The study also evaluated postoperative changes in strength by using the Medical Research Council (MRC) grade assessed strength testing. Results Patients who received HWDS compared to PLACEBO demonstrated, on average, significantly improved range of motion. Results confirm a significant difference for external rotation at 45 and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), active at 90 days postoperatively (p = 0.007). Internal rotation also demonstrated significant improvement compared to PLACEBO at 45 and 90 days postoperatively; active range at 45 days postoperatively (p = 0.007), and active range at 90 days postoperatively (p = 0.006). There was no significant difference between the two groups for strength testing. Conclusion HWDS compared to PLACEBO induces a significant increase in range of motion in positive management of rotator cuff reconstruction, supporting other previous research on HWDS and improvement in function. Interpretation of this preliminary investigation while suggestive of significant increases in Range of Motion of Post -Operative Rotator Cuff Reconstruction, warrants further confirmation in a larger double-blinded sham controlled randomized study. PMID:19874593

Blum, Kenneth; Chen, Amanda LC; Chen, Thomas JH; Waite, Roger L; Downs, B William; Braverman, Eric R; Kerner, Mallory M; Savarimuthu, Stella M; DiNubile, Nicholas

2009-01-01

174

Full thickness tears: retaining the cuff.  

PubMed

Repair of rotator cuff tears is technically challenging. Full thickness rotator cuff tears have no potential for spontaneous healing, no reliable tendons substitutes are available, and their management is only partially understood. Many factors seem to contribute to the final outcome, and considerable variations in the decision-making process exist. For these reasons, decisions are often taken on the basis of surgeon's clinical experience. Accurate and prompt diagnosis is fundamental to guide correct management, and the tear pattern should be carefully evaluated to planning the most appropriate repair. PMID:22089291

Osti, Leonardo; Rizzello, Giacomo; Panascì, Manlio; Denaro, Vincenzo; Maffulli, Nicola

2011-12-01

175

Suprascapular nerve: is it important in cuff pathology?  

PubMed

Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting. PMID:23193484

Shi, Lewis L; Freehill, Michael T; Yannopoulos, Paul; Warner, Jon J P

2012-01-01

176

Suprascapular Nerve: Is It Important in Cuff Pathology?  

PubMed Central

Suprascapular nerve and rotator cuff function are intimately connected. The incidence of suprascapular neuropathy has been increasing due to improved understanding of the disease entity and detection methods. The nerve dysfunction often results from a traction injury or compression, and a common cause is increased tension on the nerve from retracted rotator cuff tears. Suprascapular neuropathy should be considered as a diagnosis if patients exhibit posterosuperior shoulder pain, atrophy or weakness of supraspinatus and infraspinatus without rotator cuff tear, or massive rotator cuff with retraction. Magnetic resonance imaging and electromyography studies are indicated to evaluate the rotator cuff and function of the nerve. Fluoroscopically guided injections to the suprascapular notch can also be considered as a diagnostic option. Nonoperative treatment of suprascapular neuropathy can be successful, but in the recent decade there is increasing evidence espousing the success of surgical treatment, in particular arthroscopic suprascapular nerve decompression. There is often reliable improvement in shoulder pain, but muscle atrophy recovery is less predictable. More clinical data are needed to determine the role of rotator cuff repair and nerve decompression in the same setting. PMID:23193484

Shi, Lewis L.; Freehill, Michael T.; Yannopoulos, Paul; Warner, Jon J. P.

2012-01-01

177

Changes in lower limb rotation after soft tissue surgery in spastic diplegia  

PubMed Central

Background and purpose Rotational osteotomies are usually necessary to correct pronounced rotational deformities in ambulant children with cerebral palsy. The effects of soft tissue surgery on such deformities are unclear. In this retrospective study, we determined whether multilevel soft tissue surgery, performed to correct deformities in the sagittal plane, would also have an effect on rotational parameters. Patients and methods We examined 28 ambulant children with spastic diplegia with an average age of 12 (7–19) years. They underwent multilevel soft tissue surgery (with 6 surgical procedures per child on average). 3-dimensional gait analysis was performed preoperatively and at an average follow-up of 1–2 years. The indications for surgery were abnormalities in the sagittal plane. Gait analysis data from healthy children were used in defining normal ranges of kinematic variables. For assessment of changes in the transverse plane, the angles of foot progression, hip rotation, and pelvic rotation were studied. Results The transverse plane kinematic results showed no statistically significant postoperative changes when the preoperative parameters were within the normal range (within 2 SD of the mean of the normal material). In limbs where the preoperative values were abnormal (more than 2 SD above the normal mean), there was a mean reduction in internal foot progression of 12° (p = 0.01) and a mean reduction in external pelvic rotation of 6° (p = 0.02). The effect was more pronounced in children under 12 years of age. Internal hip rotation was not significantly reduced. Interpretation When the preoperative rotational parameters were abnormal, multilevel soft tissue surgery resulted in improved transverse plane kinematics. This could be of importance in preoperative decision making, especially when there is doubt as to whether to include rotational osteotomies in multilevel operations in younger children. PMID:20175660

Terjesen, Terje

2010-01-01

178

[Arthroscopic reconstruction of the rotor cuff].  

PubMed

Over the last years treatment of rotator cuff tears is evolving gradually from open to complete arthroscopic repair. There had been fast developments in arthroscopic techniques and instruments and there is a better understanding of biomechanical backgrounds. For a good clinical outcome it is not necessary to obtain a watertight closure in all cases but to balance the force couples in the coronal and transverse plane. There is recent discussion regarding the optimum techniques and stitches for cuff reconstruction and resulting developments in this field. To determine the individual reconstruction technique it is crucial to recognize the different tear categories. Based on these findings we are now able to treat nearly every cuff tear arthroscopically, even a retracted massive lesion. PMID:16897022

Bauer, G J; Kniesel, B

2006-08-01

179

Airway obstruction caused by endotracheal tube cuff herniation during creation of tracheal stoma.  

PubMed

We report an unusual case of airway obstruction caused by herniation of endotracheal tube (ETT) cuff in a 62-year-old male who underwent surgery for hypopharyngeal carcinoma. During the procedure of creating a tracheal stoma, a new oral ETT was inserted by the surgical team to the lower portion of the trachea through the cut opening to replace the old for ventilation and prevention of soiling of the airway. Upon resumption of surgical manipulation, right endobronchial intubation was disclosed. The ETT cuff was therefore repositioned and reinflated, but airway obstruction persisted in spite of tube obstruction being ruled out by successfully passing a suction catheter through the ETT. After deflating the cuff the obstruction was resolved, and ventilation was eased. Thus the ETT was replaced with another new one and careful scrutiny made after the event revealed a herniating cuff due to manufacturing defect. It was conceivable that endobronchial intubation with over-inflation of the tube cuff may cause cuff herniation, particularly when surgical manipulation was active at the adjacency, in spite of the use of a modern tube with low-pressure high-volume cuff. Performing the "cuff deflation test" is the simple way to diagnose cuff herniation. Awareness of this condition, especially when anesthesiologists lose direct control of the airway during such procedures is important because undesirable complications can be prevented through quick decision and action. PMID:15869007

Kao, Ming-Chang; Yu, Ya-Sheng; Liu, Hsu-Tang; Tsai, Shen-Kou; Lin, Su-Man; Huang, Ying-Che

2005-03-01

180

COMMUNITY CUFF: MANUALLYPOWERED BLOOD PRESSURE CUFF FOR SUBSAHARAN AFRICA  

E-print Network

clinics Community health workers CriBcal need High blood pressure (BP) is a major contributorCOMMUNITY CUFF: MANUALLYPOWERED BLOOD PRESSURE CUFF FOR SUBSAHARAN AFRICA Stepbystep instruc a manuallypowered, inexpensive, and easytouse blood pressure monitoring device for use by a minimally trained

McGaughey, Alan

181

[Arthroscopy of the shoulder joint. Technique, indications, surgery and complications].  

PubMed

Diagnostic and operative arthroscopy of the shoulder joint has gained considerable importance in traumatology and orthopedic surgery over the last years. Injuries of the limbus glenoidalis, in particular traumatic shoulder luxation, injuries of the rotator cuff, infection of the glenohumeral joint and unclear posttraumatic pain are indications for diagnostic and operative arthroscopy. Arthroscopy of the shoulder is a procedure, which offers exact diagnosis and the possibility of immediate surgery at the same time. The technique of the shoulder joint arthroscopy has to be carried out carefully and according to a standard protocol. The complication rate of around 5% of shoulder arthroscopy has not to be neglected. PMID:8366732

Brülhart, K B; Roggo, A; Kossmann, T; Duff, C; Schimmer, R; Glinz, W

1993-01-01

182

Efficacy of Various Analgesics on Shoulder Function and Rotator Cuff Tendon-to-Bone Healing in a Rat (Rattus norvegicus) Model  

PubMed Central

Although relief of postoperative pain is an imperative aspect of animal welfare, analgesics that do not interfere with the scientific goals of the study must be used. Here we compared the efficacy of different analgesic agents by using an established rat model of supraspinatus tendon healing and a novel gait-analysis system. We hypothesized that different analgesic agents would all provide pain relief in this model but would cause differences in tendon-to-bone healing and gait parameters. Buprenorphine, ibuprofen, tramadol–gabapentin, and acetaminophen were compared with a no-analgesia control group. Gait measures (stride length and vertical force) on the operative forelimb differed between the control group and both the buprenorphine (2 and 4 d postsurgery) and ibuprofen (2 d postsurgery) groups. Step length was different in the control group as compared with the tramadol–gabapentin (2 d after surgery), buprenorphine (2 and 4 d after surgery), and ibuprofen (2 d after surgery) groups. Regarding tendon-to-bone healing, the ibuprofen group showed less stiffness at the insertion site; no other differences in tendon-to-bone healing were detected. In summary, the analgesics evaluated were associated with differences in both animal gait and tendon-to-bone healing. This information will be useful for improving the management of postsurgical pain without adversely affecting tissue healing. Given its ability to improve gait without impeding healing, we recommend use of buprenorphine for postsurgical pain management in rats. In addition, our gait-analysis system can be used to evaluate new analgesics. PMID:24602546

Caro, Adam C; Tucker, Jennica J; Yannascoli, Sarah M; Dunkman, Andrew A; Thomas, Stephen J; Soslowsky, Louis J

2014-01-01

183

Rolling cuff flexible bellows  

DOEpatents

A flexible connector apparatus used to join two stiff non-deformable members, such as piping. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

Lambert, Donald R. (Livermore, CA)

1985-01-01

184

A reverse shoulder arthroplasty with increased offset for the treatment of cuff-deficient shoulders with glenohumeral arthritis.  

PubMed

Inherent disadvantages of reverse shoulder arthroplasty designs based on the Grammont concept have raised a renewed interest in less-medialised designs and techniques. The aim of this study was to evaluate the outcome of reverse shoulder arthroplasty (RSA) with the fully-constrained, less-medialised, Bayley-Walker prosthesis performed for the treatment of rotator-cuff-deficient shoulders with glenohumeral arthritis. A total of 97 arthroplasties in 92 patients (53 women and 44 men, mean age 67 years (standard deviation (sd) 10, (49 to 85)) were retrospectively reviewed at a mean follow-up of 50 months ((sd 25) (24 to 96)). The mean Oxford shoulder score and subjective shoulder value improved from 47 (sd 9) and 24 points (sd 18) respectively before surgery to 28 (sd 11) and 61 (sd 24) points after surgery (p < 0.001). The mean pain at rest decreased from 5.3 (sd 2.8) to 1.5 (sd 2.3) (p < 0.001). The mean active forward elevation and external rotation increased from 42(°)(sd 30) and 9(°) (sd 15) respectively pre-operatively to 78(°) (sd 39) and 24(°) (sd 17) post-operatively (p < 0.001). A total of 20 patients required further surgery for complications; 13 required revision of components. No patient developed scapular notching. The Bayley-Walker prosthesis provides reliable pain relief and reasonable functional improvement for patients with symptomatic cuff-deficient shoulders. Compared with other designs of RSA, it offers a modest improvement in forward elevation, but restores external rotation to some extent and prevents scapular notching. A longer follow-up is required to assess the survival of the prosthesis and the clinical performance over time. PMID:24986948

Middleton, C; Uri, O; Phillips, S; Barmpagiannis, K; Higgs, D; Falworth, M; Bayley, I; Lambert, S

2014-07-01

185

Oxidized Regenerated Cellulose Resembling Vaginal Cuff Abscess  

PubMed Central

Introduction: Application of oxidized regenerated cellulose is commonly performed in laparoscopy to achieve hemostasis during surgery. The appearance of an abscess resembles oxidized regenerated cellulose, causing imaging studies to be difficult to interpret. Case Description: We describe the cases of 3 patients who underwent oxidized regenerated cellulose placement during laparoscopic gynecologic surgery. They subsequently presented with signs and symptoms resembling an abscess. Computed tomographic imaging can be challenging to interpret in such cases; radiologic findings can be used to differentiate between the characteristics of oxidized regenerated cellulose and those of abscess formation on the vaginal cuff. Discussion: Oxidized regenerated cellulose has an appearance that often mimics postsurgical abscess formation. There are distinct characteristics that distinguish both findings. It is essential that patients' records accurately describe the presence and location of regenerated oxidized cellulose when placed intraoperatively, and this information must be relayed to the interpreting radiologist to facilitate medical diagnosis and guide clinical management. PMID:24960506

Harkins, Gerald; Dykes, Thomas; Gockley, Allison; Davies, Matthew

2014-01-01

186

Surgery  

MedlinePLUS

... for ENews Home > Lung Disease > COPD > Treating COPD Surgery Some COPD patients with very severe symptoms may ... lung surgery. Are You a Candidate for Lung Surgery? Some people with COPD have improved lung function ...

187

Shoulder Impingement/Rotator Cuff Tendinitis  

MedlinePLUS

... focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have di? culty reaching behind your back, you may have developed ... shoulder). Speci? c stretching of the posterior capsule can be very e? ...

188

Rotator Cuff Tears: Surgical Treatment Options  

MedlinePLUS

... time, sti? ness will improve with more aggressive therapy and exercise. • Tendon re-tear. There is a chance for re-tear following ... of re-tear. Patients who re-tear their tendons usually do not have greater pain or decreased shoulder function. ... .org Page ( 5 ) AAOS does not ...

189

Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique  

PubMed Central

Summary Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

De Cupis, Vincenzo; De Cupis, Mauro

2012-01-01

190

Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique.  

PubMed

Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

De Cupis, Vincenzo; De Cupis, Mauro

2012-04-01

191

21 CFR 870.1120 - Blood pressure cuff.  

Code of Federal Regulations, 2013 CFR

... 2013-04-01 2013-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

2013-04-01

192

21 CFR 870.1120 - Blood pressure cuff.  

... 2014-04-01 2014-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

2014-04-01

193

21 CFR 870.1120 - Blood pressure cuff.  

Code of Federal Regulations, 2010 CFR

... 2010-04-01 2010-04-01 false Blood pressure cuff. 870.1120 Section 870...Cardiovascular Diagnostic Devices § 870.1120 Blood pressure cuff. (a) Identification. A blood pressure cuff is a device that has...

2010-04-01

194

Long-Term Efficacy and Rotational Stability of AcrySof Toric Intraocular Lens Implantation in Cataract Surgery  

PubMed Central

Purpose To evaluate the long-term efficacy and rotational stability of the AcrySof toric intraocular lens (IOL) in correcting preoperative astigmatism in cataract patients. Methods This prospective observational study included 30 eyes from 24 consecutive patients who underwent implantation of an AcrySof toric IOL with micro-coaxial cataract surgery between May 2008 and September 2008. Outcomes of visual acuity, refractive and keratometric astigmatism, and IOL rotation after 1 day, 1 month, 3 months, and long-term (mean, 13.3±5.0 months) follow-up were evaluated. Results At final follow-up, 73.3% of eyes showed an uncorrected visual acuity of 20/25 or better. The postoperative keratometric value was not different from the preoperative value; mean refractive astigmatism was reduced to -0.28±0.38 diopter (D) from -1.28±0.48 D. The mean rotation of the toric IOL was 3.45±3.39 degrees at final follow-up. One eye (3.3%) exhibited IOL rotation of 10.3 degrees, the remaining eyes (96.7%) had IOL rotation of less than 10 degrees. Conclusions Early postoperative and long-term follow-up showed that implantation of the AcrySof toric IOL is an effective, safe, and predictable method for managing corneal astigmatism in cataract patients. PMID:20714383

Kim, Myung Hun; Chung, Tae-Young

2010-01-01

195

Vaginal cuff dehiscence after vaginal cuff brachytherapy for uterine cancer. A case report  

PubMed Central

Vaginal cuff dehiscence is a rare, but potentially serious complication after total hysterectomy. We report a case of vaginal cuff dehiscence after vaginal cuff brachytherapy. A 62 year old female underwent a robotic-assisted laparoscopic hysterectomy with bilateral salpingo-oophorectomy, and was found to have International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB endometrioid adenocarcinoma of the uterus. The patient was referred for adjuvant vaginal cuff brachytherapy. During the radiation treatment simulation, a computerized tomography (CT) of the pelvis showed abnormal position of the vaginal cylinder. She was found to have vaginal cuff dehiscence that required immediate surgical repair. Vaginal cuff dehiscence triggered by vaginal cuff brachytherapy is very rare with only one case report in the literature. PMID:24143152

Cattaneo, Richard; Bellon, Maria

2013-01-01

196

Rolling-cuff flexible bellows  

DOEpatents

A flexible connector apparatus used to join two stiff non-deformable members, such as piping, is described. The apparatus is provided with one or more flexible sections or assemblies each utilizing a bellows of a rolling cuff type connected between two ridge members, with the bellows being supported by a back-up ring, such that only the curved end sections of the bellows are unsupported. Thus, the bellows can be considered as being of a tube-shaped configuration and thus have high pressure resistance. The components of the flexible apparatus are sealed or welded one to another such that it is fluid tight.

Lambert, D.R.

1982-09-27

197

Continuous Measurement of Endotracheal Tube Cuff Pressure  

PubMed Central

Continuous monitoring and download of endotracheal tube cuff pressure for a 12-hour period were required to collect data for an ongoing program of research related to airway management of the critically ill patient. On the basis of reports from the anesthesia literature, continuous monitoring of cuff pressure via a traditional pressure transducer and monitor was identified as the best method to collect data. Although continuous pressure monitoring of many physiologic variables is routine in critical care settings, application of the technology to measurement of endotracheal tube cuff pressure has not been reported outside the operating room. The research team conducted bench testing and pilot testing in human subjects to establish feasibility, accuracy, and safety of continuous cuff pressure monitoring. Monitoring was feasible with stringent procedures applied to ensure safety. A bias of 0.5 cm H2O between continuous and intermittent measures was obtained in both in vitro and in vivo testing. PMID:18560292

Sole, Mary Lou; Aragon, Daleen; Bennett, Melody; Johnson, Randall L.

2012-01-01

198

Anatomical knowledge retention in third-year medical students prior to obstetrics and gynecology and surgery rotations.  

PubMed

Surgical anatomy is taught early in medical school training. The literature shows that many physicians, especially surgical specialists, think that anatomical knowledge of medical students is inadequate and nesting of anatomical sciences later in the clinical curriculum may be necessary. Quantitative data concerning this perception of an anatomical knowledge deficit are lacking, as are specifics as to what content should be reinforced. This study identifies baseline areas of strength and weakness in the surgical anatomy knowledge of medical students entering surgical rotations. Third-year medical students completed a 20-25-question test at the beginning of the General Surgery and Obstetrics and Gynecology rotations. Knowledge of inguinal anatomy (45.3%), orientation in abdominal cavity (38.8%), colon (27.7%), and esophageal varices (12.8%) was poor. The numbers in parentheses are the percentage of questions answered correctly per topic. In comparing those scores to matched test items from this cohort as first-year students in the anatomy course, the drop in retention overall was very significant (P = 0.009) from 86.9 to 51.5%. Students also scored lower in questions relating to pelvic organs (46.7%), urogenital development (54.0%), pulmonary development (17.8%), and pregnancy (17.8%). These data showed that indeed, knowledge of surgical anatomy is poor for medical students entering surgical clerkships. These data collected will be utilized to create interactive learning modules, aimed at improving clinically relevant anatomical knowledge retention. These modules, which will be available to students during their inpatient surgical rotations, connect basic anatomy principles to clinical cases, with the ultimate goal of closing the anatomical knowledge gap. PMID:24591485

Jurjus, Rosalyn A; Lee, Juliet; Ahle, Samantha; Brown, Kirsten M; Butera, Gisela; Goldman, Ellen F; Krapf, Jill M

2014-01-01

199

The influence of computer-assisted surgery on rotational, coronal and sagittal alignment in revision total knee arthroplasty  

PubMed Central

Background Despite good results of primary total knee arthroplasty (TKA), the number of revision total knee arthroplasties (rTKAs) is rising. Proper implant position is essential, since malposition leads to worse clinical outcome. In rTKA most anatomical landmarks have disappeared because of extensive bone loss, making it more difficult to adequately implant the knee prosthesis. In primary TKA, computer-assisted surgery (CAS) leads to better prosthetic alignment than mechanical navigation guides. Literature about the use of CAS in rTKA is scarce though, and the effect on rotational prosthetic alignment has not been investigated yet. Hence the primary objective of this study is to compare rotational prosthetic alignment when using CAS in rTKA compared to a mechanical navigation guide. Secondary objectives are to compare prosthetic alignment in the coronal and sagittal planes. It is hypothesized that CAS leads to better rotational, coronal and sagittal prosthetic alignment when used during rTKA. Methods/Design A prospective clinical intervention study with use of a historical control group will be conducted. Forty-four patients with a minimum age of 18 to be admitted for CAS-rTKA between September 2012 and September 2015 will be included in the intervention group. Forty-four patients with a minimum age of 18 who underwent rTKA with the use of a mechanical navigation guide between January 2002 and April 2012 will form the historical control group. Both groups will be matched according to gender and type of revision prosthesis. Rotational prosthesis alignment will be evaluated using a CT-scan of the knee joint. Discussion Proper implant position is essential, since malposition leads to worse clinical outcome. Several studies show a significantly positive influence of CAS on prosthetic alignment in primary TKA, but literature about the use of CAS in rTKA is limited. The purpose of this study is thus to investigate the influence of CAS during rTKA on postoperative prosthetic alignment, compared to mechanical navigation guides. Trial registration Netherlands National Trial Register NTR3512 PMID:24646028

2014-01-01

200

Prehospital endotracheal intubation; need for routine cuff pressure measurement?  

PubMed

In endotracheal intubation, a secured airway includes an insufflated cuff distal to the vocal cords. High cuff pressures may lead to major complications occurring after a short period of time. Cuff pressures are not routinely checked after intubation in the prehospital setting, dealing with a vulnerable group of patients. We reviewed cuff pressures after intubation by Helicopter Emergency Medical Services and paramedics noted in a dispatch database. Initial cuff pressures are almost all too high, needing adjustment to be in the safe zone. Dutch paramedics lack manometers and, therefore, only few paramedic intubations are followed by cuff pressure measurements. We recommend cuff pressure measurements after all (prehospital) intubations and, therefore, all ambulances need to be equipped with cuff manometers. PMID:23100319

Peters, Joost H; Hoogerwerf, Nico

2013-10-01

201

Rotationally actuated prosthetic helping hand  

NASA Technical Reports Server (NTRS)

A prosthetic device has been developed for below-the-elbow amputees. The device consists of a cuff, a stem, a housing, two hook-like fingers, an elastic band for holding the fingers together, and a brace. The fingers are pivotally mounted on a housing that is secured to the amputee's upper arm with the brace. The stem, which also contains a cam, is rotationally mounted within the housing and is secured to the cuff, which fits over the amputee's stump. By rotating the cammed stem between the fingers with the lower arm, the amputee can open and close the fingers.

Norton, William E. (inventor); Belcher, Jewell G., Jr. (inventor); Carden, James R. (inventor); West, Thomas W. (inventor)

1991-01-01

202

A retrospective analysis of 509 consecutive interscalene catheter insertions for ambulatory surgery.  

PubMed

Effective pain therapy after shoulder surgery is the main prerequisite for safe management in an ambulatory setting. We evaluated adverse events and hospital re-admission using a database of 509 interscalene catheters inserted during ambulatory shoulder surgery. Adverse events were recorded for 34 (6.7%) patients (9 (1.8%) catheter dislocations diagnosed in the recovery room, 9 (1.8%) catheter dislocations at home with pain, 2 (0.4%) pain without catheter dislocation, 1 (0.2%) 'secondary' pneumothorax without intervention and 13 (2.6%) other). Twelve (2.4%) patients were re-admitted to hospital (8 (1.6%) for pain, 2 (0.4%) for dyspnoea and 2 (0.4%) for nausea and vomiting), 9 of whom had rotator cuff repair. A well-organised infrastructure, optimally trained medical professionals and appropriate patient selection are the main prerequisites for the safe, effective implementation of ambulatory interscalene catheters in routine clinical practice. PMID:25209310

Marhofer, P; Anderl, W; Heuberer, P; Fritz, M; Kimberger, O; Marhofer, D; Klug, W; Blasl, J

2015-01-01

203

Baby cuff as a reason for laryngeal mask airway cuff malfunction during airway management for anesthesia  

PubMed Central

Placement of laryngeal mask airway (LMA) is a blind procedure without requiring laryngoscopy. The reported success rate for LMA insertion at the first attempt is almost 95%; however, many functioning LMAs may not be in an ideal anatomic place. It seems that disposable LMAs have more stable cuff pressure compared to reusable LMAs; therefore, Anesthesiologists should bear in mind this fact when using reusable LMAs to achieve a proper sealing and safe airway management. In this report, we introduced a case with malfunction of LMA cuff during the airway management. PMID:25191199

Panahi, Jafar Rahimi; Mahmoodpoor, Ata; Golzari, Samad E. J.; Soleimanpour, Hassan

2014-01-01

204

Comprehensive Approach to Arthroscopic Rotator Cuff Repair: Options and Techniques  

MedlinePLUS

... feel better, but it's an individualized process of decision-making. 00:03:46 LAURENCE D. HIGGINS, MD: But ... been -- that have occurred have been my own making, and that had to ... things that are surgeoncontrolled factors. Now you look here you see very nicely ...

205

Effect of tear size, corticosteroids and subacromial decompression surgery on the hierarchical structural properties of torn supraspinatus tendons  

PubMed Central

Objectives The effects of disease progression and common tendinopathy treatments on the tissue characteristics of human rotator cuff tendons have not previously been evaluated in detail owing to a lack of suitable sampling techniques. This study evaluated the structural characteristics of torn human supraspinatus tendons across the full disease spectrum, and the short-term effects of subacromial corticosteroid injections (SCIs) and subacromial decompression (SAD) surgery on these structural characteristics. Methods Samples were collected inter-operatively from supraspinatus tendons containing small, medium, large and massive full thickness tears (n = 33). Using a novel minimally invasive biopsy technique, paired samples were also collected from supraspinatus tendons containing partial thickness tears either before and seven weeks after subacromial SCI (n = 11), or before and seven weeks after SAD surgery (n = 14). Macroscopically normal subscapularis tendons of older patients (n = 5, mean age = 74.6 years) and supraspinatus tendons of younger patients (n = 16, mean age = 23.3) served as controls. Ultra- and micro-structural characteristics were assessed using atomic force microscopy and polarised light microscopy respectively. Results Significant structural differences existed between torn and control groups. Differences were identifiable early in the disease spectrum, and increased with increasing tear size. Neither SCI nor SAD surgery altered the structural properties of partially torn tendons seven weeks after treatment. Conclusions These findings may suggest the need for early clinical intervention strategies for torn rotator cuff tendons in order to prevent further degeneration of the tissue as tear size increases. Further work is required to establish the long-term abilities of SCI and SAD to prevent, and even reverse, such degeneration. Cite this article: Bone Joint Res 2014;3:252–61. PMID:25106417

Tilley, J. M. R.; Murphy, R. J.; Chaudhury, S.; Czernuszka, J. T.; Carr, A. J.

2014-01-01

206

Magnitude of Interfractional Vaginal Cuff Movement: Implications for External Irradiation  

SciTech Connect

Purpose: To quantify the extent of interfractional vaginal cuff movement in patients receiving postoperative irradiation for cervical or endometrial cancer in the absence of bowel/bladder instruction. Methods and Materials: Eleven consecutive patients with cervical or endometrial cancer underwent placement of three gold seed fiducial markers in the vaginal cuff apex as part of standard of care before simulation. Patients subsequently underwent external irradiation and brachytherapy treatment based on institutional guidelines. Daily megavoltage CT imaging was performed during each external radiation treatment fraction. The daily positions of the vaginal apex fiducial markers were subsequently compared with the original position of the fiducial markers on the simulation CT. Composite dose-volume histograms were also created by summing daily target positions. Results: The average ({+-} standard deviation) vaginal cuff movement throughout daily pelvic external radiotherapy when referenced to the simulation position was 16.2 {+-} 8.3 mm. The maximum vaginal cuff movement for any patient during treatment was 34.5 mm. In the axial plane the mean vaginal cuff movement was 12.9 {+-} 6.7 mm. The maximum vaginal cuff axial movement was 30.7 mm. In the craniocaudal axis the mean movement was 10.3 {+-} 7.6 mm, with a maximum movement of 27.0 mm. Probability of cuff excursion outside of the clinical target volume steadily dropped as margin size increased (53%, 26%, 4.2%, and 1.4% for 1.0, 1.5, 2.0, and 2.5 cm, respectively.) However, rectal and bladder doses steadily increased with larger margin sizes. Conclusions: The magnitude of vaginal cuff movement is highly patient specific and can impact target coverage in patients without bowel/bladder instructions at simulation. The use of vaginal cuff fiducials can help identify patients at risk for target volume excursion.

Ma, Daniel J. [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Michaletz-Lorenz, Martha [Department of Education and Training, Elekta, Maryland Heights, MO (United States); Goddu, S. Murty [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Grigsby, Perry W., E-mail: pgrigsby@wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO (United States)

2012-03-15

207

Return to Sport Following Shoulder Surgery in the Elite Pitcher  

PubMed Central

Context: The ability to return to elite pitching, performance, and clinical outcomes of shoulder surgery in elite baseball pitchers are not definitively established. Objective: To determine (1) the rate of return to sport (RTS) in elite pitchers following shoulder surgery, (2) postoperative clinical outcomes upon RTS, and (3) performance upon RTS and to compare RTS rates in different types of shoulder surgery. Data Sources: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched. Study Selection: Levels I-IV evidence were eligible for inclusion if performance-based (eg, RTS) and/or clinical outcome–based reporting of outcomes were reported following surgical treatment of shoulder pathology in elite pitchers (major or minor league or collegiate). Data Extraction: Subject, shoulder, and pre- and postoperative performance-based variables of interest were extracted. All shoulder surgery types were potentially inclusive (eg, open, arthroscopic, rotator cuff, labrum, biceps, acromioclavicular joint, fracture). Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS). Results: Six studies were analyzed (287 elite male pitchers [mean age, 27 years] who underwent shoulder surgery, with 99% on the dominant, throwing shoulder). MCMS was 38 (poor). Most pitchers were professional, with a mean career length of 6.58 years and postoperative clinical follow-up of 3.62 years. In 5 of 6 studies, multiple diagnoses were addressed concomitantly at surgery. Rate of RTS was 68% at mean 12 months following surgery. Twenty-two percent of Major League Baseball (MLB) pitchers never RTS in MLB. Overall performance did improve following surgery; however, this did not improve to pre-injury levels. Conclusion: In this systematic review, the rate of return to elite baseball pitching following surgery was established. Performance tended to decrease prior to surgery and gradually improve postoperatively, though not reaching pre-injury levels of pitching. Level of Evidence: IV (systematic review of studies level I-IV evidence), therapeutic. PMID:24459557

Harris, Joshua D.; Frank, Jonathan M.; Jordan, Mark A.; Bush-Joseph, Charles A.; Romeo, Anthony A.; Gupta, Anil K.; Abrams, Geoffrey D.; McCormick, Frank M.; Bach, Bernard R.

2013-01-01

208

Fresh Frozen Plasma in Pump Priming for Congenital Heart Surgery: Evaluation of Effects on Postoperative Coagulation Profiles Using a Fibrinogen Assay and Rotational Thromboelastometry  

PubMed Central

Purpose In this prospective study, the effects of fresh frozen plasma (FFP) included in pump priming for congenital heart surgery in infants and children on post-bypass coagulation profiles were evaluated. Materials and Methods Either 20% albumin (50-100 mL) or FFP (1-2 units) was added to pump priming for patients randomly allocated into control or treatment groups, respectively. Hematologic assays, including functional fibrinogen level, and rotational thromboelastometry (ROTEM®) were measured before skin incision (baseline), after weaning from cardiopulmonary bypass (CPB) and heparin reversal, and at 24 hours (h) in the intensive care unit (ICU). Results All the baseline measurements were comparable between the control and treatment groups of infants and children. After heparin reversal, however, significantly higher fibrinogen levels and less reduced ROTEM parameters, which reflect clot formation and firmness, were demonstrated in the treatment groups of infants and children. At 24 h in the ICU, hematologic assays and ROTEM measurements were comparable between the control and treatment groups of infants and children. Transfusion requirements, excluding FFP in pump prime, and postoperative bleeding were comparable between the control and treatment groups of infants and children. Conclusion Although clinical benefits were not clearly found, the inclusion of FFP in pump priming for congenital heart surgery in infants and children was shown to improve the hemodilution-related hemostatic dysfunction immediately after weaning from CPB and heparin reversal. PMID:23549826

Lee, Jong Wha; Yoo, Young-Chul; Park, Han Ki; Bang, Sou-Ouk; Lee, Ki-Young

2013-01-01

209

The changes of endotracheal tube cuff pressure by the position changes from supine to prone and the flexion and extension of head  

PubMed Central

Background The proper cuff pressure is important to prevent complications related to the endotracheal tube (ETT). We evaluated the change in ETT cuff pressure by changing the position from supine to prone without head movement. Methods Fifty-five patients were enrolled and scheduled for lumbar spine surgery. Neutral angle, which was the angle on the mandibular angle between the neck midline and mandibular inferior border, was measured. The initial neutral pressure of the ETT cuff was measured, and the cuff pressure was subsequently adjusted to 26 cmH2O. Flexed or extended angles and cuff pressure were measured in both supine and prone positions, when the patient's head was flexed or extended. Initial neutral pressure in prone was compared with adjusted neutral pressure (26 cmH2O) in supine. Flexed and extended pressure were compared with adjusted neutral pressure in supine or prone, respectively. Results There were no differences between supine and prone position for neutral, flexed, and extended angles. The initial neutral pressure increased after changing position from supine to prone (26.0 vs. 31.5 ± 5.9 cmH2O, P < 0.001). Flexed and extended pressure in supine were increased to 38.7 ± 6.7 (P < 0.001) and 26.7 ± 4.7 cmH2O (not statistically significant) than the adjusted neutral pressure. Flexed and extended pressure in prone were increased to 40.5 ± 8.8 (P < 0.001) and 29.9 ± 8.7 cmH2O (P = 0.002) than the adjusted neutral pressure. Conclusions The position change from supine to prone without head movement can cause a change in ETT cuff pressure.

Kim, Deokkyu; Jeon, Byeongdo; Son, Ji-Seon; Lee, Jun-Rae; Ko, Seonghoon

2015-01-01

210

Descriptive Report of Shoulder Range of Motion and Rotational Strength Six and 12 Weeks Following Arthroscopic Superior Labral Repair  

PubMed Central

Objectives To measure short-term post surgery glenohumeral internal and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following arthroscopic superior labral (SLAP) repair. Background Physical therapists provide rehabilitation for patients following arthroscopic repair of the superior labrum. Little research has been published regarding the short-term results of this procedure while the patient is typically under the direct care of the physical therapist. Methods Charts from 39 patients (7 females and 32 males) with a mean age of 43.4±14.9 years following SLAP repair were reviewed. All patients underwent rehabilitation by the same therapist using a standardized protocol and were operated on and referred by the same orthopaedic surgeon. Retrospective chart review was performed to obtain descriptive profiles of shoulder ROM at 6 and 12 weeks post surgery and isokinetically documented internal and external rotation strength 12 weeks post surgery. Results At 12 weeks post-surgery, involved shoulder flexion, abduction, and external rotation active ROM values were 2-6 degrees greater than the contralateral, non-involved extremity. Isokinetic internal and external rotation strength deficits of 7-11% were found as compared to the uninjured extremity. Patients completed the self-report section of the Modified American Shoulder Elbow Surgeons Rating Scale and scored a mean of 37/45 points. Conclusion The results of this study provide objective data for both glenohumeral joint ROM and rotator cuff strength following superior labral repair at time points during which the patient is under the direct care of the physical therapist. These results show a nearly complete return of active ROM and muscular strength following repair of the superior labrum and post-operative physical therapy. PMID:21509132

Sueyoshi, Tetsuro; Winters, Matthew; Zeman, David

2008-01-01

211

Severe, Steroid-responsive, Myositis Mimicking Necrotizing Fasciitis following Orthopedic Surgery: A Pyoderma Variant with Myonecrosis  

PubMed Central

Summary: Postoperative pyoderma gangrenosum is a rare neutrophilic dermatosis that may be confused for necrotizing fasciitis. The inflammatory response is triggered by the trauma of surgery and thus must be managed nonsurgically. Clinical and pathological findings in the 2 diseases can be identical, leading to misdiagnosis and massive surgical defects from the ensuing surgery. This report documents a severe case of postsurgical pyoderma following an elective rotator cuff repair presenting with myositis and myonecrosis. The patient was initially treated as having an infection, which resulted in multiple aggressive surgical debridements. Despite this, the patient continued to deteriorate and was in a critical and hemodynamically unstable condition. Following administration of high-dose intravenous corticosteroids, the patient made a dramatic recovery and went on to have internal fixation of the shoulder and closure of the wound with a combination of a free flap and a rotational flap. Extensive myositis, as seen in this case, has not been previously reported in postoperative pyoderma gangrenosum variants. Clinicians should be aware that the presence of myositis and myonecrosis should not preclude this diagnosis. PMID:25289368

Stanley, Peter; Grinsell, Damien; Daffy, John R.

2014-01-01

212

What went wrong and what was done about it: pitfalls in the treatment of common shoulder surgery.  

PubMed

When performing revision shoulder surgery, it is important that the surgeon understands why the index procedure failed and has a clear plan to address problems in the revision procedure. The most common cause of failure after anterior instability shoulder surgery is a failure to treat the underlying glenoid bone loss. For most defects, a Latarjet transfer can effectively restore anterior glenoid bone stock and restore shoulder stability. Persistent anterior shoulder pain after rotator cuff surgery may be the result of missed biceps pathology. This can be effectively treated via a biceps tenodesis. The most difficult failures to treat after acromioclavicular joint reconstruction surgery are those involving fractures of either the coracoid or the clavicle. Clavicle hook plates can be used as supplemental fixation during the treatment of these fractures to help offload the fracture site and allow healing while restoring stability to the acromioclavicular articulation. A failed hemiarthroplasty for a proximal humeral fracture frequently results when the tuberosities fail to heal correctly. This complication can be avoided by paying close attention to the implant position and the tuberosity fixation. If hemiarthroplasty is unsuccessful, the patient is best treated with conversion to a reverse shoulder arthroplasty. PMID:24720296

Wiesel, Brent B; Gartsman, Gary M; Press, Cyrus M; Spencer, Edwin E; Morris, Brent J; Zuckerman, Joseph D; Roghani, Reza; Williams, Gerald R

2014-01-01

213

Training general surgery residents in pediatric surgery: educational value vs time and cost  

Microsoft Academic Search

BackgroundThis study evaluated the educational value of pediatric surgery rotations, the likelihood of performing pediatric operations upon completing general surgery (GS) residency, and time and cost of training GS residents in pediatric surgery.

Steven L. Lee; Roman M. Sydorak; Harry Applebaum

2009-01-01

214

Leakage of fluid around endotracheal tube cuffs: a cadaver study  

PubMed Central

Background The aim of the study was to evaluate the leakage of liquid past the cuffs of tracheal tubes in fresh frozen human heads. Methods Six truncated fresh frozen heads were used and intubated with 8.0 mm endotracheal tubes. The intracuff pressures tested were 30 and 100 cmH2O. Subsequently, 20 ml of each of two oral antiseptic rinses (0.2% chlorhexidine and octenidine [octenidol®, Schülke & Mayr GmbH, Norderstedt, Germany]) was applied for thirty seconds in the mouth. During the trial, leakage of the cuffs was examined. Results The sealing between the tracheal cuff and tracheal wall was leakage-proof for all tested intracuff pressures and all tested antiseptic rinses. However, approximately 5.6 ml and 1.8 ml leaked into the esophagus and remained as a cuff-puddle, respectively. Conclusions The sealing between an endotracheal tube cuff with an intracuff pressure of 30 cmH2O and the tracheal wall is leakage-proof during oral care with antiseptic rinsing. An increase of intracuff pressure to 100 cmH2O does not appear to be required. PMID:24363847

Lucius, Ralph; Ewald, Kristian

2013-01-01

215

Tracheal tube cuff inflation guided by pressure volume loop closure associated with lower postoperative cuff-related complications: Prospective, randomized clinical trial  

PubMed Central

Background: The main function of an endotracheal tube (ETT) cuff is to prevent aspiration. High cuff pressure is usually associated with postoperative complications. We tried to compare cuff inflation guided by pressure volume loop closure (PV-L) with those by just to seal technique (JS) and assess the postoperative incidence of sore throat, cough and hoarseness. Materials and Methods: In a prospective, randomized clinical trial, 100 patients’ tracheas were intubated. In the first group (n = 50), ETT cuff inflation was guided by PV-L, while in the second group (n. = 50) the ETT cuff was inflated using the JS technique. Intracuff pressures and volumes were measured. The incidence of postoperative cuff-related complications was reported. Results: Demographic data and durations of intubation were comparable between the groups. The use of PV-L was associated with a lesser amount of intracuff air [4.05 (3.7-4.5) vs 5 (4.8-5.5), P < 0.001] and lower cuff pressure than those in the JS group [18.25 (18-19) vs 33 (32-35), P ? 0.001]. The incidence of postextubation cuff-related complications was significantly less frequent among the PV-L group patients as compared with the JS group patients (P ? 0.009), except for hoarseness of voice, which was less frequent among the PV-L group, but not statistically significant (P ? 0.065). Multiple regression models for prediction of intra-cuff pressure after intubation and before extubation revealed a statistically significant association with the technique used for cuff inflation (P < 0.0001). Conclusions: The study confirms that PV-L-guided ETT cuff inflation is an effective way to seal the airway and associates with a lower ETT cuff pressure and lower incidence of cuff-related complications. PMID:25191181

Almarakbi, Waleed A.; Kaki, Abdullah M.

2014-01-01

216

Considering Surgery?  

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... to happen before, during, and after surgery. Outpatient Surgery Outpatient surgery, sometimes called same-day surgery, is ... outpatient surgery is right for you. Planning for Surgery There are many steps you can take to ...

217

Fluid leakage across tracheal tube cuff, effect of different cuff material, shape, and positive expiratory pressure: a bench-top study  

Microsoft Academic Search

Purpose  Standard polyvinylchloride (PVC) endotracheal tube (ETT) cuffs do not protect from aspiration across the cuff, a leading cause\\u000a of ventilator-associated pneumonia (VAP). In a long-lasting in vitro study we compared the effect of different cuff materials\\u000a (PVC, polyurethane, and guayule latex), shapes (cylindrical, conical), and positive end expiratory pressures (PEEP) in reducing\\u000a fluid leakage across the cuff.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We compared fluid

Alberto Zanella; Vittorio Scaravilli; Stefano Isgrò; Manuela Milan; Massimo Cressoni; Nicolò Patroniti; Roberto Fumagalli; Antonio Pesenti

2011-01-01

218

The evolution of artificial sphincter cuff in growing animals.  

PubMed

An animal model was developed to simulate the effect of implantation of artificial sphincter cuff on the urethra in children. The study was conducted on 28 pigs, 15 castrated males, four uncastrated males and nine females, divided into four groups: control unoperated, and three operated groups. Group I contained young piglets (castrated males, uncastrated males and females), group II contained adult animals and group III contained sham operated animals. An AS 800 belt occlusion cuff was implanted in the deflated state distal to the bladder neck around the urethra in the young and adult groups, while no sphincter was implanted in the sham group. Neither primary nor secondary activation was done. The pigs were followed for a period of six to eight weeks and then sacrificed. The morphological and histological observations on the effects of the artificial sphincter cuff on the underlying urethral tissue showed significant transmural atrophy of the urethral and prostatic segment underlying the cuff in the young growing castrated and uncastrated male group with mild changes in the young female group. Bladder rupture occurred in three uncastrated males. There were no changes encountered in the adult or sham operated groups. Variable degrees of upper tract changes and renal deterioration were seen in the young group. These changes occurred mainly in the male piglets while a lesser degree occurred in the female piglets. No changes were demonstrated in the adult and sham groups. This study suggests the possibility of similar changes occurring in young male children who have undergone artificial sphincter implantation. PMID:3411693

Mokhless, I; Hassouna, M M; Kiruluta, G H; Seemeyer, T A; Homsy, Y L; Coolsaet, B L; Elhilali, M M

1988-09-01

219

Cosmetic Surgery  

MedlinePLUS

... Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

220

Dose-Response Evaluation of Braslet-M Occlusion Cuffs  

NASA Technical Reports Server (NTRS)

Introduction: Braslet-M is a set of special elasticized thigh cuffs used by the Russian space agency to reduce the effects of the head-ward fluid shift during early adaptation to microgravity by sequestering fluid in the lower extremities. Currently, no imaging modalities are used in the calibration of the device, and the pressure required to produce a predictable physiological response is unknown. This investigation intends to relate the pressure exerted by the cuffs to the extent of fluid redistribution and commensurate physiological effects. Materials and Methods: Ten healthy subjects with standardized fluid intake participated in the study. Data collection included femoral and internal jugular vein imaging in two orthogonal planes, pulsed Doppler of cervical and femoral vessels and middle cerebral artery, optic nerve imaging, and echocardiography. Braslet-M cuff pressure was monitored at the skin interface using pre-calibrated pressure sensors. Using 6 and 30 head-down tilt in two separate sessions, the effect of Braslet-M was assessed while incrementally tightening the cuffs. Cuffs were then simultaneously released to document the resulting hemodynamic change. Results: Preliminary analysis shows correlation between physical pressure exerted by the Braslet-M device and several parameters such as jugular and femoral vein cross-sections, resistivity of the lower extremity vascular bed, and others. A number of parameters reflect blood redistribution and will be used to determine the therapeutic range of the device and to prevent unsafe application. Conclusion: Braslet-M exerts a physical effect that can be measured and correlated with many changes in central and peripheral hemodynamics. Analysis of the full data set will be required to make definitive recommendations regarding the range of safe therapeutic application. Objective data and subjective responses suggest that a safer and equally effective use of Braslet can be achieved when compared with the current non-imaging calibration techniques.

Ebert, Douglas; Garcia, Kathleen; Sargsyan, Ashot E.; Ham, David; Hamilton, Douglas; Dulchavsky, Scott A.

2010-01-01

221

Comparative effects of cuff size and tightness of fit on accuracy of blood pressure measurements  

Microsoft Academic Search

To determine the effect of snugness of cuff wrap on the accuracy of blood pressure (BP) measurements, we performed two studies\\u000a on 6 healthy volunteers. In both studies, control values were obtained from the right upper arm with cuffs of appropriate\\u000a size and snug fit. Study 1 had two phases. In the first, cuffs of appropriate size were wrapped snugly

Tina E. Banner; J. S. Gravenstein

1991-01-01

222

Lung surgery  

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... Lung tissue removal; Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... do surgery on your lungs are thoracotomy and video-assisted thoracoscopic surgery (VATS). Lung surgery using a ...

223

Rhabdomyosarcoma: Surgery  

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... is rhabdomyosarcoma treated? Next Topic Chemotherapy for rhabdomyosarcoma Surgery for rhabdomyosarcoma Surgery is an important part of ... be done at all. What to expect with surgery The type and extent of surgery can vary ...

224

Neuroblastoma: Surgery  

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... neuroblastoma treated? Next Topic Chemotherapy for neuroblastoma Neuroblastoma surgery Surgery can be used both to help diagnose ... long, thin instruments and remove pieces of tumor. Surgery as treatment After neuroblastoma is diagnosed, surgery is ...

225

Cataract Surgery  

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... Cataract Vision Simulator Pre-operative tests for cataract surgery Before surgery, the length of your eye will ... calculate the correct IOL power. Medications and cataract surgery If you are having cataract surgery, be sure ...

226

Ultrasonic blood flow measurements: transcutaneous compared with implanted cuff.  

PubMed

Experiments were undertaken in our laboratory to establish relationships between flow parameters calculated from implanted ultrasonic cuff signals and those obtained with a transcutaneous probe. Analog signals were received from crystals surgically implanted on the right carotid, right femoral, and abdominal aorta of a mature male beagle dog. Near these locations, transcutaneous measurements were made using a prescribed technique. From these ultrasonic signals, the following time dependent flow parameters were calculated: spatial velocities, velocity profiles, diameters, flows, and velocity frequency distributions. Using these measurements, a comparison between the implanted cuff and transcutaneous probe was made. In addition to high reproductibility, results confirm a strong correlation between the two techniques; consequently, the validity of the less traumatic transcutaneous method is substantiated. PMID:950285

Greene, E R; Histand, M B; Miller, C W

1976-01-01

227

Evaluation of an Intervention to Maintain Endotracheal Tube Cuff Pressure Within Therapeutic Range  

PubMed Central

Background Endotracheal tube cuff pressure must be kept within an optimal range that ensures ventilation and prevents aspiration while maintaining tracheal perfusion. Objectives To test the effect of an intervention (adding or removing air) on the proportion of time that cuff pressure was between 20 and 30 cm H2O and to evaluate changes in cuff pressure over time. Methods A repeated-measure crossover design was used to study 32 orally intubated patients receiving mechanical ventilation for two 12-hour shifts (randomized control and intervention conditions). Continuous cuff pressure monitoring was initiated, and the pressure was adjusted to a minimum of 22 cm H2O. Caregivers were blinded to cuff pressure data, and usual care was provided during the control condition. During the intervention condition, cuff pressure alarm or clinical triggers guided the intervention. Results Most patients were men (mean age, 61.6 years). During the control condition, 51.7% of cuff pressure values were out of range compared with 11.1% during the intervention condition (P < .001). During the intervention, a mean of 8 adjustments were required, mostly to add air to the endotracheal tube cuff (mean 0.28 [SD, 0.13] mL). During the control condition, cuff pressure decreased over time (P < .001). Conclusions The intervention was effective in maintaining cuff pressure within an optimal range, and cuff pressure decreased over time without intervention. The effect of the intervention on outcomes such as ventilator-associated pneumonia and tracheal damage requires further study. PMID:21362715

Sole, Mary Lou; Su, Xiaogang; Talbert, Steve; Penoyer, Daleen Aragon; Kalita, Samar; Jimenez, Edgar; Ludy, Jeffery E.; Bennett, Melody

2012-01-01

228

Arthroscopic double row cuff repair with suture-bridging and autologous conditioned plasma injection: Functional and structural results  

PubMed Central

Purpose: The double row cuff repair with suture bridging is commonly used for arthroscopic rotator cuff repair (RCR). Despite its biomechanical qualities, the rate of iterative tears with this technique is important. The aim of our study was to evaluate the effect of autologous conditioned plasma (ACP) on functional results and on the rate of iterative tears after RCR by suture bridging. Materials and Methods: A consecutive series of 65 patients who underwent arthroscopic double-row suture bridge (Speed-Bridge, Arthrex) primary cuff repair of symptomatic full-thickness supraspinatus tear (retraction <3 in the Patte classification) were evaluated. Mean patient age was 60 (+/-8). The supraspinatus was repaired by knot-less bridging (SwiveLock, Arthrex) with suture tape material. 2 homogenous groups were created (A: 33 patients, B: 32 patients). In group A, all patients received, besides the cuff repair, an intra-tendinous ACP injection. Constant scores and Simple Shoulder Tests (SST) were measured pre-operatively and after a minimum follow-up period of 12 months post-operatively. Structural integrity of the repairs was evaluated by MRI according to the Sugaya classification. Sugaya >4 were considered as iterative tears. Results: Mean follow-up was 19 months (+/?42) in the 2 groups. The mean quantity of ACP injected was 6ml. (+/?1.5) and no specific complication of the injection was found. Mean preoperative Constant-Murley scores were 41,2 (±7,7) and 38 (±11)in group B. Mean normalized Constant-Murley score increased from 41 points (±7) pre-operatively to 70 points (±8) post-operatively in group A and from 38 points (±11) to 73 points (±11) in group B. There were no significative differences between the two groups (P > 0.05). In group A, 31 repairs were Sugaya 1-3 (94%), vs. 30 in group B (93%), and 1 was type 4 in group A (5%) vs. 2 in group B (8%). Conclusion: In both groups, RCR with suture bridging gave successful functional outcomes, with a low rate of iterative tear. In this preliminary study, the adjuvant effect of ACP injections could not be showed on both functional and structural results. Longer follow-up is needed to evaluate potential differences.

Werthel, Jean-David; Pelissier, Alexandre; Massin, Philippe; Boyer, Patrick; Valenti, Philippe

2014-01-01

229

Rotational thromboelastometry and multiple electrode platelet aggregometry in four patients with abnormal routine coagulation studies before removal of epidural catheters after major surgery: a case series and research study  

PubMed Central

Introduction Routine coagulation tests have a low predictability for perioperative bleeding complications, and spinal hematoma after removal of epidural catheters is very infrequent. Thromboelastometry and point-of-care platelet aggregometry may improve hemostatic monitoring but have not been studied in the context of safety around epidural removal. Methods Twenty patients who received an epidural catheter for major thoracoabdominal and abdominal surgery were included prospectively. In addition to routine coagulation tests, rotational thromboelastometry and multiple electrode platelet aggregometry were carried out. Results A coagulation deficit was suggested by routine coagulation tests on the intended day of epidural catheter removal in four out of 20 patients. Prothrombin time-international normalized ratio was elevated to 1.5 in one patient (normal range: 0.9 to 1.2) while rotational thromboelastometry and multiple electrode platelet aggregometry parameters were within normal limits. Activated partial thromboplastin time was elevated to 47 to 50 seconds in the remaining three patients (normal range 28 to 45 seconds). Rotational thromboelastometry showed that one of the patients’ results was due to heparin effect: the clotting time with the HEPTEM® activator was 154 seconds as compared to 261 seconds with INTEM. The three remaining patients with prolonged routine coagulation test results had all received over 1L of hydroxyethyl starch (Venofundin®) and thrombosis prophylaxis with low-molecular-weight heparin (enoxaparin). Rotational thromboelastometry and multiple electrode platelet aggregometrygave normal or hypercoagulative signals in most patients. Conclusions This case series is new in that it examines rotational thromboelastometry and multiple electrode platelet aggregometry postoperatively in the context of epidural analgesia and shows that they may be clinically useful. These methods should be validated before they can be used for standard patient care. PMID:24377397

2013-01-01

230

Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff.  

PubMed

Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15 mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27 mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3 min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup. PMID:24870932

Efrati, Shai; Deutsch, Israel; Weksler, Nathan; Gurman, Gabriel M

2015-02-01

231

Evaluation of tracheal cuff pressure variation in spontaneously breathing patients  

PubMed Central

Background: Most of the studies referring cuff tubes’ issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation. Objective: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center. Materials and Methods: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry. Results: In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings. Conclusion: The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently. PMID:24459624

Plotnikow, Gustavo A; Roux, Nicolas; Feld, Viviana; Gogniat, Emiliano; Villalba, Dario; Ribero, Noelia Vairo; Sartore, Marisa; Bosso, Mauro; Quiroga, Corina; Leiva, Valeria; Scrigna, Mariana; Puchulu, Facundo; Distéfano, Eduardo; Scapellato, Jose Luis; Intile, Dante; Planells, Fernando; Noval, Diego; Buñirigo, Pablo; Jofré, Ricardo; Nielsen, Ernesto Díaz

2013-01-01

232

Robotic surgery  

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Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

233

} Surgery 7 weeks } Medicine 7 weeks  

E-print Network

#12;} Surgery 7 weeks } Medicine 7 weeks } Pediatrics 7 weeks } OB-GYN 7 weeks } Psychiatry 7 weeks;} Medicine, Surgery, Pediatrics 8 weeks } OB-GYN, Family Med, Psychiatry 6 weeks } Elective block 6 weeks;} Educational and LCME concerns } Student wish for longer Medicine and Surgery rotations } National norms

Myers, Lawrence C.

234

[Isokinetic evaluation of external rotators and abductors of the shoulder before and after arthroscopic decompression of suprascapular nerve due to its neuropathy--preliminary report].  

PubMed

The paper presents results of objective isokinetic evaluation of shoulder abductors and external rotators peak torque in 4 cases (2 women and 2 men) suffering from suprascapular nerve neuropathy (SNN). The mean age of patients was 25 years. The clinical diagnosis of SSN involvement was confirmed by electromyographic study in all cases. The radiological, sonographic and additionally magnetic resonas (2 cases operated on) examinations proved the absence of bone and soft tissues pathologies (ganglion and rotator cuff). The arthroscopic decompression of SSN was done in 2 cases. Isokinetic evaluation (180 degrees/s) disclosed weakness of shoulder abductors and external rotators in all cases and decrease of side to side difference of their peak torque 6 months after surgery. The patients operated on refused control EMG evaluation since they experience complete pain relief and improvement of function. There were no complications. Arthroscopic suprascapular nerve decompression can be done safely and effectively in properly selected cases. The isokinetics offers objective pre and postoperative evaluation of muscles involved by SNN. PMID:18078284

Fabi?, Jaros?aw

2007-01-01

235

Cuff electrodes for very small diameter nerves - Prototyping and first recordings in vivo.  

PubMed

A fabrication method for cuff electrodes to interface small nerves was developed. Medical grade silicone rubber conforms the body of the cuff and insulation of the wires, platinum was used as metal for the embedded wiring and contacts. Planar electrode arrays where fabricated using a picosecond laser and then positioned into a carrying tube to provide the third dimension with the desired inner diameter (Ø 0.3-0.5 mm). The post preparation of the cuffs after structuring allows the fabrication of a stable self-closing flap that insulates the opening slit of the cuff without the need of extra sutures. Basic for the success of the cuff is the laser-based local thinning of both the silicone rubber and the metal at defined sections. This is critical to permit the PDMS' body to dominate the mechanical properties. Finite element modeling was applied to optimize the displacement ability of the cuff, leading to design capable of withstanding multiple implantation procedures without wire damage. Furthermore, the contact's surface was roughened by laser patterning to increase the charge injection capacity of Pt to 285 ?C/cm(2) measured by voltage transient detection during pulse testing. The cuff electrodes were placed on a small sympathetic nerve of an adult female Sprague-Dawley rat for recording of spontaneous and evoked neural activity in vivo. PMID:25571569

Ordonez, Juan S; Pikov, Victor; Wiggins, Harvey; Patten, Craig; Stieglitz, Thomas; Rickert, J; Schuettler, Martin

2014-08-01

236

Condensation of humidified air in the inflation line of a polyurethane cuff precludes correct continuous pressure monitoring during mechanical ventilation.  

PubMed

Within continuously controlled limits of cuff pressure, an endotracheal tube cuff made of polyurethane (PU) prevents secretion inflow better than a conventional polyvinylchloride cuff. However, the temperature difference between ventilator gas and the air inside a PU cuff produces condensation droplets that accumulate in the cuff inflation canal. We investigated whether condensation influenced continuous cuff pressure monitoring. A PU-cuffed tube was placed into an artificial trachea and connected to a ventilator and test lung. An additional line was inserted at the distal cuff end to directly measure pressure inside the cuff. Methylene blue instillation via the inflation line mimicked condensation. Inspiratory (Pinsp) and expiratory (Pexp) pressures were continuously recorded. Six consecutive experiments were performed comparing pressures at baseline (T0) and at 24 h (T24). Shortly after dye instillation, pressures recorded at the inflation canal became permanently fixed at 25 cmH2O. In contrast, pressures measured directly in the cuff progressively decreased (mean Pinsp 30 ± 3 vs. 20 ± 2 cmH2O and mean Pexp 25 ± 0 vs. 12 ± 2 cmH2O, T0 vs. T24, both P < 0.05). Thus, condensation in the inflation line of a PU-cuffed tube renders continuous cuff pressure monitoring unreliable, thereby increasing the risk for microaspiration. PMID:24854520

Spapen, Herbert; Moeyersons, Walter; Stiers, Wim; Desmet, Geert; Suys, Emiel

2014-12-01

237

Bone-prosthesis composite with rotating hinged-knee prosthesis in limb salvage surgery for high-grade sarcoma around the knee.  

PubMed

Bone prosthesis composite (BPC) had been widely-used in reconstruction after wide excision of malignant tumors around the knee. However, implant selection for BPC remains a dilemma. Forty-one patients with high-grade malignant bone tumors around the knee who underwent excision and reconstruction with BPC and rotating hinged knee (RHK) prosthesis were included. The mean follow-up time was 54months (range, 31-78months). The average Musculoskeletal Tumor Society Rating score was 93.4% (range, 73-100%). The mean range of motion was 125°. Complications included 2 local recurrences, 2 nonunions, and 1 peri-prosthetic fracture. The reconstruction with BPC using the RHK prosthesis provided consistently good functional results with a low complication rate. The RHK prosthesis is a promising choice for BPC reconstruction. PMID:25155237

Wang, Chien-Shun; Wu, Po-Kuei; Chen, Cheng-Fong; Chen, Wei-Ming; Liu, Chien-Lin; Chen, Tain-Hsiung

2015-01-01

238

US demographic trends in mid-arm circumference and recommended blood pressure cuffs: 1988–2002  

Microsoft Academic Search

Mid-arm circumference (AC) measurement is a prerequisite for the selection of properly sized blood pressure (BP) cuffs and accurate BP readings. This study examined trends in the frequency distribution of mid-AC and corresponding recommended BP cuff sizes using National Health and Nutrition Examination Survey (NHANES) III (1988–1994) and NHANES 1999–2002 data. Both surveys used a complex sample design to obtain

Y Ostchega; C Dillon; M Carroll; R J Prineas; M McDowell

2005-01-01

239

Reversed shoulder arthroplasty in cuff tear arthritis, fracture sequelae, and revision arthroplasty  

PubMed Central

Background and purpose Reversed shoulder arthroplasty may be used for severe arthropathy where conventional prostheses cannot restore the function sufficiently. We analyzed the medium–term results and potential complications of the reversed prostheses, and also the influence of etiology on the result. Methods 52 women and 7 men, average age 70 (60–82) years, were followed for mean 4 (2–7) years. The indications were cuff tear arthropathy (CTA) (23), fracture sequelae (20), and revision of a failed conventional arthroplasty (16). Results The average Constant score improved from 18 (2–55) points to 59 (17–96) points. It rose from 26 to 74 points in patients with CTA, from 12 to 48 in those with fracture sequelae, and from 10 to 54 points in revision arthroplasty. We also found an overall improvement in active forward flexion from 47° to 105°, and in active abduction from 46° to 93°. Scapular notching was seen in 51 shoulders. Radiolucent lines below the base–plate were present in 2 cases. There were no instances of loosening. Revisions were necessary in 15 patients: 5 with infections (all had had prior surgery), 5 with hematoma, 3 with dislocations, and 2 with disconnections of the shaft components. Interpretation Reversed prosthetic replacement is a suitable method for restoring function and attaining pain relief in severe arthropathies. The results in revision arthroplasty are less predictable, with complications and revision rates higher than those in CTA patients. The reversed prosthesis should therefore only be used when conventional methods have failed. PMID:20450427

Stechel, Annika; Fuhrmann, Uwe; Rott, Olaf; Irlenbusch, Ulrich

2010-01-01

240

Rodding Surgery  

MedlinePLUS

... and After Their Child is in the Hospital.” Potential Complications Rodding is major surgery, and as with any major surgical procedure, there are potential complications. Complications from surgery include risks related to ...

241

Sinus Surgery  

MedlinePLUS

... evaluation of chronic sinusitis. Sinus Surgical Options Include: Functional endoscopic sinus surgery (FESS): Developed in the 1950s, ... altered anatomical landmarks, or where a patient?s sinus anatomy is very unusual, making typical surgery difficult. Image ...

242

Plastic Surgery  

MedlinePLUS

... forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word "plastic" ... such treatments. Continue Why Do Teens Get Plastic Surgery? Most teens don't, of course. But some ...

243

Brain surgery  

MedlinePLUS

Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... Before surgery, the hair on part of the scalp is shaved and the area is cleaned. The doctor makes ...

244

Turbinate surgery  

MedlinePLUS

Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

245

Hemorrhoid Surgery  

MedlinePLUS Videos and Cool Tools

Hemorrhoid Surgery Introduction Swollen hemorrhoids are a common condition that affects millions of people. Your doctor may recommend a ... months later. Hemorrhoids could come back. After the Surgery Most patients go home the same day of ...

246

After Surgery  

MedlinePLUS

... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

247

Cardiac and vascular adaptation to 0g with and without thigh cuffs (Antares 14 and Altair 21 day Mir spaceflights)  

NASA Astrophysics Data System (ADS)

Cardiovascular Actaptation was evaluated on 2 astronauts: one wearing thigh cuffs from flight day 1 to 8 (14d flight), the second without cuffs (21d flight). Ultrasound investigations were performed at rest and during LBNP. Results: Without thigh cuffs the cardiovascular Actaptation consists in (1) the development of a hypovolemia with an increase of the heart rate and the cardiac output, (2) the decrease of the vascular tone in the deep (mesenteric and splanchnic) and peripheral (Lower limbs) vascular areas. The use of thigh cuffs maintains the volemia and the cardiac output at the preflight level (without heart rate increase) and prevents the loss of vascular tone in the deep and peripheral areas. Moreover the adaptative process changes since the cuffs are removed and even the volemia seems to be unaffected at this stage the vascular tone decreases to a comparable extend as during the flight without cuffs. Nevertheless during the flight without cuffs or 3 days after removing the cuffs hemodynamic signs of decreased orthostatic tolerance are present during the inflight and the 3 days post flight LBNP. Presently the possible contribution of the thigh cuffs to the reduction of the vascular deconditioning has not been tested yet.

Arbeille, Ph.; Fomina, G.; Achaibou, F.; Pottier, J.; Kotovskaya, A.

248

Clinical effects of thigh cuffs during a 7-day 6° head-down bed rest  

NASA Astrophysics Data System (ADS)

Thigh cuffs are used by Russian cosmonauts to limit the fluid shift induced by space flight. A ground simulation using the head-down bed rest (HDBR) model was performed to assess the effects of thigh cuffs on clinical tolerance and orthostatic adaptation. 8 male healthy volunteers (32.4±1.9 years) participated twice in a 7-day HDBR — one time with thigh cuffs (worm daily from 9 am to 7 pm) (TC) and one time without (WTC). Orthostatic tolerance was assessed by a 10 minute stand test and by a LBNP test (5 min at -15, -30, -45 mmHg) before (BDC-1) and at the end of the HDBR period (R+1). Plasma volume was measured before and at the end of HDBR by the Evans blue dye dilution technique. Thigh cuffs limits headache due to fluid shift, as well as the loss in plasma volume (TC: -5.85±0.95%; WTC: -9.09±0.82%, p<0.05). The mean duration of the stand test (R+1) did not differ in the two group (TC 7.1±1.3 min; WTC 7.0±1.0 min). The increase in HR and decrease in diastolic blood pressure were slightly but significantly larger without thigh cuffs. Duration of the LBNP tests did not differ with thigh cuffs. Thigh cuffs limit the symptoms due to fluid shift and the loss in plasma volume. They partly reduced the increase in HR during orthostatic stress but had no effect on duration of orthostatic stress tests.

Pavy-Le Traon, Anne; Maillet, Alain; Vasseur Clausen, Pascale; Custaud, Marc-Antoine; Alferova, Irina; Gharib, Claude; Fortrat, Jacques-Olivier

2001-08-01

249

Ineffectiveness of using the pressure relief valve technique during cuff inflation  

PubMed Central

Objective To test the effectiveness of using a cuff pressure relief valve technique to maintain cuff pressure levels within the normal in vitro range (Phase 1) in patients admitted to the intensive care unit (Phase 2) and to test the reproducibility of the technique using different syringes. Methods In Phase 1, a tracheal tube was inserted into a trachea model. Ten- and 20mL syringes were used to inflate the cuff through the tracheal tube. The cuff was slowly and steadily inflated until the syringe plunger would move in the opposite direction of the application. After the plunger stopped, the cuff pressures were recorded. In Phase 2, the same maneuvers for inflating the cuff were performed on 20 patients using 5, 10, and 20mL syringes and were compared with manometer measurements. The intraclass correlation coefficient and Bland-Altman analysis were employed to determine the reproducibility and agreement between syringes. Data were expressed as medians (interquartile range). Results There was no reproducibility between syringes with an intraclass correlation coefficient ranging between -0.33 and 0.8 (p>0.05). The pressures generated with the syringes were higher than the pressures generated using a standard manometer: the 5mL syringe pressure was 105cmH2O (82.5-120cmH2O), the 10mL syringe pressure was 69cmH2O (47.5-111.3cmH2O), and the 20mL syringe pressure was 45cmH2O (35-59.5cmH2O). The Bland-Altman analysis confirmed the large bias and variability between the syringes used, compared with the manometer. Conclusion The use of syringes is not an effective technique for determining the cuff pressure in patients admitted to the intensive care unit. PMID:25607265

Annoni, Raquel; Pires-Neto, Ruy Camargo

2014-01-01

250

Adolescent hypertension identified with correct cuff and its cardiovascular and gestational problems after 29 years  

PubMed Central

Objective to identify, in 2011, rates of hypertension, cardiovascular and gestational problems in subjects presenting high blood pressure in 1982, when correct cuff size was used, according to the American Heart Association Arm Circumference/Cuff Width ratio of 0.40. Methods high blood pressure was defined in 2011 as systolic = 115 mmHg and diastolic = 80mmHg, resulting in 20 subjects between 39 and 43 years old. (Risk Group). They were compared to 20 subjects from the original sample with lower blood pressure values (Control group). Results the rates of hypertension, cardiovascular and gestational problems were significantly higher (Fisher: p=0.02) in the Risk Group, with one case of cardiovascular death. Our findings arouse speculations about whether, if a proper cuff had been used in clinical practice, the complications and death could have been avoided. Conclusions data suggest compliance with the use of cuff width corresponding to 40% of arm circumference, despite polemics concerning cuff availability and difficulties of using many sizes. PMID:24553697

Silva, Sandra Regina Ramos; Arcuri, Edna Apparecida Moura; Isabella, Adriana Paula Jordão; Arcuri, Silvia Maria; Santos, Jair Lício Ferreira

2014-01-01

251

Runway Rotations  

NSDL National Science Digital Library

Students will use small paper airplanes to model rotations required to turn onto a runway. Students will rotate planes 45, 90, 180, 270, and 360 degrees. Students will identify and describe the results of rotations using benchmark angles.

2012-11-16

252

Tracheal cuff pressure monitoring in the ICU: a literature review and survey of current practice in Queensland.  

PubMed

The application of tracheal cuff pressure monitoring is likely to vary between institutions. The aim of this study was therefore to review current evidence concerning this intervention in the intensive care unit (ICU) and to appraise regional practice by performing a state-wide survey. Publications for review were identified through searches of PubMed, EMBASE and Cochrane (1977 to 2014). All studies in English relevant to critical care and with complete data were included. Survey questions were developed by small-group consensus. Public and private ICUs across Queensland were contacted, with responses obtained from a representative member of the medical or nursing staff. Existing literature suggests significant variability in tracheal cuff pressure monitoring in the ICU, particularly in the applied technique, frequency of assessment and optimal intra-cuff pressures. Twenty-nine respondents completed the survey, representing 80.5% (29/36) of ICUs in Queensland. Twenty-eight out of twenty-nine respondents reported routinely monitoring tracheal cuff function, primarily employing cuff pressure measurement (26/28). Target cuff pressures varied, with 3/26 respondents aiming for 10 to 20 cmH2O, 10/26 for 21 to 25 cmH2O, and 13/26 for 26 to 30 cmH2O. Fifteen out of twenty-nine reported they had no current guideline or protocol for tracheal cuff management and only 16/29 indicated there was a dedicated area in the clinical record for reporting cuff intervention. Our results indicate that many ICUs across Queensland routinely measure tracheal cuff function, with most utilising pressure monitoring devices. Consistent with existing literature, the optimum cuff pressure remains uncertain. Most, however, considered that this should be a routine part of ICU care. PMID:25342409

Talekar, C R; Udy, A A; Boots, R J; Lipman, J; Cook, D

2014-11-01

253

Arterial pressure: agreement between a brachial cuff-based device and radial tonometry  

PubMed Central

Objectives: Aortic (central) blood pressure (BP) differs from brachial BP and may be a superior predictor of cardiovascular events. However, its measurement is currently restricted to research settings, owing to a moderate level of operator dependency. We tested a new noninvasive device in a large UK cohort. The device estimates central BP using measurements obtained with an upper arm cuff inflated to suprasystolic pressure. We compared these estimates with those obtained using radial tonometry as well as with invasively acquired measurements of aortic BP in a limited number of individuals. Methods: Consecutive cuff-based and tonometry-based estimates of the pressure waveform and the central BP were obtained from 1107 individuals (70?±?6 years). Short-term and long-term reproducibility studies were performed on 28 individuals. Simultaneous cuff-based and invasively measured pressure traces were acquired and compared in an additional six individuals (65?±?20 years). Results: Central systolic BP, as estimated by the cuff-based device, was found to be highly reproducible (coefficient of variation 4 and 8% for short and long-term reproducibility, respectively) and was comparable to that estimated by tonometry (average difference 3?±?6?mmHg, intraclass correlation coefficient?=?0.91). The cuff-based pressure waveforms were similar to those acquired invasively (cross-correlation coefficient 0.93), and the difference in the estimated central systolic BP was ?5?±?8?mmHg (P?=?0.2). Conclusion: Cuff-based devices show promise to simplify the measurement of central BP, whilst maintaining a similar fidelity to tonometry. This could lead to improved adoption of estimates of central BP in clinical practice. PMID:24379000

Park, Chloe M.; Korolkova, Olga; Davies, Justin E.; Parker, Kim H.; Siggers, Jennifer H.; March, Katherine; Tillin, Therese; Chaturvedi, Nish; Hughes, Alun D.

2014-01-01

254

Endoscopic Versus Open Approach of Bladder Cuff and Distal Ureter in the Management of Upper Urinary Tract Transitional Cell Carcinoma  

PubMed Central

Objective: Nephroureterectomy with the removal of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment for upper urinary tract urothelial cancer. The distal ureter can be removed with the open surgical technique or endoscopic approach. We compared the outcomes of the endoscopic approach with those of conventional open surgery on the distal ureter. Materials and Methods: We collected data from the charts of 30 patients who underwent radical nephroureterectomy at our clinic from January 1997 to January 2007 for upper urinary tract urothelial carcinoma. The patients were divided into two groups according to procedure performed on the distal ureter. Group I (n:12) was comprised of patients who underwent an open surgical procedure, and group II (n:18), was comprised of patients who underwent an endoscopic approach. Both groups were compared in terms of operative time, blood loss, transurethral catheter duration and duration of hospital stay. Results: Patient age and tumor location showed no significant differences between the two groups. The operative time was significantly longer in group I than group II (181 versus 128 minutes; p<0.05). On the other hand, the estimated blood loss, transurethral catheter duration and duration of hospital stay were significantly lower in group II (205 mL versus 435 mL, 5 versus 8.5 days and 5.6 versus 9.2 days, respectively; p <0.05). Conclusion: The results of our study show that the endoscopic approach is less invasive than open surgery on the distal ureter. This procedure can easily be performed in the management of upper urinary tract urothelial carcinoma.

Yapanoglu, Turgut; Kocaturk, Huseyin; Polat, Ozkan; Demirel, Azam; Okyar, Guray

2008-01-01

255

Bariatric Surgery  

MedlinePLUS

... to monitor the effects of surgery. How are postoperative nutritional deficiencies managed? Because your body absorbs fewer ... Vomiting occurs most commonly during the first few postoperative months, when you are adapting to a small ...

256

Thyroid Surgery  

MedlinePLUS

... especially true if you had surgery for thyroid cancer. Thyroid hormone replacement therapy may be delayed for several ... you are to receive radioactive iodine therapy (see Thyroid Cancer brochure ). Further Information Further details on this and ...

257

Osseous Surgery  

MedlinePLUS

... Before your surgery, you need to have basic periodontal treatment called scaling and root planing. You also ... be covered with a bandage known as a periodontal pack or dressing. Follow-Up You may get ...

258

Thyroid surgery.  

PubMed

Diseases of the thyroid are common and surgical treatment is often the preferred option. Thyroid surgery is becoming subspecialised and falls within the repertoire of maxillofacial, and head and neck surgeons. Multidisciplinary management of most patients with diseases of the thyroid is key to providing the best care particularly for those with malignancies and retrosternal extension. To reduce postoperative complications a meticulous search for, and protection of the recurrent laryngeal nerve and parathyroid glands, with an incision along the skin crease in the lower neck, which can be extended for neck dissection, are paramount. Recent advances in thyroid surgery include ultrasound-guided cervical plexus block, use of the Harmonic Scalpel(®) (Ethicon Endo-Surgery, Inc., USA), intraoperative nerve stimulation to monitor the recurrent laryngeal nerve, use of TissuePatch™ 3 (Tissuemed Ltd., Leeds, UK) adhesive sealant, and minimal access surgery. PMID:22192610

Cheng, Leo H-H; Hutchison, Iain L

2012-10-01

259

Oculoplastic surgery.  

PubMed

Esthetic and functional surgery in the periocular region falls into the domain of oculoplastic surgeons, as well as plastic surgeons and otorhinolaryngologists with training in facial plastic surgery. This article provides a description of 8 common eyelid procedures that are routinely performed under local anesthesia, with or without mild intravenous sedation. Serious complications are rare. The rate of postoperative infection in the highly vascularized eyelid tissues is less than 1% in our experience. PMID:24093658

Mehta, Sonul; Belliveau, Michel J; Oestreicher, James H

2013-10-01

260

Finite element study of composite cuff connections for pultruded box sections  

Microsoft Academic Search

Detailed finite element models were developed to represent beam and column test frames comprising box sections connected together with innovative monolithic glass fiber reinforced plastic (GFRP) cuff connections. Model mechanical properties (both stiffness and strength) for the member and connection composite materials were determined from tests on the composite constituent materials and on composite lamina coupons. Damage was investigated in

Juan E. Carrion; Keith D. Hjelmstad; James M. LaFave

2005-01-01

261

The Single Needle Lockstitch Machine. [Making and Setting Cuffs.] Module 6.  

ERIC Educational Resources Information Center

This module on making and setting cuffs, one in a series on the single needle lockstitch sewing machine for student self-study, contains three sections. Each section includes the following parts: an introduction, directions, an objective, learning activities, student information, student self-check, check-out activities, and an instructor's final…

South Carolina State Dept. of Education, Columbia. Office of Vocational Education.

262

Prospective observational study on tracheal tube cuff pressures in emergency patients– is neglecting the problem the problem?  

PubMed Central

Background Inappropriately cuffed tracheal tubes can lead to inadequate ventilation or silent aspiration, or to serious tracheal damage. Cuff pressures are of particular importance during aeromedical transport as they increase due to decreased atmospheric pressure at flight level. We hypothesised, that cuff pressures are frequently too high in emergency and critically ill patients but are dependent on providers’ professional background. Methods Tracheal cuff pressures in patients intubated before arrival of a helicopter-based rescue team were prospectively recorded during a 12-month period. Information about the method used for initial cuff pressure assessment, profession of provider and time since intubation was collected by interview during patient handover. Indications for helicopter missions were either Intensive Care Unit (ICU) transports or emergency transfers. ICU transports were between ICUs of two hospitals. Emergency transfers were either evacuation from the scene or transfer from an emergency department to a higher facility. Results This study included 101 patients scheduled for aeromedical transport. Median cuff pressure measured at handover was 45 (25.0/80.0) cmH2O; range, 8-120 cmH2O. There was no difference between patient characteristics and tracheal tube-size or whether anaesthesia personnel or non-anaesthesia personnel inflated the cuff (30 (24.8/70.0) cmH2O vs. 50 (28.0/90.0) cmH2O); p?=?0.113. With regard to mission type (63 patients underwent an emergency transfer, 38 patients an ICU transport), median cuff pressure was different: 58 (30.0/100.0) cmH2O in emergency transfers vs. 30 (20.0/45.8) cmH2O in inter-ICU transports; p?cuff pressure assessment by the intubating team, a manometer had been applied in 2 of 59 emergency transfers and in 20 of 34 inter-ICU transports (method was unknown for 4 cases each). If a manometer was used, median cuff pressure was 27 (20.0/30.0) cmH2O, if not 70 (47.3/102.8) cmH2O; p?Cuff pressures in the pre-hospital setting and in intensive care units are often too high. Interestingly, there is no significant difference between non-anaesthesia and anaesthesia personnel. Acceptable cuff pressures are best achieved when a cuff pressure manometer has been used. This method seems to be the only feasible one and is recommended for general use. PMID:24304522

2013-01-01

263

Robotic Surgery  

PubMed Central

Objective: To review the history, development, and current applications of robotics in surgery. Background: Surgical robotics is a new technology that holds significant promise. Robotic surgery is often heralded as the new revolution, and it is one of the most talked about subjects in surgery today. Up to this point in time, however, the drive to develop and obtain robotic devices has been largely driven by the market. There is no doubt that they will become an important tool in the surgical armamentarium, but the extent of their use is still evolving. Methods: A review of the literature was undertaken using Medline. Articles describing the history and development of surgical robots were identified as were articles reporting data on applications. Results: Several centers are currently using surgical robots and publishing data. Most of these early studies report that robotic surgery is feasible. There is, however, a paucity of data regarding costs and benefits of robotics versus conventional techniques. Conclusions: Robotic surgery is still in its infancy and its niche has not yet been well defined. Its current practical uses are mostly confined to smaller surgical procedures. PMID:14685095

Lanfranco, Anthony R.; Castellanos, Andres E.; Desai, Jaydev P.; Meyers, William C.

2004-01-01

264

DEHN SURGERY 1. Introduction  

E-print Network

DEHN SURGERY 1. Introduction Dehn surgery hyperbolic knot exceptional surgery (§2) link Dehn surgery (§3) 2. Exceptional surgery and boundary slopes hyperbolic knot exceptional surgery ? S3 ( S3 homotopy S3 ) Dehn surgery K S3 knot E(K) = S3 -intN(K) exterior prim- itive class H1(E(K); Z) ( ) m K

Hachimori, Masahiro

265

Wound surgery.  

PubMed

The purpose of this article is to review the concepts behind, and practice of, wound surgery. The techniques of wound surgery, born of necessity in the art of military surgeons, have found their renaissance in the modern age of wound care driven by the economic and functional considerations inherent to the outcome-based management of chronic disease. Over 300 years of literature on wound healing has shown an innate ability of the wound (in the absence of infection and repeated trauma) to control its progress, largely through the local inflammatory cells. This article discusses several historical works on wound surgery and healing, topical wound therapy, minimal intervention, and emphasizes the closure of chronic wounds. PMID:21074031

Caldwell, Michael D

2010-12-01

266

Craniopharyngioma surgery.  

PubMed

Ideal surgical treatment of craniopharyngiomas remains a major challenge for neurosurgeons. Craniopharyngiomas grow in the deep-seated hypothalamic area that is paramount for vegetative, emotional and endocrine function, and for maintaining worthwhile life. The benign histological nature of craniopharyngiomas belies their biological behavior and the propensity to recur is a major threat. Surgical treatment has to weigh the risk of hypothalamic damage against the risk of tumor recurrence or progression. Both aggressive surgery and conservative minor surgery followed by radiotherapy has been proclaimed by the proponents of different schools. During the past decade, the pendulum has swung back to surgery with the attempt at radical removal. Refined neurosurgical techniques and innovative approaches yielded improved surgical results. The contemporary neurosurgical strategy of treating craniopharyngiomas with early and late outcome data is presented. Neurosurgical therapy is only beneficial in the context of an interdisciplinary treatment concept as discussed here. PMID:18636330

Honegger, Jürgen; Tatagiba, Marcos

2008-01-01

267

[Metabolic surgery].  

PubMed

The prevalence of obesity and diabetes mellitus type 2 is constantly rising worldwide and is one of the most threatening global health and health economic problems. Whereas bariatric surgery is well established in the treatment of morbid obesity, the surgical treatment options for type 2 diabetes mellitus alone are still under discussion (metabolic surgery). Bariatric procedures differ considering weight loss and influencing associated comorbidities. Detailed knowledge of available surgical treatment options for morbid obesity, the risks and requirements of laparoscopic skills, effectiveness and, as far as already known, mechanisms of action are crucial for appropriate implementation. PMID:22695815

Jurowich, C; Germer, C T; Seyfried, F; Thalheimer, A

2012-06-01

268

Fetal Surgery  

PubMed Central

Fetal surgery has come of age. For decades experimental fetal surgery proved essential in studying normal fetal physiology and development, and pathophysiology of congenital defects. Clinical fetal surgery started in the 1960s with intrauterine transfusions. In the 1970s, the advent of ultrasonography revolutionized fetal diagnosis and created a therapeutic vacuum. Fetal treatment, medical and surgical, is slowly trying to fill the gap. Most defects detected are best treated after birth, some requiring a modification in the time, mode and place of delivery for optimal obstetrical and neonatal care. Surgical intervention in utero should be considered for malformations that cause progressive damage to the fetus, leading to death or severe morbidity; that can be corrected or palliated in utero with a reasonable expectation of normal postnatal development; that cannot wait to be corrected after birth, even considering pre-term delivery; that are not accompanied by chromosomal or other major anomalies. At present, congenital hydronephrosis is the most common indication for fetal surgery, followed by obstructive hydrocephalus. Congenital diaphragmatic hernia also fulfills the criteria, but its correction poses more problems, and no clinical attempts have been reported so far. In the future many other malformations or diseases may become best treated in utero. The ethical and moral issues are complex and need to be discussed as clinical and experimental progress is made. PMID:21267309

Laberge, Jean-Martin

1986-01-01

269

Arthroscopic Surgery.  

ERIC Educational Resources Information Center

Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…

Connors, G. Patrick

270

Robotic surgery  

Microsoft Academic Search

The application of an active surgical robot, the Surgical Assistant Robot for Prostatectomy (SARP), to transurethral resection of the prostate is discussed. SARP performs surgery under the supervision of a surgeon. The mechanical construction computing system, software, motion controller and image system of SARP are discussed

W. S. Ng; B. L. Davies; R. D. Hibberd; A. G. Timoney

1993-01-01

271

[Laparoscopic surgery in day surgery].  

PubMed

Since ten years laparoscopic techniques have been employed as alternatives of many established open procedures in gynecologic, abdominal and finally urologic surgery. Laparoscopic techniques show significant advantages compared to open surgery, such as less hospitalization, reduced need of analgesic drugs, quick return to daily activities and far a better cosmetic results. Laparoscopic surgery has been advocated for urologic, uro-gynecologic and andrologic diseases. Since 1983 one-day surgery was proposed for only a few gynecologic and abdominal procedures and only recently for laparoscopic renal biopsy and abdominal testis evaluation. In these preliminary experiences the conditions for a correct management of laparoscopic one-day surgery have been clearly pointed out: 1. correct surgical indication; 2. through knowledge of surgical technique; 3. duration of the procedure less than 90 minutes; 4. correct anesthesia. Technique of anesthesia must be adapted to the surgical procedure required, its duration and the physical features of the patient. General anesthesia is usually preferred for either longer and more complex procedures or when a higher abdominal insufflation pressure is needed. Spinal or local anesthesia are preferred for simpler procedures or when only one trocar is required. At date only few urologic procedures seem to be suitable to one-day laparoscopic surgery. 1) Varicocele: although laparoscopic varicocelectomy in one-day surgery has never been reported previously, it can be performed in a short time, only 3 trocars are needed and insufflation pressure can be maintained within 15 mm Hg. 2) Renal biopsy and marsupialization of renal cysts. These are usually managed percutaneously but in some particular indications procedures under direct vision should be preferable. Both are short-lasting and only superficial general anesthesia is required; as surgical access is retroperitoneal only two trocars are sufficient; at date only renal biopsies have previously been reported. 3) Diagnostic procedures on abdominal testis. The procedure is brief only superficial general anesthesia is needed and only one trocar is required. Conclusions. One-day laparoscopic surgery will require in the future a more and more strict cooperation between urologists and anesthetists in order to tailor the correct anesthesiological and laparoscopic technique to the procedure required and the features of the patient. PMID:9707775

Micali, S; Bitelli, M; Torelli, F; Valitutti, M; Micali, F

1998-06-01

272

Gallbladder Cancer: Surgery  

MedlinePLUS

... treated? Next Topic Radiation therapy for gallbladder cancer Surgery for gallbladder cancer There are 2 general types ... gallbladder: Potentially curative surgery Palliative surgery Potentially curative surgery is done when imaging tests or the results ...

273

Ear Plastic Surgery  

MedlinePLUS

Ear Plastic Surgery Ear Plastic Surgery Patient Health Information News media interested in covering the latest from AAO-HNS/F can ... weight earrings. Does Insurance Pay for Cosmetic Ear Surgery? Insurance usually does not cover surgery solely for ...

274

Pediatric heart surgery  

MedlinePLUS

Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... outside the heart. Some heart defects may need surgery right after the baby is born. For others, ...

275

[Glaucoma and retinal surgery].  

PubMed

In the therapeutic approach to complex glaucomas different initial situations were considered: pre-existing glaucoma, induction of glaucoma after vitreoretinal surgery and antiglaucomatous procedures. In pre-existing glaucoma and after filtering surgery maintenance of the filtering bleb requires a vitreoretinal approach for conjunctiva preservation with techniques such as pneumatic retinopexy or small gauge vitrectomy. After vitreoretinal surgery an increase in intraocular pressure (IOP) is common. Secondary glaucoma may occur after scleral buckling and after vitrectomy with or without gas or silicone oil tamponade as well as after application of steroids. Angle closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Vitreous tamponades with expansive or saturated gases may cause angle-closure glaucoma with or without pupillary blockage and may critically shorten ocular perfusion. Postoperative checks, immediate action and a ban on boarding aircraft over the period of intraocular gas tamponade prevent permanent damage to the eye. The majority of secondary glaucomas can effectively be controlled by topical medication and adequate postoperative posture of the patient. Besides the temporary use of systemic antiglaucomatous medication or laser therapy, very rarely in cases of massive swelling or overfill, a direct intervention, such as partial gas or silicone oil removal is required. A prophylactic inferior peripheral iridectomy prevents pupillary blockage in aphakic eyes with intraocular tamponade. In cases of heavy silicone oil use, the peripheral iridectomy is placed in the superior position. Nd:YAG laser application will regulate IOP in cases of occlusion. Secondary glaucoma due to silicone oil emulsification overload is treated by trabecular meshwork aspiration and lavage. In refractory glaucoma repetitive cyclophotocoagulation and drainage implants represent an approved method for long-term IOP regulation. The underlying cause of secondary glaucoma after vitreoretinal surgery is often multifactorial in nature and may benefit from an exact analysis for an adequate and successful treatment regimen. PMID:20454902

Müller, M; Geerling, G; Zierhut, M; Klink, T

2010-05-01

276

Effect of the Push-up Plus (PUP) Exercise at Different Shoulder Rotation Angles on Shoulder Muscle Activities.  

PubMed

[Purpose] Although the Push-Up Plus is a useful exercise method for shoulder stabilization, few studies have examined its effects at different angles of shoulder rotation. Therefore, the present study investigated the most effective exercise method for shoulder stabilization by analyzing muscle activities of the rotator cuff muscles at different angles of shoulder rotation. [Subjects] Fifteen healthy university students in their 20s were the subjects of this study. [Methods] Changes in muscle EMG related to shoulder stabilization were analyzed by performing the Push-Up Plus in shoulder positions of neutral, internal and external rotation. [Results] The highest muscle activity was found in external rotation, and in internal rotation the pectoralis major and levator scapula showed significantly lower activities than the other positions. [Conclusion] Selectively changing the rotation angle of the shoulder for different purposes of the shoulder exercise would be an effective exercise method. PMID:25435689

Cho, Sung-Hak; Baek, Il-Hun; Cheon, Ju Young; Cho, Min Jung; Choi, Mi Young; Jung, Da Hye

2014-11-01

277

Effect of the Push-up Plus (PUP) Exercise at Different Shoulder Rotation Angles on Shoulder Muscle Activities  

PubMed Central

[Purpose] Although the Push-Up Plus is a useful exercise method for shoulder stabilization, few studies have examined its effects at different angles of shoulder rotation. Therefore, the present study investigated the most effective exercise method for shoulder stabilization by analyzing muscle activities of the rotator cuff muscles at different angles of shoulder rotation. [Subjects] Fifteen healthy university students in their 20s were the subjects of this study. [Methods] Changes in muscle EMG related to shoulder stabilization were analyzed by performing the Push-Up Plus in shoulder positions of neutral, internal and external rotation. [Results] The highest muscle activity was found in external rotation, and in internal rotation the pectoralis major and levator scapula showed significantly lower activities than the other positions. [Conclusion] Selectively changing the rotation angle of the shoulder for different purposes of the shoulder exercise would be an effective exercise method. PMID:25435689

Cho, Sung-Hak; Baek, Il-Hun; Cheon, Ju Young; Cho, Min Jung; Choi, Mi Young; Jung, Da Hye

2014-01-01

278

Orthopaedic Surgery Sports Medicine  

E-print Network

Orthopaedic Surgery Sports Medicine How Does Arthroscopic Shoulder Instability Surgery Work? Rev. 2/13 1 Table of Contents · Introduction to Shoulder Instability Surgery (Page 1) · Shoulder Instability Surgery Illustrations (Page 2) · Preparing for Shoulder Surgery (Pages 3-4) · General Post Surgery (Pages

Kim, Duck O.

279

Cerebral autoregulation index at high altitude assessed by leg cuff and transfer function analysis techniques.  

PubMed

The occurrence and implications of changes in cerebral autoregulation (CA) at high altitude are controversial and confounded by differences in methods used to assess CA. To compare two of the most common methods of dynamic CA assessment, we studied 11 young, healthy sea-level residents (6 female, 5 male; 20.5 ± 2.3 years) as they ascended and acclimatized to 3424 m over 13 days. A common autoregulation index (ARI) was calculated from 1) transfer function analysis (TFA ARI) of resting oscillations in arterial blood pressure (ABP; finger plethysmography) and middle cerebral artery blood velocity (MCAv; transcranial Doppler), and 2) MCAv responses following large, abrupt drops in ABP using the classic leg cuff technique (Cuff ARI). Symptoms of acute mountain sickness (AMS) were monitored using the Lake Louise AMS Questionnaire. Cuff ARI scores decreased (P = 0.021) as subjects ascended from low (4.7± 1.5) to high altitude (3.2 ± 1.6) and did not change after 13 days of acclimatization (2.9 ± 1.3). TFA ARI scores were not affected by ascent or acclimatization to 3424 m. Neither Cuff nor TFA ARI scores were correlated with AMS symptoms. These findings suggest that the cerebral vasculature of healthy individuals may become less able to buffer large step changes in ABP, while still maintaining the ability to regulate slow rhythmical oscillations, during periods of moderate hypoxemia. Given the inherent differences in the autoregulatory stimulus between methods, multiple assessment techniques may be needed to clarify the implications of changes in cerebrovascular regulation at high altitude. This article is protected by copyright. All rights reserved. PMID:25480158

Subudhi, Andrew W; Grajzel, Katalin; Langolf, Robert J; Roach, Robert C; Panerai, Ronney B; Davis, John E

2014-12-01

280

High-dose-rate postoperative vaginal cuff irradiation alone for stage Ib and Ic endometrial cancer  

Microsoft Academic Search

Purpose: To evaluate the effectiveness of postoperative high-dose-rate (HDR) vaginal cuff irradiation alone (1500 cGy in 3 fractions) in patients with Stage Ib and Ic endometrial cancer.Methods and Materials: This is a retrospective review of 102 patients with Stage Ib and Ic endometrial cancer treated with a hysterectomy and postoperative HDR intracavitary therapy alone during the period of 1\\/1\\/90–12\\/31\\/96. Each

John M Anderson; Baldassarre Stea; Alton V Hallum; Edward Rogoff; Joel Childers

2000-01-01

281

Replantation surgery  

Microsoft Academic Search

Summary  \\u000a In the early days of replantation surgery, if viability was restored the operation was judged a success. Nowadays restoration\\u000a of viability alone is not sufficient to fulfill the criteria of successful replantation, which are as follows: Lack of severe\\u000a systemic disturbances due to the replantation, a “functional extremity” according to the definition of Chen et al. (1978),\\u000a no or

A. Berger; R. Hierner; M. H.-J. Becker; B. Rieck; F. Lassner

1997-01-01

282

Cuff-type pneumatic stimulator for studying somatosensory evoked responses with fMRI.  

PubMed

For quantitative somatosensory testing in the clinical environment a microprocessor controlled MR-compatible stimulation device was developed. A main feature of this device is the use of an inflatable cuff allowing the application of defined test pressures (0-1000 mbar) to the skin surface. The cuff is pressurized by a piezoelectric proportional valve with embedded closed loop controller. The distortion of the pressure pulses, introduced by the tube between valve and cuff (tube lengths of 2 and 6 m), was evaluated. Two kinds of stimulation patterns were implemented by the microprocessor: constant frequency stimulation (selectable between 1 and 20 Hz) and stimulation with stepwise changing frequencies according to a pseudorandom sequence. Imaging tests (n=8, index finger) showed more robust responses in S1 (contralateral) and S2 (bilaterally) if evoked by the random sequence. Both, the technical tests and the imaging results, demonstrate that this new stimulation system is well suited to set a standard for somatosensory stimulation in individual longitudinal studies or multicenter comparisons. PMID:20079447

Gallasch, Eugen; Fend, Martin; Rafolt, Dietmar; Nardone, Raffaele; Kunz, Alexander; Kronbichler, Martin; Beisteiner, Roland; Golaszewski, Stefan

2010-04-15

283

Optimal care and design of the tracheal cuff in the critically ill patient  

PubMed Central

Despite the increasing use of non-invasive ventilation and high-flow nasal-oxygen therapy, intubation is still performed in a large proportion of critically ill patients. The aim of this narrative review is to discuss recent data on long-term intubation-related complications, such as microaspiration, and tracheal ischemic lesions. These complications are common in critically ill patients, and are associated with substantial morbidity and mortality. Recent data suggest beneficial effects of tapered cuffed tracheal tubes in reducing aspiration. However, clinical data are needed in critically ill patients to confirm this hypothesis. Polyurethane-cuffed tracheal tubes and continuous control of cuff pressure could be beneficial in preventing microaspiration and ventilator-associated pneumonia (VAP). However, large multicenter studies are needed before recommending their routine use. Cuff pressure should be maintained between 20 and 30 cmH2O to prevent intubation-related complications. Tracheal ischemia could be prevented by manual or continuous control of cuff pressure. PMID:24572178

2014-01-01

284

Novel Cuff Design to Facilitate Anastomosis of Small Vessels During Cervical Heterotopic Heart Transplantation in Rats  

PubMed Central

Cervical heterotopic heart transplantation in rodents is a useful tool for studying transplantation immunology. However, end-to-end anastomosis of small-diameter vessels by using standard microsurgical technique is technically difficult and can require prolonged graft ischemia. A novel cuff system was designed from polyethylene tubing to allow anastomosis of vessels with internal luminal diameters of 0.3 to 0.9 mm. Key features include a spring-like adjustable lumen to facilitate vessel eversion, a barb to hold vessel ends in place after eversion, and a handling system that allows easy manipulation and stabilization of cuffs by a single operator. After a training period, a single operator performed a series of 8 transplants in which the mean warm ischemic time of grafts was 8.5 ± 2.9 min. Here we provide a detailed description of how to construct and perform end-to-end vessel anastomosis by using our novel cuff system. The discussion of the technique is supplemented with tips learned during the process of developing a reliable experimental model. PMID:25296016

Fensterer, Tathyana F; Miller, Cynthia J; Perez-Abadia, Gustavo; Maldonado, Claudio

2014-01-01

285

Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------  

E-print Network

38 Surgical Sciences Cardiovascular Surgery, Thoracic Surgery ------------------------------------------------------ http://ctstokyo.umin.ne.jp/ We are leading in Japan by annual surgery case volume of 700. New knowledge. ·Clinical research · Brain and spinal cord protection in thoracic aortic surgery · Minimally invasive

Miyashita, Yasushi

286

[Robotic surgery].  

PubMed

Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures. PMID:24144815

Sándor, József; Haidegger, Tamás; Kormos, Katalin; Ferencz, Andrea; Csukás, Domokos; Bráth, Endre; Szabó, Györgyi; Wéber, György

2013-10-01

287

DEHN SURGERY SIDDHARTHA GADGIL  

E-print Network

DEHN SURGERY SIDDHARTHA GADGIL Contents 1. Introduction 1 2. Co-ordinates for surgery 1 3. Some algebraic topology 2 4. The theorem of Lickorish and Wallace 3 5. Surgeries and Cobordisms 4 6. The Kirby Calculus 5 7. Constructing knots using surgery 5 8. Surgeries about knots 5 References 6 1. Introduction

Gadgil, Siddhartha

288

Measuring service-specific performance and educational value within a general surgery residency: The power of a prospective, anonymous, Web-based rotation evaluation system in the optimization of resident satisfaction  

Microsoft Academic Search

Background. We used a Web-based evaluation system to institute specific changes to various clinical teaching services in our integrated residency in an effort to optimize the overall quality of the educational experience and measured the resident satisfaction in these rotations. Methods. Residents rated 8 categories of experience on a scale of 1 to 5 (maximum summation score, 40 points). Data

Orlando C. Kirton; Marc Antonetti; Orlando Morejon; Eric Dobkin; Michael D. Angelica; Patricia J. Reilly; Igor Serebriakov; Sheryl Horowitz; Joseph M. Civetta

2001-01-01

289

Minimally Invasive Surgery  

MedlinePLUS

... incisions made. Benefits of minimally invasive surgery Fewer scars on the outside Scars from minimally invasive surgery ... womb) from the vagina into the uterus. Fewer scars on the inside In general, all surgery can ...

290

Scoliosis surgery - child  

MedlinePLUS

Spinal curvature surgery - child; Kyphoscoliosis surgery - child; Video-assisted thoracoscopic surgery - child; VATS - child ... may also do the procedure using a special video camera. A surgical cut in the back is ...

291

Surgery for Testicular Cancer  

MedlinePLUS

... treated? Next Topic Radiation therapy for testicular cancer Surgery for testicular cancer Surgery is typically the first ... very experienced. Possible risks and side effects of surgery The short-term risks of any type of ...

292

Pancreatic Cancer: Surgery  

MedlinePLUS

... Topic Ablation or embolization treatments for pancreatic cancer Surgery for pancreatic cancer There are 2 general types ... and risks of such surgery carefully. Potentially curative surgery Fewer than 1 in 5 pancreatic cancers appear ...

293

Coronary Artery Bypass Surgery  

MedlinePLUS

... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

294

Laser surgery - skin  

MedlinePLUS

Surgery using a laser ... used is directly related to the type of surgery being performed and the color of the tissue ... Laser surgery can be used to: Close small blood vessels to reduce blood loss Remove warts , moles , sunspots, and ...

295

Cavus Foot Surgery  

MedlinePLUS

... the Smaller Toes AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A ... problems. What are the goals of cavus foot surgery? The main goal of surgery is to reduce ...

296

Endodontic surgery.  

PubMed

Conventional endodontic therapy is successful approximately 80-85% of the time. Many of these failures will occur after one year. The presence of continued pain, drainage, mobility or an increasing size of a radiolucent area are some of the indications to treat the case surgically. Since many of these cases may have had final restorations placed by the dentist, the salvage of these cases is of importance to the patient. Advances in periapical surgery have included the use of ultrasonic root end preparation. With the use of these piezoelectric devices, a more controlled apical preparation can be achieved. Additionally, isthmus areas between canals can be appropriately prepared and sealed. The precision afforded with these devices reduces the chances for a malpositioned fill and a more successful outcome. PMID:22117946

Lieblich, Stuart E

2012-01-01

297

Robotic Surgery  

NASA Technical Reports Server (NTRS)

The Automated Endoscopic System for Optimal Positioning, or AESOP, was developed by Computer Motion, Inc. under a SBIR contract from the Jet Propulsion Lab. AESOP is a robotic endoscopic positioning system used to control the motion of a camera during endoscopic surgery. The camera, which is mounted at the end of a robotic arm, previously had to be held in place by the surgical staff. With AESOP the robotic arm can make more precise and consistent movements. AESOP is also voice controlled by the surgeon. It is hoped that this technology can be used in space repair missions which require precision beyond human dexterity. A new generation of the same technology entitled the ZEUS Robotic Surgical System can make endoscopic procedures even more successful. ZEUS allows the surgeon control various instruments in its robotic arms, allowing for the precision the procedure requires.

2000-01-01

298

Assessment of air pockets in high-dose-rate vaginal cuff brachytherapy using cylindrical applicators  

PubMed Central

Purpose To retrospectively assess the incidence and magnitude of air pockets around vaginal cylinders and its impact on dose distribution in vaginal cuff image-guided high-dose-rate (HDR) brachytherapy. Material and methods Fifty endometrial carcinoma patients treated by postoperative HDR vaginal cuff brachytherapy were included in the study. The average age of patients was 58.3 ± 11.8 years (range: 31-87 years). Brachytherapy was performed using cylindrical applicators, and the dose prescribed to 0.5 cm from the applicator's surface, over a length of 5 cm from the applicator's tip. Computed tomography (CT) simulation was used for each brachytherapy fraction. The incidence, vaginal mucosa displacement, volume, and dosimetric effect of air pockets around the vaginal cylinder were evaluated. Results A total of 78 air pockets were found in 29/50 patients (58%) and 45/135 (33%) brachytherapy plans. They were located at the apex: 16/78 (20%) and lateral to the applicator: 62/78 (80%). The volume of air pockets ranged between 0.01 and 2.1 cm3 (mean: 0.15 cm3 ± 0.36 cm3), and the maximum displacement of vaginal mucosa from cylinder surface was between 0.1 and 1.09 cm (mean: 0.34 cm ± 0.2 cm). The dose reduction to the vaginal mucosa generated by the air pockets ranged from 0.5 to 66% (mean: 26.4% ± 13.9%). Conclusions The presence of air pockets around vaginal cylinder applicators is frequently noticed in post-operative vaginal cuff brachytherapy. The dose to the vaginal mucosa is reduced, as a result of displacement generated by air pockets. The effect on the clinical outcome of this dose reduction is yet to be determined. PMID:25337128

Hassouna, Ashraf; Constantinescu, Camelia

2014-01-01

299

Electrochemical performance of platinum electrodes within the multi-electrode spiral nerve cuff.  

PubMed

In this study, the electrochemical performance of platinum electrodes within a multi-electrode spiral cuff to be used for selective nerve stimulation was investigated. The original cuff, simplified into a half-cuff, contained a single row of nine electrodes (0.5 × 2 mm) at a distance of 2 mm from its inner surface. Cyclic voltammetry was used to investigate the electrochemical reactions at the electrode-electrolyte interface, to define a potential window within which the electrode could be safely used in selective nerve stimulation, to calculate the charge injection capacity and cathodal charge storage capacity. Voltage transients retrieved during excitation with quasitrapezoidal biphasic current pulses, tested by selective nerve stimulation of the isolated porcine left cervical vagus nerve segment, were used to determine the maximum polarization across the electrode-electrolyte interface and to calculate cathodic charge injection capacity of the electrode. The results show that the most negative and most positive potentials across the electrode-electrolyte interface reached -0.54 and 0.59 V; these did not exceed the safe potential limits for water electrolysis. Furthermore, the time integral of the cathodic current by cyclic voltammetry measured over the potential range of water electrolysis, actually representing the cathodal charge storage capacity, was approximately -4 mC cm(-2). The charge injection capacity, representing the maximum charge density injected in a current stimulation pulse, using only reversible processes, however, was around 75 µC cm(-2). In conclusion, both, the tested stimulation pulse and electrode are suitable for efficient and safe selective nerve stimulation. PMID:24938675

Rozman, Janez; Pe?lin, Polona; Mehle, Andraž; Šala, Martin

2014-09-01

300

Hip fracture surgery  

MedlinePLUS

... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery ... You may receive general anesthesia before this surgery. This means ... spinal anesthesia. With this kind of anesthesia, medicine is ...

301

Cuff inflation to aid nasotracheal intubation using the C-MAC videolaryngoscope.  

PubMed

A preliminary report is presented of a technique for using the C-MAC videolaryngoscope to carry out nasopharyngeal intubations. The main thrust of the technique is that cuff inflation of the endotracheal tube is used to lift the endotracheal tube off the posterior pharyngeal wall and thus direct it towards the glottis. The technique was used successfully in 5 consecutive patients needing nasotracheal intubation. Indeed a couple of these patients might have been difficult to intubate using conventional laryngoscopy. The full technique is described together with pictures at the various stages of intubation. PMID:21857727

Baddoo, H K; Phillips, B J

2011-06-01

302

Bariatric Surgery  

PubMed Central

Executive Summary Objective To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Background Obesity is defined as a body mass index (BMI) of at last 30 kg/m2.1 Morbid obesity is defined as a BMI of at least 40 kg/m2 or at least 35 kg/m2 with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m2 has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m2. An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999–2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25–29.9 kg/m2) or obese (BMI ? 30 kg/m2). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the “normal” range may begin at slightly above 18.5 kg/m2 and extend into the “overweight” range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight. The actual number of Ontario adults who are overweight or obese may be higher. Diet, exercise, and behavioural therapy are used to help people lose weight. The goals of behavioural therapy are to identify, monitor, and alter behaviour that does not help weight loss. Techniques include self-monitoring of eating habits and physical activity, stress management, stimulus control, problem solving, cognitive restructuring, contingency management, and identifying and using social support. Relapse, when people resume old, unhealthy behaviour and then regain the weight, can be problematic. Drugs (including gastrointestinal lipase inhibitors, serotonin norepinephrine reuptake inhibitors, and appetite suppressants) may be used if behavioural interventions fail. However, estimates of efficacy may be confounded by high rates of noncompliance, in part owing to the side effects of the drugs. In addition, the drugs have not been approved for indefinite use, despite the chronic nature of obesity. The Technology Morbidly obese people may be eligible for bariatric surgery. Bariatric surgery for morbid obesity is considered an intervention of last resort for patients who have attempted first-line forms of medical management, such as diet, increased physical activity, behavioural modification, and drugs. There are various bariatric surgical procedures and several different variations for each of these procedures. The surgical interventions can be divided into 2 general types: malabsorptive (bypassing parts of the gastrointestinal tract to limit the absorption of food), and restrictive (decreasing the size of the stomach so that the patient is satiated with less food). All of these may be performed as either open surgery or laparoscopically. An example of a malabsorptive technique is Roux-en-Y gastric bypass (RYGB). Examples of restrictive techniques are vertical banded gastroplasty (VBG) and adjustable gastric banding (AGB). The Ontario Health Insurance Plan (OHIP) Schedule of Benefits for Physician Services includ

2005-01-01

303

Robotic mitral valve surgery  

Microsoft Academic Search

Traditionally mitral valve surgery has been performed via median sternotomy. However, a renaissance in cardiac surgery is occurring. Cardiac operations are being performed through smaller and alternative incisions with enhanced technological assistance. Specifically, minimally invasive mitral valve surgery has become standard for many surgeons. At our institution, we have developed a robotic mitral surgery program with the da VinciTM telemanipulation

Alan P. Kypson; L. Wiley Nifong; W. Randolph Chitwood

2003-01-01

304

Identification of brachial artery characteristic using a cuff for noninvasive detection of coronary artery disease.  

PubMed

How could a cuff cause a peripheral artery to enter its resonance mode? How could the arterial oscillations be used to evaluate the arteries and to diagnose coronary artery disease (CAD)? This paper answers. A conceptual model representing the role of cuff-artery connection to produce a step-like (sharpened) pressure stimulator is also introduced. The arterial dynamic response is recorded noninvasively in the form of arterio- oscillo-gram (AOG) via an accelerometer. Only, the big oscillatory parts of AOG are used to assess the arterial structure. Due to CAD correlation with peripheral arteriosclerosis, the CAD can also be diagnosed by analyzing AOG peaks. For every person of 51 samples including 22 CAD, 22 normal and 7 heart murmur (HM) patients, the mean of five largest peak durations is calculated. The more severity of CAD causes the less duration time. Hence, simply, by defining a threshold of 9.25 ms, two CAD and non-CAD groups were classified with accuracies of 77% (17/22), and 82% (17/22 for normal, and 7/7 for HM), respectively. This simple noninvasive method mainly aims the vascular characteristics evaluation, thus it does not have the usual limitations of other CAD detection methods. PMID:17271124

Pouladian, Majid

2004-01-01

305

Numerical validation of a suprasystolic brachial cuff-based method for estimating aortic pressure.  

PubMed

Central aortic pressures are better predictors of cardiovascular events than peripheral pressures. However, central aortic blood pressures cannot be measured noninvasively; for this reason, estimating aortic pressures from noninvasive measurements of peripheral pressures has been the subject of numerous studies. In the present study, a novel method was proposed to noninvasively estimate aortic pressures from the oscillometric wave of a suprasystolic brachial cuff. The errors of estimation were evaluated in relation to various cardiovascular properties using an integrated cardiovascular-cuff model. Obtained results demonstrated that the estimation errors are affected mainly by aortic stiffness. The estimation errors for aortic systolic pressure, diastolic pressure, pulse pressure and wave shape under the assumed cardiovascular conditions were 5.84 ± 1.58 mmHg, -0.28 ± 0.41 mmHg, 6.12 ± 1.42 mmHg and 1.72 ± 0.57 mmHg, respectively, all of which fell within the error ranges established by existing devices. Since the method is easy to be automated and bases the estimation fully on patient-specific information, its clinical application is promising, although further clinical studies are awaited to validate the method in vivo. PMID:24211996

Liang, Fuyou

2014-01-01

306

Rotation Matrices  

NSDL National Science Digital Library

Using Maple, Mathmatica, or MatLab, learner should be able to introduce the concept of using matrix multiplication to rotate vectors in two-dimensional space; to provide motivation for the definition of matrix multiplication; to lay the groundwork for using matrices to work with graphics.

Smith, David

2002-01-11

307

Rotation Curves  

NSDL National Science Digital Library

This website, from the University of California, Berkeley, provides a description of the study of stellar motion around the center of a galaxy, and includes a graph of rotational speed versus distance from the center. The site relates this study to the prediction of dark matter. The page also gives explanations of other lines of evidence for dark matter. ____________________________________

White, Martin

2008-08-04

308

Rotating Phasors  

NSDL National Science Digital Library

This interactive phasor page allows you to control the values of a rotating phasor and see a visualization of each change that is done. You can control: one, pos/neg, two, beats, delta, sawtooth, square, triangle, time, zoom, plus you can put into five different values: Frequency (rel, HZ, mHZ), Amplitude (raw, rel), and Phases (Deg, Rad, unitrad).

Sharp, Cory

309

Rotating Light  

NSDL National Science Digital Library

This Exploratorium webpage describes the classic Caro® syrup demonstration of the rotation of the plane of polarized light by an optically active material. The webpage lists the materials, how they are assembled, the observations, and the physics that explains what happens. A photo and drawing are provided.

2012-02-27

310

Repeat gas insufflation for successful closure of idiopathic macular hole following failed primary surgery.  

PubMed

A 65-year-old lady presented with decreased vision in left eye since seven months. Vision was 6/9 in right eye and 6/36 in left. Examination revealed idiopathic, full-thickness macular hole in left eye; confirmed by optical coherence tomography (OCT). Patient underwent phacoemulsification with intraocular lens (IOL) implantation, vitrectomy, internal limiting membrane (ILM) peeling and 14% C ? F ? gas injection. OCT repeated after six weeks revealed type II closure with cuff of subretinal fluid. Four weeks later, patient underwent fluid-gas exchange with 14% C ? F ? gas and postoperative positioning. OCT was repeated after two weeks, which showed complete closure of the macular hole. OCT can help in selection of eyes for re-surgery that stand a better chance for hole closure. Macular holes with cuff of subretinal fluid are probably more likely to close on re-surgery than those without. However, larger studies with longer follow-up are required to validate this finding. PMID:24008807

Rishi, Pukhraj; Reddy, Sumanth; Rishi, Ekta

2014-03-01

311

Comparative analysis of transverse intrafascicular multichannel, longitudinal intrafascicular and multipolar cuff electrodes for the selective stimulation of nerve fascicles  

NASA Astrophysics Data System (ADS)

The selection of a suitable nerve electrode for neuroprosthetic applications implies a trade-off between invasiveness and selectivity, wherein the ultimate goal is achieving the highest selectivity for a high number of nerve fascicles by the least invasiveness and potential damage to the nerve. The transverse intrafascicular multichannel electrode (TIME) is intended to be transversally inserted into the peripheral nerve and to be useful to selectively activate subsets of axons in different fascicles within the same nerve. We present a comparative study of TIME, LIFE and multipolar cuff electrodes for the selective stimulation of small nerves. The electrodes were implanted on the rat sciatic nerve, and the activation of gastrocnemius, plantar and tibialis anterior muscles was recorded by EMG signals. Thus, the study allowed us to ascertain the selectivity of stimulation at the interfascicular and also at the intrafascicular level. The results of this study indicate that (1) intrafascicular electrodes (LIFE and TIME) provide excitation circumscribed to the implanted fascicle, whereas extraneural electrodes (cuffs) predominantly excite nerve fascicles located superficially; (2) the minimum threshold for muscle activation with TIME and LIFE was significantly lower than with cuff electrodes; (3) TIME allowed us to selectively activate the three tested muscles when stimulating through different active sites of one device, both at inter- and intrafascicular levels, whereas selective activation using multipolar cuff (with a longitudinal tripolar stimulation configuration) was only possible for two muscles, at the interfascicular level, and LIFE did not activate selectively more than one muscle in the implanted nerve fascicle.

Badia, Jordi; Boretius, Tim; Andreu, David; Azevedo-Coste, Christine; Stieglitz, Thomas; Navarro, Xavier

2011-06-01

312

Fit and seal characteristics of a new paediatric tracheal tube with high volume-low pressure polyurethane cuff  

Microsoft Academic Search

Background: To evaluate a new paediatric tracheal tube (Microcuff, Weinheim, Germany) with an ultrathin high volume—low pressure polyurethane cuff. Methods: With approval of the Hospital Ethics Committee tracheas of children undergoing general anaesthesia were intub- ated using a Microcuff tube. Tube sizes were selected accord- ing to: internal diameter (mm) ¼ age\\/4 þ 3.5 in children aged ? 2 years.

A. Dullenkopf; A. C. Gerber; M. Weiss

2005-01-01

313

Chronic stability and selectivity of four-contact spiral nerve-cuff electrodes in stimulating the human femoral nerve  

NASA Astrophysics Data System (ADS)

This study describes the stability and selectivity of four-contact spiral nerve-cuff electrodes implanted bilaterally on distal branches of the femoral nerves of a human volunteer with spinal cord injury as part of a neuroprosthesis for standing and transfers. Stimulation charge threshold, the minimum charge required to elicit a visible muscle contraction, was consistent and low (mean threshold charge at 63 weeks post-implantation: 23.3 ± 8.5 nC) for all nerve-cuff electrode contacts over 63 weeks after implantation, indicating a stable interface with the peripheral nervous system. The ability of individual nerve-cuff electrode contacts to selectively stimulate separate components of the femoral nerve to activate individual heads of the quadriceps was assessed with fine-wire intramuscular electromyography while measuring isometric twitch knee extension moment. Six of eight electrode contacts could selectively activate one head of the quadriceps while selectively excluding others to produce maximum twitch responses of between 3.8 and 8.1 N m. The relationship between isometric twitch and tetanic knee extension moment was quantified, and selective twitch muscle responses scaled to between 15 and 35 N m in tetanic response to pulse trains with similar stimulation parameters. These results suggest that this nerve-cuff electrode can be an effective and chronically stable tool for selectively stimulating distal nerve branches in the lower extremities for neuroprosthetic applications.

Fisher, L. E.; Tyler, D. J.; Anderson, J. S.; Triolo, R. J.

2009-08-01

314

Endotracheal tube and laryngeal mask airway cuff volume changes with altitude: a rule of thumb for aeromedical transport  

Microsoft Academic Search

Background: Helicopters and light (unpressurised) aircraft are used increasingly for the transport of ventilated patients. Most of these patients are ventilated through endotracheal tubes (ETTs), others through laryngeal mask airways (LMAs). The cuffs of both ETTs and LMAs inflate with increases in altitude as barometric pressure decreases (30 mbar\\/1000 feet).Tracheal mucosa perfusion becomes compromised at a pressure of approximately 30

Catherine Mann; Neil Parkinson; Anthony Bleetman

2007-01-01

315

Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis  

Microsoft Academic Search

Acupuncture has gained increasing attention in the treatment of chronic pain. The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena. Also, the effectiveness of acupuncture has not been demonstrated sufficiently.

Julia Kleinhenz; Konrad Streitberger; Jürgen Windeler; Albert Güßbacher; Georg Mavridis; Eike Martin

1999-01-01

316

Rotation Matrices  

NSDL National Science Digital Library

Created by Lewis Blake and David Smith for the Connected Curriculum Project, the purposes of this module are to introduce the concept of using matrix multiplication to rotate vectors in two-dimensional space; to provide motivation for the definition of matrix multiplication; to lay the groundwork for using matrices to work with graphics. This is part of a larger collection of learning modules hosted by Duke University.

Blake, Lewis; Smith, David

2010-05-24

317

Rotating Motion  

NSDL National Science Digital Library

In these problems, two people ride on a merry-go-round (radius fixed at 10 m..it's big!). One rider tosses a ball toward the other. The period of motion can be varied as can the initial velocity of the ball, relative to rider. One of the problems is to select the initial velocity of the ball so that it passes through center of the merry-go-round. Another is for the rider who throws the ball to catch it him/herself after exactly half a rotation.

Christian, Wolfgang; Belloni, Mario

2008-02-19

318

Assessment of central haemomodynamics from a brachial cuff in a community setting  

PubMed Central

Background Large artery stiffening and wave reflections are independent predictors of adverse events. To date, their assessment has been limited to specialised techniques and settings. A new, more practical method allowing assessment of central blood pressure from waveforms recorded using a conventional automated oscillometric monitor has recently been validated in laboratory settings. However, the feasibility of this method in a community based setting has not been assessed. Methods One-off peripheral and central haemodynamic (systolic and diastolic blood pressure (BP) and pulse pressure) and wave reflection parameters (augmentation pressure (AP) and index, AIx) were obtained from 1,903 volunteers in an Austrian community setting using a transfer-function like method (ARCSolver algorithm) and from waveforms recorded with a regular oscillometric cuff. We assessed these parameters for known differences and associations according to gender and age deciles from <30?years to >80?years in the whole population and a subset with a systolic BP?cuff-based waveform recordings, provides robust and feasible estimates of central systolic pressure and augmentation in community-based settings. PMID:22734820

2012-01-01

319

Fibre-selective recording from the peripheral nerves of frogs using a multi-electrode cuff  

NASA Astrophysics Data System (ADS)

Objective. We investigate the ability of the method of velocity selective recording (VSR) to determine the fibre types that contribute to a compound action potential (CAP) propagating along a peripheral nerve. Real-time identification of the active fibre types by determining the direction of action potential propagation (afferent or efferent) and velocity might allow future neural prostheses to make better use of biological sensor signals and provide a new and simple tool for use in fundamental neuroscience. Approach. Fibre activity was recorded from explanted Xenopus Laevis frog sciatic nerve using a single multi-electrode cuff that records whole nerve activity with 11 equidistant ring-shaped electrodes. The recorded signals were amplified, delayed against each other with variable delay times, added and band-pass filtered. Finally, the resulting amplitudes were measured. Main Result. Our experiments showed that electrically evoked frog CAP was dominated by two fibre populations, propagating at around 20 and 40 m/s, respectively. The velocity selectivity, i.e. the ability of the system to discriminate between individual populations was increased by applying band-pass filtering. The method extracted an entire velocity spectrum from a 10 ms CAP recording sample in real time. Significance. Unlike the techniques introduced in the 1970s and subsequently, VSR requires only a single nerve cuff and does not require averaging to provide velocity spectral information. This makes it potentially suitable for the generation of highly-selective real-time control-signals for future neural prostheses. In our study, electrically evoked CAPs were analysed and it remains to be proven whether the method can reliably classify physiological nerve traffic. The work presented here was carried out at the laboratories of the Implanted Devices Group, Department of Medical Physics and Bioengineering, University College London, UK.

Schuettler, Martin; Donaldson, Nick; Seetohul, Vipin; Taylor, John

2013-06-01

320

American Board of Surgery  

MedlinePLUS

... Appeals Re-entry to Surgical Practice Replacement of Certificate Reporting of Status and Clinically Inactive Representation of Certification Status Revocation of Certificate Substance Abuse Specialty Definitions General Surgery Vascular Surgery ...

321

Laser Eye Surgery  

MedlinePLUS

... vision so they no longer need glasses or contact lenses. Laser eye surgery reshapes the cornea, the clear front part of the eye. This changes its focusing power. There are different types of laser eye surgery. ...

322

Weight Loss Surgery  

MedlinePLUS

Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight ... obesity. There are different types of weight loss surgery. They often limit the amount of food you ...

323

Who Needs Heart Surgery?  

MedlinePLUS

... page from the NHLBI on Twitter. Who Needs Heart Surgery? Heart surgery is used to treat many heart problems. For example, it's used to: Treat heart failure and coronary heart disease (CHD) Fix heart ...

324

Joint Replacement Surgery  

MedlinePLUS

... and extend your arm. Will My Surgery Be Successful? The success of your surgery depends a lot ... learn why some types of prostheses are more successful than others. Other scientists are also trying to ...

325

Lung surgery - discharge  

MedlinePLUS

Thoracotomy - discharge; Lung tissue removal - discharge; Pneumonectomy - discharge; Lobectomy - discharge; Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - ...

326

Brain surgery - discharge  

MedlinePLUS

Craniotomy - discharge; Surgery - brain - discharge; Neurosurgery - discharge; Craniectomy - discharge; Stereotactic craniotomy - discharge; Stereotactic brain biopsy - discharge; Endoscopic craniotomy - discharge

327

Single-site robotic surgery in gynecologic cancer: a pilot study  

PubMed Central

Objective To discuss the feasibility of single-site robotic surgery for benign gynecologic tumors and early stage gynecologic cancers. Methods In this single institution, prospective analysis, we analyzed six patients who had undergone single-site robotic surgery between December 2013 and August 2014. Surgery was performed using the da Vinci Si Surgical System. Patient characteristics and surgical outcomes were analyzed. Results Single-site robotic surgery was performed successfully in all six cases. The median patient age was 48 years, and the median body mass index was 25.5 kg/m2 (range, 22 to 33 kg/m2). The median total operative time was 211 minutes, and the median duration of intracorporeal vaginal cuff suturing was 32 minutes (range, 22 to 47 minutes). The median duration of pelvic lymph node dissection was 31 minutes on one side and 27 minutes on the other side. Patients' postoperative courses were uneventful. The median postoperative hospital stay was 4 days. No postoperative complications occurred. Conclusion When used to treat benign gynecologic tumors and early stage gynecologic cancers, the single-site da Vinci robotic surgery is feasible, safe, and produces favorable surgical outcomes. PMID:25609162

Yoo, Ha-Na; Lee, Yoo-Young; Choi, Chel Hun; Lee, Jeong-Won; Bae, Duk-Soo; Kim, Byoung-Gie

2015-01-01

328

Elec 331 -Minimally Invasive Surgery Minimally Invasive Surgery  

E-print Network

Elec 331 - Minimally Invasive Surgery 1 Minimally Invasive Surgery · Small incision ­ Low risk surgery ­ Laparoscopic surgery ­ Arthroscopic surgery Instruments Laparoscope / Arthroscope Trocar Forceps / Scissors Elevator / Retractor Stapler #12;Elec 331 - Minimally Invasive Surgery 2 Instrument Types · Trocar

Pulfrey, David L.

329

Intracranial Hypertension: Medication and Surgery  

MedlinePLUS

... Espanol. STORE Shop the IHRF Store Medication and Surgery Medication and Surgery Both drugs and surgery are used to treat ... http://www.ihrfoundation.org/intracranial/hypertension/info/C172 Surgery Optic Nerve Fenestration When sight is at risk ...

330

Surgery for an Inguinal Hernia  

MedlinePLUS

... Inguinal Hernia" /> Consumer Summary – Jul. 24, 2013 Surgery for an Inguinal Hernia Formats View PDF (PDF) ... pronounced lah-puh-ruh-SKAHP-ik) surgery. Open Surgery In an open surgery, the surgeon makes a ...

331

Types of Heart Surgery  

MedlinePLUS

... heart transplants, and place VADs and TAHs. Off-Pump Heart Surgery Surgeons also use off-pump, or beating heart, surgery to do CABG. This ... heart-lung bypass machine isn't used. Off-pump heart surgery isn't right for all patients. ...

332

Pediatric Surgery Gallengangatresie  

E-print Network

1 Pediatric Surgery Gallengangatresie: eine seltene Erkrankung fällt durch die Maschen eines Versorgungsnetzes C. Petersen, B. M. Ure Pediatric Surgery Warum machen wir so viel Wirbel um eine seltene Surgery Die Gallengangatresie ist ein Problem! Seltene Erkrankung: ca. 1: 18.000 In Deutschland ca. 40

Manstein, Dietmar J.

333

Simulation of Endoscopic Surgery  

E-print Network

Simulation of Endoscopic Surgery Nicholas AYACHE 1 - Stéphane COTIN 1 - Hervé DELINGETTE 1 Jean of therapy. This is particularly true for video-surgery, where the use of video-images during, in order to rehearse a difficult surgical procedure. In the future, we believe that surgery simulators

Boyer, Edmond

334

Gastric bypass surgery  

MedlinePLUS

... Breathing problems Heart attack or stroke during or after surgery Infection, including in the cut, lungs (pneumonia), bladder, or kidney There are a number of risks for any weight-loss surgery. ... also risks that are more likely after gastric bypass surgery.

335

Surgery for Breast Cancer  

MedlinePLUS

... side effects of breast surgery Aside from pain after the surgery and the change in the shape of the breast(s), the possible side effects of mastectomy and breast-conserving surgery include wound infection, build-up of blood in the wound, and ...

336

Successful incorporation of robotic surgery into gynecologic oncology fellowship training  

PubMed Central

Background The increasing role of robotic surgery in gynecologic oncology may impact fellowship training. The purpose of this study was to review the proportion of robotic procedures performed by fellows at the console, and compare operative times and lymph node yields to faculty surgeons. Methods A prospective database of women undergoing robotic gynecologic surgery has been maintained since 2008. Intra-operative datasheets completed include surgical times and primary surgeon at the console. Operative times were compared between faculty and fellows for simple hysterectomy (SH), bilateral salpingo-oophorectomy (BSO), pelvic (PLND) and paraaortic lymph node dissection (PALND) and vaginal cuff closure (VCC). Lymph nodes counts were also compared. Results Times were recorded for 239 SH, 43 BSOs, 105 right PLNDs, 104 left PLNDs, 34 PALND and 269 VCC. Comparing 2008 to 2011, procedures performed by the fellow significantly increased; SH 16% to 83% (p<0.001), BSO 7% to 75% (p=0.005), right PLND 4% to 44% (p<0.001), left PLND 0% to 56% (p<0.001), and VCC 59% to 82% (p=0.024). Console times (min) were similar for SH (60vs. 63, p= 0.73), BSO (48 vs. 43, p=0.55), and VCC (20 vs. 22, p=0.26). Faculty times (min) were shorter for PLND (right 26 vs. 30, p=0.04, left 23 vs. 27, p=0.02). Nodal counts were not significantly different (right 7 vs. 8, p=0.17 or left 7 vs. 7, p=0.87). Conclusions Robotic surgery can be successfully incorporated into gynecologic oncology fellowship training. With increased exposure to robotic surgery, fellows had similar operative times and lymph node yields as faculty surgeons. PMID:24055616

Soliman, Pamela T.; Iglesias, David; Munsell, Mark F.; Frumovitz, Michael; Westin, Shannon N.; Nick, Alpa M.; Schmeler, Kathleen M.; Ramirez, Pedro T.

2013-01-01

337

Benign paroxysmal positional vertigo after dental surgery.  

PubMed

We investigated the relationship between dental and maxillofacial surgery and benign paroxysmal positional vertigo (BPPV). BPPV represents the most frequent cause of vertigo of labyrinthine origin. BPPV has been reported following surgical trauma from various surgical interventions, regarding anatomical site and technical execution. A surgical origin is, in many cases, supported by the temporal relation to the surgical intervention as well as by the clinical picture. We considered eight BPPV cases of suspected iatrogenic origin focusing our attention on dental surgery with particular reference to surgical extraction of included teeth through rotating tools. The cases taken into account had no other inner ear disease and BPPV risk indicator. We conclude that dental surgery is a risk factor for BPPV. PMID:17647006

Chiarella, Giuseppe; Leopardi, Gianluca; De Fazio, Luca; Chiarella, Rosarita; Cassandro, Ettore

2008-01-01

338

Rotating Bioreactor  

NASA Technical Reports Server (NTRS)

The NASA Bioreactor provides a low turbulence culture environment which promotes the formation of large, three-dimensional cell clusters. Due to their high level of cellular organization and specialization, samples constructed in the bioreactor more closely resemble the original tumor or tissue found in the body. NASA-sponsored bioreactor research has been instrumental in helping scientists to better understand normal and cancerous tissue development. In cooperation with the medical community, the bioreactor design is being used to prepare better models of human colon, prostate, breast and ovarian tumors. Cartilage, bone marrow, heart muscle, skeletal muscle, pancreatic islet cells, liver and kidney are just a few of the normal tissues currently being cultured in rotating bioreactors by investigators.

1988-01-01

339

Precision in liver surgery.  

PubMed

Continuous theoretical and technological progress in the face of increasing expectations for quality health care has transformed the surgical paradigm. The authors systematically review these historical trends and propose the novel paradigm of "precision surgery," featuring certainty-based practice to ensure the best result for each patient with multiobjective optimization of therapeutic effectiveness, surgical safety, and minimal invasiveness. The main characteristics of precision surgery may be summarized as determinacy, predictability, controllability, integration, standardization, and individualization. The strategy of precision in liver surgery is to seek a balance of maximizing the removal of the target lesion, while maximizing the functional liver remnant and minimizing surgical invasiveness. In this article, the authors demonstrate the application of precision approaches in specific settings in complex liver surgery. They propose that the concept of precision surgery should be considered for wider application in liver surgery and other fields as a step toward the ultimate goal of perfect surgery. PMID:23943100

Dong, Jiahong; Yang, Shizhong; Zeng, Jianping; Cai, Shouwang; Ji, Wenbin; Duan, Weidong; Zhang, Aiqun; Ren, Weizheng; Xu, Yinzhe; Tan, Jingwang; Bu, Xiangyang; Zhang, Ning; Wang, Xuedong; Wang, Xianqiang; Meng, Xiangfei; Jiang, Kai; Gu, Wanqing; Huang, Zhiqiang

2013-08-01

340

General surgery career resource.  

PubMed

General surgery residency training can lead to a rewarding career in general surgery and serve as the foundation for careers in several surgical subspecialties. It offers broad-based training with exposure to the cognitive and technical aspects of several surgical specialties and prepares graduating residents for a wide range of career paths. This career development resource discusses the training aspects of general surgery. PMID:24157351

Parsee, Ana M; Ross, Sharona B; Gantt, Nancy L; Kichler, Kandace; Hollands, Celeste

2013-11-01

341

CV Surgery Online  

NSDL National Science Digital Library

Stanford University's HighWire Press has announced the online publication of several journals. CV Surgery Online offers "a fully searchable online compilation of articles pertinent to the cardiothoracic and vascular surgeon from the 5 American Heart Association Journals: Circulation, Circulation Research, Hypertension, Stroke, and Arteriosclerosis, Thrombosis, and Vascular Surgery." Published by the American Heart Association in conjunction with HighWire Press, the free trial period for CV Surgery Online ended December 31, 2000.

1999-01-01

342

Internal Rotation and Scapular Position Differences: A Comparison of Collegiate and High School Baseball Players  

PubMed Central

Abstract Context: Conditions such as labral and rotator cuff injuries have been linked with decreases in glenohumeral internal-rotation and increases in external-rotation motion. Also, decreased glenohumeral internal rotation is strongly associated with scapular dyskinesis. Objective: To compare healthy collegiate and high school baseball players' glenohumeral joint range of motion and scapular position. Design: Cross-sectional study. Setting: Institutional research laboratory. Patients or Other Participants: Thirty-one male National Collegiate Athletic Association Division I collegiate (age ?=? 20.23 ± 1.17 years, height ?=? 186.24 ± 5.73 cm, mass ?=? 92.01 ± 7.68 kg) and 21 male high school baseball players (age ?=? 16.57 ± 0.76 years, height ?=? 180.58 ± 6.01 cm, mass ?=? 79.09 ± 11.51 kg). Main Outcome Measure(s): Glenohumeral internal and external rotation and scapular upward rotation were measured with a digital inclinometer. Scapular protraction was measured with a vernier caliper. All variables except scapular upward rotation were calculated as the difference between the dominant and nondominant sides. Results: Collegiate baseball players had more glenohumeral internal-rotation deficit (4.80°, P ?=? .028) and total motion deficit (5.73°, P ?=? .009) and less glenohumeral external-rotation gain (3.00°, P ?=? .028) than high school players. Collegiate baseball players had less scapular upward rotation than high school players at the 90° (4.12°, P ?=? .015, versus 3.00°, P ?=? .025) and 120° (4.00°, P ?=? .007, versus 3.40°, P ?=? .005) positions. The scapular protraction difference was greater in collegiate baseball players than in high school players in the hands-on-hips and 90° positions (0.77 cm, P ?=? .021, and 1.4 cm, P ?=? .001). Conclusions: When comparing high school with collegiate baseball players, these data suggest that glenohumeral internal-rotation deficit and scapular position change as the level of competition increases. PMID:20064047

Thomas, Stephen J.; Swanik, Kathleen A.; Swanik, Charles B.; Kelly, John D.

2010-01-01

343

Pediatric heart surgery - discharge  

MedlinePLUS

Congenital heart surgery - discharge; Patent ductus arteriosus ligation - discharge; Hypoplastic left heart repair - discharge; Tetralogy of Fallot repair - discharge; Coarctation of the aorta repair - discharge; ...

344

Motion control of the ankle joint with a multiple contact nerve cuff electrode: a simulation study.  

PubMed

The flat interface nerve electrode (FINE) has demonstrated significant capability for fascicular and subfascicular stimulation selectivity. However, due to the inherent complexity of the neuromuscular skeletal systems and nerve-electrode interface, a trajectory tracking motion control algorithm of musculoskeletal systems for functional electrical stimulation using a multiple contact nerve cuff electrode such as FINE has not yet been developed. In our previous study, a control system was developed for multiple-input multiple-output (MIMO) musculoskeletal systems with little prior knowledge of the system. In this study, more realistic computational ankle/subtalar joint model including a finite element model of the sciatic nerve was developed. The control system was tested to control the motion of ankle/subtalar joint angles by modulating the pulse amplitude of each contact of a FINE placed on the sciatic nerve. The simulation results showed that the control strategy based on the separation of steady state and dynamic properties of the system resulted in small output tracking errors for different reference trajectories such as sinusoidal and filtered random signals. The proposed control method also demonstrated robustness against external disturbances and system parameter variations such as muscle fatigue. These simulation results under various circumstances indicate that it is possible to take advantage of multiple contact nerve electrodes with spatial selectivity for the control of limb motion by peripheral nerve stimulation even with limited individual muscle selectivity. This technology could be useful to restore neural function in patients with paralysis. PMID:24939581

Park, Hyun-Joo; Durand, Dominique M

2014-08-01

345

Perivascular biodegradable microneedle cuff for reduction of neointima formation after vascular injury.  

PubMed

Restenosis often occurs at the site of vascular grafting and may become fatal for patients. Restenosis at anastomosis sites is due to neointimal hyperplasia (NH) and difficult to treat with conventional treatments. Such abnormal growth of smooth muscle cells in tunica media of vascular tissue can be reduced by delivering anti-proliferation drugs such as paclitaxel (PTX) to the inner vascular layer. Drug eluting stents (DES) or drug eluting balloon (DEB) have been developed to treat such vascular diseases. However, they are less efficient in drug delivery due to the drug loss to blood stream and inadequate to be applied to re-stenotic area in the presence of stent or anastomosis sites. Recently, we have introduced microneedle cuff (MNC) as perivascular delivery devices to achieve high delivery efficiency to tunica media. In this study, we investigated in vivo microneedle insertion and efficacy in treating NH using a rabbit balloon injury model. Microneedle shape was optimized for reliable insertion into tunica media layer. Uniform distribution of PTX in tunica media delivered by MNC devices was also confirmed. Animal study demonstrated significant NH reduction by MNC treatments and much higher delivery efficiency than flat type devices. PMID:25025286

Lee, Kang Ju; Park, Seung Hyun; Lee, Ji Yong; Joo, Hyun Chel; Jang, Eui Hwa; Youn, Young-Nam; Ryu, WonHyoung

2014-10-28

346

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine  

E-print Network

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine Trauma and Post Department of Orthopaedic Surgery 4860 Y Street, 1700 Sacramento, CA 95817 P: 916.734.2700 F: 916

Leistikow, Bruce N.

347

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine  

E-print Network

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine Trauma and Post______________________________: This letter is to welcome you to the University of California, Davis Department of Orthopaedic Surgery

Leistikow, Bruce N.

348

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine  

E-print Network

Adult Reconstructive Surgery Foot and Ankle Surgery Hand, Upper Extremity and Microvascular Surgery Oncology Orthopaedic Research Pediatric Surgery Spine Surgery Sports Medicine Trauma and Post OF CALIFORNIA, DAVIS Department of Orthopaedic Surgery 4860 Y Street, Suite 3800 Sacramento, CA 95817 P: 916

Leistikow, Bruce N.

349

The Effects of Repetitive Overhead Throwing on Shoulder Rotator Isokinetic Work-Fatigue.  

PubMed Central

Background Muscle strength and endurance of the shoulder rotators is important for overhead throwing performance and dynamic glenohumeral stability. Baseball pitching is distinguished as an intermittent activity with explosive, high intensity muscle contractions separated by periods of rest. Rotator cuff muscle performance could acutely decrease due to fatigue associated with bouts of throwing. Objective This study examined the effects of repeated overhead throwing upon isokinetic muscle performance of the shoulder rotators. Methods Repeated-measures analyses of vari-ance were used to compare peak torque, total work, and work-fatigue by muscle group, time, and contraction type. Ten collegiate baseball pitchers underwent isokinetic testing of the internal (IR) and external shoulder (ER) rotators one week before and immediately after a throwing protocol of 60 maximal-effort pitches arranged into four innings of 15 pitches per inning. Isokinetic testing consisted of 12 concentric and eccentric repetitions at 300 deg/sec for internal and external rotation of the throwing extremity. Results The main effect of time and the interaction of muscle group and contraction type were significant for work-fatigue. Post-hoc analysis revealed that subjects had significantly greater eccentric IR work-fatigue (13.3 + 1%) compared to the pre-test (7.3 + 2%). Discussion and Conclusions Throwing-related fatigue affected both muscle groups, especially the IR, which has implications for dynamic glenohumeral stability. Rehabilitation and conditioning programs for competitive baseball pitchers should emphasize eccentric muscle endurance training of the shoulder rotators. PMID:21522204

Kovaleski, John E.; Ogletree, Tim; Heitman, Robert J.; Norrell, Phillip M.

2007-01-01

350

Periodontal Plastic Surgery  

MedlinePLUS

Periodontal plastic surgery is designed to restore form and function to the gum tissue, periodontal ligament, and the bone that supports your teeth ... tooth. The real long-term goal of any periodontal surgery is to increase the life expectancy of ...

351

Virtual Knee Surgery  

NSDL National Science Digital Library

In this online activity, learners assist in performing a virtual total knee replacement surgery. There is a great deal of information about this procedure specifically as well as general surgical information, along with questions the learner must answer (using information given onscreen) before the surgery can proceed.

Edheads; Cosi

2007-01-01

352

Complications of Sinus Surgery  

MedlinePLUS

... be aware of potential changes in their voice after sinus surgery. Infection: The most common reason to undergo sinus surgery ... is therefore at risk of developing certain other infections in this area ... nose and sinus after the operation During the postoperative visits the scar ...

353

Preparing for Surgery  

MedlinePLUS

... have an increased chance of complications during and after surgery, including wound infections, pneumonia and heart attacks. The earlier you quit smoking before surgery, the lower your chances of complications. Make ... adult to take you home after your anesthetic or sedation. You will not be ...

354

Breast Cancer Surgery  

MedlinePLUS

... the best option for you. What to expect after surgery Before surgery, ask your doctor what changes you might expect afterwards. These may include: • Risk of infection, bleeding or slow healing of the wound. If lymph nodes have been removed, you may ...

355

Cardiac Procedures and Surgeries  

MedlinePLUS

Cardiac Procedures and Surgeries Updated:Oct 24,2014 If you've had a heart attack, you may have already had certain procedures to ... artery disease (CAD) you have. Cardiac Procedures and Surgeries Angioplasty Also known as Percutaneous Coronary Interventions [PCI], ...

356

Robot assisted knee surgery  

Microsoft Academic Search

Discusses establishing a force control strategy incorporating active motion constraint. The following subjects are considered: problems with conventional surgery; robot assisted surgery; control strategy; representing the motion constraint; design of the desired position; force control strategy; implicit force control; modified damping control; experimental results

S. C. Ho; R. D. Hibberd; B. L. Davies

1995-01-01

357

Corpus Uteri Surgery Codes  

Cancer.gov

Corpus Uteri C540–C559 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) [SEER Note: Do not code dilation and curettage (D&C) as Surgery of Primary Site for invasive cancers] Codes 00 None; no surgery

358

Cervix Uteri Surgery Codes  

Cancer.gov

Cervi x Uteri C530–C539 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) [SEER Note: Do not code dilation and curettage (D&C) as Surgery of Primary Site for invasive cancers] Codes 00 None; no surgery

359

The freezing rotation illusion  

Microsoft Academic Search

The “freezing rotation illusion” refers to decrease in perceived speed of a continuously rotating central region when a swaying surround co-rotates. We observed the following effects for rotations: First, when the centre and its surround are turning in the same direction, and their velocities are distinguishable, the perceived speed of the centre is lower than its physical speed. Second, when

Max R. Dürsteler

2008-01-01

360

[Cataract surgery in Togo].  

PubMed

Cataract remains a major cause of blindness in sub-Sahara and a major public health problem. Blindness prevalence in Togo is equal to 1%, more than half of it is due to cataract, while the number of cataract surgeries is low because of the lack of resources. We assessed the eye healthcare in Togo by cataract surgery. The aim was to estimate the number of cataract surgeries and the Cataract Surgery Rate (CSR) in the administrative regions. The demographic data (denominator) was collected from the Demography and Health Survey (1998) while the number of cataract surgeries (numerator) was obtained from medical registers. The Cataract Surgery Rate (CSR, operated cataracts per million) was assessed from 1995 to 2001. From 1995 to 2001, 3,885 cataract surgeries were performed. Public services predominated with 53.03% (n=2061) of the cataracts operated followed by confessional hospitals with 37.1% (n=1443) and private clinics 3.4% (n=143). Decentralised eye healthcares provided 241 cataract extractions. The University hospital centre of Lome Tokoin was the leader, with 32.5% (n=1,262) of operated cataracts followed by the confessional hospital of Glei, 27.2% (n=1,058). The average per centre per year was 43 cataract surgeries. The mean CSR was 126 and varied from 52 to 163 cataract surgeries per million people per year. There was an important concentration of cataract services in Lome where 41% (n=1,586) of cataracts were operated and the CSR was 334. The unequal distribution of cataract services (41% in Lome) leaves many regions without any resources. Since 1999, the CSR increased by 37% in 2000 and 14% in 2001. The Togolese eye healthcare system is poor and substantial further efforts are necessary to make it accessible and affordable to all those in need. This may be the way to reduce cataract surgery barriers and the unacceptable high prevalence of operable cataract blindness. PMID:12925316

Mensah, A; Balo, K P; Kondi, G; Banla, M; Koffigue, K B; Resnikoff, S; Astagneau, P; Brücker, G

2003-01-01

361

Influence of Head and Neck Position on Oropharyngeal Leak Pressure and Cuff Position with the ProSeal Laryngeal Mask Airway and the I-Gel: A Randomized Clinical Trial  

PubMed Central

Background. This study was designed to assess and compare the effect of head and neck position on the oropharyngeal leak pressures and cuff position (employing fibreoptic view of the glottis) and ventilation scores between ProSeal LMA and the I-gel. Material and Methods. After induction of anesthesia, the supraglottic device was inserted and ventilation confirmed. The position of the head was randomly changed from neutral to flexion, extension, and lateral rotation (left). The oropharyngeal leak pressures, fibreoptic view of glottis, ventilation scores, and delivered tidal volumes and end tidal CO2 were noted in all positions. Results. In both groups compared with neutral position, oropharyngeal leak pressures were significantly higher with flexion and lower with extension but similar with rotation of head and neck. However the oropharyngeal leak pressure was significantly higher for ProSeal LMA compared with the I-gel in all positions. Peak airway pressures were significantly higher with flexion in both groups (however this did not affect ventilation), lower with extension in ProSeal group, and comparable in I-gel group but did not change significantly with rotation of head and neck in both groups. Conclusion. Effective ventilation can be done with both ProSeal LMA and I-gel with head in all the above positions. ProSeal LMA has a better margin of safety than I-gel due to better sealing pressures except in flexion where the increase in airway pressure is more with the former. Extreme precaution should be taken in flexion position in ProSeal LMA. PMID:25648620

Mishra, Sandeep Kumar; Satyapraksh, M. V. S.; Bidkar, Prasanna Udupi; Hemavathy, Balachander

2015-01-01

362

Complications in Ankle Fracture Surgery.  

E-print Network

??Mikko Ovaska. Complications in Ankle Fracture Surgery. Helsinki Bone and Joint Research Group, Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Helsinki,… (more)

Ovaska, Mikko

2014-01-01

363

Efficiency of a pneumatic device in controlling cuff pressure of polyurethane-cuffed tracheal tubes: a randomized controlled study  

PubMed Central

Background The primary objective of this study was to determine the efficiency of a pneumatic device in controlling cuff pressure (Pcuff) in patients intubated with polyurethane-cuffed tracheal tubes. Secondary objectives were to determine the impact of continuous control of Pcuff, and cuff shape on microaspiration of gastric contents. Methods Prospective randomized controlled study. All patients requiring intubation and mechanical ventilation ?48 h were eligible. The first 32 patients were intubated with tapered polyurethane-cuffed, and the 32 following patients were intubated with cylindrical polyurethane-cuffed tracheal tubes. Patients randomly received 24 h of continuous control of Pcuff using a pneumatic device (Nosten®), and 24 h of routine care of Pcuff using a manometer. Target Pcuff was 25 cmH2O. Pcuff was continuously recorded, and pepsin was quantitatively measured in all tracheal aspirates during these periods. Results The pneumatic device was efficient in controlling Pcuff (med [IQ] 26 [24, 28] vs 22 [20, 28] cmH2O, during continuous control of Pcuff and routine care, respectively; p?=?0.017). In addition, percentage of patients with underinflation (31% vs 68%) or overinflation (53% vs 100%) of tracheal cuff, and percentage of time spent with underinflation (0.9 [0, 17] vs 14% [4, 30]) or overinflation (0 [0, 2] vs 32% [9, 54]) were significantly (p?

2013-01-01

364

Getting Surgery Right  

PubMed Central

Objective: We sought to identify factors contributing to wrong-site surgery (wrong patient, procedure, side, or part). Methods: We examined all reports from all hospitals and ambulatory surgical centers—in a state that requires reporting of wrong-site surgery—from the initiation of the reporting requirement in June 2004 through December 2006. Results: Over 30 months, there were 427 reports of near misses (253) or surgical interventions started (174) involving the wrong patient (34), wrong procedure (39), wrong side (298), and/or wrong part (60); 83 patients had incorrect procedures done to completion. Procedures on the lower extremities were the most common (30%). Common contributions to errors resulting in the initiation of wrong-site surgery involved patient positioning (20) and anesthesia interventions (29) before any planned time-out process, not verifying consents (22) or site markings (16), and not doing a proper time-out process (17). Actions involving operating surgeons contributed to 92. Common sources of successful recovery to prevent wrong-site surgery were patients (57), circulating nurses (30), and verifying consents (43). Interestingly, 31 formal time-out processes were unsuccessful in preventing “wrong” surgery. Conclusions: Wrong-site surgery continues to occur regularly, especially wrong-side surgery, even with formal site verification. Many errors occur before the time-out; some persist despite the verification protocol. Patients and nurses are the surgeons’ best allies. Verification, starting with verification of the consent, needs to occur at multiple points before the incision. PMID:17717443

Clarke, John R.; Johnston, Janet; Finley, Edward D.

2007-01-01

365

Tracheal Rupture due to Diffusion of Nitrous Oxide to Cuff of High-Volume, Low-Pressure Intubation Tube  

PubMed Central

Tracheal rupture is a rare complication of endotracheal intubation. Risk factors include short neck, repeated attempts due to failed intubation, inappropriate stylus, over-inflation of the cuff, poor positioning of the tube, inappropriate tube size, weakened membrane structure due to steroid use, chronic obstructive pulmonary disease, tracheomalacia, kyphosis, and use of nitric oxide during the operation. In this article, we suggest that high-volume, low-pressure tubes may not always provide a low-pressure effect and could rupture due to reduced tracheal perfusion pressure and ischemic damage upon over-inflation.

Atalay, Canan; Aykan, ?eyda; Can, Abdullah; Do?an, Naz?m

2009-01-01

366

Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis  

Microsoft Academic Search

Purpose  To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of upper airway obstruction secondary\\u000a to laryngeal edema and for reintubation secondary to upper airway obstruction.\\u000a \\u000a \\u000a \\u000a Methods  Systematic review without language restrictions based on electronic databases and manual review of the literature up to December\\u000a 2008. When appropriate, a random-effects meta-analysis and meta-regression (Moses’ method) were performed.

Maria Elena Ochoa; Maria del Carmen Marín; Fernando Frutos-Vivar; Federico Gordo; Jaime Latour-Pérez; Enrique Calvo; Andres Esteban

2009-01-01

367

ORTHOGNATHIC SURGERY AND INSURANCE ISSUES 1. Orthognathic surgery (surgery for the treatment of a dentofacial deformity) is  

E-print Network

ORTHOGNATHIC SURGERY AND INSURANCE ISSUES 1. Orthognathic surgery (surgery for the treatment. 2. Although there are some medical plans that specifically exclude orthognathic surgery, most insurance plans in California do permit the authorization of orthognathic surgery "when medically necessary

Mullins, Dyche

368

Teaching plastic surgery from different perspectives.  

PubMed

Just as everyone has a different learning style, teachers too approach the task from different perspectives. There are five basic teaching perspectives or styles: transmission, apprenticeship, developmental, nurturing, and social justice. The acronym BIAS is useful to describe the beliefs, intentions, assessments, and strategies associated with each perspective. The authors present a hypothetical 1-week rotation in plastic and reconstructive surgery in which a student encounters instructors who embody the five basic teaching perspectives. By presenting these perspectives, the authors introduce valuable teaching techniques that can benefit all those charged with the education of learners along the spectrum from premedical to continuing education venues. Educational objectives include the following: (1) explain and illustrate different approaches to effective teaching in plastic surgery; (2) introduce readers to the Teaching Perspectives Inventory as a means of determining their primary teaching style; and (3) argue for a "plurality of the good" in teaching. PMID:22634660

Cable, Christian; Chong, Tae; Pratt, Daniel D

2012-06-01

369

Cataract surgery following KAMRA presbyopic implant  

PubMed Central

Intrastromal corneal inlays are an emerging treatment for presbyopic patients. The KAMRA™ small aperture inlay was the first such inlay to receive Conformité Européenne (CE) marking in 2005. It has been shown to improve uncorrected near and intermediate visual acuity without adversely affecting uncorrected distance visual acuity. Due to the age of presbyopic patients, they may eventually develop cataracts. In two such cases, we found that cataract surgery with the KAMRA implant left in place was not technically more difficult, and that the surgical procedure could be improved by additional ocular rotations to improve visualization. Biometry readings were reliable, and it appeared that the SRK/T formula was accurate for calculation of intraocular lens power. Cataract surgery with the KAMRA implant left in situ is a viable option for patients. PMID:24092969

Tan, Tien-En; Mehta, Jodhbir S

2013-01-01

370

[Bariatric and metabolic surgery].  

PubMed

The prevalence of obesity and its comorbidities is constantly rising and is one of the most threatening global health and economic problems worldwide. Whereas bariatric surgery is well accepted in the treatment of morbid obesity, surgical treatment for ist comorbidities (metabolic surgery) such as type 2 diabetes mellitus, dyslipidemia and other diseases are still under discussion. A more profound knowledge of its physiologic mechanisms is crucial for the future implementation of the bariatric and metabolic surgery to treat obesity-related comorbidities. PMID:23385191

Nett, Philipp C

2013-02-01

371

UCF COLLEGE OF MEDICINE M.D. CURRICULUM Surgery Surgery  

E-print Network

UCF COLLEGE OF MEDICINE M.D. CURRICULUM May Vacation Surgery Surgery Vacation IM/FM (Continued) Internal Medicine/Family Medicine Surgery FIREMiniConference Longitudinal Curricular Themes Ethics wks) S-6 Brain and Behavior (7 wks) March April FIREMiniConference Capstone Surg Select Surgery Select

Foroosh, Hassan

372

Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery.  

E-print Network

1/ 17 Spines, backbones and orthopedic surgery. Spines, backbones and orthopedic surgery. Simon;2/ 17 Spines, backbones and orthopedic surgery. Motivation #12;2/ 17 Spines, backbones and orthopedic surgery. Motivation Recent work (B-boys & Schweinsberg, Aidekon-Harris) considers branching Brownian

373

Does a water-training macrocycle really create imbalances in swimmers' shoulder rotator muscles?  

PubMed

Abstract The continuous execution of swimming techniques may cause muscle imbalances in shoulder rotators leading to injury. However, there is a lack of published research studies on this topic. The aim of this study was to analyze the influence of a competitive swim period on the shoulder rotator-cuff balance in young swimmers. A randomized controlled pretest-posttest design was used, with two measurements performed during the first macrocycle of the swimming season (baseline and 16 weeks). Twenty-seven young male swimmers (experimental group) and 22 male students who were not involved in swim training (control group) with the same characteristics were evaluated. Peak torque of shoulder internal and external rotators was assessed. Concentric action at 1.04 rad s(-1) (3 repetitions) and 3.14 rad s(-1) (20 repetitions) was measured using an isokinetic dynamometer (Biodex System 3). External/internal rotators strength ratios were also obtained. For both protocols, there were significant training effects on internal rotator strength and external/internal rotator ratios (p ? .05). This trend was the same for both shoulders. Within-group analysis showed significant changes from baseline to 16 weeks for internal rotators strength and unilateral ratios of the experimental group. Swimmers' internal rotator strength levels increased significantly. In contrast, a significant decrease of the unilateral ratios was observed. Findings suggest that a competitive swim macrocycle leads to an increase in muscular imbalances in the shoulder rotators of young competitive swimmers. Swimming coaches should consider implementing a compensatory strength-training program. PMID:24754705

Batalha, Nuno; Marmeleira, José; Garrido, Nuno; Silva, António J

2015-03-01

374

[Urology and ambulatory surgery].  

PubMed

The ambulatory surgery is the realization of a surgical act with entrance and taken out the same day. The evolution of the surgery in traditional hospitalization towards the ambulatory is a cultural revolution. The function care and accommodation of our establishments of health are disconnected. The ambulatory surgery is source of progress for the surgery, the anesthesia, our organizations. She corresponds to a demand of the public. She is ethical. There is an institutional will shared by all the actors of health today. The AFU measured its delay and has the objective to facilitate to the urologic community this mode of taken care. Learned recommendations are going to be produced in association with the HAS. The role of the IDE of urology is specified there. PMID:23101963

Cuvelier, G

2012-11-01

375

Carpal Tunnel Surgery  

MedlinePLUS Videos and Cool Tools

... carried out for the condition of carpal tunnel syndrome. Carpal Tunnel Syndrome is a neuropathy where the median nerve gets ... of the hand. The surgery for carpal tunnel syndrome consists of a release of the transverse carpal ...

376

Laparoscopic Spine Surgery  

MedlinePLUS

... Global: Global Affairs and Humanitarian Efforts SAGES HELPS: Humanity Education Leadership Perspective Support SAGES STEP: Surgeons Training ... for a surgery. Specific recommendations may vary among health care professionals. If you have a question about ...

377

Expectations of Sinus Surgery  

MedlinePLUS

... after surgery, it can be treated with antibiotics. Steroids - One of the underlying causes of some forms ... forms of swelling, your doctor may prescribe oral steroids or topical (spray, irrigation) steroids or both. Packing – ...

378

Brain Tumor Surgery  

MedlinePLUS

... The surgical removal of a portion of the skull. Doing so allows the neurosurgeon to find the ... much of it as possible. The piece of skull that was removed is replaced following surgery. Craniectomy: ...

379

Preparing for Surgery  

MedlinePLUS

... some types of surgery. FREQUENTLY ASKED QUESTIONS FAQ080 GYNECOLOGIC PROBLEMS The American College of Obstetricians and Gynecologists ... allergies, or allergies to food or latex (some surgical gloves are made of latex). You will be ...

380

Gastric bypass surgery - discharge  

MedlinePLUS

... to your weight loss and your weight becomes stable. Because of this quick weight loss, you will ... week: Start walking after surgery. Move around the house and shower, and use the stairs at home. ...

381

Alternative Refractive Surgery Procedures  

MedlinePLUS

... of artificial lenses. Following are some of the alternative refractive surgery procedures to LASIK . Wavefront-Guided LASIK ... that releases controlled amounts of radio frequency (RF) energy, instead of a laser, to apply heat to ...

382

Robotic surgery, telerobotic surgery, telepresence, and telementoring  

Microsoft Academic Search

  Although laparoscopic cholecystectomy rapidly became the standard of care for the surgical treatment of cholelithiasis, very\\u000a few other abdominal or cardiac operations are currently performed using minimally invasive surgical techniques. The inherent\\u000a limitations of traditional laparoscopic surgery make it difficult to perform these operations. We, and others, have attempted\\u000a to use robotic technology to (a) provide a stable camera platform,

G. H. Ballantyne

2002-01-01

383

A new dimension in endo surgery: Micro endo surgery  

PubMed Central

There is an immense difference between tradizional Endodontic Surgery and Micro-Endo Surgery. Microsurgical techniques made possible and accessible results,that were unimaginable before. Under microscopic control,the operative techniques reached continous changes,allowing a better precision and quality standards. The dramatic evolution from Endo Surgery to Micro-Endo Surgery has enlarged the horizon of therapeutic options. Illumination and magnification through the Microscope has fundamentally and radically changed the way endo surgery can be performed.

Pecora, Gabriele Edoardo; Pecora, Camilla Nicole

2015-01-01

384

GIP and Bariatric Surgery  

Microsoft Academic Search

Bariatric surgery is the most effective modality of achieving weight loss as well as the most effective treatment for type\\u000a 2 diabetes mellitus (T2DM). Glucose-dependent insulinotropic polypeptide (GIP) is an incretin and is implicated in the pathogenesis\\u000a of obesity and T2DM. Its role in weight loss and resolution of T2DM after bariatric surgery is very controversial. We have\\u000a made an

Raghavendra S. Rao; Subhash Kini

2011-01-01

385

Neurological surgery planning system  

NASA Astrophysics Data System (ADS)

The computer-assisted neurological surgery planning system (NSPS), developed by the Neurological Surgery Department, Wayne State University, Detroit, MI, is designed to offer neurosurgeons a safe and accurate method to approach intracranial lesions. Software consisting of the most advanced technologies in computer vision, computer graphics, and stereotactic numeric analysis forms the kernel of the system. Our paper discusses the functionalities and background theories used in NSPS.

Jiang, Charlie Z. W.; Zamorano, Lucia J.; Kadi, A. Majeed

1993-09-01

386

Surgery in advanced borderline tumors.  

PubMed

Our retrospective study evaluates the role of conservative surgery, performed in 10 of 22 patients affected by advanced stage serous borderline ovarian tumor. Although patients who underwent conservative surgery had a higher recurrence rate (60% after conservative surgery and 8% after radical surgery), all patients are alive without evidence of disease. PMID:20036359

Viganò, Riccardo; Petrone, Micaela; Pella, Francesca; Rabaiotti, Emanuela; De Marzi, Patrizia; Mangili, Giorgia

2010-08-01

387

Postoperative Instructions Following Facial Surgery  

E-print Network

Postoperative Instructions Following Facial Surgery 1. Your surgery will be performed in the Surgery Center on the 4th floor of the Center for Health and Healing (CHH) at Oregon Health & Sciences University. The procedure is done under anesthesia administered by an anesthesiologist. After surgery, you

Chapman, Michael S.

388

Department of Surgery Reunion Gala  

E-print Network

Department of Surgery Reunion Gala Report A celebration of over 40 years of the Department of Surgery October25th&26th2013 #12;October25th2013:Wine&Cheese Surgery Reunion Gala Weekend: Wine & Cheese On Friday October 25, 2013 the Surgery Reunion Gala weekend kicked off with a wine and cheese event

Haykin, Simon

389

Robotic surgery in gynecology  

PubMed Central

FDA approved Da Vinci Surgical System in 2005 for gynecological surgery. It has been rapidly adopted and it has already assumed an important position at various centers where this is available. It comprises of three components: A surgeon's console, a patient-side cart with four robotic arms and a high-definition three-dimensional (3D) vision system. In this review we have discussed various robotic-assisted laparoscopic benign gynecological procedures like myomectomy, hysterectomy, endometriosis, tubal anastomosis and sacrocolpopexy. A PubMed search was done and relevant published studies were reviewed. Surgeries that can have future applications are also mentioned. At present most studies do not give significant advantage over conventional laparoscopic surgery in benign gynecological disease. However robotics do give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, Endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and if cost considerations are addressed may become popular among gynecological surgeons world over. PMID:25598600

Sinha, Rooma; Sanjay, Madhumati; Rupa, B.; Kumari, Samita

2015-01-01

390

Surgery for childhood epilepsy  

PubMed Central

Approximately 60% of all patients with epilepsy suffer from focal epilepsy syndromes. In about 15% of these patients, the seizures are not adequately controlled with antiepileptic drugs; such patients are potential candidates for surgical treatment and the major proportion is in the pediatric group (18 years old or less). Epilepsy surgery in children who have been carefully chosen can result in either seizure freedom or a marked (>90%) reduction in seizures in approximately two-thirds of children with intractable seizures. Advances in structural and functional neuroimaging, neurosurgery, and neuroanaesthesia have improved the outcomes of surgery for children with intractable epilepsy. Early surgery improves the quality of life and cognitive and developmental outcome and allows the child to lead a normal life. Surgically remediable epilepsies should be identified early and include temporal lobe epilepsy with hippocampal sclerosis, lesional temporal and extratemporal epilepsy, hemispherical epilepsy, and gelastic epilepsy with hypothalamic hamartoma. These syndromes have both acquired and congenital etiologies and can be treated by resective or disconnective surgery. Palliative procedures are performed in children with diffuse and multifocal epilepsies who are not candidates for resective surgery. The palliative procedures include corpus callosotomy and vagal nerve stimulation while deep brain stimulation in epilepsy is still under evaluation. For children with “surgically remediable epilepsy,” surgery should be offered as a procedure of choice rather than as a treatment of last resort. PMID:24791093

Jayalakshmi, Sita; Panigrahi, Manas; Nanda, Subrat Kumar; Vadapalli, Rammohan

2014-01-01

391

Photobiomodulation in laser surgery  

NASA Astrophysics Data System (ADS)

Laser surgery provides good exposure with clear operating fields and satisfactory preliminary functional results. In contrast to conventional excision, it was found that matrix metalloproteinases and the tissue inhibitors of metalloproteinases -1 mRNA expression is higher, myofibroblasts appeared and disappeared slower in laser excision wounds. It has been suggested that the better anatomical and functional results achieved following laser cordectomy may be explained by the fact that such procedures result in better, more rapid healing processes to recover vocal cord for early glottic tumors and better. In this paper, the role of photobiomodulation in laser surgery will be discussed by the cultured monolayer normal human skin fibroblast model of the photobiomodulation of marginal irradiation of high intensity laser beam, the photobiomodulation related to the irradiated tissue, the biological information model of photobiomodulation and the animal models of laser surgery. Although high intensity laser beam is so intense that it destroys the irradiated cells or tissue, its marginal irradiation intensity is so low that there is photobiomodulation on non-damage cells to modulate the regeneration of partly damaged tissue so that the surgery of laser of different parameters results in different post-surgical recovery. It was concluded that photobiomodulation might play an important role in the long-term effects of laser surgery, which might be used to design laser surgery.

Liu, Timon Cheng-Yi; Rong, Dong-Liang; Huang, Jin; Deng, Xiao-Yuan; Liu, Song-Hao

2006-01-01

392

Position indicating, rotating boom  

NASA Technical Reports Server (NTRS)

Universal multiplanar position indicating, rotating boom for mounting various instruments or sensors is described. Boom is telescoping, and apparatus is capable of 3 types of rotation controlled by electric motors. Movement may be continuous or incremental.

Dibble, A. C.; Gibson, F. W.; Padelt, J. R.; Saunders, W. S.

1972-01-01

393

Does an Adjuvant AV-fistula Improve the Patency of a Femorocrural PTFE bypass with Distal Vein Cuff in Critical Leg Ischaemia?—A Prospective Randomised Multicentre Trial  

Microsoft Academic Search

Introduction. A lack of suitable veins can cause serious problems when attempting to revascularise critically ischaemic legs. Prosthetic grafts have much worse patency in the femocrural position, despite the use of distal anastomotic cuffs. The use of adjuvant AV-fistula at the distal anastomosis should increase the graft flow above the thrombotic threshold velocity and thus increase prosthetic graft patency.Aim. The

K Laurila; M Lepäntalo; K Teittinen; I Kantonen; C Forssell; P Vilkko; O. M Nielsen; M Railo; A Lehtola

2004-01-01

394

Transformations: Rotation (NLVM)  

NSDL National Science Digital Library

This Java applet enables learners to explore the rotation transformation both informally and within a coordinate system. Students select and compose shapes and manipulate the center and angle of rotation to see the effect on a rotated image. Links to instructions, activities and teacher/parent information are included.

2011-01-01

395

Mechanism of rotational relaxation.  

NASA Technical Reports Server (NTRS)

A model is presented which describes the characteristic pattern of relaxation of a nonthermal rotational distribution of hydrogen halide, peaked initially at high rotational quantum number J, to a thermal distribution without generating a peak at intermediate J. A method for correcting infrared chemiluminiscence data for modest rotational relaxation is also suggested.

Polanyi, J. C.; Woodall, K. B.

1972-01-01

396

Percutaneous forefoot surgery.  

PubMed

Percutaneous methods can be used to perform many surgical procedures on the soft tissues and bones of the forefoot, thereby providing treatment options for all the disorders and deformities seen at this site. Theoretical advantages of percutaneous surgery include lower morbidity rates and faster recovery with immediate weight bearing. Disadvantages are the requirement for specific equipment, specific requirements for post-operative management, and lengthy learning curve. At present, percutaneous hallux valgus correction is mainly achieved with chevron osteotomy of the first metatarsal, for which internal fixation and a minimally invasive approach (2 cm incision) seem reliable and reproducible. This procedure is currently the focus of research and evaluation. Percutaneous surgery for hallux rigidus is simple and provides similar outcomes to those of open surgery. Lateral metatarsal malalignment and toe deformities are good indications for percutaneous treatment, which produces results similar to those of conventional surgery with lower morbidity rates. Finally, fifth ray abnormalities are currently the ideal indication for percutaneous surgery, given the simplicity of the procedure and post-operative course, high reliability, and very low rate of iatrogenic complications. The most commonly performed percutaneous techniques are described herein, with their current indications, main outcomes, and recent developments. PMID:24412043

Bauer, T

2014-02-01

397

Computer Assisted Surgery  

NASA Astrophysics Data System (ADS)

Computer assisted surgery (CAS) systems can provide different levels of assistance to a surgeon during training and execution of a surgical procedure. This is done through the integration of : measurements taken on medical images; computer graphics techniques; and positioning or tracking mechanisms which accurately locate the surgical instruments inside the operating site. According to the type of assistance that is provided to the surgeon, CAS systems can be classified as: Image guided surgery systems; Assistant robots for surgery; and Training simulators for surgery. In this work are presented the main characteristics of CAS systems. It is also described the development of a computer simulator for training on Transurethral Resection of the Prostate (TURP) based on a computer model of the prostate gland which is able to simulate, in real time, deformations and resections of tissue. The model is constructed as a 3D mesh with physical properties such as elasticity. We describe the main characteristics of the prostate model and its performance. The prostate model will also be used in the development of a CAS system designed to assist the surgeon during a real TURP procedure. The system will provide 3D views of the shape of the prostate of the patient, and the position of the surgical instrument during the operation. The development of new computer graphics models which are able to simulate, in real time, the mechanical behavior of an organ during a surgical procedure, can improve significantly the training and execution of other minimally invasive surgical procedures such as laparoscopic gall bladder surgery.

Arámbula Cosío, F.; Padilla Castañeda, M. A.

2003-09-01

398

Learning Rotations Learning rotations with little regret  

E-print Network

-line algorithms for learning rotations have developed (Arora, 2009; Abrudan et al., 2008a,b) that exploit the Lie of examples, has numerous applications in these areas (see Arora (2009) for a summary of application areas

Warmuth, Manfred K.

399

Plastic Surgery—Myths and Realities in Developing Countries: Experience from Eastern Nepal  

PubMed Central

B.P. Koirala Institute of Health Sciences, Dharan, Nepal, is the only tertiary care referral centre in the eastern region of Nepal. This paper discusses the author's experience of starting a plastic surgery unit in eastern Nepal regarding need and present status of plastic surgery care in Nepal. Methods. We analyzed the data of patients treated in Plastic surgery unit from July 2007 to February 2009. We did evaluation regarding type of patients, procedures, and their outcome. We also evaluated the limitations and their possible solutions to overcome the barriers to establish effective plastic surgical centers in developing countries. Results. Plastic surgery services were started as a unit in general surgery by single plastic surgeon and one general surgery resident on rotation. Total 848 patients were treated for different plastic-surgery-related conditions, which included 307 acute burn patients 541 general plastic surgery patients. Trauma constituted the major bulk 22%, followed by tumors 20%, while aesthetic surgery operations were only 10.1%. Conclusions. In developing countries, aesthetic procedures constitute very small part of plastic surgery interventions and plastic surgery units are primarily required for reconstructive needs for optimum management of patients. PMID:22567248

Mishra, Brijesh; Koirala, Robin; Tripathi, Nalini; Shrestha, Kajan Raj; Adhikary, Buddhinath; Shah, Surendra

2011-01-01

400

Revisiting the prone position in video-assisted thoracoscopic surgery.  

PubMed

The fully prone position, once used in surgery for chronic inflammatory lung diseases, has become obsolete. In the last 2 years, a modified semiprone position was used for video-assisted thoracoscopic surgery in 358 patients undergoing lobectomy with mediastinal complete lymphadenectomy The ports were placed with the patient in the lateral decubitus position. The patient was rotated 45-60 degrees towards the surgeon, giving enhanced exposure of the posterior mediastinum, esophagus, subcarinal and paratracheal spaces, due to displacement of the lung under gravity away from the operative field. This position is safe, well-tolerated, and allows more ergonomic and anatomical placement of the ports. PMID:20719788

Agasthian, Thirugnanam

2010-08-01

401

[Robotic surgery in gynecology].  

PubMed

Introduction of robotic surgery in the first decade of the 21 century was one of the biggest breakthroughs in surgery since the introduction of anesthesia. For the first time in history the surgeon was placed remotely from the patient and was able to operate with the device that has more degrees of freedom than human hand. Initially developed for the US Military in order to allow surgeons to be removed from the battlefield, surgical robots quickly made a leap to the mainstream medicine. One of the first surgical uses for the robot was cardiac surgery but it is urology and prostate surgery that gave it a widespread popularity Gynecologic surgeons caught on very quickly and it is estimated that 31% of hysterectomies done in the United States in 2012 will be done robotically. With over half a million hysterectomies done each year in the US alone, gynecologic surgery is one of the main driving forces behind the growth of robotic surgery Other applications in gynecology include myomectomy oophorectomy and ovarian cystectomy resection of endometriosis and lymphadenectomy Advantages of the surgical robot are clearly seen in myomectomy The wrist motion allows for better more precise suturing than conventional "straight stick" laparoscopy The strength of the arms allow for better pulling of the suture and the third arm for holding the suture on tension. Other advantage of the robot is scaling of the movements when big movement on the outside translates to very fine movement on the inside. This enables much more precise surgery and may be important in the procedures like tubal anastomosis and implantation of the ureter Three-dimensional vision provides excellent depth of field perception. It is important for surgeons who are switching from open surgeries and preliminary evidence shows that it may allow for better identification of lesions like endometriosis. Another big advantage of robotics is that the surgeon sits comfortably with his/her arms and head supported. This results in much less fatigue and therefore increases precision and potentially may decrease the number of medical errors. The eyes of the surgeon are directed at where the hands should be, which is more natural, allows for a more natural body position and mimics open surgery Robot also enables better teaching, especially when two consoles are used. The surgeon and the student may be either sharing the instruments with two consoles or switching between one another. In a situation where the student operates, the surgeon can use the telestation to teach. Robotic simulator attached to one of the consoles allows students to practice after hours. In summary surgical robot is a great tool, especially in gynecology but also in urology cardiac surgery general surgery and laryngology The device will evolve and most likely with time will eliminate laparoscopy PMID:23488297

Hibner, Micha?; Marianowski, Piotr; Szymusik, Iwona; Wielgós, Miros?aw

2012-12-01

402

Surgery for Pelvic Organ Prolapse  

MedlinePLUS

... Rectum Close-up of anterior vaginal wall Sacrospinous Fixation The prolapsed vaginal vault is attached to the ... of tissue that connects bones or supports large internal organs. Obliterative Surgery: A type of surgery for ...

403

Infant open heart surgery (image)  

MedlinePLUS

During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia. ... During open-heart surgery an incision is made through the breastbone (sternum) while the child is under general anesthesia.

404

Anaesthesia for robotic gynaecological surgery.  

PubMed

Robotic surgery is gaining widespread popularity due to advantages such as reduced blood loss, reduced postoperative pain, shorter hospital stay and better visualisation of fine structures. Robots are being used in urological, cardiac, thoracic, orthopaedic, gynaecological and general surgery. Robotic surgery received US Food and Drug Administration approval for use in gynaecological surgery in 2005. The various gynaecological robotic operations being performed are myomectomy, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, tubal reanastomosis, lymph node dissection, surgery of retroperitoneal ectopic pregnancy, Moskowitz procedure and endometriosis surgery. The anaesthetic considerations include difficult access to the patient intraoperatively, steep Trendelenburg position, long surgical duration and the impact of pneumoperitoneum. We highlight the complications encountered in these surgeries and methods to prevent these complications. Robotic gynaecological surgery can be safely performed after considering the physiological effects of the steep Trendelenburg position and of pneumoperitoneum. The benefits of the surgical procedure should be weighed against the risks in patients with underlying cardiorespiratory problems. PMID:22813488

Gupta, K; Mehta, Y; Sarin Jolly, A; Khanna, S

2012-07-01

405

Bladder Surgery Codes  

Cancer.gov

Bladder C670–C679 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor destruction, NOS 11 Photodynamic therapy (PDT) 12

406

Cosmetic breast surgery - discharge  

MedlinePLUS

... soon as possible to promote blood flow and healing. You may be able to do some activity 1 to 2 days after surgery. Your health care provider may show you special exercises and breast-massaging techniques. Do these at home ...

407

Stomach Surgery Codes  

Cancer.gov

Stomach C160–C169 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor destruction, NOS 11 Photodynamic therapy (PDT) 12 Electrocautery;

408

Laparoscopic surgery in endometriosis.  

PubMed

Endometriosis (the presence of endometrial glands and stroma outside of the uterine cavity) is a common gynecologic problem affecting 10% of women in the general population, 40% of women with infertility and 60% of women with chronic pelvic pain. Laparoscopy has revolutionized management of women with endometriosis. Diagnosis of endometriosis depends on visualization of endometriotic lesions and histologic confirmation. Endometriotic implants have a multitude of appearances: powder burns, red, blue-black, yellow, white, clear vesicular and peritoneal windows. Diagnostic laparoscopy is often combined with operative procedures to treat manifestations and symptoms of endometriosis. This often includes removal or laser vaporization of endometriotic implants, lysis of adhesions, restoration of normal anatomy and removal or fulguration of ovarian endometriomas (conservative surgery). Severe incapacitating endometriosis, recurrent endometriosis following conservative surgery and symptomatic endometriosis in women not desiring more children is often treated by laparoscopic unilateral or bilateral salpingo-oophorectomy or laparoscopically-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (radical surgery). Endometriosis affecting the appendix, ureters, bladder wall and rectosigmoid colon could be treated with laparoscopic appendectomy, excision of endometriotic implants or laparoscopic colectomy and anastomosis, respectively. Hydrodis-section and use of CO2 super pulsed laser aid in removal of adherent endometriotic implants without damage to normal underlying structures. Robotic-assisted laparoscopic surgery promises to provide advantages in the management of women with severe endometriosis secondary to 3-dimensional visualization, decreasing surgeon's fatigue and hand tremors and improving surgical precision. PMID:18560348

Eltabbakh, G H; Bower, N A

2008-08-01

409

Parotid Surgery Codes  

Cancer.gov

Parotid and Other Unspecified Glands Parotid Gland C079, Major Salivary Glands C080–C089 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY

410

Heart bypass surgery  

MedlinePLUS Videos and Cool Tools

Heart bypass surgery begins with an incision made in the chest, with the breastbone cut exposing the heart. Next, a portion of the saphenous vein is ... used to bypass the blocked arteries in the heart. The venous graft is sewn to the aorta ...

411

Mohs Micrographic Surgery  

MedlinePLUS

... the first 24–48 hours. Apply Vaseline® or antimicrobial ointment daily. Keep the area covered with gauze dressing or a Band-Aid®. Non-dissolving stitches need to be removed in 5–14 days, depending on the type of suture. Risks or Side Effects Infection Bleeding during or after the surgery Bruising ...

412

Refractive corneal surgery - discharge  

MedlinePLUS

... artificial tears. Check with your doctor. Do NOT wear contact lenses on the eye that had surgery, even if you have blurry vision. Do NOT use any makeup, creams, or lotions ... being hit or bumped. Always wear sunglasses when in the sun.

413

Surgery on Nullhomologous Tori  

E-print Network

By studying the example of smooth structures on CP^2#3(-CP^2) we illustrate how surgery on a single embedded nullhomologous torus can be utilized to change the symplectic structure, the Seiberg-Witten invariant, and hence the smooth structure on a 4-manifold.

Fintushel, Ronald

2011-01-01

414

LASIK eye surgery  

MedlinePLUS

... surgery that permanently changes the shape of the cornea (the clear covering on the front of the ... For clear vision, the eye's cornea and lens must bend (refract) light rays properly. This allows images to be focused on the retina. Otherwise, the images will ...

415

Hair transplantation surgery  

PubMed Central

Techniques in hair transplantation have evolved recently which make results look more natural. Hair restoration is one of the most exciting and innovative surgical fields in aesthetic surgery today. A precise appreciation of anatomy has allowed the use of follicular unit grafts. With better methods of harvesting and implantation, hair transplantation results represent a blend of art and science. PMID:20174544

Khanna, Manoj

2008-01-01

416

Surgery in Spain  

Microsoft Academic Search

he Iberian Peninsula—the southwestern point of Europe, between the Mediterranean Sea and the Atlantic Ocean—was visited and settled in ancient times by a variety of peoples. Phoenicians, Carthaginians, Celts, Greeks, Romans, Visigoths, and Arabs all left their mark on the peninsula, and their cultures blended together to found, among other things, a rich tradition in medicine and surgery. During the

Manuel Trias; Eduardo M. Targarona; Antonio Moral; Cristobal Pera

1998-01-01

417

Lung Surgery Codes  

Cancer.gov

Lung C340–C349 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 19 Local tumor destruction or excision, NOS Unknown whether a specimen was

418

Anus Surgery Codes  

Cancer.gov

Anus C210–C218 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) [SEER Note: Do not code infrared coagulation as treatment.] Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor

419

Kidney Surgery Codes  

Cancer.gov

Kidney, Renal Pelvis, and Ureter Kidney C649, Renal Pelvis C659, Ureter C669 (Except for M9727, 9733, 9741-9742, 9764-9809, 9832, 9840-9931, 9945-9946, 9950-9967, 9975-9992) Codes 00 None; no surgery of primary site; autopsy ONLY 10 Local tumor

420

Notes on rotating turbulence  

NASA Technical Reports Server (NTRS)

This work investigates the turbulent constitutive relation when turbulence is subjected to solid body rotation. Laws regarding spectra and asymptotic decay of rotating homogeneous turbulence were confirmed through large-eddy simulation (LES) computations. Rotating turbulent flows exist in many industrial, geophysical, and astrophysical applications. From Lagrangian analysis a relation between turbulent stress and strain in rotating homogeneous turbulence was inferred. This relation was used to derive the spectral energy flux and, ultimately, the energy spectrum form. If the rotation wavenumber k(sub Omega) lies in the inertial subrange, then for wavenumbers less than k(sub Omega) the turbulence motions are affected by rotation and the energy spectrum slope is modified. Energy decay laws inferred in other reports and the present results suggest a modification of the epsilon model equation and eddy viscosity in k-epsilon models.

Zeman, Otto

1994-01-01

421

Mechatronics Interface for Computer Assisted Prostate Surgery Training  

NASA Astrophysics Data System (ADS)

In this work is presented the development of a mechatronics device to simulate the interaction of the surgeon with the surgical instrument (resectoscope) used during a Transurethral Resection of the Prostate (TURP). Our mechatronics interface is part of a computer assisted system for training in TURP, which is based on a 3D graphics model of the prostate which can be deformed and resected interactively by the user. The mechatronics interface, is the device that the urology residents will manipulate to simulate the movements performed during surgery. Our current prototype has five degrees of freedom, which are enough to have a realistic simulation of the surgery movements. Two of these degrees of freedom are linear, to determinate the linear displacement of the resecting loop and the other three are rotational to determinate three directions and amounts of rotation.

Altamirano del Monte, Felipe; Padilla Castañeda, Miguel A.; Arámbula Cosío, Fernando

2006-09-01

422

Rotating Sky Module  

NSDL National Science Digital Library

This module uses interactive simulations to introduce students to the horizon and celestial coordinate systems and the apparent rotation of objects in the sky (caused by the Earth's rotation). The simulations demonstrate the horizon plane, azimuth, and altitude; compare the advantages and disadvantages of the horizon and celestial coordinate systems, and show the paths of stars and other objects as they 'rotate' through the sky. The 'Rotating Star Explorer' lets users place stars, select the observer's position, and run an animation that shows the movements of the stars in both celestial and horizon views. The module includes a pretest, posttest, and a student guide.

423

Open Heart Surgery - What to Expect  

MedlinePLUS Videos and Cool Tools

... reviewed: 01/09/2013 2 Cardiac Surgery Intensive Care Unit When you wake up from the surgery, you will be in the Cardiac Surgery Intensive Care Unit (ICU). During surgery, many tubes are placed ...

424

Learn About the Types of Surgery  

Cancer.gov

Most women with DCIS or breast cancer that can be treated with surgery have three surgery choices: breast-sparing surgery followed by radiation therapy, mastectomy, and mastectomy with breast reconstruction surgery.

425

Thurston norm and cosmetic surgeries  

E-print Network

Two Dehn surgeries on a knot are called cosmetic if they yield homeomorphic manifolds. For a null-homologous knot with certain conditions on the Thurston norm of the ambient manifold, if the knot admits cosmetic surgeries, then the surgery coefficients are equal up to sign.

Ni, Yi

2010-01-01

426

College of Medicine SUR Surgery  

E-print Network

College of Medicine SUR Surgery KEY: # = new course * = course changed = course dropped University of Kentucky 2013-2014 Undergraduate Bulletin 1 SUR 815 FIRST-YEAR ELECTIVE, SURGERY. (1-3) With the advice by the Department of Surgery. The intent is to provide the student an opportunity for exploration and study

MacAdam, Keith

427

Cataract Surgery among Medicare Beneficiaries  

PubMed Central

Purpose To present descriptive epidemiology of cataract surgery among Medicare recipients in the United States. Setting Cataract surgery performed on Medicare beneficiaries in 2003 and 2004. Methods Medicare claims data were used to identify all cataract surgery claims for procedures performed in the United States in 2003-2004. Standard assumptions were used to limit the claims to actual cataract surgery procedures performed. Summary statistics were created to determine the number of procedures performed for each outcome of interest: cataract surgery rates by age, race, and gender; surgical volume by facility type, surgeon characteristics, and state; time interval between first- and second-eye cataract surgery. Results The national cataract surgery rate for 2003-2004 was 61.8 per 1000 Medicare beneficiary person-years. The rate was significantly higher for females and for those 75-84. After adjustment for age and gender, blacks had approximately a 30% lower rate of surgery than whites. While only 5% of cataract surgeons performed more than 500 cataract surgeries annually, these surgeons performed 26% of the total cataract surgeries. Increasing surgical volume was found to be highly correlated with use of ambulatory surgical centers and reduced time interval between first- and second-eye surgery in the same patient. Conclusions The epidemiology of cataract surgery in the United States Medicare population documents substantial variation in surgical rates by race, gender, age, and by certain provider characteristics. PMID:22978526

Schein, Oliver D.; Cassard, Sandra D.; Tielsch, James M.; Gower, Emily W.

2014-01-01

428

Psychiatric aspects of bariatric surgery  

PubMed Central

Purpose of review Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. Recent findings This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. Summary Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients. PMID:25036421

Yen, Yung-Chieh; Huang, Chih-Kuan; Tai, Chi-Ming

2014-01-01

429

Minimally invasive surgery in neonates  

Microsoft Academic Search

Minimally invasive surgery (MIS) has been one of the most important developments in surgery in the last century. By reducing the incision to small puncture wounds, morbidity, pain, adhesions and scarring are reduced. Due to their small size, neonates have not benefited from the advances in endoscopic surgery as rapidly as their adult counterparts. In the last 5 years, miniaturization

Keith Georgeson

2003-01-01

430

Piecewise Mental Rotation 1 Running Head: PIECEWISE MENTAL ROTATION  

E-print Network

Piecewise Mental Rotation 1 Running Head: PIECEWISE MENTAL ROTATION Piecewise Mental Rotation Heri entries Figures: 2 (1 panel and 6 panels) Tables: 1 (2 panels) #12;Piecewise Mental Rotation 2 Abstract In mental rotation tasks, participants have to decide whether two images show the same object or scene

Pomplun, Marc

431

Optical Gyroscopes: Sensing Rotation  

E-print Network

gyroscopes are all familiar methods to measure position. The sensing of rotation by optical means was first1 Optical Gyroscopes: Sensing Rotation Without Moving Parts Robert Dahlgren Silicon Valley since ancient times. Astronomy, timekeeping, magnetic sensors, the GPS system, MEMs, and spinning- mass

Miller, Ethan L.

432

Rotatable shear plate interferometer  

DOEpatents

A rotatable shear plate interferometer comprises a transparent shear plate mounted obliquely in a tubular supporting member at 45.degree. with respect to its horizontal center axis. This tubular supporting member is supported rotatably around its center axis and a collimated laser beam is made incident on the shear plate along this center axis such that defocus in different directions can be easily measured.

Duffus, Richard C. (Livermore, CA)

1988-01-01

433

Mental Rotation Explanation  

NSDL National Science Digital Library

One of the most popular tasks used in measuring individual differences in spatial ability is a mental rotation task introduced by Shepard and Metzler (1971). This page provides information about use of a spatial ability task to illustrate the prinicple of mental rotation.

434

Diamagnetism of rotating plasma  

SciTech Connect

Diamagnetism and magnetic measurements of a supersonically rotating plasma in a shaped magnetic field demonstrate confinement of plasma pressure along the magnetic field resulting from centrifugal force. The Grad-Shafranov equation of ideal magnetohydrodynamic force balance, including supersonic rotation, is solved to confirm that the predicted angular velocity is in agreement with spectroscopic measurements of the Doppler shifts.

Young, W. C.; Hassam, A. B.; Romero-Talamas, C. A.; Ellis, R. F.; Teodorescu, C. [IREAP, University of Maryland, College Park, Maryland 20742 (United States)

2011-11-15

435

Corneoplastique™: Art of vision surgery  

PubMed Central

Corneoplastique incorporates the entire spectrum of Vision corrective surgery including Lasik, premium cataract surgery, corneal surgery, ocular surface surgery and the full range of anterior segment surgery itself in manipulating the optics of every eye towards unaided emmetropia to define each and every eye surgeon as a “Vision Corrective Surgeon”. This concept of approaching each case individually and designing vision therewith enables surgeons to correct not only virgin eyes but also approach complex cases and complications with the goal of 20/20 vision. Armed with this holistic approach, eye surgeons can use minimally invasive, aesthetically pleasing and visually focused surgery in single or staged process aiming for each patient's Best Vision Potential (BVP) raising eye surgery itself then to an Art! PMID:24492495

Gulani, Arun C

2014-01-01

436

Laser and Surgery  

NASA Astrophysics Data System (ADS)

Surgeon's hand, guiding a light ray, Laser, instead of holding a common lancet, for dissecting delicately tissues with simultaneous haemostasis on small vessels, represents one of the most interesting expressions of modern technology applied to surgery. The use of Laser in surgery dates back to 25 years ago. Its medical applications, however, are a little more recent. The word Laser comes from "Light Amplification by Stimulated Emission of Radiation". It " is known that any material, which has been stimulated, emits energy of excitation through the so called spontaneous Energy. This means irradiation of "quanta" of electro-magnetic energy untidily in space and time (so called "incoherent Emission"). A Laser source, conversely, emits "coherent" electro-magnetic radiations (so called "stimulated Emission") , whose characteristics consist in: monochromaticity,directional ity, coherence and brilliance.

Casaccia, Mario; Campisi, C.; Pasero, E.; Ieracitano, V. M.; Berardi, L.; Padula, P.; Cordaro, S.; Boccardo, F.

1990-09-01

437

Endoscopic Skull Base Surgery  

PubMed Central

Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field. PMID:19434274

Senior, Brent A

2008-01-01

438

Minor surgery in microgravity  

NASA Technical Reports Server (NTRS)

The purpose is to investigate and demonstrate equipment and techniques proposed for minor surgery on Space Station Freedom (SSF). The objectives are: (1) to test and evaluate methods of surgical instrument packaging and deployment; (2) to test and evaluate methods of surgical site preparation and draping; (3) to evaluate techniques of sterile procedure and maintaining sterile field; (4) to evaluate methods of trash management during medical/surgical procedures; and (4) to gain experience in techniques for performing surgery in microgravity. A KC-135 parabolic flight test was performed on March 30, 1990 with the goal of investigating and demonstrating surgical equipment and techniques under consideration for use on SSF. The flight followed the standard 40 parabola profile with 20 to 25 seconds of near-zero gravity in each parabola.

Billica, Roger; Krupa, Debra T.; Stonestreet, Robert; Kizzee, Victor D.

1991-01-01

439

Cataract Surgery Tool  

NASA Technical Reports Server (NTRS)

The NASA-McGannon cataract surgery tool is a tiny cutter-pump which liquefies and pumps the cataract lens material from the eye. Inserted through a small incision in the cornea, the tool can be used on the hardest cataract lens. The cutter is driven by a turbine which operates at about 200,000 revolutions per minute. Incorporated in the mechanism are two passages for saline solutions, one to maintain constant pressure within the eye, the other for removal of the fragmented lens material and fluids. Three years of effort have produced a design, now being clinically evaluated, with excellent potential for improved cataract surgery. The use of this tool is expected to reduce the patient's hospital stay and recovery period significantly.

1977-01-01