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Sample records for inferior glenohumeral ligament

  1. Neurohistological examination of the inferior glenohumeral ligament of the shoulder.

    PubMed

    Steinbeck, Jörn; Brüntrup, Jens; Greshake, Oliver; Pötzl, Wolfgang; Filler, Timm; Liljenqvist, Ulf

    2003-03-01

    The neural histology of the anterior band of the inferior glenohumeral ligament (IGHL) was studied in 11 fresh shoulder specimen using a special silver impregnation technique. Between the collagen fibers small myelinated and unmyelinated dendrites could be detected. The appearance of neurovascular structures in the adjacent synovial layer clearly exceeded the typical supply to soft tissues. Analysing about 11,000 sections Ruffini mechanoreceptors that are known to be slow adapting were found on the humeral insertion of the band. The sections containing these neural end organs were identified by means of transillumination and reflection-contrast microscopy and reconstructed using three-dimensional image processing. The presence of neural structures including Ruffini corpuscles in these most important passive stabilizers of the shoulder joint shows that these ligaments function also as an active safety device. There slow adaption is a prerequisite for muscular reflexes counteracting the tensile stresses to which the passive stabilizing structures of the shoulder are exposed. A disruption of the continuity of these structures by mechanical forces or surgery can reduce the biofeedback and proprioceptive quality and thus lead to a decrease of shoulder function and/or stability. These observations should be taken into account when planning surgical interventions involving the IGHL. Procedures like capsule shifts or plications may affect mechanoreceptor orientation and concentrations, thereby affecting the interaction between these structures and the synergistic muscles. When possible, these intervention should avoid receptor-dense regions while attempting to restore normal anatomical orientation and tissue tension.

  2. Humeral avulsion of the inferior glenohumeral ligament in college female volleyball players caused by repetitive microtrauma.

    PubMed

    Taljanovic, Mihra S; Nisbet, Jon K; Hunter, Tim B; Cohen, Randy P; Rogers, Lee F

    2011-05-01

    Humeral avulsion of the inferior glenohumeral ligament is a rare injury resulting from hyperabduction and external rotation, and it is most commonly seen with sports-related injuries, including those from volleyball. The anterior band of the inferior glenohumeral ligament is most commonly injured (93%), whereas the posterior band is infrequently injured. The axillary pouch humeral avulsion of the inferior glenohumeral ligament as a result of repetitive microtrauma has not been yet described in the English literature. Humeral avulsions of the inferior glenohumeral ligaments are identifiable in volleyball players without acute injuries, and they have a unique pathologic pattern in these athletes. Case series; Level of evidence, 4. Four female college volleyball players with pain in their dominant shoulder and with inferior capsular laxity and/or instability—without a known history of trauma or dislocation of the same shoulder—were referred by an experienced sports medicine orthopaedic surgeon for the magnetic resonance arthrogram procedure of the same shoulder. The imaging findings were retrospectively correlated with the initial interpretation and arthroscopic findings. All 4 patients had an axillary pouch humeral avulsion of the inferior glenohumeral ligament. Three had articular surface partial-thickness rotator cuff tear, and 3 had a labral tear. All were outside hitters or middle blockers who consequently performed multiple hitting maneuvers in practice and games. Repetitive microtrauma from overhead hitting in volleyball generates forces on the inferior capsule of the shoulder joint that may cause inferior capsular laxity and subsequent failure of the humeral side of the axillary pouch portion of the inferior glenohumeral ligament.

  3. MR imaging of the glenohumeral ligaments.

    PubMed

    Bencardino, Jenny T; Beltran, Javier

    2006-07-01

    The glenohumeral ligaments, particularly the inferior one, are the major passive stabilizers of the joint, and the labrum functions as a site of ligamentous attachment. The strong union between the collagen fibers of the glenohumeral ligaments and the glenoid labrum is more resistant to injury than the union between the glenoid rim and the labrum. Labral tears associated with glenohumeral instability are therefore usually secondary to avulsion rather than impaction. This article reviews the normal MR imaging anatomy, variants and pitfalls of the glenohumeral ligaments, and the basic biomechanics of the glenohumeral ligaments. Examples of injuries involving these structures are provided.

  4. Arthroscopic Bankart repair augmented by plication of the inferior glenohumeral ligament via horizontal mattress suturing for traumatic shoulder instability.

    PubMed

    Lee, Kong Hwee; Soeharno, Henry; Chew, Chee Ping; Lie, Denny

    2013-10-01

    This study aimed to evaluate the two-year clinical outcomes of arthroscopic Bankart repair augmented by plication of the inferior glenohumeral ligament (IGHL) via horizontal mattress suturing. This study was a retrospective analysis of 76 arthroscopic Bankart repairs by a single surgeon from 2004 to 2008. Bioabsorbable suture anchors were used, with anchors placed at the 5:30, 4 and 3 o'clock positions of the right shoulder (correspondingly at the 6:30, 8 and 9 o'clock positions for the left shoulder). The lower most anchor was tied via horizontal mattress suture with plication of the IGHL, while the remaining two anchors were tied using simple sutures. The patients were postoperatively assessed, clinically and using the University of California Los Angeles (UCLA) shoulder rating scale. The mean age of the patients at the time of presentation was 24.09 ± 7.98 years, and the mean duration of follow-up was 28.7 months. The postoperative recurrence rate of dislocation was 7.89% (six shoulders), of which five shoulders required revision surgeries. Excluding the revision cases, clinical assessment of the strength of the supraspinatus and the range of motion of the operated shoulders at two years post operation were either maintained or full in all patients. Analysis of the UCLA results showed pre- and postoperative mean scores of 25.94 ± 3.43 and 33.77 ± 3.07, respectively (p < 0.05). Arthroscopic Bankart repair augmented by plication of the IGHL and anchored via horizontal mattress suturing is a safe and reliable treatment for shoulder instability, with good clinical outcomes and low recurrence rates.

  5. Identification and management of chronic shoulder pain in the presence of an MRA-confirmed humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion

    PubMed Central

    Karmali, Arif; McLeod, Jennifer

    2016-01-01

    Objective: To present the assessment and conservative management of chronic shoulder pain in the presence of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion in an active individual. Clinical Features: A 47 year-old female office-worker with constant, deep, right shoulder pain with occasional clicking and catching claimed to have “tore something” in her right shoulder five years ago while performing reverse bicep curls. A physical exam led to differential diagnoses of a Superior Labrum Anterior to Posterior (SLAP) lesion, Bankart lesion, and bicipital tendinopathy. A Magnetic Resonance Arthrogram revealed a HAGL lesion. Intervention and Outcome: A conservative chiropractic treatment plan in addition to physical therapy was initiated. The patient reported 75% improvement in symptoms after 4 treatments over a four-week duration. Summary: This case demonstrates the successful implementation of a conservative plan of management suggesting that the treatment provided to this patient should be considered and attempted prior to arthroscopic surgery. PMID:27385837

  6. Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture.

    PubMed

    Michelin, Paul; Delarue, Yohann; Duparc, Fabrice; Dacher, Jean Nicolas

    2013-10-01

    The aim of this retrospective study was to measure the inferior glenohumeral capsule thickness of shoulders clinically affected by capsular contracture by comparison to the contralateral asymptomatic side. Bilateral shoulder ultrasound (US) examinations of 20 patients with clinically or MRI proven unilateral capsular contracture were retrospectively assessed. Inferior capsule evaluation was performed with a transducer placed within the axilla in maximally abducted shoulders. Measurements were symmetrically performed orthogonally to the inferior glenohumeral ligament (IGHL) in the axial plane; the coronal plane was used to ensure the tension of the IGHL. The significance of any difference in thickening was assessed with the Mann-Whitney test. The average thickness was 4.0 mm in shoulders with capsular contracture vs. 1.3 mm in asymptomatic contralateral shoulders (P < 0.0001). Twenty per cent of patients with capsular contracture and inferior capsule thickness increase showed US features of other painful diseases of the rotator cuff. The thickness of the inferior capsule is measurable through ultrasound examination and appears to be increased in shoulders with capsular contracture. Exploration of the inferior aspect of the shoulder joint could be added to shoulder US examination protocols for capsular contracture assessment even if other rotator cuff abnormalities are diagnosed by US. • Ultrasound is increasingly used to diagnose shoulder problems. • The thickness of the inferior glenohumeral ligament is measurable in the axilla. • The inferior glenohumeral ligament appears thickened in shoulders with capsular contracture. • Capsular contracture ultrasound features can be associated with other rotator cuff problems.

  7. Glenoid avulsion of the glenohumeral ligament (GAGL): a case report and review of the anatomy.

    PubMed

    Mannem, Rajeev; DuBois, Melissa; Koeberl, Matthew; Kosempa, Damian; Erickson, Scott

    2016-10-01

    Shoulder dislocations are frequently seen in the general population and can be a cause of instability. Instability can lead to debilitating symptoms and morbidity as a result of progressive damage to the shoulder. Anterior shoulder dislocations are the most frequent type of dislocations and have been studied extensively with MRI. The soft tissue Bankart lesion is the most well-known entity associated with anterior instability; however, additional structural lesions arising from traumatic events have been described in recent literature which also predispose to anterior shoulder instability. One of these lesions, the glenoid avulsion of the glenohumeral ligament (GAGL), involves avulsion of the inferior glenohumeral ligament from the glenoid and involves separation from an intact labrum. In contrast to the Bankart lesion, there has been limited discussion of the GAGL lesion in the literature and very few imaging examples. We report a case of a GAGL diagnosed on MRI and confirmed with arthroscopy. It is discussed in the context of the anatomy of the inferior glenohumeral ligament and the imaging findings.

  8. The effect of shoulder position on inferior glenohumeral mobilization.

    PubMed

    Witt, Dexter W; Talbott, Nancy R

    2017-03-09

    Cross-sectional clinical measurement study. Inferior mobilizations are used to treat patients with shoulder dysfunctions. Common positions recommended for promoting an inferior glide include: (1) an open-packed position (OPP) in which the shoulder is in 55° of abduction, 30° of horizontal adduction, and no rotation; (2) neutral position (NP) of the shoulder; and (3) position of 90° of shoulder abduction (ABDP). Studies comparing the impact of position on inferior mobilization are lacking. To determine the effect of shoulder position on humeral movement and mobilization force during inferior mobilizations. Twenty-three subjects were tested bilaterally. Subjects were placed in the OPP, and an ultrasound transducer placed over the superior glenohumeral joint. As inferior mobilization forces were applied through a dynamometer, ultrasound images were taken at rest and during 3 grades of inferior mobilization. This process was repeated in the NP and the ABDP. In the NP, movements during grade 1, 2, and 3 mobilizations were 1.8, 3.8, and 4.5 mm, respectively. Movements measured in the OPP (1.0, 2.4, and 3.6 mm, respectively) and in the ABDP (1.0, 2.2, and 2.3 mm, respectively) were less. Forces were higher in the NP during grade 1, 2, and 3 mobilizations (51.8, 138.7, and 202.1 N, respectively) than in the OPP (37.2, 91.2, and 139.9 N, respectively) and the ABPD (42.5, 115.3, and 165.5 N, respectively). Mobilization position altered the movement and force during inferior mobilizations. Shoulder position should be considered when utilizing inferior mobilizations. NA. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  9. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) in anterior shoulder instability

    PubMed Central

    Vedova, Franco Della; Ibáñez, Maximiliano; Alvarez, Victoria; Lépore, Salvador; Sulzle, Vanina Ojeda; Galan, Hernán; Slullitel, Daniel

    2015-01-01

    Introduction: Bankart lesion is the anterior glenohumeral instability most common associated injury. Tears at glenohumeral ligaments can be intra substance or at humeral insertion, this location may be the cause of instability. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) can be an isolated or associated cause of instability and it is usually related to the posterior glenohumeral instability. The aim of this article is to report the clinical assessment and postoperative outcomes of 6 patients with PHAGL with anterior shoulder instability. Materials and Methods: We evaluated six patients with PHAGL due to anterior glenohumeral instability arthroscopically repaired. All 6 patients developed the lesion after a sports-related trauma. Sixty six per cent of patients had associated intra-articular shoulder pathologies. The diagnosis with MRI arthrogram (with gadolinium) was performed preoperatively in 50% of patients. Postoperative evaluation was made with Rowe, ASES and WOSI scores. Results: All patients returned to their previous sports level. One patient had a recurrence. Postoperative scores results are WOSI: 13.13%, Rowe 83.33 and ASES 95.83. Discussion: Humeral avulsions of glenohumeral ligaments represent 25% of capsulolabral injuries. PHAGL injury was initially described as a cause of posterior instability, but according to two other series, our study shows that this lesion may also cause anterior instability. It is critical to have a high index of suspicion and make a correct arthroscopic examination to diagnose this injury, because arthroscopic repair of PHAGL has good postoperative outcomes.

  10. Glenohumeral internal rotation deficits in baseball players with ulnar collateral ligament insufficiency.

    PubMed

    Dines, Joshua S; Frank, Joshua B; Akerman, Meredith; Yocum, Lewis A

    2009-03-01

    The kinetic chain of the throwing motion functions to optimize efficiency of proximal segments to decrease force loads seen at smaller, distal segments such as the ulnar collateral ligament. Several studies have shown that shoulder internal rotation forms the physiologic counter to the valgus torque generated during the late cocking phase of throwing. Previous studies have implicated decreased glenohumeral internal rotation as a cause of shoulder internal impingement. To date, an association between pathologic glenohumeral internal rotation deficit and elbow injury has not been exhibited. Throwers with ulnar collateral ligament insufficiency will exhibit significantly increased glenohumeral internal rotation deficit. Case control study; Level of evidence, 3. Twenty-nine baseball players with ulnar collateral ligament insufficiency were demographically matched with 29 control baseball players who had no history of shoulder, elbow, or cervical spine injury. The investigators measured passive glenohumeral internal and external rotation, elbow flexion and extension, and forearm pronation and supination. The Mann-Whitney test was used to analyze continuous variables. There were no significant differences between the groups in terms of demographics. There was a significant difference in dominant arm internal rotation, with injured players having significantly less (P < .004), and in glenohumeral internal rotation deficit between players with ulnar collateral ligament insufficiency and those who were asymptomatic (28.5 degrees vs 12.7 degrees ; P < .001). Also, total range of motion was significantly decreased in the injured group. There were no significant differences in elbow or forearm range of motion between the groups. Our results indicate that pathologic glenohumeral internal rotation deficit may be associated with elbow valgus instability. This has important clinical implications both in terms of preventing ulnar collateral ligament injury and with regard to

  11. Combined posterior Bankart lesion and posterior humeral avulsion of the glenohumeral ligaments associated with recurrent posterior shoulder instability.

    PubMed

    Hill, J David; Lovejoy, John F; Kelly, Robert A

    2007-03-01

    Recurrent posterior glenohumeral instability is uncommon and is often misdiagnosed. Damage to the posterior capsule, posteroinferior glenohumeral ligament, and posterior labrum have all been implicated as sources of traumatic posterior instability. We describe a case of traumatic recurrent posterior instability resulting from a posterior Bankart lesion accompanied by posterior humeral avulsion of the glenohumeral ligaments. The Bankart lesion was repaired using a single arthroscopic suture anchor at the glenoid articular margin. The posterior humeral avulsion of the glenohumeral ligaments was addressed with 3 suture anchors placed at the capsular origin at the posterior humeral head. Using these anchors, the posterior capsule was advanced laterally and superiorly for a secure repair. Arthroscopic anatomic reconstruction of both lesions resulted in an excellent clinical outcome.

  12. CT appearance of the normal inferior pulmonary ligament

    SciTech Connect

    Cooper, C.; Moss, A.A.; Buy, J.N.; Stark, D.D.

    1983-08-01

    The inferior pulmonary ligament, a double layer of pleura that tethers the lower lobe of the lung to the mediastinum, is rarely appreciated on plain radiographs but may be involved in pathologic processes. A linear structure on axial computer tomographic (CT) images of the lung bases corresponds to the inferior pulmonary ligament on cadaver sections. Review of 100 CT studies identified at least one inferior pulmonary ligament in 42%. Its presence and configuration did not correlate with patient age or gender. The anatomy and CT appearance of the ligament are discussed.

  13. Outcomes of the biceps suspension procedure for painful inferior glenohumeral subluxation in hemiplegic patients.

    PubMed

    Namdari, Surena; Keenan, Mary Ann

    2010-11-03

    Patients with upper motor neuron injury can develop painful inferior glenohumeral subluxation with functional impairment. If the pain is relieved by manual reduction of the subluxation, this pain is considered mechanical in nature and potentially amenable to surgical treatment to maintain this reduction. The purpose of this study was to report our outcomes with use of the biceps suspension procedure to achieve shoulder joint reduction and pain relief in hemiplegic patients. This retrospective case series of eleven consecutive hemiplegic patients with painful glenohumeral subluxation underwent surgical reduction with a biceps suspension procedure. Seven patients had, in addition, extra-articular tenotomies to treat coexisting muscular contractures. Pain, physical examination findings, and radiographs were evaluated before and after surgery. Patient satisfaction with the outcome of the surgery was determined as well. The mean duration of the patient follow-up was 3.2 years (range, 2.0 to 5.8 years). The average patient age was 46.9 years (range, eighteen to eighty-one years). Ten of the patients were female. All patients had pain with passive shoulder motion preoperatively, but only one patient had such pain postoperatively (p < 0.001). At the time of follow-up after the surgery, the mean score for pain on a visual analog scale was 1.45 (range, 0 to 5), with all patients noting a decrease in pain. Ten patients noted that deformity was also decreased at the time of follow-up. All patients had a sulcus sign on physical examination preoperatively, but only three had such a sign postoperatively (p < 0.001). The seven patients who had undergone shoulder tenotomies had significant improvements in shoulder extension (p = 0.009), forward elevation (p = 0.030), abduction (p = 0.040), and external rotation (p = 0.043) postoperatively. Ten patients were satisfied with the outcome of the surgery. Preoperative radiographs demonstrated inferior subluxation of the humeral head at

  14. Traumatic shoulder dislocation with combined bankart lesion and humeral avulsion of the glenohumeral ligament in a professional basketball player: three-year follow-up of surgical stabilization.

    PubMed

    Shah, Aakash A; Selesnick, F Harlan

    2010-10-01

    Traumatic anterior shoulder instability has been well documented to have associated lesions such as a Bankart tear, humeral avulsion of the glenohumeral ligament (HAGL), Hill-Sachs lesion, fracture, and nerve injury. To our knowledge, the combined Bankart and HAGL injury in a single acute anterior shoulder dislocation has not yet been reported. We describe a traumatic first-time anterior-inferior shoulder dislocation in a professional basketball player with a combined Bankart and HAGL lesion. The patient underwent arthroscopic Bankart repair followed by open repair of the HAGL lesion with an open capsular shift reconstruction. At 3 years' follow-up, the patient had returned to an elite level of play, with an excellent outcome.

  15. Magnetic resonance imaging in glenohumeral instability

    PubMed Central

    Jana, Manisha; Gamanagatti, Shivanand

    2011-01-01

    The glenohumeral joint is the most commonly dislocated joint of the body and anterior instability is the most common type of shoulder instability. Magnetic resonance (MR) imaging, and more recently, MR arthrography, have become the essential investigation modalities of glenohumeral instability, especially for pre-procedure evaluation before arthroscopic surgery. Injuries associated with glenohumeral instability are variable, and can involve the bones, the labor-ligamentous components, or the rotator cuff. Anterior instability is associated with injuries of the anterior labrum and the anterior band of the inferior glenohumeral ligament, in the form of Bankart lesion and its variants; whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesion. Multidirectional instability often has no labral pathology on imaging but shows specific osseous changes such as increased chondrolabral retroversion. This article reviews the relevant anatomy in brief, the MR imaging technique and the arthrographic technique, and describes the MR findings in each type of instability as well as common imaging pitfalls. PMID:22007285

  16. Spectrum of magnetic resonance imaging findings in clinical glenohumeral instability

    PubMed Central

    Jana, Manisha; Srivastava, Deep Narayan; Sharma, Raju; Gamanagatti, Shivanand; Nag, Hiralal; Mittal, Ravi; Upadhyay, Ashish Dutt

    2011-01-01

    The glenohumeral joint is the most commonly dislocated joint in the body, and anterior instability is the most common type of shoulder instability. Depending on the etiology and the age of the patient, there may be associated injuries, for example, to the anterior-inferior labro-ligamentous structures (in young individuals with traumatic instability) or to the bony components (commoner in the elderly), which are best visualized using MRI and MR arthrography. Anterior instability is associated with a Bankart lesion and its variants and abnormalities of the anterior band of the inferior glenohumeral ligament (IGHL), whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesions. Cases of multidirectional instability often have no labral pathology on imaging but show specific osseous changes including increased chondrolabral retroversion. This article reviews the relevant anatomy in brief and describes the MRI findings in each type, with the imaging features of the common abnormalities. PMID:21799591

  17. The effect of coracoacromial ligament excision and acromioplasty on the amount of rotator cuff force production necessary to restore intact glenohumeral biomechanics.

    PubMed

    Budoff, Jeffrey E; Lin, Cheng-Li; Hong, Chih-Kai; Chiang, Florence L; Su, Wei-Ren

    2016-06-01

    Coracoacromial ligament (CAL) excision and acromioplasty increase superior and anterosuperior glenohumeral translation. It is unknown how much of an increase in rotator cuff force production is required to re-establish intact glenohumeral biomechanics after these surgical procedures. We hypothesized that, after CAL excision and acromioplasty, an increase in rotator cuff force production would not be necessary to reproduce the anterosuperior and superior translations of the intact specimens. Nine cadaveric shoulders were subjected to loading in the superior and anterosuperior directions in the intact state after CAL excision, acromioplasty, and recording of the translations. The rotator cuff force was then increased to normalize glenohumeral biomechanics. After CAL excision at 150 and 200 N of loading, an increase in the rotator cuff force by 25% decreased anterosuperior translation to the point where there was no significant difference from the intact specimen's translation. After acromioplasty (and CAL excision) at 150 and 200 N, an increase in the rotator cuff force of 25% and 30%, respectively, decreased superior translation to the point where there was no significant difference from the intact specimen's translation. At 150 to 200 N of loading, CAL excision and acromioplasty increase the rotator cuff force required to maintain normal glenohumeral biomechanics by 25% to 30%. After a subacromial decompression, the rotator cuff has an increased force production requirement to maintain baseline glenohumeral mechanics. Under many circumstances, in vivo force requirements may be even greater after surgical attenuation of the coracoacromial arch. Basic Science Study; Biomechanics. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Embolization in a Patient with Ruptured Anterior Inferior Pancreaticoduodenal Arterial Aneurysm with Median Arcuate Ligament Syndrome

    SciTech Connect

    Ogino, Hiroyuki; Sato, Yozo; Banno, Tatsuo; Arakawa, Toshinao; Hara, Masaki

    2002-08-15

    In median arcuate ligament syndrome, the root of the celiac artery is compressed and narrowed by the median arcuate ligament of the diaphragm during expiration, causing abdominal angina.Aneurysm may be formed in arteries of the pancreas and duodenum due toa chronic increase in blood flow from the superior mesenteric artery into the celiac arterial region. We report a patient saved by embolization with coils of ruptured aneurysm that developed with markedly dilated anterior inferior pancreaticoduodenal artery due to median arcuate ligament syndrome.

  19. Anatomy of the capsulolabral complex and rotator interval related to glenohumeral instability.

    PubMed

    Itoigawa, Yoshiaki; Itoi, Eiji

    2016-02-01

    The glenohumeral joint with instability is a common diagnosis that often requires surgery. The aim of this review was to present an overview of the anatomy of the glenohumeral joint with emphasis on instability based on the current literature and to describe the detailed anatomy and anatomical variants of the glenohumeral joint associated with anterior and posterior shoulder instability. A review was performed using PubMed/MEDLINE using key words: Search terms were "glenohumeral", "shoulder instability", "cadaver", "rotator interval", "anatomy", and "anatomical study". During the last decade, the interest in both arthroscopic repair techniques and surgical anatomy of the glenohumeral ligament (superior, middle, and inferior), labrum, and rotator interval has increased. Understanding of the rotator interval and attachment of the inferior glenohumeral ligament on the glenoid or humeral head have evolved significantly. The knowledge of the detailed anatomy and anatomical variations is essential for the surgeon in order to understand the pathology, make a correct diagnosis of instability, and select proper treatment options. Proper understanding of anatomical variants can help us avoid misdiagnosis. Level of evidence V.

  20. Anatomy, Variants, and Pathologies of the Superior Glenohumeral Ligament: Magnetic Resonance Imaging with Three-Dimensional Volumetric Interpolated Breath-Hold Examination Sequence and Conventional Magnetic Resonance Arthrography

    PubMed Central

    Ogul, Hayri; Karaca, Leyla; Can, Cahit Emre; Pirimoglu, Berhan; Tuncer, Kutsi; Topal, Murat; Okur, Aylin

    2014-01-01

    The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL. PMID:25053912

  1. Anatomy, variants, and pathologies of the superior glenohumeral ligament: magnetic resonance imaging with three-dimensional volumetric interpolated breath-hold examination sequence and conventional magnetic resonance arthrography.

    PubMed

    Ogul, Hayri; Karaca, Leyla; Can, Cahit Emre; Pirimoglu, Berhan; Tuncer, Kutsi; Topal, Murat; Okur, Aylin; Kantarci, Mecit

    2014-01-01

    The purpose of this review was to demonstrate magnetic resonance (MR) arthrography findings of anatomy, variants, and pathologic conditions of the superior glenohumeral ligament (SGHL). This review also demonstrates the applicability of a new MR arthrography sequence in the anterosuperior portion of the glenohumeral joint. The SGHL is a very important anatomical structure in the rotator interval that is responsible for stabilizing the long head of the biceps tendon. Therefore, a torn SGHL can result in pain and instability. Observation of the SGHL is difficult when using conventional MR imaging, because the ligament may be poorly visualized. Shoulder MR arthrography is the most accurately established imaging technique for identifying pathologies of the SGHL and associated structures. The use of three dimensional (3D) volumetric interpolated breath-hold examination (VIBE) sequences produces thinner image slices and enables a higher in-plane resolution than conventional MR arthrography sequences. Therefore, shoulder MR arthrography using 3D VIBE sequences may contribute to evaluating of the smaller intraarticular structures such as the SGHL.

  2. Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery

    PubMed Central

    Lamo-Espinosa, J. M.; Llombart Blanco, R.; Valentí, J. R.

    2012-01-01

    We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries. PMID:22957293

  3. Successful Nonoperative Management of HAGL (Humeral Avulsion of Glenohumeral Ligament) Lesion With Concurrent Axillary Nerve Injury in an Active-Duty US Navy SEAL.

    PubMed

    Ernat, Justin J; Bottoni, Craig R; Rowles, Douglas J

    2016-01-01

    Humeral avulsion of the glenohumeral ligament (HAGL) is a lesion that has been recognized as a cause of recurrent shoulder instability. To our knowledge there are no reports of successful return to full function in young, competitive athletes or return to manual labor following nonoperative management of a HAGL lesion. A 26-year-old Navy SEAL was diagnosed with a HAGL injury, and associated traction injury of the axillary nerve as well as a partial tear of the rotator cuff. Operative intervention was recommended; however, due to issues with training and with inability to properly rehab with the axillary nerve injury, surgical plans were delayed. Interestingly, the patient demonstrated both clinical and radiographic magnetic resonance imaging healing of his lesion over an 18-month period. At 18 months the patient had returned to full active duty without pain or instability as a Navy SEAL.

  4. Finite element modelling of the glenohumeral capsule can help assess the tested region during a clinical exam.

    PubMed

    Ellis, Benjamin J; Drury, Nicholas J; Moore, Susan M; McMahon, Patrick J; Weiss, Jeffrey A; Debski, Richard E

    2010-06-01

    The objective of this research was to examine the efficacy of evaluating the region of the glenohumeral capsule being tested by clinical exams for shoulder instability using finite element (FE) models of the glenohumeral joint. Specifically, the regions of high capsule strain produced by glenohumeral joint positions commonly used during a clinical exam were identified. Kinematics that simulated a simple translation test with an anterior load at three external rotation angles were applied to a validated, subject-specific FE model of the glenohumeral joint at 60° of abduction. Maximum principal strains on the glenoid side of the inferior glenohumeral ligament (IGHL) were significantly higher than the maximum principal strains on the humeral side, for all three regions of the IGHL at 30° and 60° of external rotation. These regions of localised strain indicate that these joint positions might be used to test the glenoid side of the IGHL during this clinical exam, but are not useful for assessing the humeral side of the IGHL. The use of FE models will facilitate the search for additional joint positions that isolate high strains to other IGHL regions, including the humeral side of the IGHL.

  5. Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction: a pictorial essay.

    PubMed

    Dalmau-Pastor, M; Yasui, Y; Calder, J D; Karlsson, J; Kerkhoffs, G M M J; Kennedy, J G

    2016-04-01

    The inferior extensor retinaculum (IER) is an aponeurotic structure, which is in continuation with the anterior part of the sural fascia. The IER has often been used to augment the reconstruction of the lateral ankle ligaments, for instance in the Broström-Gould procedure, with good outcomes reported. However, its anatomy has not been described in detail and only a few studies are available on this structure. The presence of a non-constant oblique supero-lateral band appears to be important. This structure defines whether the augmentation of the lateral ankle ligaments reconstruction is performed using true IER or only the anterior part of the sural fascia. It is concluded that the use of this structure will have an impact on the resulting ankle stability.

  6. Capsulolabral augmentation increases glenohumeral stability in the cadaver shoulder.

    PubMed

    Metcalf, M H; Pon, J D; Harryman, D T; Loutzenheiser, T; Sidles, J A

    2001-01-01

    Multidirectional instability is not clearly understood. Excessive capsular laxity has been proposed as the key component. However, because ligaments fail to resist humeral head translation until they are tensioned, glenohumeral instability in the mid range of motion cannot be explained by capsuloligamentous pathology alone. Capsulolabral augmentation is designed to increase glenohumeral stability by 2 separate mechanisms: deepening the glenoid concavity and reducing capsular laxity. This is accomplished by shifting the capsule to buttress the glenoid labrum. Hence, the glenolabral concavity in which the humeral head is stabilized by compression throughout the entire range is enhanced. The purposes of this study were to examine glenolabral depth and glenohumeral stability before and after labral augmentation and to measure the effect of diminished capsular laxity on motion in clinically important positions. We compared glenolabral depth, resistance to humeral head displacement, and glenohumeral range of motion before and after capsulolabral augmentation. Glenolabral depth was measured as the lateral displacement of the center of the humeral head translating from the glenoid fossa. We recorded a mean increase in glenoid depth of 1.9 mm inferiorly, 2.0 mm posteroinferiorly, and 0.9 mm posteriorly (P <.02). Resistance to humeral head displacement was measured by use of the stability ratio, defined as the translatory force required to displace the humeral head divided by the force compressing the humeral head into the glenoid fossa. The mean stability ratio was increased by 0.24 inferiorly and 0.24 posteroinferiorly (P <.02). Motion was measured by achieving 30 degrees and 60 degrees elevation in the 0 degrees, 30 degrees, 60 degrees, and 90 degrees planes of elevation and measuring the extent of possible internal rotation for each of these 8 positions when the capsule was tensioned to exert 1000 N-mm of torque. Reduction of internal rotation in these positions was a

  7. Glenohumeral instability associated with Buford complex.

    PubMed

    del Rey, Fernando Canillas; Vázquez, Diego García-Germán; López, Daniel Nieto

    2009-12-01

    Buford complex is described as a normal anatomical variant of the anterosuperior part of the glenoid consisting of the absence of the anterosuperior labrum with the presence of a cord-like middle glenohumeral ligament. Traditionally, reattachment to the glenoid has been discouraged. We present a case of a Buford complex associated with glenohumeral instability. The patient was operated for recurrent instability without a preoperative diagnosis of Buford complex. The diagnosis was made during shoulder arthroscopy and reattachment to the glenoid was performed with a satisfactory outcome. Here, we discuss the relationship of the Buford complex with intraarticular pathology and the surgical treatment in cases when this variant is associated with instability.

  8. The periodontal ligament (PDL) injection: an alternative to inferior alveolar nerve block.

    PubMed

    Malamed, S F

    1982-02-01

    The periodontal ligament (PDL) injection for mandibular anesthesia in isolated regions was evaluated, using both a conventional syringe and two devices designed for this procedure. A high success rate was achieved, with a low incidence of adverse reaction and highly favorable comment from both patients and administrators. Duration of pulpal anesthesia following the technique described proved adequate for most dental procedures. The newer devices appear to have some advantage over the conventional syringe technique. However, the PDL injection technique can readily be used with any conventional syringe. Further study is recommended to determine the response of periodontal and pulpal tissues.

  9. Comparison of Periodontal Ligament Injection and Inferior Alveolar Nerve Block in Mandibular Primary Molars Pulpotomy: A Randomized Control Trial

    PubMed Central

    Haghgoo, Roza; Taleghani, Ferial

    2015-01-01

    Background: Inferior alveolar nerve block is a common technique for anesthesia of the primary mandibular molars. A number of disadvantages have been shown to be associated with this technique. Periodontal ligament (PDL) injection could be considered as an alternative to inferior alveolar nerve block. The aim of this study was to evaluate the effectiveness of PDL injection in the anesthesia of primary molar pulpotomy with mandibular block. Methods: This study was performed using a sequential double-blind randomized trial design. 80 children aged 3-7 years old who required pulpotomy in symmetrical mandibular primary molars were selected. The teeth of these children were anesthetized with periodontal injection on one side of the mandible and block on the other. Pulpotomy was performed on each patient during the same appointment. Signs of discomfort, including hand and body tension and eye movement, the verbal complaint and crying (SEM scale), were evaluated by a dental assistant who was blinded to the treatment allocation of the patients. Finally, the data were analyzed using the exact Fisher test and Pearson Chi-squared exact test. Results: Success rate was 88/75 and 91/25 in the PDL injection and nerve block groups, respectively. There was no statistically significant difference between the two techniques (P = 0.250). Conclusion: Results showed that PDL injection can be used as an alternative to nerve block in pulpotomy of the mandibular primary molars. PMID:26028895

  10. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial.

    PubMed

    Detollenaere, Renée J; den Boon, Jan; Stekelenburg, Jelle; IntHout, Joanna; Vierhout, Mark E; Kluivers, Kirsten B; van Eijndhoven, Hugo W F

    2015-07-23

    To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse. Multicentre randomised controlled non-blinded non-inferiority trial. 4 non-university teaching hospitals, the Netherlands. 208 healthy women with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery. Treatment with sacrospinous hysteropexy or vaginal hysterectomy with suspension of the uterosacral ligaments. The predefined non-inferiority margin was an increase in surgical failure rate of 7%. Primary outcome was recurrent prolapse stage 2 or higher of the uterus or vaginal vault (apical compartment) evaluated by the pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months' follow-up. Secondary outcomes were overall anatomical recurrences, including recurrent anterior compartment (bladder) and/or posterior compartment (bowel) prolapse, functional outcome, complications, hospital stay, postoperative recovery, and sexual functioning. Sacrospinous hysteropexy was non-inferior for anatomical recurrence of the apical compartment with bothersome bulge symptoms or repeat surgery (n=0, 0%) compared with vaginal hysterectomy with suspension of the uterosacral ligaments (n=4, 4.0%, difference -3.9%, 95% confidence interval for difference -8.6% to 0.7%). At 12 months, overall anatomical recurrences, functional outcome, quality of life, complications, hospital stay, measures on postoperative recovery, and sexual functioning did not differ between the two groups. Five serious adverse events were reported during hospital stay. None was considered to be related to the type of surgery. Uterus preservation by sacrospinous hysteropexy was non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments for surgical failure of the

  11. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial

    PubMed Central

    den Boon, Jan; Stekelenburg, Jelle; IntHout, Joanna; Vierhout, Mark E; Kluivers, Kirsten B; van Eijndhoven, Hugo W F

    2015-01-01

    Objective To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse. Design Multicentre randomised controlled non-blinded non-inferiority trial. Setting 4 non-university teaching hospitals, the Netherlands. Participants 208 healthy women with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery. Interventions Treatment with sacrospinous hysteropexy or vaginal hysterectomy with suspension of the uterosacral ligaments. The predefined non-inferiority margin was an increase in surgical failure rate of 7%. Main outcome measures Primary outcome was recurrent prolapse stage 2 or higher of the uterus or vaginal vault (apical compartment) evaluated by the pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse at 12 months’ follow-up. Secondary outcomes were overall anatomical recurrences, including recurrent anterior compartment (bladder) and/or posterior compartment (bowel) prolapse, functional outcome, complications, hospital stay, postoperative recovery, and sexual functioning. Results Sacrospinous hysteropexy was non-inferior for anatomical recurrence of the apical compartment with bothersome bulge symptoms or repeat surgery (n=0, 0%) compared with vaginal hysterectomy with suspension of the uterosacral ligaments (n=4, 4.0%, difference −3.9%, 95% confidence interval for difference −8.6% to 0.7%). At 12 months, overall anatomical recurrences, functional outcome, quality of life, complications, hospital stay, measures on postoperative recovery, and sexual functioning did not differ between the two groups. Five serious adverse events were reported during hospital stay. None was considered to be related to the type of surgery. Conclusions Uterus preservation by sacrospinous hysteropexy was non-inferior

  12. Glenohumeral mobility in primates.

    PubMed

    Chan, Lap Ki

    2007-01-01

    This study refutes the traditional idea that the glenohumeral joint of hominoids is more mobile than that of other primates, a belief that forms a basis for the two prominent theories of hominoid evolution. According to the brachiation theory, many anatomical features of the hominoid shoulder (including those of the glenohumeral joint) increase shoulder mobility and are interpreted as adaptations for brachiation. The slow climbing theory explains the same set of features as adaptations for slow climbing. The slow-climbing primates should therefore also possess these features, and their glenohumeral mobility should be the same as that of hominoids and be higher than that of other primates. This study presents three-dimensional glenohumeral mobility data, measured using a single video camera method on fresh specimens. The results show that the hominoid glenohumeral joint is actually less mobile than those of non-hominoid primates, including the habitually slow-climbing lorines, but it is characterized by a smooth excursion in the scapulocranial direction. Copyright (c) 2007 S. Karger AG, Basel.

  13. An Intact Anterior Cruciate Ligament at the Time of Posterior Cruciate Ligament-Retaining Total Knee Arthroplasty Was Associated With Reduced Patient Satisfaction and Inferior Pain and Stair Function.

    PubMed

    Jacobs, Cale A; Christensen, Christian P; Karthikeyan, Tharun

    2016-08-01

    Patients with an intact anterior cruciate ligament (ACL) at the time of ACL-sacrificing total knee arthroplasty (TKA) have been suggested to have inferior outcomes compared with those with a dysfunctional ACL. However, to date, no published clinical studies have evaluated the potential link between the condition of the ACL at the time of posterior cruciate ligament-retaining TKA and postoperative pain, function, and satisfaction. As such, the purpose of this study was to compare subjective function, movement-elicited pain, pain at rest, and patient satisfaction between those with an intact or dysfunctional ACL. We identified 562 posterior cruciate ligament-retaining TKAs with complete intraoperative and postoperative data. Patients were categorized based on the condition of the ACL at the time of TKA as either being intact or dysfunctional (absent or lax). Knee Society Function Scores, movement-elicited pain, pain at rest, and patient satisfaction were then compared between groups. At mean follow-up of 5.1 years, a significantly lower proportion of patients in the intact group were satisfied with their operation (intact: 391/453 [86.3%] vs dysfunctional: 102/109 [93.6%], P = .0496). Inspection of the individual activities revealed that the groups did not differ in walking ability or pain when walking; however, the intact group reported significantly reduced ability to navigate stairs with greater pain during that activity. The lack of difference in pain at rest between groups suggests that pain and functional impairments during more demanding activities such as navigating stairs may be associated with the lost function of the ACL rather than by altered central pain processing. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Glenohumeral Synovial Chondromatosis.

    PubMed

    Andrade, Robert

    2016-09-01

    A 20-year-old, right hand-dominant man reported to physical therapy with a history of deep anterior left shoulder pain. Radiographs, which were obtained after physical therapy was initiated, and subsequent magnetic resonance imaging showed the presence of numerous radio-opaque loose bodies that followed bone signal characteristics dispersed throughout the glenohumeral joint, leading to a diagnosis of synovial chondromatosis. J Orthop Sports Phys Ther 2016;46(9):809. doi:10.2519/jospt.2016.0414.

  15. [Arthroscopic Bankart lesion repair by double-row vertical mattress suture with anchors for anteroinferior glenohumeral instability].

    PubMed

    Tang, Kang-Lai; Chen, Guang-Xing; Guo, Lin; Gong, Ji-Cheng; Zhou, Bing-Hua; Yang, Hui-Feng; Gu, Ling-Chuan; Li, Hong-Zhi; Yang, Liu; Xu, Jian-Zhong

    2007-10-15

    To introduce a new arthroscopic Bankart repair by vertical mattress suture with anchors, and to evaluate its clinical effectiveness. A new arthroscopic Bankart repair by vertical mattress suture with anchors was performed, including to insert only 2 anchors at 3 o'clock and 5 o'clock position and make vertical mattress suture of labrum-ligament complex at 2, 4 and 6 o'clock of labrum, and to shift up the anterior-inferior capsule. Nine cases of anterior glenohumeral instability without severe glenoid bone defect were followed-up for an average period of 14 months (range from 6 to 26 months). The average surgery age was 28 years (range from 21 to 46 years). The average surgery time was 51 min (40 - 75 min). Clinical scores as evaluated by the modified Rowe score advanced from 40 +/- 16 points to 92 +/- 19 points (75 - 94). There was no any recurrence and complication. External rotation was reduced by 5 degrees at 0 degrees adduction and by 3 degrees at 90 degrees of abduction. The arthroscopic Bankart repair by vertical mattress suture with anchors for anteroinferior glenohumeral instability is favorable as an easy, short-time surgery with excellent clinical results in short-term follow-up.

  16. Arthroscopic remplissage with Bankart repair for the treatment of glenohumeral instability with Hill-Sachs defects.

    PubMed

    Park, Min Jung; Tjoumakaris, Fotios P; Garcia, Grant; Patel, Amit; Kelly, John D

    2011-09-01

    To determine whether arthroscopic remplissage with Bankart repair is an effective treatment strategy for patients with Bankart lesions and large Hill-Sachs defects. Between 2006 and 2008, 20 patients underwent arthroscopic Bankart repair with remplissage for the treatment of recurrent anterior glenohumeral instability and large Hill-Sachs defects. Preoperative imaging in all patients identified avulsion of the anterior inferior glenohumeral ligament with an associated Hill-Sachs defect that involved greater than 25% of the humeral head. Patients were followed up postoperatively with the Western Ontario Shoulder Instability score, the American Shoulder and Elbow Surgeons score, and the Penn Shoulder Score. Recurrent subluxation or dislocation was documented. There were 15 male patients and 5 female patients. The mean age of the patients was 27.3 years. The mean length of follow-up in this series was 29.2 months (range, 24.3 to 37.7 months). At final follow-up, 3 patients reported recurrence of instability, which spontaneously reduced in all cases. The mean American Shoulder and Elbow Surgeons score was 92.5 (pain, 47.3; function, 45.3). The mean Penn score was 90 of 100 (pain, 27.3 of 30; satisfaction, 8.5 of 10; function, 54.3 of 60). The mean total Western Ontario Shoulder Instability score was 72.74% (mean physical symptom score, 77.10%; mean sports and recreation score, 70.25%; mean lifestyle score, 75%; mean emotions score, 58.50%). Using an all-arthroscopic remplissage technique with Bankart repair, we were able to restore function, diminish pain, and yield satisfaction in 85% of the patients in this study. Our results compare favorably with historic controls with similar pathology at early- to intermediate-term follow-up in terms of recurrence. Level IV, therapeutic case series. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Management of acute glenohumeral dislocations.

    PubMed

    Sileo, Michael J; Joseph, Samuel; Nelson, Cory O; Nelson, Corey O; Botts, Jonathan D; Penna, James

    2009-06-01

    The glenohumeral joint is the most commonly dislocated joint in the human body. Glenohumeral joint dislocations account for a large number of orthopedic consultations in inpatient and outpatient settings. A thorough workup is required for accurate diagnosis and appropriate treatment of this injury. Complete history and physical examination and radiographic studies are essential, and reduction should always be attempted. In this article, we review the literature for each phase of the workup for glenohumeral dislocation and describe the anatomy, biomechanics, and basic science of the injury. Featured is a detailed synopsis of the more commonly used reduction maneuvers plus their risks and success rates.

  18. Use of the Composite Pedicled Pectoralis Minor Flap after Resection of Soft Tissue Sarcoma in Reconstruction of the Glenohumeral Joint

    PubMed Central

    van de Sande, Michiel A. J.; Cosker, Tom; McDonnell, Stephen M.; Gibbons, C. L. M. H.; Giele, Henk

    2014-01-01

    The surgical repair of an extensive anterior glenohumeral soft tissue defect is complicated by glenohumeral instability and subsequent significant functional deficit. This surgical note offers a relatively simple reconstruction of the anterior capsule and subscapularis muscle using a pectoralis minor pedicle flap. This reconstruction is supplemented with functional reconstruction of the anterior glenohumeral joint. A conventional deltopectoral approach is utilized and pectoralis minor is freed from its coracoid insertion, released, and mobilized without compromising the pedicle entering from the dorsum and inferior one-third of the muscle. The mobilized pectoralis minor vascular pedicle has sufficient length for the pectoralis minor to be transferred to provide coverage of the anterior shoulder joint even in full external rotation, providing anterior stability. To further improve glenohumeral stability and shoulder function, the pectoralis major muscle can be split with the clavicular part reinserted lateral to the bicipital groove onto the lesser tuberosity replacing subscapularis function while stabilising the glenohumeral joint. PMID:25610683

  19. Peri-articular local infiltration analgesia versus femoral nerve block for postoperative pain control following anterior cruciate ligament reconstruction: Prospective, comparative, non-inferiority study.

    PubMed

    Lefevre, N; Klouche, S; de Pamphilis, O; Herman, S; Gerometta, A; Bohu, Y

    2016-11-01

    Femoral nerve block (FNB) is considered as a major advance in anterior cruciate ligament (ACL) reconstruction as it reduces the need for parenteral opioids. However, the incidence of transient or even permanent neurological deficits due to the FNB is estimated at 1.94% after knee surgery. The primary objective of this study was to compare local infiltration analgesia (LIA) to FNB during ACL reconstruction procedures. The study hypothesis was that LIA was not less effective than FNB on early postoperative pain. A retrospective analysis of data collected prospectively in the FAST cohort included a series of continuous patients who underwent primary repair for isolated ACL with a hamstring graft in 2013-2014. Changes in our anesthesia practices over time allowed us to form three successive groups: Group 1 - FNB, Group 2 - FNB+LIA, Group 3 - LIA only. Ultrasound-guided FNB was done pre-operatively. The LIA was done at the end of the procedure by the surgeon with systematic infiltration of all skin incisions and the hamstring donor site; no intra-articular injections were performed. The primary endpoint was the average early postoperative pain (Days 0-3) described by the patient on a visual analogue scale (0-10). Sample size calculation pointed to 36 subjects being needed per group for a non-inferiority study. The study involved 126 patients: G1=42, G2=38, G3=46. The patients were comparable at enrolment. The average early postoperative pain levels were 3.1±2.4, 2.8±2.0 and 2.5±2.2, respectively (P=0.66). A trend toward higher intake of tramadol was noted in the LIA group on D0 to D3, with a significant trend test on Day 1 (P=0.03) and Day 2 (P=0.02). After reconstruction of isolated ACL tears with a hamstring graft, FNB is not more effective than LIA on patients' early postoperative pain. Patients who received a FNB consumed significantly less opioid-like analgesics. III - Prospective, comparative, non-randomized study. Copyright © 2016 Elsevier Masson SAS. All

  20. In vivo estimation of the glenohumeral joint centre by functional methods: accuracy and repeatability assessment.

    PubMed

    Lempereur, Mathieu; Leboeuf, Fabien; Brochard, Sylvain; Rousset, Jean; Burdin, Valérie; Rémy-Néris, Olivier

    2010-01-19

    Several algorithms have been proposed for determining the centre of rotation of ball joints. These algorithms are used rather to locate the hip joint centre. Few studies have focused on the determination of the glenohumeral joint centre. However, no studies have assessed the accuracy and repeatability of functional methods for glenohumeral joint centre. This paper aims at evaluating the accuracy and the repeatability with which the glenohumeral joint rotation centre (GHRC) can be estimated in vivo by functional methods. The reference joint centre is the glenohumeral anatomical centre obtained by medical imaging. Five functional methods were tested: the algorithm of Gamage and Lasenby (2002), bias compensated (Halvorsen, 2003), symmetrical centre of rotation estimation (Ehrig et al., 2006), normalization method (Chang and Pollard, 2007), helical axis (Woltring et al., 1985). The glenohumeral anatomical centre (GHAC) was deduced from the fitting of the humeral head. Four subjects performed three cycles of three different movements (flexion/extension, abduction/adduction and circumduction). For each test, the location of the glenohumeral joint centre was estimated by the five methods. Analyses focused on the 3D location, on the repeatability of location and on the accuracy by computing the Euclidian distance between the estimated GHRC and the GHAC. For all the methods, the error repeatability was inferior to 8.25 mm. This study showed that there are significant differences between the five functional methods. The smallest distance between the estimated joint centre and the centre of the humeral head was obtained with the method of Gamage and Lasenby (2002).

  1. Partial-thickness tears involving the rotator cable lead to abnormal glenohumeral kinematics.

    PubMed

    Pinkowsky, Gregory J; ElAttrache, Neal S; Peterson, Alexander B; Akeda, Masaki; McGarry, Michelle H; Lee, Thay Q

    2017-07-01

    The objective of this study was to determine the biomechanical function of the rotator cable when a partial-thickness (>50%) tear is present. We compared intact specimens with partial tears of the anterior cable followed by partial anterior and posterior tears in regard to glenohumeral kinematics and translation. The hypothesis was that partial-thickness tears will lead to abnormal glenohumeral biomechanics, including glenohumeral translation and path of glenohumeral articulation. Five fresh frozen cadaveric shoulders with intact labrum, rotator cuff, and humerus were tested using a custom shoulder testing system in the scapular plane. Glenohumeral translation was measured after applying an anterior load of 30 N at different angles of external rotation. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at 30°, 60°, 90°, and 120° of external rotation. With an anterior force of 30 N, there was a significant increase in anterior and total translation at 30° of external rotation after the anterior cable was cut (P < .05). When the tear was extended to the posterior cable, there was a significant increase in anterior, inferior, and total translation at 30° and 120° of external rotation (P < .05). With respect to the path of glenohumeral articulation , the humeral head apex was shifted superiorly at 90° and 120° of external rotation after the posterior cable was cut (P < .05). Partial-thickness articular-sided rotator cuff tears with a thickness >50% involving the rotator cable increased glenohumeral translation and changed kinematics in our cadaveric biomechanical model. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation.

    PubMed

    Pagnani, M J; Deng, X H; Warren, R F; Torzilli, P A; Altchek, D W

    1995-07-01

    Lesions of the superior portion of the glenoid labrum were created in seven cadaveric shoulders. The shoulders were mounted on a special apparatus attached to a servocontrolled hydraulic materials-testing device. Sequential fifty-newton anterior, posterior, superior, and inferior forces and a twenty-two-newton joint compressive load were applied to the shoulders. In addition, a fifty-five-newton force was applied to the tendon of the long head of the biceps brachii. The shoulders were tested in seven positions of glenohumeral elevation and rotation. An isolated lesion of the anterosuperior portion of the labrum, which did not involve the supraglenoid insertion of the biceps brachii, had no significant effect on anteroposterior or superoinferior glenohumeral translation, either with or without application of the fifty-five-newton force to the biceps brachii tendon. In contrast, a complete lesion of the superior portion of the labrum that destabilized the insertion of the biceps resulted in significant increases in anteroposterior and superoinferior glenohumeral translations. At 45 degrees of glenohumeral elevation, the complete lesion led to a 6.0-millimeter increase in anterior translation when the arm was in neutral rotation and to a 6.3-millimeter increase when the arm was in internal rotation; inferior translation also increased, by 1.9 to 2.5 millimeters. The increases in translation persisted despite application of a fifty-five-newton force to the long head of the biceps.

  3. Differences in glenohumeral translations calculated with three methods: Comparison of relative positions and contact point.

    PubMed

    Matsuki, Keisuke; Kenmoku, Tomonori; Ochiai, Nobuyasu; Sugaya, Hiroyuki; Banks, Scott A

    2016-06-14

    Several published articles have reported 3-dimensional glenohumeral kinematics using model-image registration techniques. However, different methods to compute the translations were used in these articles. The purpose of this study was to compare glenohumeral translations calculated with three different methods. Fifteen healthy males with a mean age of 31 years (range, 27-36 years old) were enrolled in this study. Fluoroscopic images during scapular plane elevation were recorded at 30 frames per second for the right shoulder in each subject, and CT-derived models of the humerus and the scapula were matched with the silhouette of the bones in the fluoroscopic images using model-image registration techniques. Glenohumeral translations were computed with three methods: relative position of the origins of the humeral and scapular models, contact points of the two models, and relative positions based upon the calculated glenohumeral center of rotation (CoR). In the supero-inferior direction, translations calculated with the three methods were roughly parallel, with the maximum difference of 1.6mm (P<0.001). In the antero-posterior direction, translations with the origins and CoR were parallel; however, translations computed with the origins and contact point describe arcs that differ by almost 2mm at low humeral elevation angles and converge at higher degrees of humeral elevation (P<0.001). Glenohumeral translations calculated using three methods showed statistically significant differences that may be important when comparing detailed results of different studies. However, these relatively small differences are likely subclinical, so that all three methods can reasonably be used for description of glenohumeral translations.

  4. Extraforaminal ligament attachments of human lumbar nerves.

    PubMed

    Kraan, G A; Delwel, E J; Hoogland, P V J M; van der Veen, M R; Wuisman, P I J M; Stoeckart, R; Kleinrensink, G J; Snijders, C J

    2005-03-15

    An anatomic study of the extraforaminal attachments of the lumbar spinal nerves was performed using human lumbar spinal columns. To identify and describe the existence of ligamentous structures at each lumbar level that attach lumbar spinal nerves to structures at the level of the extraforaminal region. During the last 120 years, several mechanisms to protect the spinal nerve against traction have been described. All these structures involved are located in the spinal canal, proximal to the intervertebral foramen. Five embalmed human lumbar spines (T12-S1) were used. Bilaterally, the extraforaminal region was dissected to describe and measure anatomic structures and their relationships. Histology was performed with staining on the sites of attachment and along the ligament. The levels T12-L2 show bilaterally 2 ligaments, a superior extraforaminal ligament and an inferior extraforaminal ligament. The superior extraforaminal ligament emerges from the joint capsule of the facet joints and inserts in both, the intervertebral disc and the ventral crista of the intervertebral foramen, passing the spinal nerve laterally. In one specimen on level L2-L3, the superior extraforaminal ligament is not attached to the spinal nerve. The inferior extraforaminal ligament emerges from the intervertebral disc, passing the nerve medially and attaching the spinal nerve. At the levels L2-L5, the inferior extraforaminal ligaments are only attached to the intervertebral disc, not to the joint capsule. Histologically, the ligaments consisted of mainly collagenous structures. Ligamentous connections exist between lumbar extraforaminal spinal nerves and nearby structures.

  5. ULTRASOUND MEASUREMENTS AND OBJECTIVE FORCES OF GLENOHUMERAL TRANSLATIONS DURING SHOULDER ACCESSORY PASSIVE MOTION TESTING IN HEALTHY INDIVIDUALS

    PubMed Central

    Worst, Haley; Decarreau, Ryan; Davies, George

    2016-01-01

    Background Clinical examination of caspuloligamentous structures of the glenohumeral joint has historically been subjective in nature, as demonstrated by limited intra-rater and inter-rater reproducibility. Musculoskeletal diagnostic ultrasound was utilized to develop a clinically objective measurement technique for glenohumeral inferior and posterolateral translation. Purpose The purpose of this study was to measure the accessory passive force required to achieve end range glenohumeral posterolateral and inferior accessory translation, as well as, to quantify the amount of translation of the glenohumeral joint caused by the applied force. Study Design Cross-sectional descriptive correlational study Methods Twenty-five asymptomatic subjects between the ages of 18 and 30 were recruited via convenience sampling. Posterolateral and inferior shoulder accessory passive translation was assessed and measured using a GE LOGIQe ultrasound, while concurrently using a hand held dynamometer to quantify the passive force applied during assessment. Normative values for force and translation were described as means and standard deviations. Results Mean values for posterolateral translation were 6.5 +/− 4.0 mm on the right shoulder and 6.3 +/− 3.5 mm on the left with an associated mean force of 127.1 +/− 55.6 N and 114.4 +/− 50.7 N, respectively. Mean values for inferior translation were 4.8 +/− 1.7 mm on the right shoulder and 5.4 +/− 1.8 mm on the left with an associated mean force of 84.5 +/− 30.5 N and 76.1 +/− 30.1 N, respectively. There was a significant association between inferior translation and inferior force (r = .51). No significant association was found between posterolateral translation and posterolateral force. Significant differences were found between dominant and non-dominant shoulders for posterolateral translation, posterolateral force to produce translation, and inferior translation values

  6. Tissue engineering of the anterior cruciate ligament-sodium dodecyl sulfate-acellularized and revitalized tendons are inferior to native tendons.

    PubMed

    Tischer, Thomas; Aryee, Sebastian; Wexel, Gabriele; Steinhauser, Erwin; Adamczyk, Christopher; Eichhorn, Stefan; Milz, Stefan; Martinek, Vladimir; Gänsbacher, Bernd; Imhoff, Andreas B; Vogt, Stephan

    2010-03-01

    The acellularization of tendons using detergents (sodium dodecyl sulfate, Triton-X, tri-nitro-butyl-phosphate) is a new source of scaffolds for tissue engineering in anterior cruciate ligament (ACL) repair. In vitro testing demonstrated that acellular tendon scaffolds are biocompatible and show good biomechanical properties, but in vivo confirmation of these results is not yet available. Therefore, the aim of this study was to see in vivo if an acellular allogenic construct colonized with autologous fibroblasts improves the quality of ACL reconstruction. ACL replacement was performed in 31 New Zealand White rabbits using a standardized model. Fifteen animals received autologous semitendinosus tendon, whereas 16 animals were treated with a tissue-engineered construct. This construct was made by acellularization of allogenic semitendinosus tendons using sodium dodecyl sulfate and subsequent in vitro colonization with autologous fibroblasts. Eight weeks postoperatively, macroscopic, biomechanical (ultimate load to failure, elongation, stiffness; n = 8/9), and histological (n = 5) examinations were performed. Biomechanical testing showed decreasing strength of the constructs at 8 weeks after implantation compared with the direct postsurgical strength. However, tissue-engineered constructs (F = 19.7 +/- 20.3 N) were significantly weaker than autologous tendons (F = 61.2 +/- 31.2 N). Histologically, the autologous tendons showed signs of partial necrosis and tissue remodeling. The tissue-engineered constructs exhibited an inflammatory reaction and showed both repopulated and acellular regions. In conclusion, in vivo results were much more unfavorable than in vitro results had suggested. Further studies have to be performed to test if modifications of the acellularization process yield better results in vivo.

  7. GLENOHUMERAL MOTION DEFICITS: FRIEND OR FOE?

    PubMed Central

    Wilk, Kevin E.; Davies, George; Ellenbecker, Todd; Reinold, Mike

    2013-01-01

    In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a normal phenomenon that should be expected. Without a loss of glenohumeral internal rotation the overhead athlete will not have the requisite glenohumeral external rotation needed to throw a baseball at nearly 100 miles per hour, or serve a tennis ball at velocities of 120 miles per hour or more. Not all GIRD is pathologic. The authors of this manuscript have defined two types of GIRD; one that is normal and one that is pathologic. Anatomical GIRD (aGIRD) is one that is normal in overhead athletes and is characterized by a loss of internal rotation of less than 18°‐20° with symmetrical total rotational motion (TROM) bilaterally. Pathologic GIRD (pGIRD) is when there is a loss of glenohumeral internal rotation greater than 18°‐20° with a corresponding loss of TROM greater than 5° when compared bilaterally. A more problematic motion restriction may be that of a loss of TROM in the glenohumeral joint. Recent evidence supports that a loss of TROM is predictive of future injury to the shoulder in professional athletes. Additionally, external rotation deficiency (ERD), the difference between external rotation (ER) of the throwing shoulder and the non‐throwing shoulder of less than 5°, may be another predictor of future shoulder injury and disability. Level of Evidence: 5 PMID:24175137

  8. Outcome and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis.

    PubMed

    Rasmussen, Jeppe V

    2014-06-01

    This thesis includes four studies focusing on the functional outcome, shoulder-specific quality of life and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis without symptomatic rotator cuff pathology. The Danish version of WOOS, translated according to international standardized guidelines, had substantial psychometric properties comparable to the original version. It is recommendable to use WOOS in the evaluation of patients with glenohumeral osteoarthritis treated with shoulder replacement. Data from DSR showed that the shoulder specific quality of life following total shoulder arthroplasty was superior to that of hemiarthroplasty (resurfacing hemiarthroplasty and stemmed hemiarthroplasty). The difference between stemmed hemiarthroplasty and resurfacing hemiarthroplasty was small and did not exceed the minimal clinically important difference. The revision rate following resurfacing hemiarthroplasty was surprisingly high compared with previous reports but there were no statistical significant differences in revision rate between arthroplasty designs. The shoulder specific quality of life and revision rate in patients under the age of 55 was worrying. The use of resurfacing hemiarthroplasty has relied on the results from case series only. The efficacy in the treatment of glenohumeral osteoarthritis has been promising but the CMS found in the randomized clinical trial indicate that the functional outcome may be inferior to that of stemmed hemiarthroplasty and less favourable than previously reported. However, the limited number of patients may have influenced the results and a larger definitive RCT is needed.Shoulder replacement is relevant and effective in the treatment of glenohumeral osteoarthritis; however, resurfacing hemiarthroplasty was associated with a poorer outcome and a higher risk of revision than previously assumed especially in patients under the age of 55. Based on data from this thesis, and based on

  9. Glenohumeral arthropathy following stabilization for recurrent instability.

    PubMed

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

    2010-01-01

    Little attention has been focused on the most common risk factors for post-operative glenohumeral arthropathy in patients undergoing open and arthroscopic stabilization. We performed a literature search using Medline, Cochrane and Google Scholar using the keywords: 'Shoulder instability surgery' in combination with 'glenohumeral osteoarthrosis', 'recurrent shoulder dislocation' in combination with 'surgery' and 'complications'. We identified 33 published studies. There is evidence of long-term postoperative glenohumeral arthropathy in patients undergoing surgical management for shoulder instability. The Coleman methodology score showed great heterogeneity in terms of study design, patient characteristics, management methods and outcome assessment and generally low methodological quality. Follow-up length, age at first dislocation episode and limited external rotation have been shown to be strongly associated with shoulder arthropathy. There is no univocal outcome assessment available. To define the risk factors responsible for development of postoperative glenohumeral arthropathy, controversial findings have been detected. A common validated scale for clinical and imaging measurements for shoulder arthropathy is needed, so as to allow easier and more reliable comparison of outcomes in different studies. Patients should receive controlled imaging assessment (MR and radiographs) in addition to clinical examination. There is a need to perform appropriately powered randomized clinical trials comparing clinical and imaging related outcomes in patients undergoing open, arthroscopic and conservative management for shoulder instability. Standard diagnostic assessment, common and validated clinical and imaging scoring systems are needed.

  10. Extensor retinaculum augmentation reinforces anterior talofibular ligament repair.

    PubMed

    Aydogan, Umur; Glisson, Richard R; Nunley, James A

    2006-01-01

    Repair of the anterior talofibular ligament often is augmented with the inferior extensor retinaculum because it is thought to reinforce the primary ligament repair. The additional dissection and suturing extend the duration of surgery, and not all surgeons routinely include inferior extensor retinaculum augmentation in anterior talofibular ligament repairs. To determine whether there is a reasonable basis for this surgery, we ascertained the degree to which inferior extensor retinaculum augmentation reinforced the primary anterior talofibular ligament repair. Matched pairs of cadaveric ankles had controlled inversion while monitoring resistance to inversion, first with the anterior talofibular ligament sectioned, then with primary anterior talofibular ligament repair alone or with inferior extensor retinaculum augmentation. The resistance to ankle inversion was greater at 5 degrees, 10 degrees, 15 degrees, 20 degrees, and 25 degrees rotation in ankles that had inferior extensor retinaculum augmentation. Anterior talofibular ligament failure occurred at similar inversion angles in both treatment groups, but the primary anterior talofibular ligament repair required more torque to fail in the augmented group. With these ankle loading conditions, inferior extensor retinaculum augmentation provided protection to the primary anterior talofibular ligament repair, indicating that broader clinical use of augmentation may be warranted.

  11. Anterior-inferior tibiofibular ligament anatomical repair and augmentation versus trans-syndesmosis screw fixation for the syndesmotic instability in external-rotation type ankle fracture with posterior malleolus involvement: A prospective and comparative study.

    PubMed

    Zhan, Yu; Yan, Xiaoyu; Xia, Ronggang; Cheng, Tao; Luo, Congfeng

    2016-07-01

    Syndesmosis injury is common in external-rotation type ankle fractures (ERAF). Trans-syndesmosis screw fixation, the gold-standard treatment, is currently controversial for its complications and biomechanical disadvantages. The purpose of this study was to introduce a new method of anatomically repairing the anterior-inferior tibiofibular ligament (AITFL) and augmentation with anchor rope system to treat the syndesmotic instability in ERAF with posterior malleolus involvement and to compare its clinical outcomes with that of trans-syndesmosis screw fixation. 53 ERAFs with posterior malleolus involvement received surgery, and the syndesmosis was still unstable after fracture fixation. They were randomised into screw fixation group and AITFL anatomical repair with augmentation group. Reduction quality, syndesmosis diastasis recurrence, pain (VAS score), time back to work, Olerud-Molander ankle score and range of motion (ROM) of ankle were investigated. Olerud-Molander score in AITFL repair group and screw group was 90.4 and 85.8 at 12-month follow-up (P>0.05). Plantar flexion was 31.2° and 34.3° in repair and screw groups (P=0.04). Mal-reduction happened in 5 cases (19.2%) in screw group while 2 cases (7.4%) in repair group. Postoperative syndesmosis re-diastasis occurred in 3 cases in screw group while zero in repair group (P>0.05). Pain score was similar between the two groups (P>0.05). Overall complication rate and back to work time were 26.9% and 3.7% (P=0.04), 7.15 months and 5.26 months (P=0.02) in screw group and repair group, respectively. For syndesmotic instability in ERAF with posterior malleolus involvement, the method of AITFL anatomical repair and augmentation with anchor rope system had an equivalent functional outcome and reduction, earlier rehabilitation and less complication compared with screw fixation. It can be selected as an alternative. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Functional tissue engineering of ligament healing

    PubMed Central

    2010-01-01

    Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE) approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally. PMID:20492676

  13. Ligament reconstruction.

    PubMed

    Glickel, Steven Z; Gupta, Salil

    2006-05-01

    Volar ligament reconstruction is an effective technique for treating symptomatic laxity of the CMC joint of the thumb. The laxity may bea manifestation of generalized ligament laxity,post-traumatic, or metabolic (Ehler-Danlos). There construction reduces the shear forces on the joint that contribute to the development and persistence of inflammation. Although there have been only a few reports of the results of volar ligament reconstruction, the use of the procedure to treat Stage I and Stage II disease gives good to excellent results consistently. More advanced stages of disease are best treated by trapeziectomy, with or without ligament reconstruction.

  14. [Lower glenohumeral recurrent luxation (luxatio erecta) arthroscopic treatment, literature review and case report].

    PubMed

    Ortiz-Díaz, L G; Villalobos-Cacho, M D

    2017-01-01

    It is extremely important to take into account the complications of inferior gelnohumeral dislocation, which, although infrequent, may become incapacitating in the medium and long term, even in some cases reported, endangering the life of the same. Material and methods: We present the case of a young adult patient diagnosed with inferior rectal glenohumeral dislocation (luxatio erecta), with Bankart lesion and Hill Sachs lesion, treated by arthroscopy with repair of the Bankart lesion, plication of the lower capsular recess and remplissage. Results: We evaluated the functionality of the patient at 18 months with the UCLA scale, obtaining a final score of 30 points with good functional results.

  15. In vivo quantification of capsular end-point in the nonimpaired glenohumeral joint using an instrumented measurement system.

    PubMed

    Borsa, P A; Sauers, E L; Herling, D E; Manzour, W F

    2001-08-01

    Single-group factorial. Quantify glenohumeral joint translations as a function of force using an instrumented measurement system. Our first specific aim was to compare the magnitude of force (N) required to reach capsular end-point between the anterior, posterior, and inferior directions. Our second specific aim was to compare the magnitude of translation (mm) at capsular end-point between the anterior, posterior, and inferior directions. Manual force-displacement techniques are subjective in nature, and the clinician must rely on "feel" to determine capsular end-point. Several investigators have attempted to utilize more objective measures at the glenohumeral joint, however none have quantified the force or displacements necessary to achieve a true capsular end-point. An arthrometric technique was used to measure anterior, posterior, and inferior glenohumeral translations in 20 nonimpaired shoulders (11 women and 9 men with a mean age of 20.9 +/- 3.6 years). The magnitude of applied force required to reach capsular end-point was significantly different between directions of translations. Anterior-directed translations required a significantly greater magnitude of applied force to reach capsular end-point than inferior-directed translations. The magnitude of translation was not significantly different between directions at capsular end-point. Applied forces in the range of 181 to 203 N are necessary to reach capsular end-point in subjects with nonimpaired shoulders. Anterior translation required significantly higher forces (203.1 +/- 13.1 N) to reach capsular end-point than inferior translation (181.4 +/- 31.9 N).

  16. In Vivo Measurement of Glenohumeral Joint Contact Patterns

    NASA Astrophysics Data System (ADS)

    Bey, Michael J.; Kline, Stephanie K.; Zauel, Roger; Kolowich, Patricia A.; Lock, Terrence R.

    2009-12-01

    The objectives of this study were to describe a technique for measuring in-vivo glenohumeral joint contact patterns during dynamic activities and to demonstrate application of this technique. The experimental technique calculated joint contact patterns by combining CT-based 3D bone models with joint motion data that were accurately measured from biplane x-ray images. Joint contact patterns were calculated for the repaired and contralateral shoulders of 20 patients who had undergone rotator cuff repair. Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition (i.e., repaired versus contralateral). Abduction angle had a significant effect on the superior/inferior contact center position, with the average joint contact center of the repaired shoulder 12.1% higher on the glenoid than the contralateral shoulder. This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics.

  17. In Vivo Measurement of Glenohumeral Joint Contact Patterns

    PubMed Central

    Bey, Michael J.; Kline, Stephanie K.; Zauel, Roger; Kolowich, Patricia A.; Lock, Terrence R.

    2011-01-01

    The objectives of this study were to describe a technique for measuring in-vivo glenohumeral joint contact patterns during dynamic activities and to demonstrate application of this technique. The experimental technique calculated joint contact patterns by combining CT-based 3D bone models with joint motion data that were accurately measured from biplane x-ray images. Joint contact patterns were calculated for the repaired and contralateral shoulders of 20 patients who had undergone rotator cuff repair. Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition (i.e., repaired versus contralateral). Abduction angle had a significant effect on the superior/inferior contact center position, with the average joint contact center of the repaired shoulder 12.1% higher on the glenoid than the contralateral shoulder. This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics. PMID:21546990

  18. In Vivo Measurement of Glenohumeral Joint Contact Patterns.

    PubMed

    Bey, Michael J; Kline, Stephanie K; Zauel, Roger; Kolowich, Patricia A; Lock, Terrence R

    2010-01-01

    The objectives of this study were to describe a technique for measuring in-vivo glenohumeral joint contact patterns during dynamic activities and to demonstrate application of this technique. The experimental technique calculated joint contact patterns by combining CT-based 3D bone models with joint motion data that were accurately measured from biplane x-ray images. Joint contact patterns were calculated for the repaired and contralateral shoulders of 20 patients who had undergone rotator cuff repair. Significant differences in joint contact patterns were detected due to abduction angle and shoulder condition (i.e., repaired versus contralateral). Abduction angle had a significant effect on the superior/inferior contact center position, with the average joint contact center of the repaired shoulder 12.1% higher on the glenoid than the contralateral shoulder. This technique provides clinically relevant information by calculating in-vivo joint contact patterns during dynamic conditions and overcomes many limitations associated with conventional techniques for quantifying joint mechanics.

  19. Measuring Dynamic In-Vivo Glenohumeral Joint Kinematics: Technique And Preliminary Results

    PubMed Central

    Bey, Michael J.; Kline, Stephanie K.; Zauel, Roger; Lock, Terrence R.; Kolowich, Patricia A.

    2008-01-01

    Rotator cuff tears are a common injury that affect a significant percentage of the population over age 60. Although it is widely believed that the rotator cuff's primary function is to stabilize the humerus against the glenoid during shoulder motion, accurately measuring the three-dimensional (3D) motion of the shoulder's glenohumeral joint under in-vivo conditions has been a challenging endeavor. In particular, conventional motion measurement techniques have frequently been limited to static or two-dimensional (2D) analyses, and have suffered from limited or unknown in-vivo accuracy. We have recently developed and validated a new model-based tracking technique that is capable of accurately measuring the 3D position and orientation of the scapula and humerus from biplane x-ray images. Herein we demonstrate the in-vivo application of this technique for accurately measuring glenohumeral joint translations during shoulder motion in the repaired and contralateral shoulders of patients following rotator cuff repair. Five male subjects were tested at 3−4 months following arthroscopic rotator cuff repair. Superior-inferior humeral translation was measured during elevation, and anterior-posterior humeral translation was measured during external rotation in both the repaired and contralateral shoulders. The data failed to detect statistically significant differences between the repaired and contralateral shoulders in superior-inferior translation (p=0.74) or anterior-posterior translation (p=0.77). The measurement technique overcomes the limitations of conventional motion measurement techniques by providing accurate, 3D, in-vivo measures of glenohumeral joint motion during dynamic activities. On-going research is using this technique to assess the effects of conservative and surgical treatment of rotator cuff tears. PMID:17996874

  20. Measuring dynamic in-vivo glenohumeral joint kinematics: technique and preliminary results.

    PubMed

    Bey, Michael J; Kline, Stephanie K; Zauel, Roger; Lock, Terrence R; Kolowich, Patricia A

    2008-01-01

    Rotator cuff tears are a common injury that affect a significant percentage of the population over age 60. Although it is widely believed that the rotator cuff's primary function is to stabilize the humerus against the glenoid during shoulder motion, accurately measuring the three-dimensional (3D) motion of the shoulder's glenohumeral joint under in-vivo conditions has been a challenging endeavor. In particular, conventional motion measurement techniques have frequently been limited to static or two-dimensional (2D) analyses, and have suffered from limited or unknown in-vivo accuracy. We have recently developed and validated a new model-based tracking technique that is capable of accurately measuring the 3D position and orientation of the scapula and humerus from biplane X-ray images. Herein we demonstrate the in-vivo application of this technique for accurately measuring glenohumeral joint translations during shoulder motion in the repaired and contralateral shoulders of patients following rotator cuff repair. Five male subjects were tested at 3-4 months following arthroscopic rotator cuff repair. Superior-inferior humeral translation was measured during elevation, and anterior-posterior humeral translation was measured during external rotation in both the repaired and contralateral shoulders. The data failed to detect statistically significant differences between the repaired and contralateral shoulders in superior-inferior translation (p=0.74) or anterior-posterior translation (p=0.77). The measurement technique overcomes the limitations of conventional motion measurement techniques by providing accurate, 3D, in-vivo measures of glenohumeral joint motion during dynamic activities. On-going research is using this technique to assess the effects of conservative and surgical treatment of rotator cuff tears.

  1. The Effects of Posterior Rotator Cuff Cable Tears on Glenohumeral Biomechanics in a Cadaveric Model of the Throwing Shoulder

    PubMed Central

    Photopoulos, Christos Demetris; ElAttrache, Neal S.; Doermann, Alex; Akeda, Masaki; McGarry, Michelle H.; Lee, Thay Q.

    2017-01-01

    .37±3.18mm and 23.37±5.05mm, respectively; p<0.05). No significant differences were apparent at other degrees of rotation (30, 60, 90 degrees), or with partial-thickness tears. Changes in the path of glenohumeral articulation were likewise most evident at 120° of external rotation, with a progressively anterior, inferior, and lateral shift in articulation with sequential sectioning of the posterior cable. Lastly, with regards to alterations in glenohumeral joint force, no significant changes were seen in any of the conditions. Conclusion: In this cadaveric shoulder model of the throwing shoulder, tears of the posterior rotator cuff cable lead to altered glenohumeral biomechanics and kinematics. These changes were most profound at 120° of external rotation, suggesting the importance of an intact posterior cable as a potential stabilizer during the late-cocking phase of throwing.

  2. Glenohumeral subluxation in hemiplegia: An overview.

    PubMed

    Paci, Matteo; Nannetti, Luca; Rinaldi, Lucio A

    2005-01-01

    This review summarizes the recent advances in glenohumeral subluxation (GHS) in hemiplegic patients and analyzes the reliability and validity of clinical evaluation and the effectiveness of different treatment approaches. GHS, a common complication of stroke, can be considered an important risk factor for shoulder pain and other problems. GHS is a complex phenomenon, and its pathomechanics are not yet fully understood. Radiographic measurements are considered the best method of quantifying GHS. Clinical evaluation can be useful as screening assessment. Functional electrical stimulation and strapping are effective in an acute stage of hemiplegia; some types of slings have been shown to be effective and may be used together with other strategies.

  3. Synovial Lipomatosis of the Glenohumeral Joint

    PubMed Central

    Safran, Ori

    2016-01-01

    Synovial lipomatosis (also known as lipoma arborescens) is a rare and benign lesion affecting synovium-lined cavities. It is characterized by hyperplasia of mature fat tissue in the subsynovial layer. Although the most commonly affected site is the knee joint, rarely additional locations such as tendon sheath and other joints are involved. We present a case of synovial lipomatosis of the glenohumeral joint in a 44-year-old man. The clinical data radiological studies and histopathologic results are described, as well as a review of the current literature. PMID:27563476

  4. Synovial Lipomatosis of the Glenohumeral Joint.

    PubMed

    Beyth, Shaul; Safran, Ori

    2016-01-01

    Synovial lipomatosis (also known as lipoma arborescens) is a rare and benign lesion affecting synovium-lined cavities. It is characterized by hyperplasia of mature fat tissue in the subsynovial layer. Although the most commonly affected site is the knee joint, rarely additional locations such as tendon sheath and other joints are involved. We present a case of synovial lipomatosis of the glenohumeral joint in a 44-year-old man. The clinical data radiological studies and histopathologic results are described, as well as a review of the current literature.

  5. Rotator Cuff Tear Consequent to Glenohumeral Dislocation.

    PubMed

    Gilotra, Mohit N; Christian, Matthew W; Lovering, Richard M

    2016-08-01

    The patient was a 21-year-old collegiate running back who was tackled during a football game and sustained a posterior glenohumeral dislocation. He was referred to an orthopaedist and presented 3 weeks after the injury, and, following examination, further imaging was ordered by the orthopaedist due to rotator cuff weakness. Magnetic resonance imaging showed a complete tear of the supraspinatus and infraspinatus, as well as a posterior Bankart lesion, a subscapularis tear, and a dislocation of the biceps long head tendon into the reverse Hill-Sachs lesion. J Orthop Sports Phys Ther 2016;46(8):708. doi:10.2519/jospt.2016.0413.

  6. Dimensions and attachments of the ankle ligaments: evaluation for ligament reconstruction.

    PubMed

    Wenny, Raphael; Duscher, Dominik; Meytap, Emmy; Weninger, Patrick; Hirtler, Lena

    2015-06-01

    For operative reconstruction, precise anatomic information on the dimensions of the ankle ligaments is important and can help to optimize these procedures. The purpose of this study was to investigate the length and width dimensions of the ankle ligaments and to contrast the results with the published literature. Seventeen non-paired adult, formalin-fixed ankle specimen were dissected to expose the capsuloligamentous structures. The following ligaments were investigated: tibiofibular syndesmosis (anterior and posterior tibiofibular ligament/ATiFL and PTiFL), lateral ankle ligaments (anterior and posterior talofibular ligament, calcaneofibular ligament/ATFL, PTFL and CFL), medial ankle ligaments (deltoid ligament, anterior and posterior tibiotalar ligament/ATTL and PTTL). After identification of the ligaments, the dimensions were measured with a ruler and a sliding caliper. Additionally, the attachment area and the center of insertion (COI) were evaluated. The dimensions of the ligaments were recorded. Measurements were calculated and discussed according to the existing literature. The tibial COI of the ATiFL was situated 8.35 ± 2.05 mm from the inferior articular surface of the tibia and 5.04 ± 1.32 mm from the fibular notch. Its fibular COI was situated 25.45 ± 5.84 mm from the tip of the lateral malleolus and 3.12 ± 1.01 mm from the malleolar articular surface. The calcaneal COI of the CFL was situated 20.63 ± 3.56 mm anterior and 5.73 ± 1.89 mm plantar to the superior edge of the calcaneal. Its fibular attachment of the CFL was directly at the tip of the lateral malleolus, dorsal to the fibular attachment of the ATFL. Studies of the therapeutic options in severe ankle ligament injuries have shown better results in anatomical reconstructions compared to other operative treatments. To optimize these procedures, exact anatomical information on the dimensions of the ankle ligaments should be beneficial.

  7. Suprascapular intraneural ganglia and glenohumeral joint connections.

    PubMed

    Spinner, Robert J; Amrami, Kimberly K; Kliot, Michel; Johnston, Shawn P; Casañas, Joaquim

    2006-04-01

    Unlike the more commonly noted paralabral cysts (extraneural ganglia), which are well known to result in suprascapular nerve compression, only four cases of suprascapular intraneural ganglia have been reported. Because of their rarity, the pathogenesis of suprascapular intraneural ganglia has been poorly understood and a pathoanatomical explanation has not been provided. In view of the growing literature demonstrating strong associations between paralabral cysts and labral (capsular) pathology, joint connections, and joint communications, the authors retrospectively reviewed the magnetic resonance (MR) imaging studies and postoperative results in the two featured patients to test a hypothesis that suprascapular intraneural ganglia would have analogous findings. Two patients who presented with suprascapular neuropathy were found to have intraneural ganglia. Connections to the glenohumeral joint could be established in both patients through posterior labrocapsular complex tears. In neither patient was the joint connection identified preoperatively or intraoperatively, and cyst decompression was performed by itself without attention to the labral tear. The suprascapular intraneural ganglia extended from the glenohumeral joint as far proximally as the level of the nerves' origin from the upper trunk in the supraclavicular fossa. Although both patients experienced symptomatic improvement after surgery, neurological recovery was incomplete. In both cases, postoperative MR images revealed cyst persistence. In addition, previously unrecognized superior labral anteroposterior (SLAP) Type II lesions (tears of the superior labrum extending anteroposterior and involving the biceps anchor at the labrum without actual extension into the tendon) were visualized. In one patient with a persistent cyst, an MR arthrogram was obtained and demonstrated a communication between the joint and the cyst. The findings in these two patients support the synovial theory for intraneural ganglia

  8. Glenohumeral Joint Kinematics following Clavicular Fracture and Repairs

    PubMed Central

    Walley, Kempland C.; Harlow, Ethan R.; Haghpanah, Babak; Vaziri, Ashkan; Ramappa, Arun J.; DeAngelis, Joseph P.

    2017-01-01

    Background The purpose of this biomechanical study was to determine the effect of shortened clavicle malunion on the center of rotation of the glenohumeral (GH) joint, and the capacity of repair to restore baseline kinematics. Methods Six shoulders underwent automated abduction (ABD) and abbreviated throwing motion (ATM) using a 7-DoF automated upper extremity testing system in combination with an infrared motion capture system to measure the center of rotation of the GH joint. ATM was defined as pure lateral abduction and late cocking phase to the end of acceleration. Torsos with intact clavicle underwent testing to establish baseline kinematics. Then, the clavicles were subjected to midshaft fracture followed by kinematics testing. The fractured clavicles underwent repairs first by clavicle length restoration with plate fixation, and then by wiring of fragments with a 2-cm overlap to simulate shortened malunion. Kinematic testing was conducted after each repair technique. Center of rotation of the GH joint was plotted across all axes to outline 3D motion trajectory and area under the curve. Results Throughout ABD, malunion resulted in increased posterior and superior translation compared to baseline. Plate fixation restored posterior and superior translations at lower abduction angles but resulted in excess anterior and inferior translation at overhead angles. Throughout ATM, all conditions were significantly anterior and superior to baseline. Translation with malunion was situated anterior to the fractured and ORIF conditions at lower angles of external rotation. Plate fixation did not restore baseline anteroposterior or superoinferior translation at any angle measured. Conclusions This study illustrates the complex interplay of the clavicle and the GH joint. While abnormal clavicle alignment alters shoulder motion, restoration of clavicle length does not necessarily restore GH kinematics to baseline. Rehabilitation of the injured shoulder must address the

  9. Glenohumeral Joint Kinematics following Clavicular Fracture and Repairs.

    PubMed

    Rosso, Claudio; Nasr, Michael; Walley, Kempland C; Harlow, Ethan R; Haghpanah, Babak; Vaziri, Ashkan; Ramappa, Arun J; Nazarian, Ara; DeAngelis, Joseph P

    2017-01-01

    The purpose of this biomechanical study was to determine the effect of shortened clavicle malunion on the center of rotation of the glenohumeral (GH) joint, and the capacity of repair to restore baseline kinematics. Six shoulders underwent automated abduction (ABD) and abbreviated throwing motion (ATM) using a 7-DoF automated upper extremity testing system in combination with an infrared motion capture system to measure the center of rotation of the GH joint. ATM was defined as pure lateral abduction and late cocking phase to the end of acceleration. Torsos with intact clavicle underwent testing to establish baseline kinematics. Then, the clavicles were subjected to midshaft fracture followed by kinematics testing. The fractured clavicles underwent repairs first by clavicle length restoration with plate fixation, and then by wiring of fragments with a 2-cm overlap to simulate shortened malunion. Kinematic testing was conducted after each repair technique. Center of rotation of the GH joint was plotted across all axes to outline 3D motion trajectory and area under the curve. Throughout ABD, malunion resulted in increased posterior and superior translation compared to baseline. Plate fixation restored posterior and superior translations at lower abduction angles but resulted in excess anterior and inferior translation at overhead angles. Throughout ATM, all conditions were significantly anterior and superior to baseline. Translation with malunion was situated anterior to the fractured and ORIF conditions at lower angles of external rotation. Plate fixation did not restore baseline anteroposterior or superoinferior translation at any angle measured. This study illustrates the complex interplay of the clavicle and the GH joint. While abnormal clavicle alignment alters shoulder motion, restoration of clavicle length does not necessarily restore GH kinematics to baseline. Rehabilitation of the injured shoulder must address the osseous injury and the dynamic forces of the

  10. Associations between in-vivo glenohumeral joint motion and morphology.

    PubMed

    Peltz, Cathryn D; Divine, George; Drake, Anne; Ramo, Nicole L; Zauel, Roger; Moutzouros, Vasilios; Bey, Michael J

    2015-09-18

    Joint morphology has a significant influence on joint motion and may contribute to the development of rotator cuff pathology, but the relationships between glenohumeral joint (GHJ) morphology and in-vivo GHJ motion are not well understood. The objectives of this study were to assess measures of joint morphology and their relationship with in-vivo joint motion in two populations: shoulders with intact rotator cuffs (n=48) and shoulders with rotator cuff pathology (n=36, including 5 symptomatic tears, 9 asymptomatic tears and 22 repaired tears). GHJ morphology was measured from CT-based three-dimensional models of the humerus and scapula. In-vivo GHJ motion was measured during shoulder abduction using biplane x-ray imaging. Associations between GHJ morphology and motion were assessed with univariate and best subsets regression. The only morphological difference identified between the populations was the critical shoulder angle (intact: 34.5 ± 4.7°, pathologic: 36.9 ± 5.0°, p=0.03), which is consistent with previous research. In intact shoulders, the superior/inferior (S/I) position of the humerus on the glenoid during shoulder abduction was significantly associated with the glenoid's S/I radius of curvature (p<0.01), conformity index (p<0.01), and stability angle (p<0.01). Furthermore, the S/I position of the humerus on the glenoid was negatively associated with the critical shoulder angle (p=0.04), which contradicts previous research. No significant associations between GHJ morphology and GHJ motion were detected in shoulders with rotator cuff tears. It is unknown if rotator cuff pathology compromises the relationships between GHJ morphology and motion, or if the absence of this relationship is a pre-existing condition that increases the likelihood of pathology. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. A new shoulder model with a biologically inspired glenohumeral joint.

    PubMed

    Quental, C; Folgado, J; Ambrósio, J; Monteiro, J

    2016-09-01

    Kinematically unconstrained biomechanical models of the glenohumeral (GH) joint are needed to study the GH joint function, especially the mechanisms of joint stability. The purpose of this study is to develop a large-scale multibody model of the upper limb that simulates the 6 degrees of freedom (DOF) of the GH joint and to propose a novel inverse dynamics procedure that allows the evaluation of not only the muscle and joint reaction forces of the upper limb but also the GH joint translations. The biomechanical model developed is composed of 7 rigid bodies, constrained by 6 anatomical joints, and acted upon by 21 muscles. The GH joint is described as a spherical joint with clearance. Assuming that the GH joint translates according to the muscle load distribution, the redundant muscle load sharing problem is formulated considering as design variables the 3 translational coordinates associated with the GH joint translations, the joint reaction forces associated with the remaining kinematic constraints, and the muscle activations. For the abduction motion in the frontal plane analysed, the muscle and joint reaction forces estimated by the new biomechanical model proposed are similar to those estimated by a model in which the GH joint is modeled as an ideal spherical joint. Even though this result supports the assumption of an ideal GH joint to study the muscle load sharing problem, only a 6 DOF model of the GH joint, as the one proposed here, provides information regarding the joint translations. In this study, the biomechanical model developed predicts an initial upward and posterior migration of the humeral head, followed by an inferior and anterior movement, which is in good agreement with the literature.

  12. Multidirectional kinematics of the glenohumeral joint during simulated simple translation tests: impact on clinical diagnoses.

    PubMed

    Moore, Susan M; Musahl, Volker; McMahon, Patrick J; Debski, Richard E

    2004-07-01

    At the end ranges of motion, the glenohumeral capsule limits translation of the humeral head in multiple directions. Since the 6-degree of freedom kinematics of clinical tests are commonly utilized to diagnose shoulder injuries, the objective of this study was to determine the magnitude and repeatability of glenohumeral joint kinematics during a simulated simple anteroposterior translation test in the anterior and posterior directions. A magnetic tracking system was used to determine the kinematics of the humerus with respect to the scapula in eight cadaveric shoulders. At 60 degrees of glenohumeral abduction and 0 degrees of flexion/extension, a clinician applied anterior and posterior loads to the humerus at 0 degrees, 30 degrees, and 60 degrees of external rotation until a manual maximum (simulating a simple translation test) was achieved. Prior to each test, the reference position of the humerus shifted posteriorly 1.8+/-2.0 and 4.1+/-3.8 mm at 30 degrees and 60 degrees of external rotation, respectively. Anterior translation decreased significantly (p < 0.05) from 18.2+/-5.3 mm at 0 degrees of external rotation to 15.5+/-5.1 and 9.9+/-5.5 mm at 30 degrees and 60 degrees, respectively. However, no significant differences were detected between the posterior translations of 13.4+/-6.4, 17.1+/-5.0, and 15.8+/-6.0 mm at 0 degrees, 30 degrees, and 60 degrees of external rotation, respectively. Coupled translations (perpendicular to the direction of loading) at 0 degrees (6.1+/-4.0 and 3.8+/-2.9 mm), 30 degrees (4.7+/-2.7 and 5.9+/-3.1 mm), and 60 degrees (2.3+/-2.3 and 5.0+/-3.5 mm) of external rotation were in the inferior direction in both the anterior and posterior directions, respectively. Based on the data obtained, performing a simulated simple translation test should result in coupled inferior translations and anterior translations that are a function of external rotation. The low standard deviations demonstrate that the observed translations should be

  13. COMPREHENSIVE POST‐ARTHROSCOPIC MANAGEMENT OF A MIDDLE‐AGED ADULT WITH GLENOHUMERAL OSTEOARTHRITIS: A CASE REPORT

    PubMed Central

    Olson, Thomas; Millett, Peter

    2013-01-01

    Comprehensive Arthroscopic Management (CAM) is a new glenohumeral debridement procedure developed as a joint preserving alternative to total shoulder arthroplasty (TSA). The procedure consists of several arthroscopic components including: A. scar tissue and chondral debridement, B. synovectomy, C. inferior humeral osteoplasty, D. capsular release, E. axillary nerve decompression, and F. tenodesis of the long head of the biceps. In this case, an active, middle age patient who failed physical therapy treatment and corticosteroid injections was evaluated and diagnosed with glenohumeral osteoarthritis. Anterior‐ posterior (AP) and axillary radiographs showed grade IV changes of the articular cartilage, confirming the diagnosis. The patient was not an ideal candidate for TSA because of her age, activity level, and concern for implant survival; therefore surgical intervention was performed using the CAM procedure. After the surgery, the patient demonstrated increased joint space as shown using radiographic imaging. The patient underwent intensive postoperative rehabilitation with a heavy emphasis on joint range of motion (ROM) and capsular mobility. By eight weeks she achieved 85% active ROM compared to her uninvolved shoulder, and a 55% improvement on the Pennsylvania Shoulder Score. Radiographic imaging provided an understanding of the severity of the arthritic changes present in this patient, identified the limited potential of continued conservative management, and showed structural changes that may be correlated with improved function following the surgical intervention. For patients less than 55 years of age diagnosed with severe glenohumeral osteoarthritis, the CAM procedure and intensive, motion focused therapy presents a promising treatment combination. Level of Evidence: IIIb PMID:23439911

  14. Quantitative assessment and characterization of glenoid bone loss in a spectrum of patients with glenohumeral osteoarthritis.

    PubMed

    Lombardo, D J; Khan, J; Prey, B; Zhang, L; Petersen-Fitts, G R; Sabesan, V J

    2016-12-01

    Eccentric posterior bone loss and associated glenoid retroversion represent challenges to glenoid placement during total shoulder arthroplasty. This bone loss can lead to poor stability and perforation of the glenoid during arthroplasty. The purpose of this study was to evaluate the morphology of glenoid bone loss for a spectrum of osteoarthritis patients using 3D computed tomography imaging and simulation software. This study included 29 patients with glenohumeral osteoarthritis treated with shoulder arthroplasty. Three-dimensional reconstruction of preoperative CT images was performed. Glenoid bone loss was measured at ten, vertically equidistant axial planes along the glenoid surface at four distinct anterior-posterior points on each plane. The images were fitted with modeled pegged glenoid implants to predict glenoid perforation. The 3D maps demonstrated greatest average bone loss posteriorly in the AP plane at the central axis of the glenoid in the SI plane. The average amount of bone loss was 3.85 mm. Walch A2 and B1 shoulders showed more central bone loss, while Walch B2 shoulders displayed more posterior and inferior bone loss. Patients with predicted peg perforation displayed significantly greater bone loss than those without predicted peg perforation (p = 0.037). Peg perforation was most common in Walch B2 shoulders occurring in the posterior direction involving the central and posterior-inferior peg. These data demonstrate an anatomic pattern of glenoid bone loss for different classes of glenohumeral arthritis. These findings can be used to develop various models of glenoid bone loss to guide surgeons, predict failures, and develop better glenoid implants. This study has been approved by the Cleveland Clinic IRB: Number 6235.

  15. Glenohumeral Range of Motion in Major League Pitchers

    PubMed Central

    Freehill, Michael T.; Ebel, Brian G.; Archer, Kristin R.; Bancells, Richard L.; Wilckens, John H.; McFarland, Edward G.; Cosgarea, Andrew J.

    2011-01-01

    Background: Although overhead throwing athletes may develop unique glenohumeral range of motion characteristics, to our knowledge these characteristics have not been studied longitudinally in major league pitchers. Hypothesis: Major league pitchers (starters and relievers) experience an increase in glenohumeral external rotation and a decrease in internal rotation and total range of motion. Glenohumeral internal rotation deficit worsens over a regular playing season. Study Design: Retrospective cohort study. Methods: In 21 major league baseball pitchers (29 individual playing seasons), glenohumeral range of motion was measured in external and internal rotation for the throwing and nonthrowing shoulders before and at the conclusion of the regular season. The total range of motion (the sum of external rotation and internal rotation) and the glenohumeral internal rotation deficit were calculated (the difference between internal rotation of the nonthrowing shoulder minus that of the throwing shoulder), and data were compared between starting and relief pitchers. Results: The overall mean changes in external rotation (+1.5°), internal rotation (+2.7°), and total range of motion (+3.3°) were not statistically significant. However, starting pitchers showed statistically significant increases in internal rotation (+6.5°, P = 0.01) and total range of motion (+7.9°, P = 0.04), whereas relief pitchers had significant worsening of glenohumeral internal rotation deficit (+5.3°, P = 0.04). Conclusions: The characteristics of glenohumeral range of motion in major league pitchers did not differ significantly from the beginning to the end of a season, but significant changes did occur between starting and relief pitchers. Clinical Relevance: Adaptations to the daily routines of starter and reliever pitchers may be warranted on the basis of these findings. PMID:23015997

  16. Treatment of glenohumeral instability in rugby players.

    PubMed

    Funk, Lennard

    2016-02-01

    Rugby is a high-impact collision sport, with impact forces. Shoulder injuries are common and result in the longest time off sport for any joint injury in rugby. The most common injuries are to the glenohumeral joint with varying degrees of instability. The degree of instability can guide management. The three main types of instability presentations are: (1) frank dislocation, (2) subluxations and (3) subclinical instability with pain and clicking. Understanding the exact mechanism of injury can guide diagnosis with classical patterns of structural injuries. The standard clinical examination in a large, muscular athlete may be normal, so specific tests and techniques are needed to unearth signs of pathology. Taking these factors into consideration, along with the imaging, allows a treatment strategy. However, patient and sport factors need to be also considered, particularly the time of the season and stage of sporting career. Surgery to repair the structural damage should include all lesions found. In chronic, recurrent dislocations with major structural lesions, reconstruction procedures such as the Latarjet procedure yields better outcomes. Rehabilitation should be safe, goal-driven and athlete-specific. Return to sport is dependent on a number of factors, driven by the healing process, sport requirements and extrinsic pressures. Level of evidence V.

  17. Thickness Distribution of Glenohumeral Joint Cartilage.

    PubMed

    Schleich, Christoph; Bittersohl, Bernd; Antoch, Gerald; Krauspe, Rüdiger; Zilkens, Christoph; Kircher, Jörn

    2017-04-01

    High-resolution 3-dimensional cartilage-specific magnetic resonance imaging (MRI) was performed at 3 T to test the following hypotheses: (1) there is a nonuniform cartilage thickness distribution both on the proximal humerus and on the glenoid surface and (2) the glenohumeral joint as a combined system is congruent with the level of the joint cartilage surface without substantial radial mismatch. Inclusion of 38 volunteers (19 females, mean age 24.34 ± 2.22 years; range 21-29 years) in a prospective study. Measurements of: cartilage thickness in 3 regions and 3 zones; radius of both circles (glenoid and humeral cartilage) for congruency calculation using 3-T MRI with 3-dimensional dual-echo steady-state sequence with water excitation. A homogenous mean cartilage thickness (1.2-1.5 mm) and slightly higher values for the glenoidal articulating surface radii both in the mid-paracoronar section (2.4 vs. 2.1 cm, P < 0.001) and in the mid-paraaxial section (2.4 vs. 2.1 cm, P < 0.001) compared with the humeral side were observed. The concept of a radial mismatch between the humeral head and the glenoid in healthy human subjects can be confirmed. This study provides normative data for the comparison of joint cartilage changes at the shoulder for future studies.

  18. Change in the Distance From the Axillary Nerve to the Glenohumeral Joint With Shoulder External Rotation or Abduction Position.

    PubMed

    Simone, Juan Pablo; Streubel, Philipp N; Sanchez-Sotelo, Joaquin; Steinmann, Scott P; Adams, Julie E

    2017-07-01

    This study investigated whether axillary nerve (AN) distance to the inferior border of the humeral head and inferior glenoid would change while placing the glenohumeral joint in different degrees of external rotation and abduction. A standard deltopectoral approach was performed on 10 fresh-frozen cadaveric specimens. The distance between AN and the inferior border of the humeral head and inferior glenoid while placing the shoulder in 0°, 45°, and 90° of external rotation or abduction was measured. Continuous variables for changes in AN position were compared with paired 2-tailed Student t test. The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of external rotation and 0° of abduction was 13.77 mm (SD 4.31), 13.99 mm (SD 4.12), and 16.28 mm (SD 5.40), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of external rotation was 16.33 mm (SD 3.60), 15.60 mm (SD 4.19), and 16.43 (SD 5.35), respectively. The mean distance between the AN and the humeral head with the shoulder in 0°, 45°, and 90° of abduction and 0° of external rotation was 13.76 mm (SD 4.31), 10.68 mm (SD 4.19), and 3.81 mm (SD 3.08), respectively. The mean distance between the AN and glenoid with the shoulder in 0°, 45°, and 90° of abduction was 16.33 mm (SD 3.60), 17.66 mm (SD 5.80), and 12.44 mm (SD 5.57), respectively. The AN position relative to the inferior aspect of the glenohumeral joint does not significantly change despite position of external rotation. Increasing shoulder abduction over 45° decreases the distance from the glenohumeral joint to the AN and should be avoided.

  19. Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera.

    PubMed

    Pagnani, M J; Deng, X H; Warren, R F; Torzilli, P A; O'Brien, S J

    1996-01-01

    Ten cadaveric shoulders were tested to evaluate the effect of simulated contraction of the long head of the biceps brachii on glenohumeral translation. The shoulders were mounted on a special apparatus attached to a servo-controlled hydraulic testing device. Sequential 50 N anterior, posterior, superior, and inferior forces and a 22 N joint compressive load were applied to the shoulders. An air cylinder applied a constant force to the tendon of the long head of the biceps brachii. The shoulders were tested in seven positions of glenohumeral elevation and rotation. Application of a force to the long head of the biceps brachii resulted in statistically significant decreases in humeral head translation. The influence of the long head of the biceps was more pronounced at middle and lower elevation angles. When the shoulder was placed in 45 degrees of elevation and neutral rotation, application of a 55 N force to the biceps tendon reduced anterior translation by 10.4 mm (p = 0.001), inferior translation by 5.3 mm (p = 0.01), and superior translation by 1.2 mm (p = 0.004).

  20. Alterations in Glenohumeral Kinematics in Patients With Rotator Cuff Tears Measured With Biplane Fluoroscopy.

    PubMed

    Millett, Peter J; Giphart, J Erik; Wilson, Katharine J; Kagnes, Kine; Greenspoon, Joshua A

    2016-03-01

    To quantitatively measure the 3-dimensional (3D) glenohumeral translations during dynamic shoulder abduction in the scapular plane, using a biplane fluoroscopy system, in patients with supraspinatus rotator cuff tears. A custom biplane fluoroscopy system was used to measure the 3D position and orientation of the scapula and humerus of 14 patients with full-thickness supraspinatus or supraspinatus and infraspinatus rotator cuff tears and 10 controls as they performed shoulder abduction over their full range of motion. The 3D geometries of the scapula and humerus were extracted from a computed tomography scan of each shoulder. For each frame, the 3D bone position and orientation were estimated using a contour-based matching algorithm, and the 3D position of the humeral head center was determined relative to the glenoid. For each subject the superior-inferior and anterior-posterior translation curves were determined from 20° through 150° of arm elevation. The humeral head in shoulders with rotator cuff tears was positioned significantly inferior compared with controls for higher elevation angles of 80° to 140° (P < .05). For both groups the humeral head translated inferiorly during shoulder abduction from 80° (P = .044; rotator cuff tear v controls: -0.2 ± 1.3 v 1.2 ± 1.4 mm) up to 140° (P = .047; rotator cuff tear v controls: -1.3 ± 2.2 v 0.44 ± 1.4 mm). There was no significant translation in the anterior- posterior direction. Patients with well-compensated single or 2-tendon rotator cuff tears show no dynamic superior humeral head migration but unexpectedly show an inferior shift during active elevation. It is unclear whether the size of the translational differences found in this study, while statistically significant, are also of clinical significance. Level III, comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  1. Normalization of glenohumeral articular contact pressures after Latarjet or iliac crest bone-grafting.

    PubMed

    Ghodadra, Neil; Gupta, Aman; Romeo, Anthony A; Bach, Bernard R; Verma, Nikhil; Shewman, Elizabeth; Goldstein, Jordan; Provencher, Matthew T

    2010-06-01

    Multiple bone-grafting procedures have been described for patients with glenoid bone loss and shoulder instability. The purpose of this study was to investigate the alterations in glenohumeral contact pressure associated with the placement and orientation of Latarjet or iliac crest bone graft augmentation and to compare the amount of glenoid bone reconstruction with two coracoid face orientations. Twelve fresh-frozen cadaver shoulders were tested in static positions of humeral abduction (30 degrees , 60 degrees , and 60 degrees with 90 degrees of external rotation) with a 440-N compressive load. Glenohumeral contact pressure and area were determined sequentially for (1) the intact glenoid; (2) a glenoid with an anterior bone defect involving 15% or 30% of the glenoid surface area; (3) a 30% glenoid defect treated with a Latarjet or iliac crest bone graft placed 2 mm proud, placed flush, or recessed 2 mm in relation to the level of the glenoid; and (4) a Latarjet bone block placed flush and oriented with either the lateral (Latarjet-LAT) or the inferior (Latarjet-INF) surface of the coracoid as the glenoid face. The amount of glenoid bone reconstructed was compared between the Latarjet-LAT and Latarjet-INF conditions. Bone grafts in the flush position restored the mean peak contact pressure to 116% of normal when the iliac crest bone graft was used (p < 0.03 compared with the pressure with the 30% defect), 120% when the Latarjet-INF bone block was used (p < 0.03), and 137% when the Latarjet-LAT bone block was used (p < 0.04). Use of the Latarjet-LAT bone block resulted in mean peak pressures that were significantly higher than those associated with the iliac crest bone graft (p < 0.02) or the Latarjet-INF bone block (p < 0.03) at 60 degrees of abduction and 90 degrees of external rotation. With the bone grafts placed in a proud position, peak contact pressure increased to 250% of normal (p < 0.01) in the anteroinferior quadrant and there was a concomitant increase

  2. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  3. Associations among shoulder strength, glenohumeral joint motion, and clinical outcome after rotator cuff repair.

    PubMed

    Peltz, Cathryn D; Haladik, Jeffrey A; Hoffman, Scott E; McDonald, Michael; Ramo, Nicole; Moutzouros, Vasilios; Bey, Michael J

    2014-05-01

    Rotator cuff tears are a common condition causing pain and disability, but the relationships among clinical measures of shoulder function and measures of glenohumeral joint (GHJ) function are not well known. In the study reported here, dynamic in vivo GHJ motion was measured during abduction from biplane radiographs in 22 rotator cuff repair (RCR) patients and 36 control subjects. Isometric shoulder strength was measured and clinical outcomes were assessed using the Western Ontario Rotator Cuff (WORC) Index. Associations among WORC, GHJ motion, and several shoulder strength ratios were assessed with linear regression. An association was detected between higher ER/ABD (external rotation/coronal-plane abduction) strength ratio and a humerus positioned more inferiorly relative to the glenoid in control subjects and RCR patients. Higher ER/ABD strength ratio was also associated with better clinical outcome in RCR patients. These findings suggest a relationship between ER/ABD strength ratio and a more centrally located average superior/inferior contact center in RCR patients and control subjects. The ER/ABD strength ratio can be easily measured in a clinical setting and therefore can be used in larger studies to investigate its relation to clinical outcomes over time or perhaps to predict superior migration of the humeral head.

  4. Anatomic Variant of Liver, Gall Bladder and Inferior Vena Cava.

    PubMed

    Sontakke, Yogesh Ashok; Gladwin, V; Chand, Parkash

    2016-07-01

    The morphology and relations of liver, gall bladder and inferior vena cava are cardinal. Their anatomical variations may be a reason for the adverse surgical outcome. During routine anatomy dissection of an abdomen, we noticed a variant liver, gall bladder and inferior vena cava in a 63-year-old male cadaver. In the specimen, a retrohepatic segment of inferior vena cava was found to be intrahepatic. On dissection, it was observed that inferior vena cava was covered entirely by a liver tissue on its dorsal aspect. In the same specimen, the gall bladder had undulated inferior surface. On dissection of the gall bladder, numerous mucosal folds were present in the interior. A band of fibrous tissue was found, which was extending from the right side of the gall bladder to the falciform ligament. Hence, preoperative scanning of congenital variations of the liver, gall bladder and inferior vena cava may be compassionate in planning safe surgeries and interventional abdominal procedures.

  5. Orthopaedic manual physical therapy for shoulder pain and impaired movement in a patient with glenohumeral joint osteoarthritis: a case report.

    PubMed

    Crowell, Michael S; Tragord, Bradley S

    2015-06-01

    Case report. Comprehensive treatment strategies are needed for individuals with glenohumeral joint osteoarthritis (OA), especially when they are young and active. Prior dislocation, with or without subsequent shoulder stabilization surgery, complicates the clinical presentation and increases the risk of OA progression. The purpose of this case report was to describe an orthopaedic manual physical therapy approach used in a patient with glenohumeral joint OA who presented with shoulder pain and impaired movement. CASE DESCRIPTION A 38-year-old male military officer presented with left-shoulder pain of 2 months in duration that was unrelieved with a subacromial injection. He reported a history of anterior-inferior dislocation with subsequent stabilization surgery 15 years prior and arthroscopic subacromial decompression 2 years prior. Physical examination demonstrated painful limitations in shoulder elevation and internal/external rotation movements, stiffness with testing using accessory glides, and rotator cuff and scapular musculature weakness associated with pain. Treatment consisted of 5 sessions provided over 4 weeks. The plan of care included manual physical therapy, exercises, and progressive functional activities specifically tailored to the patient's clinical presentation. Shoulder Pain and Disability Index scores decreased from 43% to 17%, and the Patient-Specific Functional Scale average score improved from 3.0 to 7.3 out of 10. After 4 additional weeks of a home exercise program, the Shoulder Pain and Disability Index score was 4% and Patient-Specific Functional Scale average score was 9.0. Improvements in self-reported function were maintained at 6 months. Four "booster" treatment sessions were administered at 9 months, contributing to sustained outcomes through 1 year. In a young, active patient with glenohumeral joint OA, clinically meaningful short-term improvements in self-reported function and pain, maintained at 1 year, were observed with manual

  6. Bristow-Latarjet Technique: Still a Very Successful Surgery for Anterior Glenohumeral Instability - A Forty Year One Clinic Experience

    PubMed Central

    Ruci, Vilson; Duni, Artid; Cake, Alfred; Ruci, Dorina; Ruci, Julian

    2015-01-01

    AIM: To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability. PATIENTS AND METHODS: Personal clinical records of 42 patients with 45 operated shoulders were reviewed retrospectively. Patient age at time of first dislocation, injury mechanism, and number of recurring dislocations before surgery were recorded. The overall function and stability of the shoulder was evaluated. RESULTS: Thirty five (78%) of the scapulohumeral humeral instabilities were caused by trauma. The mean number of recurring dislocations was 9 (95% confidence interval [CI], 0–18); one patient had had 17 recurrences. Mean follow-up 46 months (95% CI, 16-88). No dislocation happened postoperatively. Four patients have fibrous union (9%). Only two had clinical sign of pain and discomfort. One of them was reoperated for screw removal with very good post-operative result. The overall functional outcome was good, with a mean Rowe score of 88 points (95% CI, 78–100). Scores of 27 (64%) of the patients were excellent, 9 (22%) were good, 4 (9.5%) were fair, and 2 (4.5%) were poor. CONCLUSION: The Bristow-Latarjet procedure is a very good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint. It must not be used for multidirectional instability or psychogenic habitual dislocations. PMID:27275242

  7. Bristow-Latarjet Technique: Still a Very Successful Surgery for Anterior Glenohumeral Instability - A Forty Year One Clinic Experience.

    PubMed

    Ruci, Vilson; Duni, Artid; Cake, Alfred; Ruci, Dorina; Ruci, Julian

    2015-06-15

    To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability. Personal clinical records of 42 patients with 45 operated shoulders were reviewed retrospectively. Patient age at time of first dislocation, injury mechanism, and number of recurring dislocations before surgery were recorded. The overall function and stability of the shoulder was evaluated. Thirty five (78%) of the scapulohumeral humeral instabilities were caused by trauma. The mean number of recurring dislocations was 9 (95% confidence interval [CI], 0-18); one patient had had 17 recurrences. Mean follow-up 46 months (95% CI, 16-88). No dislocation happened postoperatively. Four patients have fibrous union (9%). Only two had clinical sign of pain and discomfort. One of them was reoperated for screw removal with very good post-operative result. The overall functional outcome was good, with a mean Rowe score of 88 points (95% CI, 78-100). Scores of 27 (64%) of the patients were excellent, 9 (22%) were good, 4 (9.5%) were fair, and 2 (4.5%) were poor. The Bristow-Latarjet procedure is a very good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint. It must not be used for multidirectional instability or psychogenic habitual dislocations.

  8. Automatic segmentation of the glenohumeral cartilages from magnetic resonance images.

    PubMed

    Neubert, A; Yang, Z; Engstrom, C; Xia, Y; Strudwick, M W; Chandra, S S; Fripp, J; Crozier, S

    2016-10-01

    Magnetic resonance (MR) imaging plays a key role in investigating early degenerative disorders and traumatic injuries of the glenohumeral cartilages. Subtle morphometric and biochemical changes of potential relevance to clinical diagnosis, treatment planning, and evaluation can be assessed from measurements derived from in vivo MR segmentation of the cartilages. However, segmentation of the glenohumeral cartilages, using approaches spanning manual to automated methods, is technically challenging, due to their thin, curved structure and overlapping intensities of surrounding tissues. Automatic segmentation of the glenohumeral cartilages from MR imaging is not at the same level compared to the weight-bearing knee and hip joint cartilages despite the potential applications with respect to clinical investigation of shoulder disorders. In this work, the authors present a fully automated segmentation method for the glenohumeral cartilages using MR images of healthy shoulders. The method involves automated segmentation of the humerus and scapula bones using 3D active shape models, the extraction of the expected bone-cartilage interface, and cartilage segmentation using a graph-based method. The cartilage segmentation uses localization, patient specific tissue estimation, and a model of the cartilage thickness variation. The accuracy of this method was experimentally validated using a leave-one-out scheme on a database of MR images acquired from 44 asymptomatic subjects with a true fast imaging with steady state precession sequence on a 3 T scanner (Siemens Trio) using a dedicated shoulder coil. The automated results were compared to manual segmentations from two experts (an experienced radiographer and an experienced musculoskeletal anatomist) using the Dice similarity coefficient (DSC) and mean absolute surface distance (MASD) metrics. Accurate and precise bone segmentations were achieved with mean DSC of 0.98 and 0.93 for the humeral head and glenoid fossa, respectively

  9. Management of irreparable rotator cuff tears and glenohumeral arthritis.

    PubMed

    Laudicina, Laurence; D'Ambrosia, Robert

    2005-04-01

    Glenohumeral arthritis with irreparable rotator cuff tears remain a difficult entity to treat. Varied causes include rotator cuff tear arthropathy, osteoarthritis, or rheumatoid arthritis with irreparable cuff tear. Common symptoms are progressive pain and dysfunction. Physical examination may reveal pain, crepitance, rotator cuff weakness, and loss of motion and function. Radiographs may reveal varying degrees of osteophyte formation, sclerotic bone, superior humeral head migration, and bony erosion. Additional imaging modalities may reveal cuff tear size, retraction, atrophy, and fatty infiltration. Failure of nonoperative management may lead to operative intervention. Rotator cuff repair or reconstruction may help prevent progression of tears and future arthritic changes. In patients with moderate to severe glenohumeral arthritis and irreparable rotator cuff tears, hemiarthroplasty is currently the procedure of choice. For patients with severe cuff dysfunction or loss of coracoacromial arch, or for patients who require revision, the reverse shoulder prosthesis may offer a treatment option. Future management continues to be defined with additional study.

  10. Immediate Cementless Hemiarthroplasty for Severe Destructive Glenohumeral Tuberculous Arthritis

    PubMed Central

    Kosiyatrakul, Arkaphat

    2013-01-01

    The glenohumeral joint tuberculosis (TB) is rare as compared with other joints. Plaster immobilization, arthrodesis, and resection arthroplasty have been proposed as the additional treatments with anti-TB medications in severe destructive arthritis. To our knowledge, however, the surgical treatment with shoulder arthroplasty has never been reported. We present two cases of active TB with unsalvageable glenohumeral joint. The cementless hemishoulder arthroplasties were performed immediately following the radical debridement. Anti-TB medications were given for 12 months after the surgery. Postoperatively, the patients were satisfied with the rapid symptomatic relief and significant functional recovery. With the follow-up period of 5 years, the operative results were still satisfactory and the reactivation of the infection was not detected. PMID:24167752

  11. Glenoid inclination: in vivo measures in rotator cuff tear patients and associations with superior glenohumeral joint translation.

    PubMed

    Bishop, Jennifer L; Kline, Stephanie K; Aalderink, Kristopher J; Zauel, Roger; Bey, Michael J

    2009-01-01

    Glenoid inclination has been associated with rotator cuff tears and superior humeral translation, but the relationship between glenoid inclination and superior humeral translation has not been assessed in vivo. This study compared glenoid inclination between repaired and contralateral shoulders in 21 unilateral rotator cuff repair patients. As a secondary analysis, we assessed the relationship between glenoid inclination and in vivo superior humeral translation. Glenoid inclination was measured from patient-specific, computed tomography-based bone models. Glenohumeral joint motion was measured from biplane radiographs collected during coronal-plane abductions. Glenoid inclination was significantly lower for the rotator cuff tear shoulders (90.7 degrees ) than the asymptomatic, contralateral shoulders (92.3 degrees , P = .04). No significant correlation existed between increased glenoid inclination and superior-inferior translation of the uninjured shoulder (P > .30). This study failed to support the theory that glenoid inclination is responsible for superior humeral translation and the development of subacromial impingement.

  12. Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing.

    PubMed

    Kibler, W Ben; Sciascia, Aaron; Thomas, Stephen J

    2012-03-01

    Overhand throwing places high loads and stresses on the joints and tissues of the shoulder and arm. As a result, throwing athletes regularly demonstrate altered shoulder internal and external ranges of motion where internal rotation (IR) is decreased and external rotation is increased in the dominant arm when compared with the nondominant arm. This alteration can exist as a result of alterations to the bones (humeral retroversion), capsule (posterior thickening), or muscle (passive stiffness known as thixotropy). When the amount of IR or total arc of motion difference reaches a certain threshold (typically 20 or more degrees of IR or 8 degrees total arc difference), it is known as glenohumeral internal rotation deficit or total arc of motion deficit. Glenohumeral internal rotation deficit and total arc of motion deficit can cause alterations in biomechanics such as scapular "wind-up" or alteration of glenohumeral joint kinematics, which can in turn lead to clinical findings of impingement and labral pathology. This study will review the causes of motion alteration, effects of altered motion on the throwing motion, provide definitions for the various types of rotation deficits, and how to evaluate and treat rotational deficits.

  13. Arthroscopic treatment of glenohumeral instability in soccer goalkeepers.

    PubMed

    Terra, B B; Ejnisman, B; Figueiredo, E A; Andreoli, C V; Pochini, A C; Cohen, C; Arliani, G G; Cohen, M

    2013-06-01

    The aim of this study was to report epidemiologic data and results of arthroscopic treatment of glenohumeral instability in soccer goalkeepers. We included 12 soccer goalkeepers with a mean age of 28.9 years (range 18-45 years) with acute or recurrent traumatic anterior instability who underwent an arthroscopic anatomic capsulolabral repair with bone anchors. Patients who underwent surgery within 4 weeks of the first episode of dislocation were classified as acute instability. The results were evaluated using the Rowe Scale and analyzed according to stability, range of motion and function. The mean follow-up was 3.8 years. The most common mechanism of injury (90% of the cases) was abduction, external rotation and extension. Associated injuries were present in 57.2% of recurrent cases and 20% of acute cases (p<0.293). Excellent or good results were observed in 80% of the cases of acute instability and in 57.2% of cases in the group with recurrent instability (p<0.586). From a total of 12 soccer goalkeepers who underwent the arthroscopic capsulolabral repair, good or excellent results were obtained in 66.6% of cases of glenohumeral instability. Surgical arthroscopic repair was possible in all cases of acute or recurrent instability based on well-established inclusion criteria, i. e., with well-defined exclusion criteria, such as HAGL lesion and significant glenohumeral bone loss, the arthroscopic capsulolabral repair can be carried out in soccer goalkeepers.

  14. Nontraumatic glenohumeral instability and coracoacromial impingement in swimmers.

    PubMed

    Bak, K

    1996-06-01

    Competitive swimming is one of the most demanding and time-consuming sports. Swimmers at elite level practice 20-30 h per week. During 1 year's practice, the average top level swimmer performs more than 500,000 stroke revolutions per arm. These innumerable repetitions over many years of hard training together with an increasing muscular imbalance around the shoulder girdle seem to be the main etiological factors in the development of the over-use syndrome swimmer's shoulder. Shoulder pain in swimmers has in general been regarded as synonymous with coracoacromial impingement, i.e. anterior shoulder pain due to rotator cuff tendinitis, but new knowledge suggests that a concomitant glenohumeral instability plays an additional role. The diagnostic complexity of the problem is as challenging as the search for the gold standard of treatment. The condition should ideally be diagnosed as early as possible, and intensive functional rehabilitation of the shoulder girdle including the scapular muscles should be started in order to restore muscle balance. The surgical possibilities include subacromial decompression in cases of purely mechanical impingement. If a painful glenohumeral instability persists after intensive functional rehabilitation, anterior capsulolabral reconstruction can be performed. Still, however, short- and long-term results show that surgery is less successful in elite athletes involved in overhead sports. Prevention protocols include education of coaches in primary injury prophylaxis and the institution of resistance strength training in prepubescent swimmers. Emphasis should be made to improve muscular balance around the glenohumeral and scapulothoracic joints.

  15. The Comprehensive Arthroscopic Management Procedure for Treatment of Glenohumeral Osteoarthritis.

    PubMed

    Mook, William R; Petri, Maximilian; Greenspoon, Joshua A; Millett, Peter J

    2015-10-01

    Younger, high-demand patients who are less suitable for joint replacement procedures are often affected by advanced glenohumeral osteoarthritis. There are several alternatives to total joint arthroplasty for the treatment of these patients. However, the outcomes of these procedures are less predictable and have limited durability. The comprehensive arthroscopic management procedure, which includes a combination of arthroscopic glenohumeral debridement, chondroplasty, synovectomy, loose body removal, humeral osteoplasty with excision of the goat's beard osteophyte, capsular releases, subacromial and subcoracoid decompressions, axillary nerve decompression, and biceps tenodesis, has been shown to reduce pain, improve function, and provide a predictable short-term joint-preserving option for patients with advanced glenohumeral osteoarthritis. A unique feature of the comprehensive arthroscopic management procedure is the indirect and direct decompression of the axillary nerve, which may explain the difference in outcomes with this technique compared with other approaches. Furthermore, the technique is technically demanding and associated with several notable pitfalls that are preventable when using the meticulous surgical technique detailed in this article and accompanying video.

  16. Scapular Resting Position and Gleno-Humeral Movement Dysfunction in Asymptomatic Racquet Players: A Case-Control Study

    PubMed Central

    Shimpi, Apurv P.; Bhakti, Shah; Roshni, Karnik; Rairikar, Savita A.; Shyam, Ashok; Sancheti, Parag K.

    2015-01-01

    Background: Racquet sports, especially lawn tennis and badminton have been gaining popularity in Asian countries like India. With this increase in popularity, the injury rate in the sport has also increased. Objectives: The study will help detect the presence of gleno-humeral movement dysfunction and scapular resting position abnormality in asymptomatic racquet players, thus providing basis for screening the players and allow the clinician to determine if the asymmetry is a normal adaptation in the player or an abnormal change associated with injury. Materials and Methods: 46 asymptomatic professional players were divided into a study group of 23 players (16 tennis and 7 badminton) and control group of 23 football players. Assessment of passive gleno-humeral range of motion and distance of spine and inferior angle of scapula from corresponding spinous process were measured bilaterally and between groups. Results: There was statistically significant reduction in range of internal rotation (62.17 ± 8.09), extension (39.78 ± 4.12) and an increase in the external rotation (106.95 ± 7.49) of dominant compared to non-dominant arm of racquet players and a statistically significant decrease in internal rotation (78.69 ± 10.24), extension (44.78 ± 3.19), adduction (37.39 ± 6.54) and an increase in external rotation (102.6 ± 5.19) of dominant arm of racquet players compared to football players. Study also showed statistically significant increase in the spino-scapular distance at the level of inferior angle of scapula (10.23 ± 1.43) on dominant side compared to non-dominant. Conclusions: The dominant side scapula of asymptomatic racquet players showed increased external rotation and elevation as compared to the non-dominant side. Also, reduced shoulder internal rotation, extension and adduction and gain in shoulder external rotation was observed on the dominant side of racquet players when compared to the control group. PMID:26715968

  17. Glenohumeral arthritis after Latarjet procedure: Progression and it's clinical significance.

    PubMed

    Kee, Young Moon; Kim, Hwan Jin; Kim, Jung Youn; Rhee, Yong Girl

    2017-09-01

    The risk factors of glenohumeral arthritis after the Latarjet procedure remain relatively unexplored. The purposes of this study are to evaluate the clinical significance of glenohumeral arthritis after the Latarjet procedure, and to investigate risk factors associated with arthritis progression. We evaluated 110 patients (110 shoulders) who underwent the Latarjet procedure for recurrent anterior shoulder instability. Patients had a mean age of 23.8 years (range, 14-52 years) at the time of the operation, and the mean duration of follow-up was 31 months (range, 24-111 months). At the last follow-up, the mean Visual Analog Scale (VAS), Rowe and University of California at Los Angeles (UCLA) scores significantly improved from 3.1, 36.5 and 23.6 points preoperatively to 1.6, 87.6 and 32.6 points (all P < 0.05, respectively). The postoperative rate of recurrence was 5.4%. Among the 14 shoulders with preoperative arthritis, 8 (57.1%) showed progression of arthritis at the last follow up. New occurrence or progression of arthritis after the Latarjet procedure was in 20 shoulders (18.2%). At the final, overall prevalence of arthritis was 23.6% (26 shoulders). The non-arthritis group showed significantly better functional outcomes (VAS score: 0.9, Rowe Score: 89.3, UCLA score: 33.5) than the arthritis group (2.1, 84.9, 29.2; all P < 0.05, respectively). Preoperative generalized laxity and lateral overhang were associated with glenohumeral arthritis progression after surgery. (all P < 0.05, retrospectively). The Latarjet procedure yielded satisfactory functional outcomes with low recurrent rate at mid-term follow-up. Development or progression of arthritis was observed in 18.2% of patients, postoperatively. Glenohumeral arthritis after the Latarjet procedure had an adverse effect on clinical outcome. Generalized laxity and lateral overhang should be considered as risk factors of progression to glenohumeral arthritis after the Latarjet procedure. Copyright © 2017 The

  18. Post-traumatic glenohumeral cartilage lesions: a systematic review

    PubMed Central

    Ruckstuhl, Heidi; de Bruin, Eling D; Stussi, Edgar; Vanwanseele, Benedicte

    2008-01-01

    Background Any cartilage damage to the glenohumeral joint should be avoided, as these damages may result in osteoarthritis of the shoulder. To understand the pathomechanism leading to shoulder cartilage damage, we conducted a systematic review on the subject of articular cartilage lesions caused by traumas where non impression fracture of the subchondral bone is present. Methods PubMed (MEDLINE), ScienceDirect (EMBASE, BIOBASE, BIOSIS Previews) and the COCHRANE database of systematic reviews were systematically scanned using a defined search strategy to identify relevant articles in this field of research. First selection was done based on abstracts according to specific criteria, where the methodological quality in selected full text articles was assessed by two reviewers. Agreement between raters was investigated using percentage agreement and Cohen's Kappa statistic. The traumatic events were divided into two categories: 1) acute trauma which refers to any single impact situation which directly damages the articular cartilage, and 2) chronic trauma which means cartilage lesions due to overuse or disuse of the shoulder joint. Results The agreement on data quality between the two reviewers was 93% with a Kappa value of 0.79 indicating an agreement considered to be 'substantial'. It was found that acute trauma on the shoulder causes humeral articular cartilage to disrupt from the underlying bone. The pathomechanism is said to be due to compression or shearing, which can be caused by a sudden subluxation or dislocation. However, such impact lesions are rarely reported. In the case of chronic trauma glenohumeral cartilage degeneration is a result of overuse and is associated to other shoulder joint pathologies. In these latter cases it is the rotator cuff which is injured first. This can result in instability and consequent impingement which may progress to glenohumeral cartilage damage. Conclusion The great majority of glenohumeral cartilage lesions without any bony

  19. Artificial Ligaments: Promise or Panacea?

    ERIC Educational Resources Information Center

    Lubell, Adele

    1987-01-01

    The Food and Drug Administration has approved a prosthetic ligament for limited use in persons with damaged anterior cruciate ligaments (ACL). This article addresses ligament repair, ACL tears, current treatment, development of the Gore-Tex artificial ligament, other artificial ligaments in process, and arguments for and against their use.…

  20. Artificial Ligaments: Promise or Panacea?

    ERIC Educational Resources Information Center

    Lubell, Adele

    1987-01-01

    The Food and Drug Administration has approved a prosthetic ligament for limited use in persons with damaged anterior cruciate ligaments (ACL). This article addresses ligament repair, ACL tears, current treatment, development of the Gore-Tex artificial ligament, other artificial ligaments in process, and arguments for and against their use.…

  1. Arthroscopic posteroinferior capsular plication and rotator interval closure after Bankart repair in patients with traumatic anterior glenohumeral instability—A minimum follow-up of 5 years.

    PubMed

    Chiang, En-Rung; Wang, Jung-Pan; Wang, Shih-Tien; Ma, Hsiao-Li; Liu, Chien-Lin; Chen, Tain-Hsiung

    2010-10-01

    Shoulder joint laxity over anteroinferior and posteroinferior labral–capsular structure inpatients with traumatic anterior glenohumeral instability was reported in the previous literature. The purpose of this study was to report our experience in arthroscopic treatment of traumatic anterior–inferior shoulder instability by Bankart lesion stabilisation with rotator interval closure and posteroinferior capsular plication. From August 2000 to November 2004, 45 patients with traumatic anterior–inferior shoulder instability were retrospectively enrolled. Each shoulder was treated with absorbable suture for rotator interval closure and posteroinferior capsular plication after anteroinferior stabilisation. The assessments were performed using the Rowe score, the University of California at Los Angeles (UCLA) shoulder rating scale, the American Shoulder and Elbow Surgeons (ASES) score) and shoulder range of motion (ROM). With the average follow-up time of 77.1 months, all shoulder scores improved after surgery(P < 0.001). The average ROM deficit of the operated shoulders was not significant (P > 0.05) as compared with the healthy side. A total of 42 shoulders remained stable (93.3%) and there were three recurrences (6.6%). All patients without recurrence returned to their pre-injury levels of athletic activity. In patients with anterior glenohumeral instability, arthroscopic stabilisation of anteroinferior capsulolabral structure with rotator interval closure and posteroinferior capsular plication provided a reasonable result without significant loss of ROM at a minimum follow-up of 5 years. 2010 Published by Elsevier Ltd. All rights reserved.

  2. Acute traumatic anterior glenohumeral dislocation complicated by axillary nerve damage: a case report

    PubMed Central

    Kazemi, Mohsen

    1998-01-01

    An elite soccer player presented with a classic acute anterior dislocation of the glenohumeral joint complicated by axillary nerve damage. The incidence, mechanism of injury, clinical presentation, conservative treatment and rehabilitation of the anterior glenohumeral joint dislocation and associated axillary nerve damage are discussed in this paper. ImagesFigure 3

  3. Anterior cruciate ligament (ACL) injury

    MedlinePlus

    Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL) ... knee. It prevents the knee from bending out. Anterior cruciate ligament (ACL) is in the middle of the knee. ...

  4. Medial Collateral Ligament (MCL) Injuries

    MedlinePlus

    ... of Healthy Breakfasts Shyness Medial Collateral Ligament (MCL) Injuries KidsHealth > For Teens > Medial Collateral Ligament (MCL) Injuries ... Treatment Coping With an MCL Injury About MCL Injuries A torn medial collateral ligament (MCL) is a ...

  5. Anterior cruciate ligament repair - slideshow

    MedlinePlus

    ... this page: //medlineplus.gov/ency/presentations/100230.htm Anterior cruciate ligament repair - Series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The anterior cruciate ligament (ACL) is a ligament in the center of ...

  6. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... Week of Healthy Breakfasts Shyness Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  7. Analyzing glenohumeral torque-rotation response in vivo

    PubMed Central

    Beardsley, Christina L.; Howard, Alan B.; Wisotsky, Scott M.; Shafritz, Adam B.; Beynnon, Bruce D.

    2010-01-01

    Background Because the human shoulder has many degrees of freedom that allow redundant means of producing the same net humerothoracic motion, there are many impediments to objective, repeatable assessment of shoulder function in vivo. Devices designed to date have suffered from poor reliability. In this study we introduce a new device and methods to evaluate human shoulder kinematics and evaluate its reproducibility from subject to subject and from day to day. Methods This was a controlled laboratory study. Using electromagnetic motion sensors to record the position and orientation of the thorax, scapula, and humerus, we quantified the kinematic response of twenty four normal shoulders in response to known internal-external torque application. A four-parameter logistic function was selected to characterize the strident features of the torque-rotation relationship. Findings Our analysis in conjunction with the measurement technique described herein, allowed the passive glenohumeral internal-external range of motion to be differentiated from other motion components and was determined to within 9.6% of full scale over three repeated trials. Range of motion was the most reliable biomechanical outcome, more so than computed indices of glenohumeral flexibility and hysteresis. The exact profile of the torque-rotation response, and therefore the repeatability of the calculated outcomes, was unique from shoulder to shoulder. Interpretation The development of the capacity for precise, non-invasive measurement of shoulder biomechanics over time is a requisite step towards optimizing treatment of shoulder injury and disease. Our current methods are superior to previous attempts at trying to non-invasively evaluate the biomechanics of the glenohumeral joint. PMID:20609502

  8. Upright MRI of glenohumeral dysplasia following obstetric brachial plexus injury.

    PubMed

    Nath, Rahul K; Paizi, Melia; Melcher, Sonya E; Farina, Kim L

    2007-11-01

    The purpose of this study was to evaluate the role of upright magnetic resonance imaging (MRI) shoulder scanning in the diagnosis of glenohumeral deformity following obstetric brachial plexus injury (OBPI). Eighty-nine children (ages 0.4 to 17.9 years) with OBPI who have medial rotation contracture and reduced passive and active lateral rotation of the shoulder were evaluated via upright MRI of the affected glenohumeral joint. Qualitative impressions of glenoid form were recorded, and quantitative measurements were made of glenoid version and posterior subluxation. Glenoid version of the affected shoulder averaged -16.8 +/- 11.0 degrees (range, -55 degrees to 1 degrees ), and percentage of the humeral head anterior to the glenoid fossa (PHHA) averaged 32.6 +/- 16.5% (range, -17.8% to 52.4%). The glenoid form was normal in 43 children, convex in 19 children and biconcave in 27 children. Standard MRI protocols were used to obtain bilateral images from 14 of these patients. Among the patients with bilateral MR images, glenoid version and PHHA were significantly different between the involved and uninvolved shoulders (P<.000). Glenoid version in the involved shoulder averaged -19.0 +/- 13.1 degrees (range, -52 degrees to -3 degrees ), and PHHA averaged 29.7 +/- 18.4% (range, -16.2% to 48.7%). In the uninvolved shoulder, the average glenoid version and PHHA were -5.2 +/- 3.7 degrees (range, -12 degrees to -1 degrees ) and 47.7 +/- 3.0% (range, 43% to 54%), respectively. The relative beneficial aspects of upright MRI include lack of need for sedation, low claustrophobic potential and, most important, natural, gravity-influenced position, enabling the surgeon to visualize the true preoperative picture of the shoulder. It is an effective tool for demonstrating glenohumeral abnormalities resulting from brachial plexus injury worthy of surgical exploration.

  9. Tendon and ligament imaging

    PubMed Central

    Hodgson, R J; O'Connor, P J; Grainger, A J

    2012-01-01

    MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease. PMID:22553301

  10. Lumbar intrathecal ligaments.

    PubMed

    Kershner, David E; Binhammer, Robert T

    2002-03-01

    A meticulous examination was performed on 56 vertebral columns from cadavers between 64 and 89 years of age. Identification of all contents within the dural sac was completed; however, the main focus was the cauda equina and lumbar region. In addition to scope dissection, radiographs and histological preparations were used to identify structures, tissue types, and any possible pathology. Discrete intrathecal ligamentous bands were observed in all cadavers examined. They were found randomly binding the dorsal nerve roots of the cauda equina to the dura. Occasional binding of the ventral nerve roots to the dorsal roots was observed. Histological examination demonstrated a dense collagen ligament varying between 0.13 and 0.35 microm in thickness and from 3 mm to 3.5 cm in length. The average number of ligaments found per cadaver was 18. These ligaments displayed a broad base attachment to the nerve root or dura of approximately 3 mm. Looping of the nerve roots associated with these ligaments was seen in one cadaver with a burst fracture. Electron microscopic studies of these ligaments demonstrated similarities to denticulate ligaments. It is suggested that the intrathecal ligaments represent remnants from fetal development of the denticulate ligaments.

  11. The morphology of ligament insertions after failure at low strain velocity: an evaluation of ligament entheses in the rabbit knee.

    PubMed Central

    Gao, J; Räsänen, T; Persliden, J; Messner, K

    1996-01-01

    The morphology of failed rabbit knee entheses is described after in vitro load to failure testing at low strain velocity. Avulsion fracture was the dominant failure mode both for the cruciate ligaments and the medial collateral ligament. The patellar ligament became avulsed in most cases from the patellar insertion. The ligamentous anterior attachment of the medial meniscus failed by a midsubstance rupture and the posterior fibrocartilaginous attachment by a rupture near to the meniscal horn. On histological inspection the failure characteristics usually appeared more elaborate, involving to different degrees all portions of the bone-ligament-bone complexes. Avulsion fracture through subchondral bone was often combined with a partial ligament midsubstance rupture. In few cases avulsion from the cement line was combined with a rupture between the uncalcified fibrocartilage and the ligament. The medial collateral ligament failed in one case entirely at the cement line of its femoral insertion. Horizontal rupture through the calcified fibrocartilage and a vertical cleavage crossing the tidemark were also observed. The superficial portion of the patellar ligament failed with a midsubstance rupture, and the deeper part with an avulsion through the calcified fibrocartilage or an avulsion fracture. The complex failure characteristics may be attributed to uneven loading, nonuniformity of the structure, and specific anatomical location. Subchondral bone beneath femoral and tibial insertions seems to be weaker than the transitional zone between soft tissue and hard bone at the enthesis. The overall inferior structural quality of a ruptured ligament has to be taken into account when parts of the original structure are used for suturing or reconstruction. Images Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 PMID:8771403

  12. Glenohumeral joint rotation range of motion in competitive swimmers.

    PubMed

    Riemann, Bryan L; Witt, Joe; Davies, George J

    2011-08-01

    Much research has examined shoulder range of motion adaptations in overhead-unilateral athletes. Based on the void examining overhead-bilateral athletes, especially competitive swimmers, we examined shoulder external rotation, isolated internal rotation, composite internal rotation, and total arc of motion range of motion of competitive swimmers. The range of motion of registered competitive swimmers (n = 144, age = 12-61 years) was compared by limb (dominant, non-dominant), sex, and age group (youth, high school, college, masters). Significantly (P < 0.05) greater dominant external rotation was observed for both men and women high school and college swimmers, youth women swimmers, and men masters swimmers compared with the non-dominant limb. The isolated internal rotation (glenohumeral rotation), composite internal rotation (glenohumeral rotation plus scapulothoracic protraction), and total arc of motion (external rotation plus composite internal rotation) of the non-dominant limb was significantly greater than that of the dominant limb by sex and age group. Youth and high school swimmers demonstrated significantly greater composite internal rotation than college and masters swimmers. Youth swimmers displayed significantly greater total arc of motion than all other age groups. These data will aid in the interpretation of shoulder range of motion values in competitive swimmers during preseason screenings, injury evaluations and post-rehabilitation programmes, with the results suggesting that differences exist in bilateral external rotation, isolated internal rotation, composite internal rotation, and total arc of motion range of motion.

  13. TREATMENT OF TRAUMATIC GLENOHUMERAL DISLOCATION: A CROSS-SECTIONAL STUDY

    PubMed Central

    Wajnsztejn, André; Sugawara Tamaoki, Marcel Jun; Netto, Nicola Archetti; Belotti, João Carlos; Matsumoto, Marcelo Hide; Faloppa, Flavio

    2015-01-01

    Objective: The aim of the present study was to investigate Brazilian orthopedists' opinions regarding the main aspects of the treatment of glenohumeral traumatic dislocation and compare these to literature's current concepts. Methods: Two hundred questionnaires containing 13 items were randomly distributed to orthopedists who were attending a Brazilian orthopedics congress; 158 were filled, in correctly and were considered in this study. Results: The preferred maneuver was traction-countertraction (60.8%). Among the respondents, 68.4% stated that glenohumeral dislocation reduction was achieved in the first attempt in 90% of the cases. The first attempt of reduction occurred mainly in the Emergency room (96.5%). Seventy-nine individuals (50%) reported that they do not use any analgesic prior to reduction. The majority of the participants immobilize their patients after the reduction (98.1%). 75.4% of them keep their patients immobilized from 2 to 3 weeks. Conclusion: Generally, Brazilian orthopaedists perform tractioncountertraction maneuvers, achieving reduction in the first attempt in more than 90% of the cases in the Emergency room. No previous analgesic agent is used prior to reduction. Immobilization of the patient is made with a Velpeau dressing or a sling for 2 to 3 weeks. PMID:27004185

  14. Creep behaviour and creep mechanisms of normal and healing ligaments

    NASA Astrophysics Data System (ADS)

    Thornton, Gail Marilyn

    Patients with knee ligament injuries often undergo ligament reconstructions to restore joint stability and, potentially, abate osteoarthritis. Careful literature review suggests that in 10% to 40% of these patients the graft tissue "stretches out". Some graft elongation is likely due to creep (increased elongation of tissue under repeated or sustained load). Quantifying creep behaviour and identifying creep mechanisms in both normal and healing ligaments is important for finding clinically relevant means to prevent creep. Ligament creep was accurately predicted using a novel yet simple structural model that incorporated both collagen fibre recruitment and fibre creep. Using the inverse stress relaxation function to model fibre creep in conjunction with fibre recruitment produced a superior prediction of ligament creep than that obtained from the inverse stress relaxation function alone. This implied mechanistic role of fibre recruitment during creep was supported using a new approach to quantify crimp patterns at stresses in the toe region (increasing stiffness) and linear region (constant stiffness) of the stress-strain curve. Ligament creep was relatively insensitive to increases in stress in the toe region; however, creep strain increased significantly when tested at the linear region stress. Concomitantly, fibre recruitment was evident at the toe region stresses; however, recruitment was limited at the linear region stress. Elevating the water content of normal ligament using phosphate buffered saline increased the creep response. Therefore, both water content and fibre recruitment are important mechanistic factors involved in creep of normal ligaments. Ligament scars had inferior creep behaviour compared to normal ligaments even after 14 weeks. In addition to inferior collagen properties affecting fibre recruitment and increased water content, increased glycosaminoglycan content and flaws in scar tissue were implicated as potential mechanisms of scar creep

  15. Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina.

    PubMed

    Yuan, Shi-Guo; Wen, You-Liang; Zhang, Pei; Li, Yi-Kai

    2015-11-01

    To provide an anatomical basis for intrusive treatment using an approach through the lateral zones of the lumbar intervertebral foramina (LIF), especially for acupotomology lysis, percutaneous transforaminal endoscopy, and lumbar nerve root block. Blood vessels, ligaments, nerves, and adjacent structures of ten cadavers were exposed through the L1-2 to L5-S1 intervertebral foramina and examined. The lateral zones of the LIF were almost filled by ligaments, nerves, and blood vessels, which were separated into compartments by superior/inferior transforaminal ligaments and corporotransverse superior/inferior ligaments. Two zones relatively lacking in blood vessels and nerves (triangular working zones) were found beside the lamina of the vertebral arch and on the root of the transverse processus. Both the ascending lumbar vein and branches of the intervetebral vein were observed in 12 Kambin's triangles, and in only seven Kambin's triangles were without any veins. Nerves and blood vessels are fixed and protected by transforaminal ligaments and/or corporotransverse ligaments. It is necessary to distinguish the ligaments from nerves using transforaminal endoscopy so that the ligaments can be cut without damaging nerves. Care needs to be taken in intrusive operations because of the veins running through Kambin's triangle. We recommend injecting into the lamina of the vertebral arch and the midpoint between the adjacent roots of the transverse processus when administering nerve root block. Blind percutaneous incision and acupotomology lysis is dangerous in the lateral zones of the LIF, as they are filled with nerves and blood vessels.

  16. Visualization of Penile Suspensory Ligamentous System Based on Visible Human Data Sets

    PubMed Central

    Chen, Xianzhuo; Wu, Yi; Tao, Ling; Yan, Yan; Pang, Jun; Zhang, Shaoxiang; Li, Shirong

    2017-01-01

    Background The aim of this study was to use a three-dimensional (3D) visualization technology to illustrate and describe the anatomical features of the penile suspensory ligamentous system based on the Visible Human data sets and to explore the suspensory mechanism of the penis for the further improvement of the penis-lengthening surgery. Material/Methods Cross-sectional images retrieved from the first Chinese Visible Human (CVH-1), third Chinese Visible Human (CVH-3), and Visible Human Male (VHM) data sets were used to segment the suspensory ligamentous system and its adjacent structures. The magnetic resonance imaging (MRI) images of this system were studied and compared with those from the Visible Human data sets. The 3D models reconstructed from the Visible Human data sets were used to provide morphological features of the penile suspensory ligamentous system and its related structures. Results The fundiform ligament was a superficial, loose, fibro-fatty tissue which originated from Scarpa’s fascia superiorly and continued to the scrotal septum inferiorly. The suspensory ligament and arcuate pubic ligament were dense fibrous connective tissues which started from the pubic symphysis and terminated by attaching to the tunica albuginea of the corpora cavernosa. Furthermore, the arcuate pubic ligament attached to the inferior rami of the pubis laterally. Conclusions The 3D model based on Visible Human data sets can be used to clarify the anatomical features of the suspensory ligamentous system, thereby contributing to the improvement of penis-lengthening surgery. PMID:28530218

  17. Glenohumeral translation in ABER position during muscle activity in patients treated with Latarjet procedure: an in vivo MRI study.

    PubMed

    Di Giacomo, Giovanni; Scarso, Paolo; De Vita, Andrea; Rojas Beccaglia, Mario A; Pouliart, Nicole; de Gasperis, Nicola

    2016-02-01

    The Latarjet procedure is frequently performed when treating traumatic anteroinferior shoulder instability. This procedure is supposed to have a triple effect: osseous, muscular and ligamentous. The main stabilizing mechanism in cadaver studies on fresh-frozen shoulders seems to be the sling effect produced by the subscapularis and the conjoint tendon. It has been hypothesized that muscle contraction in ABER position (abduction-external rotation) is able to translate the humeral head posteriorly and superiorly due to the sling effect. The aim of this study was to analyse the humeral head translation relative to the glenoid with the arm in ABER position with and without muscle contraction. Twenty-one subjects divided into two groups (Group A: after Latarjet; Group B: healthy subjects) were examined with an open MRI system with the shoulder in abduction-external rotation (ABER) position to analyse humeral head translation during muscle activity. In normal shoulders, there was no significant difference in anteroposterior or superoinferior translation between the rest position and the muscle-activated state. In subjects after the Latarjet procedure, the difference was significant and was also significant between both groups of subjects for posterior translation, but not for superior translation. In patients treated with Latarjet procedure, there are significant changes in glenohumeral translation during muscular activity when in ABER position, with the humeral head going more posteriorly, in comparison with normal shoulders. This study confirms the stabilizing sling effect of the transposed conjoint tendon in the ABER position. Retrospective case-control study, Level III.

  18. Development and Reliability Testing of the FEDS System for Classifying Glenohumeral Instability

    PubMed Central

    Kuhn, John E.; Helmer, Tara T.; Dunn, Warren R.; Throckmorton V, Thomas W.

    2010-01-01

    Background Classification systems for glenohumeral instability (GHI) are opinion based, not validated, and poorly defined. This study is designed to methodologically develop and test a GHI classification system. Methods: Classification System Development A systematic literature review identified 18 systems for classifying GHI. The frequency characteristics used was recorded. Additionally 31 members of the American Shoulder and Elbow Surgeons responded to a survey to identify features important to characterize GHI. Frequency, Etiology, Direction, and Severity (FEDS), were found to be most important. Frequency was defined as solitary (one episode), occasional (2–5x/year), or frequent (>5x/year). Etiology was defined as traumatic or atraumatic. Direction referred to the primary direction of instability (anterior, posterior, or inferior). Severity was defined as either subluxation or dislocation. Methods: Reliability Testing Fifty GHI patients completed a questionnaire at their initial visit. One of six sports medicine fellowship trained physicians completed a similar questionnaire after examining the patient. Patients returned after two weeks and were examined by the original physician and two other physicians. Inter- and intra-rater agreement for the FEDS classification system was calculated. Results Agreement between patients and physicians was lowest for frequency (39%; k=0.130) and highest for direction (82%; k=0.636). Physician intra-rater agreement was 84– 97% for the individual FEDS characteristics (k=0.69 to 0.87)). Physician inter-rater agreement ranged from 82–90% (k=0.44 to 0.76). Conclusions The FEDS system has content validity and is highly reliable for classifying GHI. Physical examination using provocative testing to determine the primary direction of instability produces very high levels of inter- and intra-rater agreement. Level of evidence Level II, Development of Diagnostic Criteria with Consecutive Series of Patients, Diagnosis Study. PMID

  19. Differences in glenohumeral joint morphology between patients with anterior shoulder instability and healthy, uninjured volunteers.

    PubMed

    Peltz, Cathryn D; Zauel, Roger; Ramo, Nicole; Mehran, Nima; Moutzouros, Vasilios; Bey, Michael J

    2015-07-01

    Traumatic glenohumeral joint (GHJ) dislocations are common, resulting in significant shoulder disability and pain. Previous research indicates that bony morphology is associated with an increased risk of injury in other joints (eg, the knee), but the extent to which bony morphology is associated with traumatic GHJ dislocation is unknown. This study assessed GHJ morphology in patients with anterior GHJ instability and in a control population of healthy volunteers. Bilateral computed tomography scans were used to measure GHJ morphology in both shoulders of 11 patients with instability and 11 control subjects. Specific outcome measures included the glenoid radius of curvature (ROC) in the anterior/posterior (A/P) and superior/inferior (S/I) directions, humeral head ROC, A/P and S/I conformity index, and A/P and S/I stability angle. Compared with the control subjects, the glenoid of the instability the injured shoulder in patients with instability was flatter (ie, higher ROC) in the A/P (P = .001) and S/I (P = .01) directions and this finding was also true for uninjured, contralateral shoulder (A/P: P = .01, S/I: P = .03). No differences in GHJ morphology were detected between the instability patients' injured and contralateral shoulders (P > .07). Similarly, no differences in GHJ morphology were detected between the control subjects' dominant and nondominant shoulders (P > .51). There are significant differences in GHJ morphology between healthy control subjects and both shoulders (injured and uninjured, contralateral) of patients diagnosed with anterior instability after GHJ dislocation. These findings are important clinically because they suggest that glenoid morphology may influence the risk of GHJ dislocation. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal.

  1. Glenohumeral osteoarthrosis after the Eden-Hybbinette procedure.

    PubMed

    Rachbauer, F; Ogon, M; Wimmer, C; Sterzinger, W; Huter, B

    2000-04-01

    Thirty-six patients (36 shoulders) who underwent the Eden-Hybbinette procedure for recurrent anterior dislocation of the shoulder with an average followup of 15 years were evaluated. Evaluation consisted of radiographic assessment in a true anteroposterior view and an axillary lateral view of both shoulders, physical examination, and a questionnaire. Mild glenohumeral osteoarthrosis was present in 1/3 of the patients, and moderate and severe osteoarthrosis was evident in 1/2. There were no signs of osteoarthrosis in four shoulders. Function, as assessed by the Rowe score as modified by Young and Rockwood, was excellent or good in 27 shoulders and fair or poor in nine shoulders. The extent of osteoarthrosis was related to restriction of external rotation, length of followup, and function.

  2. Surgical options for the young patient with glenohumeral arthritis

    PubMed Central

    Barlow, Jonathan D.; Abboud, Joseph

    2016-01-01

    Young patients with glenohumeral arthritis are an ongoing treatment challenge. They typically have high demands of their shoulders, require long-term durability due to their young age, and often have altered local anatomy, through their disease process (instability arthropathy, juvenile rheumatoid arthritis, etc.) or from previous surgery (capsulorraphy arthropathy, chondrolysis, etc.). Workup to evaluate underlying causes of early arthritis, and to exclude infectious causes are necessary. When nonoperative management fails, arthroscopic debridement, hemiarthroplasty (isolated, with glenoid reaming, or with biological interposition), and total shoulder arthroplasty are treatment options available to the treating surgeon. Debridement or hemiarthroplasty can provide pain relief for a subset of patients, but results have not been reproducible across the literature and have not been durable over time. Total shoulder arthroplasty provides the most reliable pain relief, but long-term glenoid loosening and wear continue to lead to high revision rates in this patient population. PMID:26980987

  3. Hip and glenohumeral rotational range of motion in healthy professional baseball pitchers and position players.

    PubMed

    Sauers, Eric L; Huxel Bliven, Kellie C; Johnson, Michael P; Falsone, Susan; Walters, Sheri

    2014-02-01

    Research suggests that limitations in the hip motion of baseball players may lead to altered motion at the glenohumeral joint to maintain throwing velocity, thereby predisposing the upper extremity to injury. To measure and evaluate the correlation between hip and shoulder rotational range of motion (ROM) in healthy professional baseball players. Descriptive laboratory study. Ninety-nine professional baseball players (50 pitchers and 49 position players; mean age ± standard deviation [SD], 22 ± 2.8 years; mean height ± SD, 187 ± 5.4 cm; mean weight ± SD, 81.6 ± 7.7 kg) with no history of hip or shoulder injury were tested. Dominant and nondominant hip and glenohumeral joints were measured for the following passive ROM variables: (1) hip internal rotation (IR), (2) hip external rotation (ER), (3) total hip rotational ROM (IR + ER), (4) isolated glenohumeral IR, (5) isolated glenohumeral ER, and (6) total glenohumeral rotational ROM (IR + ER). Statistically, hip ER and total hip rotational ROM were greater in position players than in pitchers and less in the lead leg compared with the stance leg hip with groups combined; however, differences are not clinically meaningful. Pitchers had more glenohumeral rotational ROM than did position players. For all players, glenohumeral motion had less IR and greater ER in the throwing arm than the nonthrowing arm, but total glenohumeral rotational ROM was equivalent between sides. The correlations between hip and glenohumeral ROM were little, if any, and ranged from r = -0.19 to 0.11 (P = .006-.94) for all players and r = -0.29 to 0.23 (P = .04-.97) for pitchers only. These data suggest no clinically meaningful differences in hip ROM between pitchers and position players and between lead leg and stance legs of all players. There is little or no relationship between hip and glenohumeral ROM in healthy professional baseball players. The study findings add to the growing body of evidence that suggests an absence of chronic hip

  4. The Forgotten Lumbocostal Ligament: Anatomical Study with Application to Thoracolumbar Surgery

    PubMed Central

    Tardieu, Gabrielle G; Alonso, Fernando; Chung, Beom Sun; Fisahn, Christian; Loukas, Marios; Oskouian, Rod J; Tubbs, R. Shane

    2016-01-01

    Introduction: Most ligaments of the human body have been well studied. However, the lumbocostal ligament has received little attention in the extant medical literature and, to our knowledge, has not undergone anatomical study. Therefore, the present study was performed to better characterize this structure’s anatomy and relationships. Methods: In the prone position, 10 adult cadavers underwent dissection of their lumbocostal ligaments. All specimens were unembalmed and had no history of surgery to the spine. The lumbocostal ligament was dissected and measurements made using calipers and a ruler. This ligament’s attachments were determined as well as its relationships to surrounding fasciae, muscle, and nerves. Results: A lumbocostal ligament was identified on all sides. The ligament was posterior to the quadratus lumborum muscle on all sides. The mean length of the ligament was 3 cm. The overall shape of the ligaments ranged from short bands to large rhomboidal sheets. Inferiorly, the lumbocostal ligament blended with the middle layer of the thoracolumbar fascia on all sides. The ligament attached to the transverse processes of L1 on 25% of sides and onto the transverse processes of L1 and L2 on 75% of sides. The ligament became taut with rib elevation and was lax with rib depression. Conclusions: The lumbocostal ligament is a constant structure of the thoracolumbar junction. Appreciation of this ligament can help localize the transverse processes of L1 and L2 and adjacent nerves, such as the regional dorsal rami as they exit near its attachment onto the lumbar transverse processes.  PMID:28090418

  5. Tendon vs. ligament (image)

    MedlinePlus

    ... the eyeball. A tendon serves to move the bone or structure. A ligament is a fibrous connective tissue which attaches bone to bone, and usually serves to hold structures together and keep them stable.

  6. Posterior Cruciate Ligament Injury

    MedlinePlus

    ... tear. Contact sports. Athletes in sports such as football and soccer can tear their posterior cruciate ligament ... vehicle accident and participating in sports such as football and soccer are the most common risk factors ...

  7. Errors in Shoulder Joint Position Sense Mainly Come from the Glenohumeral Joint.

    PubMed

    Lin, Yin-Liang; Karduna, Andrew

    2017-02-01

    While synchronous movement of the glenohumeral and scapulothoracic joints has been emphasized in previous kinematics studies, most investigations of shoulder joint position sense have treated the shoulder complex as a single joint. The purposes of this study were to investigate the joint position sense errors of the humerothoracic, glenohumeral, and scapulothoracic joints at different elevation angles and to examine whether the errors of the glenohumeral and scapulothoracic joints contribute to the errors of the humerothoracic joint. Fifty-one subjects with healthy shoulders were recruited. Active joint position sense of the humerothoracic, glenohumeral, and scapulothoracic joints was measured at 50°, 70°, and 90° of humerothoracic elevation in the scapular plane. The results showed that while scapulothoracic joint position sense errors were not affected by target angles, there was an angle effect on humerothoracic and glenohumeral errors, with errors decreasing as the target angles approached 90° of elevation. The results of a multiple regression analysis revealed that glenohumeral errors explained most of the variance of the humerothoracic errors and that scapulothoracic errors had a weaker predictive relationship with humerothoracic errors. Therefore, it may be necessary to test scapular joint position sense separately in addition to the assessment of the overall shoulder joint position sense.

  8. The effect of long and short head biceps loading on glenohumeral joint rotational range of motion and humeral head position.

    PubMed

    McGarry, Michelle H; Nguyen, Michael L; Quigley, Ryan J; Hanypsiak, Bryan; Gupta, Ranjan; Lee, Thay Q

    2016-06-01

    To evaluate the effect of loading the long and short heads of the biceps on glenohumeral range of motion and humeral head position. Eight cadaveric shoulders were tested in 60° abduction in the scapula and coronal plane. Muscle loading was applied based on cross-sectional area ratios. The short and long head of the biceps were loaded individually followed by combined loading. Range of motion was measured with 2.2 Nm torque, and the humeral head apex position was measured using a MicroScribe. A paired t test with Bonferroni correction was used for statistics. Long head loading decreased internal rotation in both the scapular (17.9 %) and coronal planes (5.7 %) and external rotation in the scapular plane (2.6 %) (P < 0.04). With only short head loading, maximum internal rotation was significantly increased in the scapular and coronal plane. Long head and short head loading shifted the humeral head apex posteriorly in maximum internal rotation in both planes with the long head shift being significantly greater than the short head. Long head loading also shifted the humeral apex inferiorly in internal rotation and inferiorly posteriorly in neutral rotation in the scapular plane. With the long head unloaded, there was a significant superior shift with short head loading in both planes. Loading the long head of the biceps had a much greater effect on glenohumeral range of motion and humeral head shift than the short head of the biceps; however, in the absence of long head loading, with the short head loaded, maximum internal rotation increases and the humeral head shifts superiorly, which may contribute to impingement following tenodesis of the long head of the biceps. These small changes in rotational range of motion and humeral head position with biceps tenodesis may not lead to pathologic conditions in low-demand patients; however, in throwers, biceps tenodesis may lead to increased contact pressures in late-cocking and deceleration that will likely translate

  9. Ligaments associated with lumbar intervertebral foramina. 2. The fifth lumbar level.

    PubMed Central

    Amonoo-Kuofi, H S; el-Badawi, M G; Fatani, J A; Butt, M M

    1988-01-01

    The lumbosacral spines of two fetal and twelve adult cadavers have been studied by dissection. Evidence shows that the fifth lumbar intervertebral foramen is crossed on its external aspect by a strong, cord-like corporotransverse ligament passing obliquely downwards, forwards and medially from the inferior aspect of the accessory process of the fifth lumbar vertebra to the lateral surface of the intervertebral disc and the adjacent parts of the bodies of the fifth and first sacral vertebrae. Superficially, the ligament is related to another flat band--the lumbosacral hood. Together these ligaments separate and provide openings for the sympathetic ramus, the ventral ramus and blood vessels related to the intervertebral foramen. On the dorsal aspect, a tripartite ligament, the mamillo-transverso-accessory ligament, bears important relationships to the subdivisions of the dorsal ramus and also the zygapophyseal joint. The significance of these findings is discussed. Images Fig. 2 Fig. 3 Fig. 4 Fig. 1 Fig. 5 PMID:3248957

  10. Inferior vestibular neuritis.

    PubMed

    Kim, Ji-Soo; Kim, Hyo Jung

    2012-08-01

    Vestibular neuritis (VN) mostly involves the superior portion of the vestibular nerve and labyrinth. This study aimed to describe the clinical features of VN involving the inferior vestibular labyrinth and its afferents only. Of the 703 patients with a diagnosis of VN or labyrinthitis at Seoul National University Bundang Hospital from 2004 to 2010, we retrospectively recruited 9 patients (6 women, age range 15-75) with a diagnosis of isolated inferior VN. Diagnosis of isolated inferior VN was based on torsional downbeating spontaneous nystagmus, abnormal head-impulse test (HIT) for the posterior semicircular canal (PC), and abnormal cervical vestibular-evoked myogenic potentials (VEMP) in the presence of normally functioning horizontal and anterior semicircular canals, as determined by normal HIT and bithermal caloric tests. All patients presented with acute vertigo with nausea, vomiting, and imbalance. Three patients also had tinnitus and hearing loss in the involved side. The rotation axis of torsional downbeating spontaneous nystagmus was best aligned with that of the involved PC. HIT was also positive only for the involved PC. Cervical VEMP was abnormal in seven patients, and ocular VEMP was normal in all four patients tested. Ocular torsion and subjective visual vertical tests were mostly within the normal range. Since isolated inferior VN lacks the typical findings of much more prevalent superior VN, it may be mistaken for a central vestibular disorder. Recognition of this rare disorder may help avoid unnecessary workups in patients with acute vestibulopathy.

  11. Inferiority is compex

    NASA Astrophysics Data System (ADS)

    Wade, Jess

    2017-07-01

    In Inferior: How Science Got Women Wrong and the New Research That's Rewriting the Story, author Angela Saini puts forward the idea that bad science has been used to endorse the cultural prejudice that women are both biologically and psychologically second rate to men.

  12. Glenohumeral Joint Laxity and Stiffness in the Functional Throwing Position of High School Baseball Pitchers

    PubMed Central

    Crawford, Scott D; Sauers, Eric L

    2006-01-01

    Context: Repetitive overhead throwing has been theorized to result in chronic adaptations to the capsuloligamentous restraints of the glenohumeral joint. Objective: To compare glenohumeral joint laxity and stiffness between the throwing and nonthrowing shoulders of high school baseball pitchers. Design: Repeated measures. Setting: High school athletic training facilities. Patients or Other Participants: Twenty-two asymptomatic high school baseball pitchers (age = 16.50 ± 0.74 years, height = 178.51 ± 7.66 cm, mass = 75.43 ± 13.24 kg) from a sample of convenience. Main Outcomes Measure(s): We used computerized stress arthrometry to measure glenohumeral joint laxity and stiffness. Anterior glenohumeral joint laxity and stiffness measures were obtained with the shoulder in 90° of abduction and both neutral rotation and 90° of external rotation. Posterior laxity and stiffness measures were obtained with the shoulder in 90° of abduction and neutral rotation. Results: No clinically significant differences were found for glenohumeral laxity or stiffness between sides. However, a statistically significant main effect for position was present for both laxity and stiffness. Anterior glenohumeral joint laxity in the 90° external rotation position was significantly decreased and stiffness was increased in this position compared with the anterior at neutral and posterior at neutral positions. Conclusions: Glenohumeral joint laxity decreases and stiffness increases in the functional throwing position of 90° of abduction and 90° of external rotation. No clinically significant side-to-side differences or directional differences were found in high school baseball pitchers. PMID:16619095

  13. Glenoid Inclination: In-Vivo Measures in Rotator Cuff Tear Patients and Associations with Superior Glenohumeral Joint Translation

    PubMed Central

    Bishop, Jennifer L.; Kline, Stephanie K.; Aalderink, Kristopher J.; Zauel, Roger; Bey, Michael J.

    2009-01-01

    Glenoid inclination has been associated with rotator cuff tears and superior humeral translation, but the relationship between glenoid inclination and superior humeral translation has not been assessed in-vivo. The objective of this study was to compare glenoid inclination between repaired and contralateral shoulders of unilateral rotator cuff repair patients. As a secondary analysis, we assessed the relationship between glenoid inclination and in-vivo superior humeral translation. Glenoid inclination was measured from patient-specific, CT-based bone models. Glenohumeral joint motion was measured from biplane x-ray images collected during coronal-plane abduction of 21 rotator cuff repair patients. Glenoid inclination was significantly lower for the rotator cuff tear shoulders (90.7°) than the asymptomatic, contralateral shoulders (92.3°, p=0.04). There was no significant correlation between increased glenoid inclination and superior/inferior translation of the uninjured shoulder (p>0.30). This study failed to support the theory that glenoid inclination is responsible for superior humeral translation and the development of subacromial impingement. PMID:19062313

  14. Glenohumeral contact force during flat and topspin tennis forehand drives.

    PubMed

    Blache, Yoann; Creveaux, Thomas; Dumas, Raphaël; Chèze, Laurence; Rogowski, Isabelle

    2017-03-01

    The primary role of the shoulder joint in tennis forehand drive is at the expense of the loadings undergone by this joint. Nevertheless, few studies investigated glenohumeral (GH) contact forces during forehand drives. The aim of this study was to investigate GH compressive and shearing forces during the flat and topspin forehand drives in advanced tennis players. 3D kinematics of flat and topspin forehand drives of 11 advanced tennis players were recorded. The Delft Shoulder and Elbow musculoskeletal model was implemented to assess the magnitude and orientation of GH contact forces during the forehand drives. The results showed no differences in magnitude and orientation of GH contact forces between the flat and topspin forehand drives. The estimated maximal GH contact force during the forward swing phase was 3573 ± 1383 N, which was on average 1.25 times greater than during the follow-through phase, and 5.8 times greater than during the backswing phase. Regardless the phase of the forehand drive, GH contact forces pointed towards the anterior-superior part of the glenoid therefore standing for shearing forces. Knowledge of GH contact forces during real sport tasks performed at high velocity may improve the understanding of various sport-specific adaptations and causative factors for shoulder problems.

  15. Optical Enhancement of Exoskeleton-Based Estimation of Glenohumeral Angles

    PubMed Central

    Cortés, Camilo; Unzueta, Luis; de los Reyes-Guzmán, Ana; Ruiz, Oscar E.; Flórez, Julián

    2016-01-01

    In Robot-Assisted Rehabilitation (RAR) the accurate estimation of the patient limb joint angles is critical for assessing therapy efficacy. In RAR, the use of classic motion capture systems (MOCAPs) (e.g., optical and electromagnetic) to estimate the Glenohumeral (GH) joint angles is hindered by the exoskeleton body, which causes occlusions and magnetic disturbances. Moreover, the exoskeleton posture does not accurately reflect limb posture, as their kinematic models differ. To address the said limitations in posture estimation, we propose installing the cameras of an optical marker-based MOCAP in the rehabilitation exoskeleton. Then, the GH joint angles are estimated by combining the estimated marker poses and exoskeleton Forward Kinematics. Such hybrid system prevents problems related to marker occlusions, reduced camera detection volume, and imprecise joint angle estimation due to the kinematic mismatch of the patient and exoskeleton models. This paper presents the formulation, simulation, and accuracy quantification of the proposed method with simulated human movements. In addition, a sensitivity analysis of the method accuracy to marker position estimation errors, due to system calibration errors and marker drifts, has been carried out. The results show that, even with significant errors in the marker position estimation, method accuracy is adequate for RAR. PMID:27403044

  16. Optical Enhancement of Exoskeleton-Based Estimation of Glenohumeral Angles.

    PubMed

    Cortés, Camilo; Unzueta, Luis; de Los Reyes-Guzmán, Ana; Ruiz, Oscar E; Flórez, Julián

    2016-01-01

    In Robot-Assisted Rehabilitation (RAR) the accurate estimation of the patient limb joint angles is critical for assessing therapy efficacy. In RAR, the use of classic motion capture systems (MOCAPs) (e.g., optical and electromagnetic) to estimate the Glenohumeral (GH) joint angles is hindered by the exoskeleton body, which causes occlusions and magnetic disturbances. Moreover, the exoskeleton posture does not accurately reflect limb posture, as their kinematic models differ. To address the said limitations in posture estimation, we propose installing the cameras of an optical marker-based MOCAP in the rehabilitation exoskeleton. Then, the GH joint angles are estimated by combining the estimated marker poses and exoskeleton Forward Kinematics. Such hybrid system prevents problems related to marker occlusions, reduced camera detection volume, and imprecise joint angle estimation due to the kinematic mismatch of the patient and exoskeleton models. This paper presents the formulation, simulation, and accuracy quantification of the proposed method with simulated human movements. In addition, a sensitivity analysis of the method accuracy to marker position estimation errors, due to system calibration errors and marker drifts, has been carried out. The results show that, even with significant errors in the marker position estimation, method accuracy is adequate for RAR.

  17. Prevention and management of post-instability glenohumeral arthropathy

    PubMed Central

    Waterman, Brian R; Kilcoyne, Kelly G; Parada, Stephen A; Eichinger, Josef K

    2017-01-01

    Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability, both with and without surgical stabilization. Classically related to anterior shoulder instability, the incidence and rates of arthritic progression may vary widely. Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30% after Latarjet procedure, with increasing rates associated with recurrent dislocation history, prominent implant position, non-anatomic reconstruction, and/or lateralized bone graft placement. However, the presence radiographic arthrosis does not predict poor patient-reported function. After exhausting conservative measures, both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors. Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology. For more advanced secondary arthropathy, total shoulder arthroplasty remains the most reliable option, although the clinical outcomes, wear characteristics, and implant survivorship remains a concern among active, young patients. PMID:28361016

  18. Prevention and management of post-instability glenohumeral arthropathy.

    PubMed

    Waterman, Brian R; Kilcoyne, Kelly G; Parada, Stephen A; Eichinger, Josef K

    2017-03-18

    Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability, both with and without surgical stabilization. Classically related to anterior shoulder instability, the incidence and rates of arthritic progression may vary widely. Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30% after Latarjet procedure, with increasing rates associated with recurrent dislocation history, prominent implant position, non-anatomic reconstruction, and/or lateralized bone graft placement. However, the presence radiographic arthrosis does not predict poor patient-reported function. After exhausting conservative measures, both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors. Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology. For more advanced secondary arthropathy, total shoulder arthroplasty remains the most reliable option, although the clinical outcomes, wear characteristics, and implant survivorship remains a concern among active, young patients.

  19. Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries.

    PubMed

    Jensen, Gunnar; Millett, Peter J; Tahal, Dimitri S; Al Ibadi, Mireille; Lill, Helmut; Katthagen, Jan Christoph

    2017-08-01

    The purpose of this study was to identify the risk of concomitant glenohumeral pathologies with acromioclavicular joint injuries grade III and V. Patients who underwent arthroscopically-assisted stabilization of acromioclavicular joint injuries grade III or grade V between 01/2007 and 12/2015 were identified in the patient databases of two surgical centres. Gender, age at index surgery, grade of acromioclavicular joint injury (Rockwood III or Rockwood V), and duration between injury and index surgery (classified as acute or chronic) were of interest. Concomitant glenohumeral pathologies were noted and their treatment was classified as debridement or reconstructive procedure. A total of 376 patients (336 male, 40 female) were included. Mean age at time of arthroscopic acromioclavicular joint reconstruction surgery was 42.1 ± 14.0 years. Overall, 201 patients (53%) had one or more concomitant glenohumeral pathologies. Lesions of the biceps tendon complex and rotator cuff were the most common. Forty-five patients (12.0%) had concomitant glenohumeral pathologies that required an additional repair. The remaining 156 patients (41.5%) received a debridement of their concomitant pathologies. Rockwood grade V compared to Rockwood grade III (p = 0.013; odds ratio 1.7), and chronic compared to acute injury were significantly associated with having a concomitant glenohumeral pathology (p = 0.019; odds ratio 1.7). The probability of having a concomitant glenohumeral pathology was also significantly associated with increasing age (p < 0.0001). Concomitant glenohumeral pathologies were observed in 53% of surgically treated patients with an acute or chronic acromioclavicular joint injury of either grade III or V. Twenty-two percent of these patients with concomitant glenohumeral pathologies received an additional dedicated repair procedure. Although a significant difference in occurrence of concomitant glenohumeral pathologies was seen between Rockwood grades III and V

  20. Coracoid abnormalities and their relationship with glenohumeral deformities in children with obstetric brachial plexus injury.

    PubMed

    Nath, Rahul K; Mahmooduddin, Faiz; Liu, Xiaomei; Wentz, Melissa J; Humphries, Andrea D

    2010-10-13

    Patients with incomplete recovery from obstetric brachial plexus injury (OBPI) usually develop secondary muscle imbalances and bone deformities at the shoulder joint. Considerable efforts have been made to characterize and correct the glenohumeral deformities, and relatively less emphasis has been placed on the more subtle ones, such as those of the coracoid process. The purpose of this retrospective study is to determine the relationship between coracoid abnormalities and glenohumeral deformities in OBPI patients. We hypothesize that coracoscapular angles and distances, as well as coracohumeral distances, diminish with increasing glenohumeral deformity, whereas coracoid overlap will increase. 39 patients (age range: 2-13 years, average: 4.7 years), with deformities secondary to OBPI were included in this study. Parameters for quantifying coracoid abnormalities (coracoscapular angle, coracoid overlap, coracohumeral distance, and coracoscapular distance) and shoulder deformities (posterior subluxation and glenoid retroversion) were measured on CT images from these patients before any surgical intervention. Paired Student t-tests and Pearson correlations were used to analyze different parameters. Significant differences between affected and contralateral shoulders were found for all coracoid and shoulder deformity parameters. Percent of humeral head anterior to scapular line (PHHA), glenoid version, coracoscapular angles, and coracoscapular and coracohumeral distances were significantly lower for affected shoulders compared to contralateral ones. Coracoid overlap was significantly higher for affected sides compared to contralateral sides. Significant and positive correlations were found between coracoscapular distances and glenohumeral parameters (PHHA and version), as well as between coracoscapular angles and glenohumeral parameters, for affected shoulders. Moderate and positive correlations existed between coracoid overlap and glenohumeral parameters for affected

  1. Coracoid Abnormalities and Their Relationship with Glenohumeral Deformities in Children with Obstetric Brachial Plexus Injury

    PubMed Central

    2010-01-01

    Background Patients with incomplete recovery from obstetric brachial plexus injury (OBPI) usually develop secondary muscle imbalances and bone deformities at the shoulder joint. Considerable efforts have been made to characterize and correct the glenohumeral deformities, and relatively less emphasis has been placed on the more subtle ones, such as those of the coracoid process. The purpose of this retrospective study is to determine the relationship between coracoid abnormalities and glenohumeral deformities in OBPI patients. We hypothesize that coracoscapular angles and distances, as well as coracohumeral distances, diminish with increasing glenohumeral deformity, whereas coracoid overlap will increase. Methods 39 patients (age range: 2-13 years, average: 4.7 years), with deformities secondary to OBPI were included in this study. Parameters for quantifying coracoid abnormalities (coracoscapular angle, coracoid overlap, coracohumeral distance, and coracoscapular distance) and shoulder deformities (posterior subluxation and glenoid retroversion) were measured on CT images from these patients before any surgical intervention. Paired Student t-tests and Pearson correlations were used to analyze different parameters. Results Significant differences between affected and contralateral shoulders were found for all coracoid and shoulder deformity parameters. Percent of humeral head anterior to scapular line (PHHA), glenoid version, coracoscapular angles, and coracoscapular and coracohumeral distances were significantly lower for affected shoulders compared to contralateral ones. Coracoid overlap was significantly higher for affected sides compared to contralateral sides. Significant and positive correlations were found between coracoscapular distances and glenohumeral parameters (PHHA and version), as well as between coracoscapular angles and glenohumeral parameters, for affected shoulders. Moderate and positive correlations existed between coracoid overlap and

  2. Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?

    PubMed Central

    Lädermann, Alexandre; Denard, Patrick J.; Tirefort, Jérôme; Kolo, Frank C.; Chagué, Sylvain; Cunningham, Grégory; Charbonnier, Caecilia

    2016-01-01

    Abstract Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation. Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography. Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values. While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder. PMID:27495043

  3. The physical examination of the glenohumeral joint: emphasis on the stabilizing structures.

    PubMed

    Wilk, K E; Andrews, J R; Arrigo, C A

    1997-06-01

    Thorough descriptions of specific physical examination tests used to determine glenohumeral instability are lacking in the scientific literature. The purpose of this paper was to discuss the importance of the subjective history and illustrate the physical examination of the glenohumeral joint. Additionally, the authors will illustrate specific stability assessment for the glenohumeral joint based on current basic science and clinical research. The physical examination of a patient whose history suggests subtle glenohumeral joint instability may be extremely difficult for the clinician due to the normal amount of capsular laxity commonly present in most individuals. An essential component of the physical examination is a through and meticulous subjective history which includes the mechanisms of injury and/or dysfunction, chief complaint, level of disability, and aggravating movements. The physical examination must include an assessment of motion, static stability testing, muscle testing, and a neurologic assessment. A comprehensive understanding of various stability testing maneuvers is important for the clinician to appreciate. The evaluation techniques discussed in this paper should assist the clinician in determining the passive stability of the glenohumeral joint.

  4. The Influence of Task Constraints on the Glenohumeral Horizontal Abduction Angle of the Overarm Throw of Novice Throwers

    ERIC Educational Resources Information Center

    Breslin, Casey M.; Garner, John C.; Rudisill, Mary E.; Parish, Loraine E.; St. Onge, Paul M.; Campbell, Brian J.; Weimar, Wendi H.

    2009-01-01

    This study determines the effects of three baseballs and softballs of different masses (0.113 kg, 0.198 kg, 0.340 kg) and regulation diameters (22.86 and 30.48 cm, respectively) on the glenohumeral horizontal abduction angle of an overarm throw performed by young children who were novice throwers. Glenohumeral horizontal abduction angle was…

  5. The Influence of Task Constraints on the Glenohumeral Horizontal Abduction Angle of the Overarm Throw of Novice Throwers

    ERIC Educational Resources Information Center

    Breslin, Casey M.; Garner, John C.; Rudisill, Mary E.; Parish, Loraine E.; St. Onge, Paul M.; Campbell, Brian J.; Weimar, Wendi H.

    2009-01-01

    This study determines the effects of three baseballs and softballs of different masses (0.113 kg, 0.198 kg, 0.340 kg) and regulation diameters (22.86 and 30.48 cm, respectively) on the glenohumeral horizontal abduction angle of an overarm throw performed by young children who were novice throwers. Glenohumeral horizontal abduction angle was…

  6. Scar formation and ligament healing.

    PubMed

    Hildebrand, K A; Frank, C B

    1998-12-01

    Ligaments are highly organized, dense, fibrous connective-tissue structures that provide stability to joints and participate in joint proprioception. Injuries to ligaments induce a healing response that is characterized by the formation of a scar. The scar tissue is weaker, larger and creeps more than normal ligament and is associated with an increased amount of minor collagens (types III, V and VI), decreased collagen cross-links and an increased amount of glycosaminoglycans. Studies have shown that certain surgical variables alter the healing of ligaments. Such factors include the size of gap between the healing ligament, ends, the use of motion in a stable joint and the presence of multiple ligamentous injuries. Research on ligament healing includes studies on low-load and failure-load properties, alterations in the expression of matrix molecules, cytokine modulation of healing and gene therapy as a method to alter matrix protein and cytokine production.

  7. Influence of glenohumeral conformity on glenoid stresses after total shoulder arthroplasty.

    PubMed

    Terrier, Alexandre; Büchler, Philippe; Farron, Alain

    2006-01-01

    Glenohumeral conformity has been reported to be one of the most critical implant-related features that may affect the occurrence of glenoid loosening. This study evaluated the mechanical effects of this parameter with a 3-dimensional finite element model of a prosthetic shoulder, which included the scapula, the humerus, and the rotator cuff muscles. Aequalis humeral and glenoid components were implanted numerically according to manufacturer's recommendations for 2 different orientations of the glenoid component (0 degrees and 15 degrees of retroversion). Different values of glenohumeral conformity (1-15 mm of radial mismatch) were tested by a progressive flattening of the glenoid surface. Free and countered rotation movements were simulated. Glenohumeral contact pressure, cement stress, shear stress, and micromotions at the bone-cement interface were calculated. At 0 degrees of retroversion, conformity had only a slight effect, whereas at 15 degrees of retroversion, all quantities increased by more than 200% and exceeded critical values above 10 mm of mismatch.

  8. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear.

    PubMed

    Agnollitto, Paulo Moraes; Chu, Marcio Wen King; Lorenzato, Mario Muller; Zatiti, Salomão Chade Assan; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma.

  9. Glenohumeral interposition of rotator cuff stumps: a rare complication of traumatic rotator cuff tear*

    PubMed Central

    Agnollitto, Paulo Moraes; Chu, Marcio Wen King; Lorenzato, Mario Muller; Zatiti, Salomão Chade Assan; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    The present report describes a case where typical findings of traumatic glenohumeral interposition of rotator cuff stumps were surgically confirmed. This condition is a rare complication of shoulder trauma. Generally, it occurs in high-energy trauma, frequently in association with glenohumeral joint dislocation. Radiography demonstrated increased joint space, internal rotation of the humerus and coracoid process fracture. In addition to the mentioned findings, magnetic resonance imaging showed massive rotator cuff tear with interposition of the supraspinatus, infraspinatus and subscapularis stumps within the glenohumeral joint. Surgical treatment was performed confirming the injury and the rotator cuff stumps interposition. It is important that radiologists and orthopedic surgeons become familiar with this entity which, because of its rarity, might be neglected in cases of shoulder trauma. PMID:26929462

  10. Role of the superior labrum after biceps tenodesis in glenohumeral stability.

    PubMed

    Strauss, Eric J; Salata, Michael J; Sershon, Robert A; Garbis, Nickolas; Provencher, Matthew T; Wang, Vincent M; McGill, Kevin C; Bush-Joseph, Charles A; Nicholson, Gregory P; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

    2014-04-01

    Little is known about the role that a torn superior labrum (SLAP) plays in glenohumeral stability after biceps tenodesis. This biomechanical study evaluated the contribution of a type II SLAP lesion to glenohumeral translation in the presence of biceps tenodesis. The authors hypothesize that subsequent to biceps tenodesis, a torn superior labrum does not affect glenohumeral stability and therefore does not require anatomic repair in an overhead throwing athlete. Baseline anterior, posterior, and abduction and maximal external rotation glenohumeral translation data were collected from 20 cadaveric shoulders. Translation testing was repeated after the creation of anterior (n = 10) and posterior (n = 10) type II SLAP lesions. Translation re-evaluation after biceps tenodesis was performed for each specimen. Finally, anatomic SLAP lesion repair and testing were performed. Anterior and posterior SLAP lesions led to significant increases in glenohumeral translation in all directions (P < .0125). Biceps tenodesis showed no significance in stability compared with SLAP alone (P > .0125). Arthroscopic repair of anterior SLAP lesions did not restore anterior translation compared with the baseline state (P = .0011) but did restore posterior (P = .823) and abduction and maximal external rotation (P = .806) translations. Repair of posterior SLAP lesions demonstrated no statistical difference compared with the baseline state (P > .0125). With no detrimental effect on glenohumeral stability in the presence of a SLAP lesion, biceps tenodesis may be considered a valid primary or revision surgery for patients suffering from symptomatic type II SLAP tears. However, biceps tenodesis should be considered with caution as the primary treatment of SLAP lesions in overhead throwing athletes secondary to its inability to completely restore translational stability. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

  11. Glenohumeral rotation and scapular position adaptations after a single high school female sports season.

    PubMed

    Thomas, Stephen John; Swanik, Kathleen A; Swanik, Charles; Huxel, Kellie C

    2009-01-01

    Anterior instability and impingement are common in overhead athletes and have been associated with decreases in internal rotation (IR) and increases in external rotation (ER) motion. However, the chronology and the effect of different female sports on these conditions have yet to be determined. To measure glenohumeral IR and ER rotation, total range of motion, and scapular position in female overhead athletes over a single competitive season. Multiple group pretest-posttest study. High school. Thirty-six female overhead athletes (age = 15.29 +/- 1.18 years, height = 164.16 +/- 7.14 cm, mass = 58.24 +/- 9.54 kg) with no history of shoulder or elbow surgery participating in high school swimming, volleyball, or tennis. Participants were measured for all dependent variables at preseason and postseason. Participants were measured for glenohumeral IR and ER with the scapula stabilized. Total glenohumeral range of motion was calculated as the sum of IR and ER. Scapular upward rotation was measured at 0 degrees , 60 degrees , 90 degrees , and 120 degrees of glenohumeral abduction in the scapular plane, and scapular protraction was measured at 0 degrees , 45 degrees (hands on hips), and 90 degrees of glenohumeral abduction. Internal rotation decreased from preseason to postseason (P = .012). Swimmers had less IR than both volleyball and tennis players (P = .001). External rotation also decreased in the swimmers (P = .001). Overall, preseason to postseason total motion decreased for athletes participating in swimming (P = .001) and tennis (P = .019). For all participants, preseason to postseason scapular protraction at 45 degrees glenohumeral abduction decreased (P = .007). Female overhead athletes demonstrated decreases in IR after only one competitive season. Clinically, our results indicate that overhead athletes should be monitored for motion changes throughout their competitive seasons.

  12. Glenohumeral, scapular, and thoracic angles at maximum shoulder external rotation in throwing.

    PubMed

    Miyashita, Koji; Kobayashi, Hirokazu; Koshida, Sentaro; Urabe, Yukio

    2010-02-01

    Because a majority of throwing injuries occur near the maximum external rotation (MER) of the throwing shoulder, sports medicine practitioners and researchers have paid special attention to the shoulder kinematics at the MER in throwing. However, little is known about the individual kinematics of the glenohumeral, scapulothoracic, and thoracic joints at the MER. Purpose To demonstrate the glenohumeral, scapulothoracic, and thoracic joint movements and their contribution to the MER in throwing for baseball players. Descriptive laboratory study. We collected throwing motion data for 20 collegiate baseball players by using 3 high-speed cameras and established 3-dimensional coordinates of each landmark with a direct linear translation method. We then obtained the MER of the shoulder complex, the external rotation angle of the glenohumeral joint, the posterior tipping angle of the scapula, and the thoracic extension angles at the MER in throwing. The mean (+/- standard deviation) value of the MER was 144.2 degrees +/- 11.0 degrees . The mean (+/- standard deviation) values of the glenohumeral external rotation, the scapular posterior tipping, and the thoracic extension angles at the MER were 105.7 degrees +/- 15.5 degrees , 23.5 degrees +/- 13.9 degrees , and 8.9 degrees +/- 7.3 degrees , respectively. Our results indicate that not only the glenohumeral joint movement but also the scapular and thoracic movements make major contributions to the MER angle. To better understand the pathomechanics of the shoulder complex in throwing, we need to take into account the individual contributions of the glenohumeral, scapulothoracic, and thoracic extension movements to the MER.

  13. In vivo measurements of humeral movement during posterior glenohumeral mobilizations.

    PubMed

    Talbott And, Nancy R; Witt, Dexter W

    2016-12-01

    The purpose of this study was to quantify in vivo posterior translational movements occurring in the glenohumeral joint during posterior mobilizations and to determine the intratester reliability of those posterior translational movements. Twenty-eight individuals (17 females, 11 males) participated in this study. One physical therapist utilized a Kaltenborn approach to apply three grades of posterior humeral mobilization. A hand held dynamometer was used to quantify the force used during each grade of mobilization. Ultrasound imaging was used to visualize and measure posterior humeral movement. Statistical analysis included descriptive statistics for force and posterior movement, intraclass correlation coefficient (ICC) for intrarater reliability of force and posterior movement during each grade of mobilization and paired t-tests to compare movement and force between grades of mobilization. Mean posterior movement (mm) measurements were 3.0, 8.2 and 10.7 for grade I, grade II and grade III mobilizations, respectively. Mean force (Newtons) measurements used during mobilization were 41.7, 121.5 and 209.4 for grade I, grade II and grade III mobilizations, respectively. The ICCs ranged from 0.849 to 0.905 for movement and from 0.717 to 0.889 for force. Force and measurement values were significantly different between grades of mobilization and between dominant and non-dominant arms. Gender was found to be significantly associated with force. Mean movements and mean forces occurring during posterior mobilization increased with increasing grades. Intratester reliability was high for all grades of manual mobilization supporting the use of subjective feedback to determine appropriate force application. Quantification of forces and movements helps to clarify parameters that can serve as a reference for clinical practice.

  14. Glenohumeral Joint Pain Referral Patterns: A Descriptive Study.

    PubMed

    Kennedy, David J; Mattie, Ryan; Nguyen, Quang; Hamilton, Scott; Conrad, Bryan

    2015-08-01

    Pain diagrams are a useful tool to help physicians understand the varying presentation patterns of specific pain generators. This study is the first to describe the potential pain patterns of the glenohumeral joint (GHJ) based on responses to diagnostic image-guided GHJ injections. To determine potential GHJ pain referral patterns. 162 consecutive patients undergoing 168 GHJ injections recorded their preprocedure pain scores and drew accurate pain diagrams prior to undergoing fluoroscopically guided GHJ injections with local anesthetic. Postprocedure pain scores were recorded and those with complete relief were considered responders. Pain diagrams were overlaid via computer software to facilitate analysis and a composite pain map. A responder composite was also compared with a nonresponder composite. The GHJ was shown to cause pain in traditionally localized areas of the anterior and/or posterior shoulder and upper arm regions in 100% of patients who experienced complete pain relief after injection. Among 100% responders, 18% had neck pain and 6% had scapular pain. Pain was shown to radiate distally, with anterior forearm pain in 9%, posterior forearm pain in 8%, and hand pain in 9%. No patients with pain both in the medial neck and below the elbow were found to be 100% responders. Similarly, no patients were 100% responders if they had pain in the medial scapula and below the elbow, or medial scapula and medial neck. Anterior or posterior shoulder and upper arm pain, or a combination of the two, is the most common pain referral area from a symptomatic shoulder joint. Referral to the lateral neck, in combination with shoulder pain, was occasionally seen. Pain referral to the forearm and hand was less common. Rarely did a symptomatic shoulder joint refer pain to the scapula or to the medial neck. Wiley Periodicals, Inc.

  15. Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke.

    PubMed

    Stolzenberg, David; Siu, Gilbert; Cruz, Ernesto

    2012-01-01

    Poststroke shoulder pain is a common issue and can be caused by glenohumeral subluxation. This entity hinders function and quality of life and is caused by changes in tone and loss of fi ne control of the shoulder joints' supporting structures after a stroke. Current treatments are limited in number and effectiveness and have significant problems and limitations to their use. Furthermore, prior to percutaneous implantable neuromuscular electrical stimulation, there was no evidence for any treatment to provide relief for chronic hemiplegic shoulder pain from glenohumeral subluxation. This clinical review provides a comprehensive review of the anatomy, pathogenesis, clinical features, management, and clinical efficacy of current treatment modalities.

  16. Glenohumeral abduction contracture in children with unresolved neonatal brachial plexus palsy.

    PubMed

    Eismann, Emily A; Little, Kevin J; Laor, Tal; Cornwall, Roger

    2015-01-21

    Following neonatal brachial plexus palsy, the Putti sign-obligatory tilt of the scapula with brachiothoracic adduction-suggests the presence of glenohumeral abduction contracture. In the present study, we utilized magnetic resonance imaging (MRI) to quantify this glenohumeral abduction contracture and evaluate its relationship to shoulder joint deformity, muscle atrophy, and function. We retrospectively reviewed MRIs of the thorax and shoulders obtained before and after shoulder rebalancing surgery (internal rotation contracture release and external rotation tendon transfer) for twenty-eight children with unresolved neonatal brachial plexus palsy. Two raters measured the coronal positions of the scapula, thoracic spine, and humeral shaft bilaterally on coronal images, correcting trigonometrically for scapular protraction on axial images. Supraspinatus, deltoid, and latissimus dorsi muscle atrophy was assessed, blinded to other measures. Correlations between glenohumeral abduction contracture and glenoid version, humeral head subluxation, passive external rotation, and Mallet shoulder function before and after surgery were performed. MRI measurements were highly reliable between raters. Glenohumeral abduction contractures were present in twenty-five of twenty-eight patients, averaging 33° (range, 10° to 65°). Among those patients, abductor atrophy was present in twenty-three of twenty-five, with adductor atrophy in twelve of twenty-five. Preoperatively, greater abduction contracture severity correlated with greater Mallet global abduction and hand-to-neck function. Abduction contracture severity did not correlate preoperatively with axial measurements of glenohumeral dysplasia, but greater glenoid retroversion was associated with worse abduction contractures postoperatively. Surgery improved passive external rotation, active abduction, and hand-to-neck function, but did not change the abduction contracture. A majority of patients with persistent shoulder weakness

  17. [Traumatology of the alar ligaments].

    PubMed

    Saternus, K S; Thrun, C

    1987-10-01

    A postmortem study of craniocerebral traumas of varying severity was done to determine the pattern of injury of the alar ligaments. It was found that in the entire group of patients (n = 30) the alar ligaments were ruptured or suffused with blood 11 times. No close relationship was found between the massive nature of the cranial trauma and the severity of the injury of the alar ligaments. In some cases the alar ligaments were not at all involved even though the skull had suffered extensive osseous lesions, whereas on the other hand the ligaments were injured even though only soft parts had been involved (e.g., haematoma or dehiscent wounds of the scalp). Ruptures of the alar ligaments were typically involved in extended ruptures of the ligamentous apparatus (see Figure 6a involving the ligamentum apicis dentis, ligamentum transversum atlantis, m.atlanto-occipitalis anterior, m.tectoria, m.atlanto-axialis anterior et posterior). In some cases the pattern of injury of the alar ligaments was found to be decisive in enabling reconstruction of the course of the accident. Damage to the alar ligaments near the dens axis represent rotation injuries. On the other hand, insertion tears out of the condyli occipitales must be related to a lateral thrust tendency in indirect fracture of the skull (bursting fracture). Within this overall framework a new mechanism of fracture of the condylus occipitalis is described. As a matter of principle, the alar ligaments can become involved in consequence of rotation, traction and compression of the cranium.

  18. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    PubMed Central

    Prasad, G. Raghavendra; Billa, Srikar; Bhandari, Pavaneel; Hussain, Aijaz

    2013-01-01

    Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI) bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric – inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up. PMID:23798814

  19. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  20. Inferior vena cava filters.

    PubMed

    Duffett, L; Carrier, M

    2017-01-01

    Use of inferior vena cava (IVC) filters has increased dramatically in recent decades, despite a lack of evidence that their use has impacted venous thromboembolism (VTE)-related mortality. This increased use appears to be primarily driven by the insertion of retrievable filters for prophylactic indications. A growing body of evidence, however, suggests that IVC filters are frequently associated with clinically important adverse events, prompting a closer look at their role. We sought to narratively review the current evidence on the efficacy and safety of IVC filter placements. Inferior vena cava filters remain the only treatment option for patients with an acute (within 2-4 weeks) proximal deep vein thrombosis (DVT) or pulmonary embolism and an absolute contraindication to anticoagulation. In such patients, anticoagulation should be resumed and IVC filters removed as soon as the contraindication has passed. For all other indications, there is insufficient evidence to support the use of IVC filters and high-quality trials are required. In patients where an IVC filter remains, regular follow-up to reassess removal and screen for filter-related complications should occur. © 2016 International Society on Thrombosis and Haemostasis.

  1. [Ligament injuries of the wrist].

    PubMed

    Schmitt, R

    2016-12-01

    The distal radioulnar joint, the triangular fibrocartilage complex (TFCC) and the wrist are stabilized by many ligaments allowing not only a wide range of motion but also providing sufficient stability. The complex arrangement of carpal ligaments and prosupination around the forearm joint enables multiaxial motion patterns. In the wrist, intra-articular ligaments can be differentiated from extra-articular capsular ligaments as well as intrinsic and extrinsic ligament courses. Imaging is essential for classification of dynamic and static instability patterns. This review article illustrates the ligamentous anatomy of the wrist, the symptoms of carpal instability as well as the diagnostic capability of projection radiography, cinematography, computed tomography (CT) arthrography, magnetic resonance imaging (MRI) and MR arthrography.

  2. A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning.

    PubMed

    McMahon, Patrick J; Chow, Stephen; Sciaroni, Laura; Yang, Bruce Y; Lee, Thay Q

    2003-01-01

    A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning is presented. This model simulates an in vivo mechanism and yields capsulolabral lesions. The scapulae of 14 cadaveric entire upper limbs (82 +/- 9 years, mean +/- standard deviation) were each rigidly fixed to a custom shoulder-testing device. A pneumatic system was used with pulleys and cables to simulate the rotator cuff and the deltoid muscles (anterior and middle portions). The glenohumeral joint was then positioned in the apprehension position of abduction, external rotation, and horizontal abduction. A 6-degree-of-freedom load cell (Assurance Technologies, Garner, North Carolina) measured the joint reaction force that was then resolved into three orthogonal components of compression force, anteriorly directed force, and superiorly directed force. With the use of a thrust bearing, the humerus was moved along a rail with a servomotor-controlled system at 50 mm/s that resulted in horizontal abduction. Force that developed passively in the pectoralis major muscle was recorded with an independent uniaxial load cell. Each of the glenohumeral joints dislocated anterior-inferior, six with avulsion of the capsulolabrum from the anterior-inferior glenoid bone and eight with capsulolabral stretching. Pectoralis major muscle force as well as the joint reaction force increased with horizontal abduction until dislocation. At dislocation, the magnitude of the pectoralis major muscle force, 609.6 N +/- 65.2 N was similar to the compression force, 569.6 N +/- 37.8 N. A cadaveric model yielded an anterior dislocation with a mechanism of forcible apprehension positioning when the appropriate shoulder muscles were simulated and a passive pectoralis major muscle was included. Capsulolabral lesions resulted, similar to those observed in vivo.

  3. Ulnar Collateral Ligament Reconstruction

    PubMed Central

    Erickson, Brandon J.; Harris, Joshua D.; Chalmers, Peter N.; Bach, Bernard R.; Verma, Nikhil N.; Bush-Joseph, Charles A.; Romeo, Anthony A.

    2015-01-01

    Context: Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower’s elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common. Evidence Acquisition: Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligament from 1970 until 2015. Study Design: Clinical review. Level of Evidence: Level 5. Results: All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance. Conclusion: Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result. PMID:26502444

  4. Contribution of the Pubofemoral Ligament to Hip Stability: A Biomechanical Study.

    PubMed

    Martin, Hal D; Khoury, Anthony N; Schröder, Ricardo; Johnson, Eric; Gómez-Hoyos, Juan; Campos, Salvador; Palmer, Ian J

    2017-02-01

    To determine the isolated function of the pubofemoral ligament of the hip capsule and its contribution to hip stability in external/internal rotational motion during flexion greater than 30° and abduction. Thirteen hips from 7 fresh-frozen pelvis-to-toe cadavers were skeletonized from the lumbar spine to the distal femur with the capsular ligaments intact. Computed tomographic imaging was performed to ensure no occult pathological state existed, and assess bony anatomy. Specimens were placed on a surgical table in supine position with lower extremities resting on a custom-designed polyvinylchloride frame. Hip internal and external rotation was measured with the hip placed into a combination of the following motions: 30°, 60°, 110° hip flexion and 0°, 20°, 40° abduction. Testing positions were randomized. The pubofemoral ligament was released and measurements were repeated, followed by releasing the ligamentum teres. Analysis of the 2,106 measurements recorded demonstrates the pubofemoral ligament as a main controller of hip internal rotation during hip flexion beyond 30° and abduction. Hip internal rotation was increased up to 438.9% (P < .001) when the pubofemoral ligament was released and 412.9% (P < .001) when both the pubofemoral and teres ligament were released, compared with the native state. The hypothesis of the pubofemoral ligament as one of the contributing factors of anterior inferior hip stability by controlling external rotation of the hip in flexion beyond 30° and abduction was disproved. The pubofemoral ligament maintains a key function in limiting internal rotation in the position of increasing hip flexion beyond 30° and abduction. This cadaveric study concludes previous attempts at understanding the anatomical and biomechanical function of the capsular ligaments and their role in hip stability. The present study contributes to the understanding of hip stability and biomechanical function of the pubofemoral ligament. Copyright © 2016

  5. Combined flexor-pronator mass and ulnar collateral ligament injuries in the elbows of older baseball players.

    PubMed

    Osbahr, Daryl C; Swaminathan, Swarup S; Allen, Answorth A; Dines, Joshua S; Coleman, Struan H; Altchek, David W

    2010-04-01

    Ulnar collateral ligament reconstruction techniques have afforded baseball players up to a reported 90% return to prior or higher level of play. A subpopulation exists with less impressive clinical outcomes potentially related to the presence of a concomitant flexor-pronator mass injury. Combined flexor-pronator and ulnar collateral ligament injuries occur in older players, and results in this group are inferior to those reported for isolated ulnar collateral ligament reconstructions. Case Series; Level of evidence, 4. All baseball players who had ulnar collateral ligament reconstructions by 1 surgeon over a 6-year period were identified, and the authors studied those treated for a combined flexor-pronator and ulnar collateral ligament injury. The ulnar collateral ligament reconstruction was accomplished using the docking technique, and the flexor-pronator injury was treated with debridement if tendinotic or reattachment if torn. A 2-sample t test was conducted to evaluate the likelihood of developing the combined flexor-pronator/ulnar collateral ligament compared with ulnar collateral ligament injury based on age, while a Pearson chi(2) test was used to evaluate the likelihood of a patient being > or =30 years of age in the combined flexor-pronator/ulnar collateral ligament versus ulnar collateral ligament groups. Outcome was assessed using a modified Conway classification. A total of 187 male baseball players between 14 and 42 years of age (mean, 20.7 years) had an ulnar collateral ligament reconstruction by 1 surgeon. Eight (4%) of 187 baseball players were treated for the combined flexor-pronator/ulnar collateral ligament injury. There was a statistically significant difference in age between the ulnar collateral ligament group (20.1 years) and the flexor-pronator/ulnar collateral ligament group (33.4 years) (P < .001). Age > or =30 years was a statistically significant age limit to predict the presence of a combined flexor-pronator/ulnar collateral ligament

  6. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    PubMed

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

  7. Incidental Anterior Cruciate Ligament Calcification: Case Report

    PubMed Central

    Hayashi, Hisami; Fischer, Hans

    2016-01-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding. PMID:27200163

  8. Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments.

    PubMed

    Ramanah, Rajeev; Berger, Mitchell B; Parratte, Bernard M; DeLancey, John O L

    2012-11-01

    The objective of this work was to collect and summarize relevant literature on the anatomy, histology, and imaging of apical support of the upper vagina and the uterus provided by the cardinal (CL) and uterosacral (USL) ligaments. A literature search in English, French, and German languages was carried out with the keywords apical support, cardinal ligament, transverse cervical ligament, Mackenrodt ligament, parametrium, paracervix, retinaculum uteri, web, uterosacral ligament, and sacrouterine ligament in the PubMed database. Other relevant journal and textbook articles were sought by retrieving references cited in previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends from the S2 to the S4 vertebra region to the dorsal margin of the uterine cervix and/or to the upper third of the posterior vaginal wall. It has a superficial and deep component. Autonomous nerve fibers are a major constituent of the deep USL. CL is defined as a perivascular sheath with a proximal insertion around the origin of the internal iliac artery and a distal insertion on the cervix and/or vagina. It is divided into a cranial (vascular) and a caudal (neural) portions. Histologically, it contains mainly vessels, with no distinct band of connective tissue. Both the deep USL and the caudal CL are closely related to the inferior hypogastric plexus. USL and CL are visceral ligaments, with mesentery-like structures containing vessels, nerves, connective tissue, and adipose tissue.

  9. Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments

    PubMed Central

    Ramanah, Rajeev; Berger, Mitchell B.; Parratte, Bernard M.

    2014-01-01

    The objective of this work was to collect and summarize relevant literature on the anatomy, histology, and imaging of apical support of the upper vagina and the uterus provided by the cardinal (CL) and uterosacral (USL) ligaments. A literature search in English, French, and German languages was carried out with the keywords apical support, cardinal ligament, transverse cervical ligament, Mackenrodt ligament, parametrium, paracervix, retinaculum uteri, web, uterosacral ligament, and sacrouterine ligament in the PubMed database. Other relevant journal and textbook articles were sought by retrieving references cited in previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends from the S2 to the S4 vertebra region to the dorsal margin of the uterine cervix and/or to the upper third of the posterior vaginal wall. It has a superficial and deep component. Autonomous nerve fibers are a major constituent of the deep USL. CL is defined as a perivascular sheath with a proximal insertion around the origin of the internal iliac artery and a distal insertion on the cervix and/or vagina. It is divided into a cranial (vascular) and a caudal (neural) portions. Histologically, it contains mainly vessels, with no distinct band of connective tissue. Both the deep USL and the caudal CL are closely related to the inferior hypogastric plexus. USL and CL are visceral ligaments, with mesentery-like structures containing vessels, nerves, connective tissue, and adipose tissue. PMID:22618209

  10. The effects of prosthetic humeral head shape on glenohumeral joint kinematics during humeral axial rotation in total shoulder arthroplasty.

    PubMed

    Jun, Bong Jae; Lee, Thay Q; McGarry, Michelle H; Quigley, Ryan J; Shin, Sang Jin; Iannotti, Joseph P

    2016-07-01

    A non-spherical humeral head has been shown to influence kinematics and stability of the glenohumeral joint; yet, most prosthetic humeral head components are designed to be a perfect sphere. The effect of humeral head shape on prosthetic joint kinematics after total shoulder arthroplasty is not well understood. We hypothesized that prosthetic joint kinematics during humeral axial rotation is dependent on humeral head shape, regardless of joint conformity. Four prosthetic configurations were investigated using a spherical and a non-spherical prosthetic humeral head articulated with a conforming and a non-conforming glenoid component. Testing was performed in the coronal, scapular, and forward flexion plane at 0°, 30°, and 60° of abduction. Prosthetic joint kinematics was measured in 10° intervals during a 100° arc of humeral axial rotation. Glenohumeral translation patterns, net glenohumeral translation, and averaged glenohumeral translation were compared for each of 4 configurations. Non-spherical head configurations increased the net glenohumeral translation during humeral axial rotation in multiple test positions compared with spherical head configurations (P < .05). Spherical head configurations resulted in a relatively small amount of glenohumeral translation, less than 2 mm. The radius of curvature of the glenoid component alone did not affect the net glenohumeral translation within each of the 2 head groups (P > .05). During humeral axial rotation, the non-spherical humeral head shape contributes to increased glenohumeral translation during humeral axial rotation. However, the spherical head shape does not show significant glenohumeral translation during humeral axial rotation, regardless of glenoid conformity. Copyright © 2016. Published by Elsevier Inc.

  11. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.

    PubMed

    Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

    2007-06-01

    Background  Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives  Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy  A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria  Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant

  12. Glenohumeral kinematics after soft tissue interposition graft and glenoid reaming: A cadaveric study

    PubMed Central

    Garbis, Nickolas G; Weber, Alexander E; Shewman, Elizabeth F; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

    2016-01-01

    Background: The management of young patients with glenohumeral arthritis is controversial. Resurfacing of the glenoid with biologic interposition and reaming of the glenoid have been suggested as potential treatment options. The goal of this study was to determine the change in glenohumeral contact pressures in interposition arthroplasty, as well as glenoid reaming in an arthritis model. We hypothesized that interposition with meniscal allograft will lead to the best normalization of contact pressure throughout the glenohumeral range of motion. Materials and Methods: Eight fresh-frozen cadaveric shoulders were tested in static positions of humeral abduction with a compressive load. Glenohumeral contact area, contact pressure, and peak force were determined sequentially for (1) intact glenoid (2) glenoid with cartilage removed (arthritis model) (3) placement of lateral meniscus allograft (4) placement of Achilles allograft (5) arthritis model with reamed glenoid. Results: The arthritis model demonstrated statistically higher peak pressures than intact glenoid and glenoid with interpositional allograft. Meniscal and Achilles allograft lowered mean contact pressure and increased contact area to a level equal to or more favorable than the control state. In contrast, the reamed glenoid did not show any statistical difference from the arthritis model for any of the recorded measures. Conclusion: Glenohumeral contact pressure is significantly improved with interposition of allograft at time zero compared to an arthritic state. Our findings suggest that concentric reaming did not differ from the arthritic model when compared to normal. These findings favor the use of allograft for interposition as a potential treatment option in patients with glenoid wear. PMID:27293292

  13. Position of Immobilization After First-Time Traumatic Anterior Glenohumeral Dislocation: A Literature Review

    PubMed Central

    Gutkowska, Olga; Martynkiewicz, Jacek; Gosk, Jerzy

    2017-01-01

    Anterior glenohumeral dislocation affects about 2% of the general population during the lifetime. The incidence of traumatic glenohumeral dislocation ranges from 8.2 to 26.69 per 100 000 population per year. The most common complication is recurrent dislocation occurring in 17–96% of the patients. The majority of patients are treated conservatively by closed reduction and immobilization in internal rotation for 2–3 weeks. However, no clear conservative treatment protocol exists. Immobilization in external rotation can be considered an alternative. A range of external rotation braces are commercially available. The purpose of this work was to review the current literature on conservative management of glenohumeral dislocation and to compare the results of immobilization in internal and external rotation. A comprehensive literature search and review was performed using the keywords “glenohumeral dislocation”, “shoulder dislocation”, “immobilization”, “external rotation”, and “recurrent dislocation” in PubMed, MEDLINE, Cochrane Library, Scopus, and Google Scholar databases from their inceptions to May 2016. Three cadaveric studies, 6 imaging studies, 10 clinical studies, and 4 meta-analyses were identified. The total number of 734 patients were included in the clinical studies. Literature analysis revealed better coaptation of the labrum on the glenoid rim in external rotation in cadaveric and imaging studies. However, this tendency was not confirmed by lower redislocation rates or better quality of life in clinical studies. On the basis of the available literature, we cannot confirm the superiority of immobilization in external rotation after glenohumeral dislocation when compared to internal rotation. A yet-to-be-determined group of patients with specific labroligamentous injury pattern may benefit from immobilization in external rotation. Further studies are needed to identify these patients. PMID:28710344

  14. [Postoperative results after arthroscopic treatment of rotator cuff calcifying tendonitis, with or without associated glenohumeral exploration].

    PubMed

    Sirveaux, F; Gosselin, O; Roche, O; Turell, P; Molé, D

    2005-06-01

    Arthroscopic treatment of calcifying tendonitis usually includes a glenohumeral exploration first, followed by deposit removal via a bursal approach. The aim of this study was to analyze the relevance of a systematic glenohumeral exploration during arthroscopic treatment of calcified tendonitis of the rotator cuff. Sixty-four consecutive patients treated by arthroscopic removal of calcific deposits in the rotator cuff were studied retrospectively. All patients had had at least six months of medical treatment. The treatment involved a glenohumeral approach in 32 patients (group GH) and an isolated bursal approach in 32 (group B). Both groups were similar with regard to epidemiological data and deposit aspect. In all cases, the deposit was removed from the bursal side and the cuff was not sutured. Assessment included duration of pain after surgery, Constant score, and x-ray aspect at six months follow-up and the delay for return to work. In the GH group, degenerative changes were noted on the labrum in three cases and a partial tear of the supraspinatus in two. No lesions noted in the glenohumeral joint required specific treatment. Postoperatively, the average duration of pain was significantly higher in group GH than in group B (11 weeks versus 6 weeks, p < 0.05) with a significant latency in return-to-work (12 weeks versus 5 weeks, p < 0.05). At six months follow-up, there was no difference between the groups for Constant score and deposit disappearance. Systematic exploration of the glenohumeral joint is not relevant in the arthroscopic treatment of calcified tendonitis and has a negative effect. Considering these results and those previously published in the literature, we recommend using an isolated bursal approach for arthroscopic calcifying tendonitis removal.

  15. Endoscopic Repair of the Superficial Deltoid Ligament and Spring Ligament.

    PubMed

    Lui, Tun Hing

    2016-06-01

    The plantar calcaneonavicular ligament, also known as the spring ligament, is an important static stabilizer of the medial longitudinal foot arch. Compromise of this ligament is a primary causative factor of peritalar subluxation, and it should be repaired in addition to treatment of tibialis posterior tendon abnormalities. Open repair of the ligament requires extensive soft-tissue dissection. The development of the high distal portal for posterior tibial tendoscopy allows repair of the ligament endoscopically. This, together with endoscopically assisted reconstruction of the tibialis posterior tendon, allows complete endoscopic treatment of stage 2 posterior tibial tendon deficiency. The major structure at risk is the medial plantar nerve. This technique is technically demanding and should be reserved for experienced foot and ankle arthroscopists.

  16. Hindlimb unloading alters ligament healing

    NASA Technical Reports Server (NTRS)

    Provenzano, Paolo P.; Martinez, Daniel A.; Grindeland, Richard E.; Dwyer, Kelley W.; Turner, Joanne; Vailas, Arthur C.; Vanderby, Ray Jr

    2003-01-01

    We investigated the hypothesis that hindlimb unloading inhibits healing in fibrous connective tissue such as ligament. Male rats were assigned to 3- and 7-wk treatment groups with three subgroups each: sham control, ambulatory healing, and hindlimb-suspended healing. Ambulatory and suspended animals underwent surgical rupture of their medial collateral ligaments, whereas sham surgeries were performed on control animals. After 3 or 7 wk, mechanical and/or morphological properties were measured in ligament, muscle, and bone. During mechanical testing, most suspended ligaments failed in the scar region, indicating the greatest impairment was to ligament and not to bone-ligament insertion. Ligament testing revealed significant reductions in maximum force, ultimate stress, elastic modulus, and low-load properties in suspended animals. In addition, femoral mineral density, femoral strength, gastrocnemius mass, and tibialis anterior mass were significantly reduced. Microscopy revealed abnormal scar formation and cell distribution in suspended ligaments with extracellular matrix discontinuities and voids between misaligned, but well-formed, collagen fiber bundles. Hence, stress levels from ambulation appear unnecessary for formation of fiber bundles yet required for collagen to form structurally competent continuous fibers. Results support our hypothesis that hindlimb unloading impairs healing of fibrous connective tissue. In addition, this study provides compelling morphological evidence explaining the altered structure-function relationship in load-deprived healing connective tissue.

  17. Hindlimb unloading alters ligament healing

    NASA Technical Reports Server (NTRS)

    Provenzano, Paolo P.; Martinez, Daniel A.; Grindeland, Richard E.; Dwyer, Kelley W.; Turner, Joanne; Vailas, Arthur C.; Vanderby, Ray Jr

    2003-01-01

    We investigated the hypothesis that hindlimb unloading inhibits healing in fibrous connective tissue such as ligament. Male rats were assigned to 3- and 7-wk treatment groups with three subgroups each: sham control, ambulatory healing, and hindlimb-suspended healing. Ambulatory and suspended animals underwent surgical rupture of their medial collateral ligaments, whereas sham surgeries were performed on control animals. After 3 or 7 wk, mechanical and/or morphological properties were measured in ligament, muscle, and bone. During mechanical testing, most suspended ligaments failed in the scar region, indicating the greatest impairment was to ligament and not to bone-ligament insertion. Ligament testing revealed significant reductions in maximum force, ultimate stress, elastic modulus, and low-load properties in suspended animals. In addition, femoral mineral density, femoral strength, gastrocnemius mass, and tibialis anterior mass were significantly reduced. Microscopy revealed abnormal scar formation and cell distribution in suspended ligaments with extracellular matrix discontinuities and voids between misaligned, but well-formed, collagen fiber bundles. Hence, stress levels from ambulation appear unnecessary for formation of fiber bundles yet required for collagen to form structurally competent continuous fibers. Results support our hypothesis that hindlimb unloading impairs healing of fibrous connective tissue. In addition, this study provides compelling morphological evidence explaining the altered structure-function relationship in load-deprived healing connective tissue.

  18. Anterior cruciate ligament - updating article.

    PubMed

    Luzo, Marcus Vinicius Malheiros; Franciozi, Carlos Eduardo da Silveira; Rezende, Fernando Cury; Gracitelli, Guilherme Conforto; Debieux, Pedro; Cohen, Moisés

    2016-01-01

    This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  19. Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the Tight Rope device: a technical note.

    PubMed

    Hosseini, Hamid; Friedmann, Svenja; Tröger, Markus; Lobenhoffer, Philipp; Agneskirchner, Jens D

    2009-01-01

    We present a new arthroscopic technique for chronic AC joint dislocations with coracoacromial ligament transposition and augmentation by the Tight Rope device (Arthrex, Naples, USA). First the glenohumeral joint is visualised to repair concomitant lesions, such as SLAP lesions, if needed. Once the rotator interval is opened and the coracoid is identified, the arthroscope is moved to an additional anterolateral portal. A 1.5 cm incision is made 2 cm medial to the AC joint. After drilling a 4 mm hole with a cannulated drill through the clavicle and coracoid a Tight Rope is inserted, the clavicule is reduced and stabilized with the implant. The arthroscope is moved to the subacromial space and a partial bursectomy is performed to visualise the CA ligament and lateral clavicle. The CA ligament is armed with a strong braided suture using a Lasso stitch and dissected from the undersurface of the acromion. It is then reattached to the distal part of the clavicle by transosseous suture fixation after abrasion of its undersurface. Although this combined arthroscopic procedure of AC joint augmentation with a Tight Rope combined with a ligament transposition is technically demanding, it is a safe method to reconstruct the coracoclavicular ligaments and achieve a sufficient reduction of the clavicle without the need of further implant removal or autologous tendon transplantation.

  20. Anatomic study of the retaining ligaments of the face and applications for facial rejuvenation.

    PubMed

    Rossell-Perry, Percy; Paredes-Leandro, Percy

    2013-06-01

    The retaining ligaments of the face support the facial soft tissue in a normal anatomic position, thereby resisting gravitational change. In this study, a technique utilizing surgical plication of the superficial musculoaponeurotic system (SMAS) to the retaining ligaments of the face and finger-assisted malar elevation (FAME) dissection of the midface is presented. The anatomy of the facial retaining ligaments was studied in 20 half-faces of ten fresh cadavers, and the localization of the ligaments was examined macroscopically. Surgical correction of facial aging with plication of the SMAS to the retaining ligaments and FAME dissection of the midface has been performed in 74 face-lift patients since 2006. Outcomes were determined by case notes, clinical review, and a patient questionnaire. The studied ligaments (zygomatic and masseteric) were present in all cadaver dissections. The zygomatic ligament was located 4.3-5.5 cm from the tragus and originates near the inferior border of the anterior zygomatic arch. The masseteric ligament was located 3.7-5.2 cm from the tragus below the junction of the zygomatic arch and masseter muscle. All the patients answered a satisfaction questionnaire and reported high levels of satisfaction at least 1 year after treatment. We have identified the facial retaining ligaments in all cadaver dissections and their relationship with other structures of the face are described here. This study demonstrates that our face-lift technique is safe and produces highly predictable and natural results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  1. Limited glenohumeral cross-body adduction in children with brachial plexus birth palsy: a contributor to scapular winging.

    PubMed

    Russo, Stephanie A; Loeffler, Bryan J; Zlotolow, Dan A; Kozin, Scott H; Richards, James G; Ashworth, Sarah

    2015-01-01

    Approximately 1 of every 1000 live births results in life-long impairments because of a brachial plexus injury. The long-term sequelae of persistent injuries include glenohumeral joint dysplasia and glenohumeral internal rotation and adduction contractures. Scapular winging is also common, and patients and their families often express concern regarding this observed scapular winging. It is difficult for clinicians to adequately address these concerns without a satisfying explanation for why scapular winging occurs in children with brachial plexus birth palsy. This study examined our proposed theory that a glenohumeral cross-body abduction contracture leads to the appearance of scapular winging in children with residual brachial plexus birth palsy. Sixteen children with brachial plexus injuries were enrolled in this study. Three-dimensional locations of markers placed on the thorax, scapula, and humerus were recorded in the hand to mouth Mallet position. The unaffected limbs served as a control. Scapulothoracic and glenohumeral cross-body adduction angles were compared between the affected and unaffected limbs. The affected limbs demonstrated significantly greater scapulothoracic and significantly smaller glenohumeral cross-body adduction angles than the unaffected limbs. The affected limbs also exhibited a significantly lower glenohumeral cross-body adduction to scapulothoracic cross-body adduction ratio. The results of this study support the theory that brachial plexus injuries can lead to a glenohumeral cross-body abduction contracture. Affected children demonstrated increased scapulothoracic cross-body adduction that is likely a compensatory mechanism because of decreased glenohumeral cross-body adduction. These findings are unique and better define the etiology of scapular winging in children with brachial plexus injuries. This information can be relayed to patients and their families when explaining the appearance of scapular winging. Level II.

  2. The relationship between glenohumeral joint total rotational range of motion and the functional movement screen™ shoulder mobility test.

    PubMed

    Sprague, Peter A; Monique Mokha, G; Gatens, Dustin R; Rodriguez, Rudy

    2014-10-01

    Side to side asymmetry in glenohumeral joint rotation correlates with injury risk in overhead athletes. The purpose of the current study was to identify the relationship between side-to-side asymmetries in glenohumeral joint total rotational range of motion and shoulder mobility test scores from the Functional Movement Screen™ in collegiate overhead athletes. The authors hypothesized that asymmetries of > 10° in glenohumeral total rotation would not be associated with asymmetrical findings in the Functional Movement Screen™ (FMS) shoulder mobility test. Passive glenohumeral total rotational range of motion and the shoulder mobility test of the FMS were measured during pre-participation examinations in 121 NCAA male and female Division II collegiate overhead athletes from varied sports. Passive shoulder range of motion was measured in supine at 90° of abduction, with the humerus in the scapular plane using two measurers and a bubble goniometer. A Pearson Chi-square analysis, p<.05 was used to associate the presence of asymmetries in glenohumeral joint rotation and in the FMS shoulder mobility test in each subject. 40/114 (35.1%) athletes demonstrated asymmetries in total glenohumeral rotation. 45/114 (39.5%) athletes demonstrated asymmetries in the shoulder mobility test. Only 17 of the 45 subjects who demonstrated asymmetry on the shoulder mobility test also demonstrated glenohumeral joint rotation differences of > 10°. Athletes with asymmetries in rotation of > 10° were not any more likely to have asymmetries identified in the shoulder mobility test (95% CI=.555-2.658, P=.627). Glenohumeral joint range of motion is one of multiple contributors to performance on the FMS shoulder mobility test, and alone, did not appear to influence results. The FMS shoulder mobility test should not be used alone as a means of identifying clinically meaningful differences of shoulder mobility in the overhead athlete. Clinicians working with overhead athletes may consider

  3. Scapholunate Ligament Reconstruction

    PubMed Central

    Ross, Mark; Loveridge, Jeremy; Cutbush, Kenneth; Couzens, Greg

    2013-01-01

    Background Scapholunate reconstruction poses a challenge to orthopedic surgeons. Materials and Methods Prospective cohort. Description of Technique Our technique for scapholunate (SL) reconstruction involves ligament reconstruction utilizing a portion of the flexor carpi radialis tendon rerouted via transosseous tunnels across the scaphoid, lunate, and triquetrum (scapholunotriquetral tenodesis). The tendon graft is secured with interference screw fixation into the triquetrum. The philosophy of this new technique is to reduce subluxation and maintain the relationship between scaphoid and lunate by placing a graft through the center of the SL articulation. This graft is then tensioned by passing it centrally through the lunate and triquetrum and secured using an interference screw in the triquetrum. Secondary stabilizers, including the dorsal intercarpal ligament, are then augmented by passing the graft back to the scaphoid, crossing from the triquetrum over the proximal capitate. This further reinforces the translational relationship between the scaphoid and the triquetrum and, therefore, augments stability of the SL articulation. Results We have utilized this technique successfully in over 40 patients since 2009. We report on a prospective consecutive series of 11 patients with over 12 months follow-up (range 12 to 24 months) demonstrating good early radiological and clinical outcomes. Conclusions In developing this technique, we aimed to take the best features of previously described techniques and address the perceived shortcomings of each. We believe there are several benefits of our technique. Moreover, few other techniques address as many of the aspects of chronic SL instability as our technique does. PMID:24436802

  4. ACUTE CHANGES IN PASSIVE GLENOHUMERAL ROTATION FOLLOWING TENNIS PLAY EXPOSURE IN ELITE FEMALE PLAYERS

    PubMed Central

    Kibler, W. Ben; Myers, Natalie L.; Smith, Belinda J.

    2016-01-01

    Background Alterations in glenohumeral (GH) rotation especially internal rotation and total range of motion have been associated with altered GH kinematics and susceptibility to injury. Researchers have evaluated long-term change in baseball and tennis players, and short-term changes in baseball players. However, acute (short-term) changes in GH rotation have not been evaluated in tennis players. Hypotheses/Purpose The purpose of this study was to quantify short-term glenohumeral rotational changes within a group of professional women's tennis players following competitive play. It was hypothesized that there would be acute alterations in passive glenohumeral internal rotation and total range of motion following episodes of tennis play. Study Design Cohort Study Methods Passive glenohumeral external rotation (GER), glenohumeral internal rotation (GIR), and total range of motion (TROM) were evaluated in a cohort of 79 professional adult female tennis players. Measurements were taken at three different time points (TP): baseline before match play (TP1), immediately after match play (TP2), and 24-hours after baseline (TP3). Results There was a statistically significant decrease in the mean GIR from TP1 (43 ± 11 °) to TP2 (39 ± 9 °) (p=0.002) and from TP1 to TP3 (38 ± 10 °) (p=0.001). All measures were at the level of minimal detectable change (MDC) (4 °) indicating clinical significance. There was a decrease in mean TROM from TP1 (146 ± 11 °) to TP2 (142 ± 12 °) (p=0.04), which was not above MDC (7 °). Subgroup analysis showed that 47% of the players demonstrated a decrease in GIR beyond MDC, and 37% demonstrated a decrease in TROM beyond MDC. GER remained unchanged across all time points (p>0.05). Conclusion Both GIR and TROM were reduced after acute exposure to tennis play. In a large subgroup of the cohort, the changes were clinically significant and approached values previously demonstrated to be associated with

  5. MRI of knee ligament injury and reconstruction.

    PubMed

    Farshad-Amacker, Nadja A; Potter, Hollis G

    2013-10-01

    Knee ligament instability may lead to meniscal and chondral damage, resulting in early osteoarthritis. Due to its superior soft tissue contrast and avoidance of harmful ionizing radiation, MRI has become the most important imaging modality for early recognition of structural defects of the knee joint. This review aims to the understanding of MRI appearances of knee ligament structures associated with knee instability, and to review the common patterns of altered knee mechanics that lead to ligament failure. Normal anatomy of the knee ligaments, pathologic conditions, and postsurgical appearances of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and posterolateral corner are described.

  6. Abducens nerve palsy due to inferior petrosal sinus thrombosis.

    PubMed

    Mittal, Shivam Om; Siddiqui, Junaid; Katirji, Bashar

    2017-02-24

    Isolated unilateral abducens nerve palsy is usually due to ischemia, trauma or neoplasm. Dorello's canal is the space between the petrous apex and superolateral portion of the clivus, bound superiorly by Gruber's ligament. The abducens nerve travels with inferior petrosal sinus (IPS) though the Dorello's canal before entering the cavernous sinus. A 31-year-old man presented with neck pain, and binocular horizontal diplopia, worse looking towards left and at distance. He had a history of intravenous drug abuse but no history of hypertension or diabetes. On examination, he had complete left 6th nerve palsy with normal fundi, pupils, and other cranial nerves. Methicillin-resistant Staphylococcus aureus bacteremia was detected with naïve tricuspid valve endocarditis and multiple septic emboli to lungs with infarcts. His cerebrospinal fluid was normal. MRI of the brain was normal. MRV of head and neck showed thrombosis of the left internal jugular vein, left sigmoid sinus and left inferior petrosal sinus with normal cavernous sinus and no evidence of mastoiditis. He was treated with broad spectrum antibiotics. He was not anticoagulated for fear of pulmonary hemorrhage from pulmonary infarcts. Although cerebral venous sinus thrombosis commonly presents with elevated intracranial pressure, isolated ipsilateral 6th nerve palsy from its compression in Dorello's canal due to thrombosis of the ipsilateral inferior petrosal sinus is extremely rare. To our knowledge, only two patients have been reported with isolated abducens palsy due to IPS thrombosis; one caused by septic emboli and the other developed it during IPS cortisol level sampling.

  7. Editorial Commentary: Shoulder Arthroscopy, Shoulder Hemiarthroplasty, and Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis.

    PubMed

    Lubowitz, James H

    2015-06-01

    Shoulder arthroscopy offers a safe, effective, and less invasive alternative to arthroplasty in patients under 60 years of age with glenohumeral arthritis. However, indications include joint space of greater than 2 mm. For patients who do not meet arthroscopic indications, total shoulder arthroplasty is more effective than hemiarthroplasty. Performance and publication bias may effect generalizability of these findings. Biologic treatment options seem on the horizon.

  8. Contributions of the individual muscles of the shoulder to glenohumeral joint stability during abduction.

    PubMed

    Yanagawa, Takashi; Goodwin, Cheryl J; Shelburne, Kevin B; Giphart, J Erik; Torry, Michael R; Pandy, Marcus G

    2008-04-01

    The aim of this study was to determine the relative contributions of the deltoid and rotator cuff muscles to glenohumeral joint stability during arm abduction. A three-dimensional model of the upper limb was used to calculate the muscle and joint-contact forces at the shoulder for abduction in the scapular plane. The joints of the shoulder girdle-sternoclavicular joint, acromioclavicular joint, and glenohumeral joint-were each represented as an ideal three degree-of-freedom ball-and-socket joint. The articulation between the scapula and thorax was modeled using two kinematic constraints. Eighteen muscle bundles were used to represent the lines of action of 11 muscle groups spanning the glenohumeral joint. The three-dimensional positions of the clavicle, scapula, and humerus during abduction were measured using intracortical bone pins implanted into one subject. The measured bone positions were inputted into the model, and an optimization problem was solved to calculate the forces developed by the shoulder muscles for abduction in the scapular plane. The model calculations showed that the rotator cuff muscles (specifically, supraspinatus, subscapularis, and infraspinatus) by virtue of their lines of action are perfectly positioned to apply compressive load across the glenohumeral joint, and that these muscles contribute most significantly to shoulder joint stability during abduction. The middle deltoid provides most of the compressive force acting between the humeral head and the glenoid, but this muscle also creates most of the shear, and so its contribution to joint stability is less than that of any of the rotator cuff muscles.

  9. Glenohumeral posterior mobilization versus conventional physiotherapy for primary adhesive capsulitis: a randomized clinical trial.

    PubMed

    Gutiérrez Espinoza, Héctor Joaquín; Pavez, Francisco; Guajardo, Cristopher; Acosta, Manuel

    2015-09-22

    To compare the short-term efficacy of a glenohumeral posterior mobilization technique versus conventional physiotherapy for the improvement of the range of external rotation in patients with primary adhesive capsulitis of the shoulder. This is a randomized clinical trial conducted at Hospital Clinico San Borja Arriaran in Chile. Fifty-seven patients with an age range of 50 to 58 years old were enrolled in two groups. Both groups were randomized to receive a treatment of 10 sessions: the experimental group (n=29) received a glenohumeral posterior mobilization technique after training with a cycle ergometer, and the control group (n=28) received conventional physiotherapy. The primary outcome measure was range of passive movement in external rotation; secondary outcomes were forward flexion and shoulder abduction, pain perception using the visual analogue scale and functionality test using the Constant-Murley Score. The study had the statistical power to detect a difference of four degrees between the groups in the improvement of the range of external rotation at the end of the treatment period. The experimental group showed a significant improvement with a mean difference of 46.3 degrees (SD=8.7) compared to 18.1 (SD=7.2) in the control group (p<0.0001). There was also a decrease in the perception of pain (p= 0.0002) and improved function (p< 0.0001) in the group treated with glenohumeral posterior mobilization technique. The glenohumeral posterior mobilization technique applied after training with cycle ergometer is an effective short-term technique to treat primary adhesive capsulitis decreasing the severity of pain and improving joint function compared with conventional physiotherapy treatment. The degree of increase in shoulder external rotation is more than 20 degrees beyond the increase achieved with conventional treatment.

  10. Acute changes in glenohumeral range-of-motion following in-season minor league pitching starts.

    PubMed

    Case, Jordan M; Mannava, Sandeep; Fallin, Joshua H; Stone, Austin V; Freehill, Michael T

    2015-11-01

    Asymmetric glenohumeral range-of-motion (ROM) between the throwing and non-throwing arms of overhead athletes has been well described in the literature. Thresholds of internal rotation (IR) loss have been associated with throwing arm injury in baseball players. Acute changes in shoulder ROM following an individual pitching appearance remain poorly understood. To determine the acute change of external rotation (ER), IR, and total arc-of-motion (TAM) in minor league starting pitchers immediately following an in-season starting pitching appearance. Nine minor league starting pitchers participated in the study with data collected for 22 individual starts. IR, ER and TAM were measured in the throwing shoulder and non-throwing shoulder at three time points for each appearance: before, immediately following, and at 24 hours following the pitching appearance. In the throwing arm, IR significantly decreased (49.4 vs 46.0, p = 0.037) immediately after pitching, and ER significantly increased immediately following an appearance (150.7 vs 153.6, p = 0.030) and at 24 hours (150.7 vs 154.0, p = 0.028). No difference was detected in throwing arm TAM and IR at 24 hours, or TAM immediately following an appearance. Minor league pitchers demonstrate the dynamic glenohumeral ROM changes after starting appearances of increased ER and diminished IR with maintenance of TAM. At 24 hours, the observed loss of IR had resolved, whereas the gains in ER remained present. Our study supports the need to further assess the acute changes of glenohumeral ROM in pitchers, and the association of acute glenohumeral ROM change with the development of pathologic ROM profiles and injury.

  11. A survey of glenohumeral joint rotational range and non-specific shoulder pain in elite cricketers.

    PubMed

    Giles, Karen; Musa, Iris

    2008-08-01

    To determine if a glenohumeral joint internal rotation range of motion difference (IRD) and external rotation difference (ERD) exists between dominant and non-dominant shoulders of cricketers as demonstrated in other overhead sports, and, if present, to establish if differences exist between cricketers with and without a history of gradual onset non-specific shoulder pain. An observational study. Non-clinical, at national cricket indoor training venues. One hundred and nine elite male and female cricketers (11-35 years), representing 97% of the England and Wales national and West of England regional Under 13 teams, consented. The final number included for data analysis was 133. Data relating to playing position, cricket exposure, shoulder pain and demographic details collected using a questionnaire. Passive isolated glenohumeral rotation measured in 90 degrees shoulder abduction using an inclinometer. Cricketers who regularly bowl or throw overarm had significantly less internal (-7.9 degrees , p<0.001) and greater external (8.6 degrees , p<0.001) dominant to non-dominant glenohumeral rotation. Wicket-keepers had tendencies for smaller differences that were still statistically significant [mean IRD -5.9 degrees (p<0.001); ERD 5.0 degrees (p=0.002)]. Cricketers who experienced shoulder pain demonstrated a significantly greater IRD [mean 3.2 degrees (p=0.032)] than those who did not. The results of this study support measurement of passive glenohumeral joint rotation during musculoskeletal profiling and indicate that a possible link between increased IRD and non-specific shoulder pain warrants further investigation.

  12. Anisotropy, inhomogeneity, and tension-compression nonlinearity of human glenohumeral cartilage in finite deformation.

    PubMed

    Huang, Chun-Yuh; Stankiewicz, Anna; Ateshian, Gerard A; Mow, Van C

    2005-04-01

    The tensile and compressive properties of human glenohumeral cartilage were determined by testing 120 rectangular strips in uniaxial tension and 70 cylindrical plugs in confined compression, obtained from five human glenohumeral joints. Specimens were harvested from five regions across the articular surface of the humeral head and two regions on the glenoid. Tensile strips were obtained along two orientations, parallel and perpendicular to the split-line directions. Two serial slices through the thickness, corresponding to the superficial and middle zones of the cartilage layers, were prepared from each tensile strip and each compressive plug. The equilibrium tensile modulus and compressive aggregate modulus of cartilage were determined from the uniaxial tensile and confined compression tests, respectively. Significant differences in the tensile moduli were found with depth and orientation relative to the local split-line direction. Articular cartilage of the humeral head was significantly stiffer in tension than that of the glenoid. There were significant differences in the aggregate compressive moduli of articular cartilage between superficial and middle zones in the humeral head. Furthermore, tensile and compressive stress-strain responses exhibited nonlinearity under finite strain, while the tensile modulus differed by up to two orders of magnitude from the compressive aggregate modulus at 0% strain, demonstrating a high degree of tension-compression nonlinearity. The complexity of the mechanical properties of human glenohumeral cartilage was exposed in this study, showing anisotropy, inhomogeneity, and tension-compression nonlinearity within the same joint. The observed differences in the tensile properties of human glenohumeral cartilage suggest that the glenoid may be more susceptible to cartilage degeneration than the humeral head.

  13. Relationship Between Posterior-Inferior Tibial Slope and Bilateral Noncontact ACL Injury.

    PubMed

    Hendrix, Steven T; Barrett, Austin M; Chrea, Bopha; Replogle, William H; Hydrick, Josie M; Barrett, Gene R

    2017-01-01

    Is there a correlation between increased posterior-inferior tibial slope angle and noncontact anterior cruciate ligament (ACL) injury? Does increasing the posterior-inferior tibial slope angle increase the risk of bilateral ACL injury? A computerized relational database (Access 2007; Microsoft Inc, Redmond, Washington) was used to conduct a retrospective review of patients undergoing bilateral or unilateral ACL reconstruction surgery or treatment by a single surgeon between 1995 and 2013. Included in the study were patients with bilateral and unilateral ACL injuries and patellofemoral pain syndrome with no associated ACL deficiency. Exclusion criteria included concomitant ligament injury, previous ACL reconstruction, and previous knee surgery. Also excluded were patients who did not have plain lateral radiographs. Fifty patients were randomly selected from each group. After controlling for age and Tegner activity level, the authors found that the posterior-inferior tibial slope angle was a significant predictor (P=.002) of noncontact ACL injury. Mean posterior-inferior tibial slope angle for the bilateral, unilateral, and control groups was 11.8°±2.3°, 9.3°±2.4°, and 7.5°±2.3°, respectively. In the group with unilateral ACL injury vs the group without ACL deficiency, a 1° increase in posterior-inferior tibial slope angle (P=.03) was associated with a 20% increase in unilateral ACL injury. In those with bilateral ACL injury vs those without ACL deficiency, a 1° increase in posterior-inferior tibial slope angle (P=.001) increased bilateral knee injury by 34%. The difference between the mean angles of the control group without ACL deficiency and both the bilateral injury and unilateral injury cohorts was statistically significant (P=.003). Increased posterior-inferior tibial slope angle is associated with an increased risk of noncontact bilateral and unilateral ACL injury. [Orthopedics. 2017; 40(1):e136-e140.]. Copyright 2016, SLACK Incorporated.

  14. Concomitant intra-articular glenohumeral injuries in displaced fractures of the lateral clavicle.

    PubMed

    Beirer, Marc; Zyskowski, Michael; Crönlein, Moritz; Pförringer, Dominik; Schmitt-Sody, Marcus; Sandmann, Gunther; Huber-Wagner, Stefan; Biberthaler, Peter; Kirchhoff, Chlodwig

    2015-11-21

    To detect concomitant intra-articular glenohumeral injuries, in acute displaced fractures of the lateral clavicle, initially missed due to unfeasible clinical evaluation of the acutely injured shoulder. All patients suffering from an acute displaced lateral clavicle fracture with indication to surgical treatment underwent diagnostic shoulder arthroscopy prior to open reduction and internal fixation. In case of therapy-relevant intra-articular glenohumeral injuries, subsequent surgical treatment was performed. Intra-articular injuries were found in 13 of 28 patients (46.4 %) with initially suspected isolated lateral clavicle fracture. Additional surgical treatment was performed in 8 of 28 cases (28.6 %). Superior labral anterior-posterior (SLAP) lesions were observed in 4 of 28 patients (14.3 %; SLAP II a: 1; II b: 1; III: 1; and IV: 1). Lesions of the pulley system were found in 3 of 28 patients (10.7 %; Habermeyer III°). One partial articular supraspinatus tendon avulsion lesion (3.6 %) and one lesion of the subscapularis tendon (3.6 %; Fox and Romeo II°) were observed. Traumatic concomitant glenohumeral injuries in lateral clavicle fractures seem to be more frequent than expected in general. Subsequent surgical treatment of these formerly missed but therapy-relevant injuries may increase functional outcome and reduce complication rate. IV.

  15. Modified Arthroscopic Latarjet Procedure With Coracoid Exteriorization for Treatment of Anterior Glenohumeral Instability

    PubMed Central

    Ranne, Juha O.; Kainonen, Terho U.; Lehtinen, Janne T.; Heinonen, Olli J.

    2013-01-01

    The Latarjet procedure for treating anterior glenohumeral instability includes transfer of the coracoid and biceps tendon to the anterior glenoid. A modified method for the arthroscopic procedure was developed to facilitate the procedure and minimize the risk of injury to the brachial plexus. The detached coracoid was exteriorized through the anteroinferior portal for drilling and shaping. A Coracoid Drill Guide (Arthrex, Naples, FL) was used to help cut the coracoid to the desired size and make 2 drill holes in the coracoid for fixation to the glenoid. The Coracoid Transfer Instrument (Acierart, Masku, Finland) was designed to facilitate coracoid transfer and serve as a pin guide for fixation. Ten patients with severe anterior glenohumeral instability were treated with this technique. They had only mild to moderate postoperative pain. There were no postoperative infections or recurrent dislocations. The safety of this operation was similar to that of other operations on the coracoid process in the proximity of the brachial plexus. The modified arthroscopic Latarjet procedure may be applied successfully to the treatment of anterior glenohumeral instability, with good patient satisfaction and functional outcome. PMID:24400183

  16. Glenohumeral joint reaction forces increase with critical shoulder angles representative of osteoarthritis-A biomechanical analysis.

    PubMed

    Viehöfer, Arnd F; Snedeker, Jess G; Baumgartner, Daniel; Gerber, Christian

    2016-06-01

    Osteoarthritis (OA) of the glenohumeral joint constitutes the most frequent indication for nontraumatic shoulder joint replacement. Recently, a small critical shoulder angle (CSA) was found to be associated with a high prevalence of OA. This study aims to verify the hypothesis that a small CSA leads to higher glenohumeral joint reaction forces during activities of daily living than a normal CSA. A shoulder simulator with simulated deltoid (DLT), supraspinatus (SSP), infraspinatus/teres minor (ISP/TM), and subscapularis (SSC) musculotendinous units was constructed. The DLT wrapping on the humerus was simulated using a pulley that could be horizontally adjusted to simulate the 28° CSA found in OA or the 33° CSA found in disease-free shoulders. Over a range of motion between 6° and 82° of thoracohumeral abduction joint forces were measured using a six-axis load cell. An OA-associated CSA yielded higher net joint reaction forces than a normal CSA over the entire range of motion. The maximum difference of 26.4 N (8.5%) was found at 55° of thoracohumeral abduction. Our model thus suggests that a CSA typical for OA predisposes the glenohumeral joint to higher joint reaction forces and could plausibly play a role in joint overloading and development of OA. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1047-1052, 2016.

  17. GLENOHUMERAL ROTATIONAL RANGE OF MOTION DIFFERENCES BETWEEN FAST BOWLERS AND SPIN BOWLERS IN ELITE CRICKETERS

    PubMed Central

    SKN, Bhargava; Karuppannan, Selvamani

    2012-01-01

    Background: The shoulder, particularly the glenohumeral joint with its predominant reliance upon soft tissues for stability is prone to injury among the cricketers who bowl regularly. These shoulder injuries are more common in spin bowlers than fast bowlers. A decreased internal rotational difference and increased external rotational difference exist when comparing the dominant shoulder with non‐dominant shoulder between overarm cricketers and non‐throwing wicket keepers. Purpose: To compare the glenohumeral internal and external rotation range of motion differences between fast bowlers and spin bowlers. Methods: A cross‐sectional design was utilized for this study. Thirty‐five fast bowlers and 31 spin bowlers from an elite group were recruited based on the selection criteria. Glenohumeral passive internal and external rotational differences between dominant and non‐dominant shoulders were measured using a standardized mechanical inclinometer. Results: Independent t‐tests revealed a statistically significant difference for external rotational difference (p=0.005) between fast and spin bowlers and no such difference for internal rotational difference (p=0.549) between them at 0.05 level. Conclusion: External rotational difference is significantly different between fast bowlers and spin bowlers but not internal rotational difference. Level of Evidence: Level 4 PMID:23316421

  18. Glenohumeral Joint Range of Motion in Elite Male Golfers: A Pilot Study

    PubMed Central

    Meria, Erik; Nee, Bob; Davidson, Greg

    2008-01-01

    Background Shoulder injuries account for up to 17% of all golf related musculoskeletal injuries. One cause may be the repetitive stresses applied to the lead shoulder during the backswing and follow-through phases, which may contribute to the frequency of these injuries. The “elite” golfer may be pre-disposed to developing a shoulder injury based upon the reported adaptations to the glenohumeral joint. Objective To examine and compare bilateral glenohumeral joint rotational range of motion in elite golfers using standard goniometric procedures. Methods Twenty-four “elite” male golfers were recruited for this study. Glenohumeral internal (IR) and external rotation (ER) passive range of motion was measured bilaterally at 90° of abduction using a standard universal goniometer. Paired t-tests were utilized to statistically compare the rotational range of motion patterns between the lead and the trailing shoulder. Results No statistical differences existed between each shoulder for mean IR or mean ER measures. This finding was consistent throughout different age groups. External rotation measurements were greater than IR measurements in both extremities. Discussion and Conclusion Unlike other sports requiring repetitive shoulder function, the “elite” golfers sampled in this pilot investigation did not demonstrate a unique passive range of motion pattern between the lead and trailing shoulders. Factors, including subjects' age, may have confounded the findings. Further studies are warranted utilizing cohorts of golfers with matching age and skill levels. Additional shoulder range of motion measures should be evaluated. PMID:21509130

  19. Collateral ligament (CL) injury - aftercare

    MedlinePlus

    ... ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 66. Miller III RH, Azar, FM. Knee injuires. In: Canale ... Dr. Anterior cruciate ligament injuries (including revision). In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic ...

  20. Biomechanical characteristics of human ankle ligaments.

    PubMed

    Attarian, D E; McCrackin, H J; DeVito, D P; McElhaney, J H; Garrett, W E

    1985-10-01

    The purpose of this study was to define the biomechanical characteristics of the isolated, individual bone-ligament-bone complexes of the human ankle. Twenty human ankles were dissected of all soft tissues to leave only the tibia, fibula, talus, and calcaneus with their intact anterior talofibular, calcaneofibular, posterior talofibular, and deep deltoid ligaments. Specimens were mounted and tested in a Minneapolis Testing System. Protocol consisted of cyclic loading of each isolated bone-ligament-bone preparation, followed by several constant velocity load-deflection tests at varying deflection rates, followed by a final, extremely rapid load to failure test. All ligaments exhibited nonlinearity and strain rate dependence in their load-deflection data. These properties were correlated with ligament function and trauma. The anterior talofibular ligament, the most commonly injured ankle ligament, had the lowest mean maximum load of the specimens tested, whereas the deep deltoid ligament, the least frequently completely disrupted ankle ligament, had the highest load to failure.

  1. Arterial Supply to the Human Anterior Cruciate Ligament

    PubMed Central

    Toy, Brian J.; Yeasting, Richard A.; Morse, Dennis E.; McCann, Patricia

    1995-01-01

    The arterial supply to the anterior cruciate ligament (ACL) was prepared for study by injecting a fresh cadaver knee with an epoxy lead-oxide solution and subsequently immersing it in 10% formalin for a 2-week period. The vasculature of the ACL was exposed through dissection for examination. A second specimen was prepared similarly and was evaluated by a CAT scan. ACL vascularization arises from the middle genicular artery and vessels of the infrapatella fat pad and adjacent synovium. The artery gives rise to periligamentous vessels which form a web-like network within the synovial membrane. These periligamentous vessels give rise to penetrating branches which transversely cross the ACL and anastomose with a network of longitudinally oriented endoligamentous vessels. Terminal branches of the inferior medial and lateral genicular arteries supply the distal portion of the ACL directly. The extremities of the ACL seem to be better vascularized than the middle part, and the proximal portion seems to have a greater vascular density than the distal portion. The arteries at the ligamentous-osseous junctions of the ACL do not significantly contribute to the ligament's vascularity. Ramifications concerning the ACL's blood supply as it relates to athletic training is also discussed. ImagesFig 1.Fig 2.Fig 3.Fig 4. PMID:16558326

  2. Arterial supply to the human anterior cruciate ligament.

    PubMed

    Toy, B J; Yeasting, R A; Morse, D E; McCann, P

    1995-06-01

    The arterial supply to the anterior cruciate ligament (ACL) was prepared for study by injecting a fresh cadaver knee with an epoxy lead-oxide solution and subsequently immersing it in 10% formalin for a 2-week period. The vasculature of the ACL was exposed through dissection for examination. A second specimen was prepared similarly and was evaluated by a CAT scan. ACL vascularization arises from the middle genicular artery and vessels of the infrapatella fat pad and adjacent synovium. The artery gives rise to periligamentous vessels which form a web-like network within the synovial membrane. These periligamentous vessels give rise to penetrating branches which transversely cross the ACL and anastomose with a network of longitudinally oriented endoligamentous vessels. Terminal branches of the inferior medial and lateral genicular arteries supply the distal portion of the ACL directly. The extremities of the ACL seem to be better vascularized than the middle part, and the proximal portion seems to have a greater vascular density than the distal portion. The arteries at the ligamentous-osseous junctions of the ACL do not significantly contribute to the ligament's vascularity. Ramifications concerning the ACL's blood supply as it relates to athletic training is also discussed.

  3. What Is the Critical Value of Glenoid Bone Loss at Which Soft Tissue Bankart Repair Does Not Restore Glenohumeral Translation, Restricts Range of Motion, and Leads to Abnormal Humeral Head Position?

    PubMed

    Shin, Sang-Jin; Koh, Yong Won; Bui, Christopher; Jeong, Woong Kyo; Akeda, Masaki; Cho, Nam Su; McGarry, Michelle H; Lee, Thay Q

    2016-11-01

    A general consensus has been formed that glenoid bone loss greater than 20% to 25% is the critical amount at which bony augmentation procedures are needed; however, recent clinical results suggest that the critical levels must be reconsidered to lower values. This study aimed to find the critical value of anterior glenoid bone loss when a soft tissue repair is not adequate to restore anterior-inferior glenohumeral translation, rotational range of motion, or humeral head position using a biomechanical anterior shoulder instability model. Controlled laboratory study. Eight cadaveric shoulders were tested with a customized shoulder testing system. Range of motion, translation, and humeral head position were measured at 60° of glenohumeral abduction in the scapular plane under a total of 40-N rotator cuff muscle loading in the following 11 conditions: intact; soft tissue Bankart lesion and repair; Bankart lesion with 10%, 15%, 20%, and 25% glenoid bone defects based on the largest anteroposterior width of the glenoid; and soft tissue Bankart repair for each respective glenoid defect. Serial osteotomies for each percentage of bone loss were made parallel to the long axis of the glenoid. There was significantly decreased external rotation (121.2° ± 2.8° to 113.5° ± 3.3°; P = .004), increased anteroinferior translation with an externally applied load (3.0 ± 1.2 mm to 7.5 ± 1.1 mm at 20 N; P = .008), and increased posterior (0.2 ± 0.6 mm to 2.7 ± 0.8 mm; P = .049) and inferior shift (2.9 ± 0.7 mm to 6.6 ± 1.1 mm; P = .018) of the humeral head apex in the position of maximum external rotation after soft tissue Bankart repair of a 15% glenoid defect compared with the repair of a Bankart lesion without a glenoid defect, respectively. Glenoid defects of 15% or more of the largest anteroposterior glenoid width should be considered the critical bone loss amount at which soft tissue repair cannot restore glenohumeral translation, restricts rotational range of motion

  4. Anatomical considerations on the discomalleolar ligament

    PubMed Central

    RODRÍGUEZ-VÁZQUEZ, J. F.; MÉRIDA-VELASCO, J. R.; MÉRIDA-VELASCO, J. A.; JIMÉNEZ-COLLADO, J.

    1998-01-01

    A study was carried out on the discomalleolar ligament by dissection of adult human cadavers. The ligament corresponds to the most internal portion of the superior lamina of the temporomandibular joint capsule. It extends from the posterointernal portion of the temporomandibular joint disc, penetrates the petrotympanic fissure and reaches the malleus of the middle ear. Because of its morphology and anatomical arrangement the discomalleolar ligament should be considered as an intrinsic ligament of the temporomandibular joint and distinguished from the tympanic portion of the sphenomandibular ligament (anterior ligament of the malleus). PMID:9723988

  5. LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Iliadis, Dimitrios Ph.; Bourlos, Dimitrios N.; Mastrokalos, Dimitrios S.; Chronopoulos, Efstathios; Babis, George C.

    2016-01-01

    Background: Graft choice for anterior cruciate ligament (ACL) reconstruction is of critical importance. Various grafts have been used so far, with autografts long considered the optimal solution for the treatment of ACL-deficient knees. Limited data are available on the long-term survivorship of synthetic grafts. Purpose: To compare the functional outcome and survivorship of ACL reconstructions performed using the LARS (ligament augmentation and reconstruction system) ligament and the ABC (active biosynthetic composite) purely polyester ligament. Study Design: Case series; Level of evidence, 4. Methods: The results of 72 patients who underwent primary arthroscopic ACL reconstruction with the LARS ligament and 31 cases with an ABC purely polyester ligament were reviewed. The mean follow-up periods for the LARS and ABC groups were 9.5 and 5.1 years, respectively. A survivorship analysis of the 2 synthetic grafts was performed using the Kaplan-Meier method with a log-rank test (Mantel-Cox, 95% CI). Lysholm, Tegner activity, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores as well as laxity measurements obtained using a KT-1000 arthrometer were recorded for all intact grafts, and a Mann-Whitney U test was used for comparison reasons. Results: The rupture rates for LARS and ABC grafts were 31% (95% CI, 20%-42%) and 42% (95% CI, 25%-59%), respectively. For intact grafts, the mean Lysholm score was good for both groups (90 for the LARS group and 89 for the ABC group), with the majority of patients returning to their preinjury level of activities, and the mean IKDC score was 90 for the LARS group and 86 for the ABC group. Conclusion: The rupture rates of both LARS and ABC grafts were both high. However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up (95% CI). PMID:27453894

  6. LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction.

    PubMed

    Iliadis, Dimitrios Ph; Bourlos, Dimitrios N; Mastrokalos, Dimitrios S; Chronopoulos, Efstathios; Babis, George C

    2016-06-01

    Graft choice for anterior cruciate ligament (ACL) reconstruction is of critical importance. Various grafts have been used so far, with autografts long considered the optimal solution for the treatment of ACL-deficient knees. Limited data are available on the long-term survivorship of synthetic grafts. To compare the functional outcome and survivorship of ACL reconstructions performed using the LARS (ligament augmentation and reconstruction system) ligament and the ABC (active biosynthetic composite) purely polyester ligament. Case series; Level of evidence, 4. The results of 72 patients who underwent primary arthroscopic ACL reconstruction with the LARS ligament and 31 cases with an ABC purely polyester ligament were reviewed. The mean follow-up periods for the LARS and ABC groups were 9.5 and 5.1 years, respectively. A survivorship analysis of the 2 synthetic grafts was performed using the Kaplan-Meier method with a log-rank test (Mantel-Cox, 95% CI). Lysholm, Tegner activity, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores as well as laxity measurements obtained using a KT-1000 arthrometer were recorded for all intact grafts, and a Mann-Whitney U test was used for comparison reasons. The rupture rates for LARS and ABC grafts were 31% (95% CI, 20%-42%) and 42% (95% CI, 25%-59%), respectively. For intact grafts, the mean Lysholm score was good for both groups (90 for the LARS group and 89 for the ABC group), with the majority of patients returning to their preinjury level of activities, and the mean IKDC score was 90 for the LARS group and 86 for the ABC group. The rupture rates of both LARS and ABC grafts were both high. However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up (95% CI).

  7. Simulation of the Inferior Mirage

    NASA Astrophysics Data System (ADS)

    Branca, Mario

    2010-09-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior" mirage.2 The most common example of an inferior mirage is when, on a hot day, a stretch of dry road off in the distance appears to be wet (see Fig. 1). Many lab activities have been described that simulate the formation of superior mirages. In these demonstrations light beams curve downward as they pass through a nonuni-form fluid.3-6 Much less common are laboratory demonstrations of upward-curving light rays of the kind responsible for inferior mirages. This paper describes a simple version of such a demonstration.

  8. Anterolateral Ligament Reconstruction

    PubMed Central

    Zordan, J.; Etcheto, H. Rivarola; Blanchod, C. Collazo; Palanconi, M.; Salinas, E. Álvarez; Autorino, CM; Escobar, G.

    2017-01-01

    Anterior cruciate ligament (ACL) reconstruction is a common procedure in daily practice with 75 to 97% excellent long-term results. But in certain cases, some patients perceive rotational instability, for this reason the revision rate can be 10 to 15%. Objectives: evaluate functional outcome in revisions of ACL reconstruction associated with ALL. Methods: Between July 2015 and February 2016 (11 knees) Eleven Revision ACL reconstruction were performed with ALL with double incision technique performed by the same surgical team. Inclusion criteria were: ACL reconstruction failures with a grade 2 or 3 Lachman test, a grade 3 pivot-shift without other ligamentary injury lesions associated and complete range of motion. Results: The concept of rotational instability associated with ACL injury has been described more than a decade ago. However, there is no consensus on how to quantify rotational instability in ACL injuries; so when associating an extracapsular technique. Currently there is a lack of high-level evidence comparing isolated ACL repair and associated with the modified reconstruction of ALL that allows us to define therapeutic approaches. The ALL reconstruction associate an ACL reconstruction remains a matter of study. Conclusion: We obtain excellent results in antero – posterior and rotational stability after performing the procedure.

  9. Arthroscopic-Assisted Management of Unstable Distal-Third Clavicle Fractures: Conoid Ligament Reconstruction and Fracture Cerclage With Sutures

    PubMed Central

    Cisneros, Luis Natera; Reiriz, Juan Sarasquete

    2015-01-01

    Surgical treatment is usually indicated for the management of Neer type IIB fractures of the distal third of the clavicle. These unstable injuries have shown a rate of nonunion that oscillates around 30% to 45% when managed conservatively, and surgical strategies often require a second operation for implant removal. We describe an arthroscopic-assisted technique for the treatment of Neer type IIB unstable distal-third clavicle fractures that overcomes the issues related to open surgery, metal hardware, and implant irritation. This technique increases the load to failure of the construct by means of adding a synthetic conoid ligament reconstruction with a nonrigid suspension device, and it allows the diagnosis and treatment of associated glenohumeral injuries. Our technique incorporates a fracture interfragmentary fixation with sutures, thus avoiding a second operation for implant removal. PMID:26870642

  10. Understanding acute ankle ligamentous sprain injury in sports.

    PubMed

    Fong, Daniel Tp; Chan, Yue-Yan; Mok, Kam-Ming; Yung, Patrick Sh; Chan, Kai-Ming

    2009-07-30

    This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing - a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60-90 ms). The failure supination or inversion torque is about 41-45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not be

  11. Understanding acute ankle ligamentous sprain injury in sports

    PubMed Central

    Fong, Daniel TP; Chan, Yue-Yan; Mok, Kam-Ming; Yung, Patrick SH; Chan, Kai-Ming

    2009-01-01

    This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms). Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms). The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative. Immobilization should not

  12. Biomechanical implications of lumbar spinal ligament transection.

    PubMed

    Von Forell, Gregory A; Bowden, Anton E

    2014-11-01

    Many lumbar spine surgeries either intentionally or inadvertently damage or transect spinal ligaments. The purpose of this work was to quantify the previously unknown biomechanical consequences of isolated spinal ligament transection on the remaining spinal ligaments (stress transfer), vertebrae (bone remodelling stimulus) and intervertebral discs (disc pressure) of the lumbar spine. A finite element model of the full lumbar spine was developed and validated against experimental data and tested in the primary modes of spinal motion in the intact condition. Once a ligament was removed, stress increased in the remaining spinal ligaments and changes occurred in vertebral strain energy, but disc pressure remained similar. All major biomechanical changes occurred at the same spinal level as the transected ligament, with minor changes at adjacent levels. This work demonstrates that iatrogenic damage to spinal ligaments disturbs the load sharing within the spinal ligament network and may induce significant clinically relevant changes in the spinal motion segment.

  13. Ligament Injury, Reconstruction and Osteoarthritis

    PubMed Central

    Fleming, Braden C.; Hulstyn, Michael J.; Oksendahl, Heidi L.; Fadale, Paul D.

    2007-01-01

    Purpose of Review The recent literature on the factors that initiate and accelerate the progression of osteoarthritis following ligament injuries and their treatment is reviewed. Recent Findings The ligament-injured joint is at high risk for osteoarthritis. Current conservative (e.g. rehabilitation) and surgical (e.g. reconstruction) treatment options appear not to reduce osteoarthritis following ligament injury. The extent of osteoarthritis does not appear dependent on which joint is affected, or the presence of damage to other tissues within the joint. Mechanical instability is the likely initiator of osteoarthritis in the ligament-injured patient. Summary The mechanism osteoarthritis begins with the injury rendering the joint unstable. The instability increases the sliding between the joint surfaces and reduces the efficiency of the muscles, factors that alter joint contact mechanics. The load distribution in the cartilage and underlying bone is disrupted, causing wear and increasing shear, which eventually leads to the osteochondral degeneration. The catalyst to the mechanical process is the inflammation response induced by the injury and sustained during healing. In contrast, the inflammation could be responsible for onset, while the mechanical factors accelerate progression. The mechanisms leading to osteoarthritis following ligament injury have not been fully established. A better understanding of these mechanisms should lead to alternative surgical, drug, and tissue-engineering treatment options, which could eliminate osteoarthritis in these patients. Progress is being made on all fronts. Considering that osteoarthritis is likely to occur despite current treatment options, the best solution may be prevention. PMID:17710194

  14. Periodontal ligament injection: alternative solutions.

    PubMed Central

    Gray, R. J.; Lomax, A. M.; Rood, J. P.

    1990-01-01

    This study was undertaken to investigate whether plain lidocaine, 3% plain mepivacaine and 3% prilocaine with felypressin were suitable epinephrine-free local anesthetic solutions for use in periodontal ligament anesthesia as alternatives to lidocaine with 1:80,000 epinephrine. Two hundred and seven patients received one of the four test solutions via a periodontal ligament injection and the success rate of anesthesia was confirmed using an electric pulp stimulator. Although neither mepivacaine nor prilocaine were as effective as lidocaine with epinephrine, the success rates of these three solutions were not statistically different. A single periodontal ligament injection of any of the solutions tested resulted in a low incidence of anesthesia. The success rate of lidocaine without epinephrine was consistently poor. PMID:2097910

  15. Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Palacios, Jose Antonio; Yacuzzi, Carlos; Oñativia, Jose I.; Zicaro, Juan Pablo; Costa-Paz, Matias

    2017-01-01

    Objectives: Recurrent patellofemoral dislocation is usually a multifactorial pathology. Different surgical techniques have been described according to the etiology of dislocation. In absence of a severe malalignment or an anatomical patellofemoral dysplasia, reconstruction of Medial Patello-femoral Ligament (MPFL) can restore the normal tracking of the patella, avoiding lateral excursion. The purpose of this study was to evaluate clinical results and complications in patients who underwent a MPFL reconstruction. Methods: We retrospectively evaluated 19 patients who underwent an anatomic MPFL reconstruction using autologous semitendinosus graft between 2007 and 2012. Exclusion criteria were patients with less than three years of follow-up and those with an associated procedure such as distal realignment or trochleoplasty. Clinical outcomes were measured using Kujala score and return to sport rate. We registered the postoperative complications and recurrence rate. Results: Nine patients were men and 10 women with a mean age of 25 years. Average follow-up was 5.8 years. Nine patients (47.4%) returned to their previous sport level, 8 (42.1%) changed to another sport or decreased their level and 2 (10.5%) were unable to practice any sports at all. Kujala score improvement was from 62.8 preoperative to 88.8 postoperative. One patient decreased the Kujala score. Eighty-nine percent of patients were satisfied with their outcome. One patient had a patellar fracture and four developed an arthrofibrosis and required mobilization under anesthesia. No recurrences were registered. Conclusion: Isolated MPFL reconstruction for recurrent patellofemoral dislocation is an effective alternative in absence of severe malalignment or anatomical dysplasia. Although no recurrences where registered at minimum 3-year follow-up, almost half of the patients were not able to return to their previous sport level.

  16. Reliability of a New Clinical Instrument for Measuring Internal and External Glenohumeral Rotation.

    PubMed

    Lindenfeld, Thomas N; Fleckenstein, Cassie M; Levy, Martin S; Grood, Edward S; Frush, Todd J; Parameswaran, A Dushi

    2015-07-01

    The shoulder plays a critical role in many overhead athletic activities. Several studies have shown alterations in shoulder range of motion (ROM) in the dominant shoulder of overhead athletes and correlation with significantly increased risk of injury to the shoulder and elbow. The purpose of this study was to measure isolated glenohumeral joint internal/external rotation (IR/ER) to determine inter- and intraobserver reliability of a new clinical device. (1) Inter- and intraobserver reliability would exceed 90% for measures of glenohumeral joint IR, ER, and total arc of motion; (2) the dominant arm would exhibit significantly increased ER, significantly decreased IR, and no difference in total arc of motion compared with the nondominant shoulder; and (3) a significant difference exists in total arc between male and female patients. Case series. Level 4. Thirty-seven subjects (mean age, 23 years; range, 13-54 years) were tested by 2 orthopaedic surgeons. A single test consisted of 1 arc of motion from neutral to external rotation to internal rotation and back to neutral within preset torque limits. Each examiner performed 3 tests on the dominant and nondominant shoulders. Each examiner completed 2 installations. Testing reliability demonstrated that neither trial, installation, nor observer were significant sources of variation. The maximum standard deviation was 1.3° for total arc of motion and less than 2° for most other measurements. Dominant arm ER was significantly greater than nondominant arm ER (P = 0.02), and dominant arm IR was significantly less than nondominant arm IR (P = 0.00). Mean total rotation was 162°, with no significant differences in total rotation between dominant and nondominant arms (P = 0.34). Mean total arc of motion was 45° greater in female subjects. Differences in total arc of motion between male and female subjects was statistically significant (P < 0.00). This simple, clinical device allows for both inter- and intraobserver

  17. Macroscopic and microscopic assessments of the glenohumeral and subacromial synovitis in rotator cuff disease.

    PubMed

    Jo, Chris H; Shin, Ji Sun; Kim, Ji Eun; Oh, Sohee

    2015-09-30

    Whereas synovitis is one of most common findings during arthroscopic surgery in patients with rotator cuff diseases, no study has investigated its characteristics. We propose a macroscopic assessment system for investigating the characteristics of synovitis. Fifty-four patients with a full-thickness rotator cuff tear undergoing arthroscopic rotator cuff repair with an average age of 62.5 ± 7.0 years were included. For the macroscopic assessment, 3 parameters, villous hypertrophy, hyperemia, and density, were measured and translated into grades in 3 regions-of-interest (ROI) in the glenohumeral joint and 4 ROIs in the subacromial space. For the microscopic assessments, 4 commonly used microscopic assessment systems were used. The reliability and association between the macroscopic and microscopic assessments were investigated. The inter- and intra-observer reliability of all of the macroscopic and microscopic assessments were excellent. The severity of synovitis was significantly greater in the glenohumeral joint than that in the subacromial space, 1.54 ± 0.61 versus 0.94 ± 0.56 (p < 0.001). Synovitis varied with respect to location, and was generally more severe near the tear with the macroscopic assessment system. Meanwhile, none of the microscopic assessment systems demonstrated differences between different ROIs in both the glenohumeral joint and the subacromial space. The macroscopic assessment system for synovitis in rotator cuff disease in this study showed excellent reliability. It critically described characteristics of synovitis that microscopic assessment systems could not. Therefore, this system could be a useful tool for investigating synovitis in rotator cuff disease.

  18. Interest in the glenoid hull method for analyzing humeral subluxation in primary glenohumeral osteoarthritis.

    PubMed

    Bouacida, Soufyane; Gauci, Marc-Olivier; Coulet, Bertrand; Lazerges, Cyril; Cyteval, Catherine; Boileau, Pascal; Chammas, Michel

    2017-07-01

    Posterior humeral subluxation is the main cause of failure of total shoulder arthroplasty. We aimed to compare humeral head subluxation in various reference planes and to search for a correlation with retroversion, inclination, and glenoid wear. We included 109 computed tomography scans of primary glenohumeral osteoarthritis and 97 of shoulder problems unrelated to shoulder osteoarthritis (controls); all computed tomography scans were reconstructed in the anatomic scapular plane and the glenoid hull plane that we defined. In both planes, we measured retroversion, inclination, glenohumeral offset (Walch index), and scapulohumeral offset. Retroversion in the scapular plane (Friedman method) was lower than that in the glenoid hull plane for controls and for arthritic shoulders. The threshold of scapulohumeral subluxation was 60% and 65% in the scapular plane and glenoid hull plane, respectively. The mean upward inclination was lower in the scapular plane (Churchill method) than in the glenoid hull plane (Maurer method). In the glenoid hull plane, 35% of type A2 glenoids showed glenohumeral offset greater than 75%, with mean retroversion of 25.6° ± 6° as compared with 7.5° ± 7.2° for the "centered" type A2 glenoids (P < .0001) and an upward inclination of -1.4° ± 8° and 6.3° ± 7° (P = .03), respectively. The correlation between retroversion and scapulohumeral offset was r = 0.64 in the glenoid hull plane and r = 0.59 in the scapular plane (P < .05). Measurement in the glenoid hull plane may be more accurate than in the scapular plane. Thus, the glenoid hull method allows for better understanding type B3 of the modified Walch classification. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Three-Dimensional Magnetic Resonance Imaging of Glenohumeral Dysplasia in Neonatal Brachial Plexus Palsy.

    PubMed

    Eismann, Emily A; Laor, Tal; Cornwall, Roger

    2016-01-20

    Existing quantitative measurements of glenohumeral dysplasia in children with unresolved neonatal brachial plexus palsy (NBPP) have been mostly limited to the axial plane. The purpose of this study was to describe the three-dimensional (3D) pathoanatomy of glenohumeral dysplasia using 3D magnetic resonance imaging (MRI) reformations. 3D MRI reformations of the scapula, glenoid labrum, and proximal part of the humerus were created from a volume-acquisition proton-density-weighted MRI sequence of both the affected and the unaffected shoulder of seventeen children less than six years of age with unresolved NBPP who had not undergone shoulder surgery. Glenoid retroversion and posterior humeral head displacement were measured on axial 2D images. Humeral head displacement in all planes, labral circumference, glenoid retroversion, glenoid declination, and scapular morphometric values were measured on 3D reformations. Contiguity of the humeral head with the labrum and the shape of the glenoid were classified. Measurements were compared between the affected and unaffected sides. On 3D evaluation, the humeral head was completely posteriorly translated in ten patients but was never outside the glenoid labrum. Instead, in these patients, the humeral head was eccentrically articulating with the dysplastic glenoid and was contained by a posteriorly elongated labrum. Glenoid dysplasia was not limited to the axial plane. Less declination of the glenoid in the coronal plane correlated with greater 3D glenoid retroversion. Glenoid retroversion resulted from underdevelopment of the posterior aspect of the glenoid rather than overdevelopment of the anterior aspect of the glenoid. 3D measurements of greater glenoid retroversion and less declination correlated with 2D measurements of glenoid retroversion and posterior humeral head displacement. Posterior humeral head displacement in NBPP should not be considered a simple "dislocation." Glenohumeral dysplasia is not limited to the axial

  20. Diagnostic accuracy of noncontrast MRI for detection of glenohumeral cartilage lesions: a prospective comparison to arthroscopy.

    PubMed

    VanBeek, Corinne; Loeffler, Bryan J; Narzikul, Alexa; Gordon, Victoria; Rasiej, Michael J; Kazam, Jonathan K; Abboud, Joseph A

    2014-07-01

    The purpose of this study was to determine the prevalence of glenohumeral articular cartilage lesions in patients with rotator cuff tendinopathy and to assess the accuracy of noncontrast magnetic resonance imaging (MRI) in detecting these defects compared with the "gold standard" of arthroscopy. Noncontrast MRI studies obtained in 84 consecutive patients undergoing shoulder arthroscopy for rotator cuff tendinopathy (mean age, 54.8 years; range, 17-82 years) were prospectively evaluated for glenohumeral cartilage lesions. Two fellowship-trained, experienced musculoskeletal radiologists were blinded from the arthroscopic findings and independently evaluated the glenoid and humeral head cartilage on 2 separate occasions. At arthroscopy, cartilage lesions of the humeral head were detected in 23 patients (frequency, 27.4%), and glenoid cartilage lesions were found in 20 patients (frequency, 23.8%). For detection of a humeral lesion on MRI, the radiologists' combined accuracy was 78%, sensitivity was 43%, and specificity was 91%. The combined accuracy for detection of glenoid lesions on MRI was 84%, sensitivity was 53%, and specificity was 93%. Combining the readers, low-grade lesions (International Cartilage Repair Society grades 1 and 2) of the glenoid and humerus were read as negative on MRI in 63% and 86% of cases, respectively. Overall accuracy of noncontrast MRI for detection of glenohumeral articular cartilage lesions is good; however, interpretation is reader dependent, and accuracy is significantly reduced for detection of low-grade lesions. On the basis of these findings, we recommend that patients with rotator cuff tendinopathy undergoing arthroscopy be informed that the presence and severity of cartilage lesions may be underestimated on MRI. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  1. Axial traction magnetic resonance imaging (MRI) of the glenohumeral joint in healthy volunteers: initial experience.

    PubMed

    Garwood, Elisabeth R; Souza, Richard B; Zhang, Amy; Zhang, Alan L; Ma, C Benjamin; Link, Thomas M; Motamedi, Daria

    Evaluate technical feasibility and potential applications of glenohumeral (GH) joint axial traction magnetic resonance imaging (MRI) in healthy volunteers. Eleven shoulders were imaged in neutral and with 4kg axial traction at 3T. Quantitative measurements were assessed. Axial traction was well tolerated. There was statistically significant widening of the superior GH joint space (p=0.002) and acromial angle (p=0.017) with traction. Inter-rater agreement was high. GH joint axial traction MRI is technically feasible and well tolerated in volunteers. Traction of the capsule, widening of the superior GH joint space and acromial angle were observed. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Ulnar Collateral Ligament Reconstruction

    PubMed Central

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common surgery performed in professional, collegiate, and high school athletes. Purpose: To report patient demographics, surgical techniques, and outcomes of all UCLRs performed at a single institution from 2004 to 2014. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCLR from January 1, 2004, through December 31, 2014, at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, athletic level, surgical technique, graft type, and complications. Data were collected prospectively, and patients were contacted via phone calls to obtain the return-to-sport rate, Conway-Jobe score, Andrews-Timmerman score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Continuous variable data were reported as weighted means, and categorical variable data were reported as frequencies with percentages. Results: A total of 187 patients (188 elbows) underwent UCLR during the study period (92% male; mean age, 19.6 ± 4.7 years; 78.2% right elbows). There were 165 baseball players (87.8% of all patients), 155 of whom were pitchers (82.5% of all patients). Ninety-seven (51.6%) were college athletes, 68 (36.2%) high school athletes, and 7 (3.7%) professional athletes at the time of surgery. The docking technique was used in 110 (58.5%) patients while the double-docking technique was used in 78 (41.5%). An ipsilateral palmaris longus graft was used in 110 (58.5%) patients while a hamstring autograft was used in 48 (25.5%) patients. The ulnar nerve was subcutaneously transposed in 79 (42%) patients. Clinical follow-up data were available on 85 patients. Mean follow-up was 60 ± 30.8 months. Overall, 94.1% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The mean KJOC score was 90.4 ± 6.7 and mean Andrews-Timmerman score was 92.5 ± 7

  3. Anatomy of the alar ligament.

    PubMed

    Iwanaga, Joe; Sardi, Juan P; Laws, Tyler; Chapman, Jens R; Oskouian, Rod J; Tubbs, R Shane

    2017-08-18

    There are four layers of ligamentous stabilizers at the cranio-cervical junction and the second layer is comprised of the apical and paired alar ligaments. The purpose of this study is to establish the tensile strength of the alar ligaments for better understanding the implications that can arise from trauma and other pathologies in the craniocervical region. Nineteen sides from ten fresh frozen adult cadaveric Caucasian heads were used in this study. The specimens were derived from six males and four females, and the age of the cadavers at death ranged from 67 to 90-years-old to measure the tensile strength, a tensile testing machine (M2-200, Mark-10 corporation, USA) was used in this study. The force (N) necessary until failure for all alar ligaments ranged from 87 to 346 N with a mean of 186.9±69.7 N. There was a significant difference when comparing tensile strength between males and females. Further studies will be needed to determine their importance as secondary stabilizers and measure their ability to support similar forces when subject to rotation and lateral bending forces, as well as with flexion-extension. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. LIGAMENT-CONTROLLED EFFERVESCENT ATOMIZATION

    EPA Science Inventory

    The operating principles and performance of a new type of spray nozzle are presented. This nozzle, termed a "ligament-controlled effervescent atomizer," was developed to allow consumer product manufacturers to replace volatile organic compound (VOC) solvents with water and hydroc...

  5. LIGAMENT-CONTROLLED EFFERVESCENT ATOMIZATION

    EPA Science Inventory

    The operating principles and performance of a new type of spray nozzle are presented. This nozzle, termed a "ligament-controlled effervescent atomizer," was developed to allow consumer product manufacturers to replace volatile organic compound (VOC) solvents with water and hydroc...

  6. Simulation of the Inferior Mirage

    ERIC Educational Resources Information Center

    Branca, Mario

    2010-01-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior"…

  7. Simulation of the Inferior Mirage

    ERIC Educational Resources Information Center

    Branca, Mario

    2010-01-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior"…

  8. The role of hyaluronic acid in patients affected by glenohumeral osteoarthritis.

    PubMed

    Di Giacomo, G; De Gasperis, N

    2015-01-01

    Persistent shoulder pain is a highly prevalent problem, due to different pathologies, that is frequently associated with limited range of motion and decreased function. The correct diagnosis can lead to the best treatment for each pathology. In this study we tried to understand what could be the role of hyaluronic acid and its effective benefit in patients affected by mild-to-moderate glenohumeral osteoarthritis. From January 2013 to June 2014, we prospectively followed-up 61 consecutive patients with shoulder osteoarthritis degrees I, II, and III. We divided the patients into 2 homogeneous groups: 31 patients in the first group treated with 5 intra-articular injections of Hyalgan 20mg/2ml and a specific physiotherapy program, and 30 patients in the second group treated only with physical therapy. The mean follow-up examination was carried out 5.2 months after the beginning of the therapy for both groups. The statistical analysis revealed a significant difference (P less than 0.05) between the two groups in terms of pain reduction and improvement in the activities of daily living. The present study demonstrates the greater and long-lasting efficacy of a five-injection treatment with hyaluronic acid (Hyalgan 20mg/2ml) combined with a physical therapy program in comparison with physical therapy only in patients affected by glenohumeral osteoarthritis degree I, II or III.

  9. Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy*

    PubMed Central

    Chagas-Neto, Francisco Abaete; Dalto, Vitor Faeda; Crema, Michel Daoud; Waters, Peter M.; Gregio-Junior, Everaldo; Mazzer, Nilton; Nogueira-Barbosa, Marcello Henrique

    2016-01-01

    Objective To assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders. Materials and Methods We conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed. Results The mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs. Conclusion The main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head. PMID:27403013

  10. In-season rehabilitation of a division III female wrestler after a glenohumeral dislocation.

    PubMed

    Brumitt, Jason; Sproul, Alma; Lentz, Philip; McIntosh, Linda; Rutt, Richard

    2009-08-01

    Wrestling is a popular sport in the United States at both the high school and collegiate levels. Traditionally a men's sport, participation by female athletes in wrestling is increasing. There exists a paucity of literature regarding injury incidence in women's wrestling. This lack of information challenges the ability of sports medicine and strength training professionals to design optimal injury prevention programs, training routines, and rehabilitation strategies. The objective of this report is to detail the successful conservative rehabilitation of a female wrestler after an initial glenohumeral dislocation. Case report. A 20-year-old female wrestling student-athlete presented to the university's sports medicine team after sustaining an anteriorly dislocated right shoulder. The patient had the goal to return back to competition in time for the National Championships. An evidenced-supported, non-traumatic glenohumeral instability rehabilitation protocol combined with weight-bearing exercises simulating functional sport positions was implemented with the goal of returning the injured collegiate female wrestler back to sport. At the end of the rehabilitation program the athlete demonstrated full active range of motion, good strength in the right shoulder, and reported her pain rating at a 1/10. The conservative rehabilitation strategy utilized in this case enabled the patient to return to wrestling and successfully compete at the National Championships.

  11. Does Repair of a Hill-Sachs Defect Increase Stability at the Glenohumeral Joint?

    PubMed Central

    Bakshi, Neil K.; Jolly, John T.; Debski, Richard E.; Sekiya, Jon K.

    2016-01-01

    Background: The effect of osteoallograft repair of a Hill-Sachs lesion and the effect of allograft fit on glenohumeral translations in response to applied force are poorly understood. Purpose: To compare the impact of a 25% Hill-Sachs lesion, a perfect osteoallograft repair (PAR) of a 25% Hill-Sachs lesion, and an “imperfect” osteoallograft repair (IAR) of a 25% Hill-Sachs lesion on glenohumeral translations in response to a compressive load and either an anterior or posterior load in 3 clinically relevant arm positions. Study Design: Controlled laboratory study. Methods: A robotic/universal force-moment sensor testing system was used to apply joint compression (22 N) and an anterior or posterior load (44 N) to cadaveric shoulders (n = 9) with the skin and deltoid removed (intact) at 3 glenohumeral joint positions (abduction/external rotation): 0°/0°, 30°/30°, and 60°/60°. The 25% bony defect state, PAR state, and IAR state were created and the loading protocol was performed. Translational motion was measured in each position for each shoulder state. A nonparametric repeated-measures Friedman test with a Wilcoxon signed-rank post hoc test was performed to compare the biomechanical parameters (P < .05). Results: Compared with the defect shoulder, the PAR shoulder had significantly less anterior translation with an anterior load in the 0°/0° (15.3 ± 8.2 vs 16.6 ± 9.0 mm, P = .008) and 30°/30° (13.6 ± 7.1 vs 14.2 ± 7.0 mm, P = .021) positions. Compared with IAR, the PAR shoulder had significantly less anterior translation with an anterior load in the 0°/0° (15.3 ± 8.2 vs 16.6 ± 9.0 mm, P = .008) and 30°/30° (13.6 ± 7.1 vs 14.4 ± 7.1 mm, P = .011) positions, and the defect shoulder had significantly less anterior translation with an anterior load in the 30°/30° (14.2 ± 7.0 vs 14.4 ± 7.0 mm, P = .038) position. Conclusion: PAR resulted in the least translational motion at the glenohumeral joint. The defect shoulder had significantly less

  12. The Effect of Combined Glenoid and Humeral Head Defects on Glenohumeral Translation

    PubMed Central

    Arciero, Robert A.; Parrino, Anthony; Diaz-Doran, Vilmaris; Obopilwe, Elifho; Cote, Mark P.; Mazzocca, Augustus D.; Provencher, Matthew

    2014-01-01

    Objectives: Bone loss in anterior glenohumeral instability has significant clinical implications and is responsible for surgical failure. Previous work has focused on glenoid and humeral head defects separately. There is no prior biomechanical work evaluating the combined effect of these lesions. The purpose of this study is to determine the effect of the combination of humeral head and glenoid bone loss on glenohumeral joint translation in a bipolar bone loss model with a Bankart lesion and after Bankart repair. Our hypothesis is that when both humeral head and glenoid defects occur together, the amount of bone loss required to compromise soft tissue Bankart repair is less than compared to when glenoid and humeral head lesions occur in isolation. Methods: Eight cadaveric shoulders were dissected to expose the intact capsule and glenohumeral joint. The set-up and testing was as described by Itoi ,Sekiya and Yamamoto1,2,3.The humeral shaft and scapula were potted and the shoulder mounted on a custom shoulder testing device permitting 6 degrees of freedom. The test positions were 60 degrees of glenohumeral abduction and 60 degrees of external rotation. A 50N compressive load was applied to the glenohumeral joint. A MTS 858 Servohydraulic test system (MTS Systems, Eden Prairie, MN) was used to translate the humeral head anteriorly 10mm at a rate of 2.0mm/sec. The peak force required to translate the humeral head 10mm was recorded. Three trials were performed in each condition, and the mean value was used for data analysis. All Bankart lesions were made sharply from the 2 o’clock to 6 o’clock position for a right shoulder. Bankart repair was made with transosseous tunnels using high strength suture. A digital micrometer was used to measure and create glenoid defects with a saw parallel to the anterior glenoid. Hill-Sachs lesions were made from 3D models created from a clinical database of computerized tomographic images of 142 patients with shoulder instability

  13. Glenohumeral Rotational Range of Motion in Collegiate Overhead-Throwing Athletes During an Athletic Season

    PubMed Central

    Dwelly, Priscilla M.; Tripp, Brady L.; Tripp, Patricia A.; Eberman, Lindsey E.; Gorin, Steven

    2009-01-01

    Abstract Context: Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the thrower's shoulder. Objective: To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD. Design: Observational, repeated-measures study. Setting: Collegiate athletic training room. Patients or Other Participants: Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age  =  19 ± 1 years, height  =  174 ± 14 cm, mass  =  77.8 ± 18.1 kg; 19 softball, 29 baseball players). Main Outcome Measure(s): We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc. Results: In the dominant shoulder, ER increased during the season (F2,96  =  17.433, P < .001), but IR remained the same (F2,96  =  1.839, P  =  .17). The total arc in the dominant shoulder increased between time intervals (F2,96  =  14.030, P < .001); the mean difference between prefall and postspring measurements was 9.694° (P < .001), and the mean difference between prefall and postspring measurements was 10.990° (P < .001). In the nondominant shoulder, ER increased over the season (F2,96  =  23.395, P < .001), but IR did not change over the season (F2,96  =  0.087, P  =  .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements

  14. Glenohumeral rotational range of motion in collegiate overhead-throwing athletes during an athletic season.

    PubMed

    Dwelly, Priscilla M; Tripp, Brady L; Tripp, Patricia A; Eberman, Lindsey E; Gorin, Steven

    2009-01-01

    Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the thrower's shoulder. To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD. Observational, repeated-measures study. Collegiate athletic training room. Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age = 19 + or - 1 years, height = 174 + or - 14 cm, mass = 77.8 + or - 18.1 kg; 19 softball, 29 baseball players). We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc. In the dominant shoulder, ER increased during the season (F(2,96) = 17.433, P < .001), but IR remained the same (F(2,96) = 1.839, P = .17). The total arc in the dominant shoulder increased between time intervals (F(2,96) = 14.030, P < .001); the mean difference between prefall and postspring measurements was 9.694 degrees (P < .001), and the mean difference between prefall and postspring measurements was 10.990 degrees (P < .001). In the nondominant shoulder, ER increased over the season (F(2,96) = 23.395, P < .001), but IR did not change over the season (F(2,96) = 0.087, P = .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements and between prefall and postspring measurements (F(2,96) = 18.552, P < .001). No changes were noted in GIRD over time. However, more

  15. Immunohistochemical evaluation for outflow reconstruction using opened round ligament in living donor right posterior sector graft liver transplantation: A case report

    PubMed Central

    Sanada, Yukihiro; Sakuma, Yasunaru; Sasanuma, Hideki; Miki, Atsushi; Katano, Takumi; Hirata, Yuta; Okada, Noriki; Yamada, Naoya; Ihara, Yoshiyuki; Urahashi, Taizen; Sata, Naohiro; Yasuda, Yoshikazu; Mizuta, Koichi

    2016-01-01

    Utilizing the opened round ligament as venous grafts during liver transplantation is useful but controversial, and there are no pathological analyses of this procedure. Herein, we describe the first reported case of a pathological analysis of an opened round ligament used as a venous patch graft in a living donor liver transplantation (LDLT). A 13-year-old female patient with biliary atresia underwent LDLT using a posterior segment graft from her mother. The graft had two hepatic veins (HVs), which included the right HV (RHV; 15 mm) and the inferior RHV (IRHV; 20 mm). The graft RHV and IRHV were formed into a single orifice using the donor’s opened round ligament (60 mm × 20 mm) as a patch graft during bench surgery; it was then anastomosed end-to-side with the recipient inferior vena cava. The recipient had no post-transplant complications involving the HVs, but she died of septic shock with persistent cholangitis and jaundice 86 d after LDLT. The HV anastomotic site had no stenosis or thrombus on autopsy. On pathology, there was adequate patency and continuity between the recipient’s HV and the donor’s opened round ligament. In addition, the stains for CD31 and CD34 on the inner membrane of the opened round ligament were positive. Hepatic venous reconstruction using the opened round ligament as a venous patch graft is effective in LDLT, as observed on pathology. PMID:27678368

  16. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle.

    PubMed

    Moor, B K; Bouaicha, S; Rothenfluh, D A; Sukthankar, A; Gerber, C

    2013-07-01

    We hypothesised that a large acromial cover with an upwardly tilted glenoid fossa would be associated with degenerative rotator cuff tears (RCTs), and conversely, that a short acromion with an inferiorly inclined glenoid would be associated with glenohumeral osteoarthritis (OA). This hypothesis was tested using a new radiological parameter, the critical shoulder angle (CSA), which combines the measurements of inclination of the glenoid and the lateral extension of the acromion (the acromion index). The CSA was measured on standardised radiographs of three groups: 1) a control group of 94 asymptomatic shoulders with normal rotator cuffs and no OA; 2) a group of 102 shoulders with MRI-documented full-thickness RCTs without OA; and 3) a group of 102 shoulders with primary OA and no RCTs noted during total shoulder replacement. The mean CSA was 33.1° (26.8° to 38.6°) in the control group, 38.0° (29.5° to 43.5°) in the RCT group and 28.1° (18.6° to 35.8°) in the OA group. Of patients with a CSA > 35°, 84% were in the RCT group and of those with a CSA < 30°, 93% were in the OA group. We therefore concluded that primary glenohumeral OA is associated with significantly smaller degenerative RCTs with significantly larger CSAs than asymptomatic shoulders without these pathologies. These findings suggest that individual quantitative anatomy may imply biomechanics that are likely to induce specific types of degenerative joint disorders.

  17. Flexibility of internal and external glenohumeral rotation of junior female tennis players and its correlation with performance ranking

    PubMed Central

    Chiang, Ching-Cheng; Hsu, Chih-Chia; Chiang, Jinn-Yen; Chang, Weng-Cheng; Tsai, Jong-Chang

    2016-01-01

    [Purpose] The purpose of this study was to compare the internal and external rotation of the dominant and nondominant shoulders of adolescent female tennis players. The correlation between the shoulder rotation range of motion and the player’s ranking was also analyzed. [Subjects and Methods] Twenty-one female junior tennis players who were 13 to 18 years old participated in this study. A standard goniometer was used to measure the internal and external rotation of both glenohumeral joints. The difference in internal and external rotation was calculated as the glenohumeral rotation deficit. The year-end ranking of each player was obtained from the Chinese Taipei Tennis Association. [Results] The internal rotation of the dominant shoulder was significantly smaller than that of the nondominant shoulder. Moreover, player ranking was significantly and negatively correlated with the internal rotation range of motion of both shoulders. On the other hand, the correlations of the internal and external rotation ranges of motion with the age, height, and weight were not significant. [Conclusion] The flexibility of the glenohumeral internal rotation is smaller in the dominant shoulder than of the nondominant shoulder in these junior female tennis players. Flexibility of the glenohumeral internal rotation may be a factor affecting performance in junior female tennis players. PMID:28174438

  18. Flexibility of internal and external glenohumeral rotation of junior female tennis players and its correlation with performance ranking.

    PubMed

    Chiang, Ching-Cheng; Hsu, Chih-Chia; Chiang, Jinn-Yen; Chang, Weng-Cheng; Tsai, Jong-Chang

    2016-12-01

    [Purpose] The purpose of this study was to compare the internal and external rotation of the dominant and nondominant shoulders of adolescent female tennis players. The correlation between the shoulder rotation range of motion and the player's ranking was also analyzed. [Subjects and Methods] Twenty-one female junior tennis players who were 13 to 18 years old participated in this study. A standard goniometer was used to measure the internal and external rotation of both glenohumeral joints. The difference in internal and external rotation was calculated as the glenohumeral rotation deficit. The year-end ranking of each player was obtained from the Chinese Taipei Tennis Association. [Results] The internal rotation of the dominant shoulder was significantly smaller than that of the nondominant shoulder. Moreover, player ranking was significantly and negatively correlated with the internal rotation range of motion of both shoulders. On the other hand, the correlations of the internal and external rotation ranges of motion with the age, height, and weight were not significant. [Conclusion] The flexibility of the glenohumeral internal rotation is smaller in the dominant shoulder than of the nondominant shoulder in these junior female tennis players. Flexibility of the glenohumeral internal rotation may be a factor affecting performance in junior female tennis players.

  19. The effect of shoulder core exercises on isometric torque of glenohumeral joint movements in healthy young females.

    PubMed

    Moghadam, Afsun Nodehi; Mohammadi, Roghayeh; Arab, Amir Massoud; Kazamnajad, Anoshirvan

    2011-12-01

    Strength improvement of the shoulder muscles is a major goal in rehabilitation or athletic conditioning programs. The purpose of this study was to determine the effect of shoulder core exercises on the isometric torque of glenohumeral joint movements. A total of 36 healthy females with no history of shoulder injury enrolled in this study. Subjects were randomly assigned into the control group (n = 18, 22 ± 2.19 years of age) or experimental group (n = 18, 21 ± 2.05 years of age). Subjects in experimental group performed shoulder core exercises, using progressive resistance training, three times a week for six weeks. Subjects in control group performed no exercise. The isometric torque of shoulder movements were measured with Dynatorq device in isolated test positions of glenohumeral muscles at the beginning and after six weeks in both groups. shoulder core exercise training led to an increase in maximal isometric torques of shoulder scaption at 0° and 90° arm elevation, external and internal rotation, horizontal adduction and extension movements (p < 0.001 in all instances). No significant difference was found between initial scores and scores after six weeks in the control group (p > 0.05). These findings indicated that shoulder core exercise training leads to an increase in peak torque for all glenohumeral movements that can be considered in glenohumeral muscles strengthening programs.

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

    PubMed

    Armstrong, April

    2014-07-01

    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.

  1. Finite Element Modelling of the Glenohumeral Capsule Can Help Assess the Tested Region during a Clinical Exam

    PubMed Central

    Ellis, Benjamin J; Drury, Nicholas J.; Moore, Susan M.; McMahon, Patrick J.; Weiss, Jeffrey A.; Debski, Richard E.

    2013-01-01

    The objective of this research was to examine the efficacy of evaluating the region of the glenohumeral capsule being tested by clinical exams for shoulder instability using finite element models of the glenohumeral joint. Specifically, the regions of high capsule strain produced by glenohumeral joint positions commonly used during a clinical exam were identified. Kinematics that simulated a simple translation test with an anterior load at three external rotation angles were applied to a validated, subject-specific finite element model of the glenohumeral joint at 60° of abduction. Maximum principal strains on the glenoid side of the IGHL were significantly higher than the maximum principal strains on the humeral side, for all three regions of the IGHL at 30° and 60° of external rotation. These regions of localized strain indicate that these joint positions might be used to test the glenoid side of the IGHL during this clinical exam, but are not useful for assessing the humeral side of the IGHL. The use of finite element models will facilitate the search for additional joint positions that isolate high strains to other IGHL regions, including the humeral side of the IGHL. PMID:20013435

  2. Ultrasound appearance of the normal Lisfranc ligament.

    PubMed

    Kaicker, Jatin; Zajac, Mercedes; Shergill, Ravi; Choudur, Hema N

    2016-12-01

    This study aims to prospectively evaluate the ultrasound appearance of the normal Lisfranc's ligament in 50 patients (100 ft) with no prior or current ligament injury. Fifty normal asymptomatic patients between the ages of 18 and 80 years were assessed. Three key features were recorded: ultrasound appearance, thickness, and length of the Lisfranc's ligament. Patients excluded from this study included pediatric patients and those with history of injury or symptoms related to the foot. The mean right- and left-sided ligament (RT) thickness were 0.096 (0.021) and 0.104 (0.023), respectively. The mean right- and left-sided ligament RT length was 0.54 (0.11) and 0.57 (0.11), respectively. The appearance of the ligament was similar in all patients with a central thin band of hypoechogenicity lined by hyperechoic lines on either side. Understanding the normal appearance, thickness, and length of the Lisfranc's ligament in a large sample is imperative to diagnose abnormal appearances of this ligament including sprains and tears by ultrasound. Ultrasound, with its easy accessibility, can be used in the emergency department to rapidly exclude injury of the ligament. Increased understanding and awareness of the Lisfranc's ligament on ultrasound can allow for more accurate diagnosis and treatment.

  3. Comparison of glenohumeral contact pressures and contact areas after glenoid reconstruction with latarjet or distal tibial osteochondral allografts.

    PubMed

    Bhatia, Sanjeev; Van Thiel, Geoffrey S; Gupta, Deepti; Ghodadra, Neil; Cole, Brian J; Bach, Bernard R; Shewman, Elizabeth; Wang, Vincent M; Romeo, Anthony A; Verma, Nikhil N; Provencher, Matthew T

    2013-08-01

    Glenoid reconstruction with distal tibial allografts offers the theoretical advantage over Latarjet reconstruction of improved joint congruity and a cartilaginous articulation for the humeral head. Hypothesis/ To investigate changes in the magnitude and location of glenohumeral contact areas, contact pressures, and peak forces after (1) the creation of a 30% anterior glenoid defect and subsequent glenoid bone augmentation with (2) a flush Latarjet coracoid graft or (3) a distal tibial osteochondral allograft. It was hypothesized that the distal tibial bone graft would best normalize glenohumeral contact areas, contact pressures, and peak forces. Controlled laboratory study. Eight cadaveric shoulder specimens were dissected free of all soft tissues and randomly tested in 3 static positions of humeral abduction with a 440-N compressive load: 30°, 60°, and 60° of abduction with 90° of external rotation (ABER). Glenohumeral contact area, contact pressure, and peak force were determined sequentially using a digital pressure mapping system for (1) the intact glenoid, (2) the glenoid with a 30% anterior bone defect, and (3) the glenoid after reconstruction with a distal tibial allograft or a Latarjet bone block. Glenoid reconstruction with distal tibial allografts resulted in significantly higher glenohumeral contact areas than reconstruction with Latarjet bone blocks in 60° of abduction (4.87 vs. 3.93 cm2, respectively; P < .05) and the ABER position (3.98 vs. 2.81 cm2, respectively; P < .05). Distal tibial allograft reconstruction also demonstrated significantly lower peak forces than Latarjet reconstruction in the ABER position (2.39 vs. 2.61 N, respectively; P < .05). Regarding the bone loss model, distal tibial allograft reconstruction exhibited significantly higher contact areas and significantly lower contact pressures and peak forces than the 30% defect model at all 3 abduction positions. Latarjet reconstruction also followed this same pattern, but

  4. Anterior cruciate ligament and medial collateral ligament injuries.

    PubMed

    Bollier, Matthew; Smith, Patrick A

    2014-10-01

    The diagnosis and treatment of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries have evolved over the past 30 years. A detailed physical examination along with careful review of the magnetic resonance imaging and stress radiographs will guide decision making. Early ACL reconstruction and acute MCL repair are recommended when there is increased medial joint space opening with valgus stress in extension, a significant meniscotibial deep MCL injury (high-riding medial meniscus), or a displaced tibial-sided superficial MCL avulsion (stener lesion of the knee). Delayed ACL reconstruction to allow for MCL healing is advised when increased valgus laxity is present only at 30 degrees of flexion and not at 0 degree. However, at the time of ACL surgery, medial stability has to be re-assessed after the reconstruction is completed. In patients with neutral alignment in the chronic setting, graft reconstruction of both the ACL and MCL is recommended.

  5. The effect of in vivo rotator cuff muscle contraction on glenohumeral joint translation: An ultrasonographic and electromyographic study.

    PubMed

    Rathi, Sangeeta; Taylor, Nicholas F; Green, Rodney A

    2016-12-08

    The proposed stabilizing mechanism of rotator cuff muscles is to limit excessive humeral head translation. However, an accurate measurement of glenohumeral joint translation in vivo has been challenging. We aimed to measure the effect of rotator cuff muscle contraction on glenohumeral joint translation using real time ultrasound (RTUS) and electromyography. Twenty healthy adults with no history of shoulder pathology were recruited. Six intramuscular electrodes were inserted in the rotator cuff muscles (supraspinatus, upper and lower infraspinatus, teres minor, upper and lower subscapularis). Anterior and posterior glenohumeral translations were measured in testing conditions (with and without translation force, with and without isometric internal and external rotation), in two positions (shoulder neutral, abduction) and views (anterior, posterior). There was reduced glenohumeral translation with rotator cuff muscle contraction in the neutral anterior (F2,38=17.8, p<0.01), neutral posterior (F1.6,31.0=44.3, p<0.01) and abducted posterior (F1.5,28.8=5.2, p<0.02) positions. There were also differences between the amount of translation limited by anterior and posterior rotator cuff muscles in response to anterior and posterior translation forces (p<0.05), indicating that their activity was, to a certain extent, direction specific. For example, in both neutral and abducted positions, contraction of the posterior rotator cuff muscles, infraspinatus and teres minor, appeared to tether anterior translation of the humeral head. Our results confirm that the rotator cuff functions as a stabilizer of the glenohumeral joint by limiting humeral head translation and this is likely to be in a direction-specific manner. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Relation between glenohumeral internal rotation deficit and valgus laxity of the elbow in high school baseball pitchers.

    PubMed

    Tajika, Tsuyoshi; Kobayashi, Tsutomu; Yamamoto, Atsushi; Shitara, Hitoshi; Ichinose, Tsuyoshi; Shimoyama, Daisuke; Oya, Noboru; Sasaki, Tsuyoshi; Takagishi, Kenji

    2017-03-01

    There are few literatures describing the association between glenohumeral internal rotation deficits (GIRD) and valgus laxity of the elbow on the throwing side of high school pitchers with and without a history of elbow symptom. The passive range of motion of glenohumeral internal and external rotation on bilateral side shoulders was measured in 75 high-school baseball pitchers during the preseason. Using ultrasonography, the width of the ulnohumeral joint of the elbow was measured at 30° of flexion, both at rest and with valgus stress in the pitching side. Comparisons of glenohumeral internal rotation deficits and the difference between the width of ulnohumeral joint space with and without valgus stress on the throwing side were made between 75 high-school pitchers with and without a history of elbow symptom. Participants with a history of elbow symptom exhibited a greater difference between the width of ulnohumeral joint with and without valgus stress in the throwing side than participants with no history of elbow symptom (P<0.05). No difference in glenohumeral internal rotation deficits was found in participants with and without a history of elbow symptom. In all participants, significant association was found between glenohumeral internal rotation deficits on the pitching side and the difference from the width of the ulnohumeral joint with and without valgus stress (P=0.04, r=0.23). Elbow valgus instability was associated with elbow joint pain in high-school pitchers. Although GIRD was not significantly different between the two groups, GIRD and elbow valgus instability might be related to the throwing side in high-school pitchers.

  7. Glenohumeral translations during range-of-motion movements, activities of daily living, and sports activities in healthy participants.

    PubMed

    Dal Maso, Fabien; Raison, Maxime; Lundberg, Arne; Arndt, Anton; Allard, Paul; Begon, Mickaël

    2015-11-01

    Glenohumeral translations have been mainly investigated during static poses while shoulder rehabilitation exercises, activities of daily living, and sports activities are dynamic. Our objective was to assess glenohumeral translations during shoulder rehabilitation exercises, activities of daily living, and sports activities to provide a preliminary analysis of glenohumeral arthrokinematics in a broad range of dynamic tasks. Glenohumeral translations were computed from trajectories of markers fitted to intracortical pins inserted into the scapula and the humerus. Two participants (P1 and P2) performed full range-of-motion movements including maximum arm elevations and internal-external rotations rehabilitation exercises, six activities of daily living, and five sports activities. During range-of-motion movements, maximum upward translation was 7.5mm (P1) and 4.7mm (P2). Upward translation during elevations was smaller with the arm internally (3.6mm (P1) and 2.9mm (P2)) than neutrally (4.2mm (P1) and 3.7mm (P2)) and externally rotated (4.3mm (P1) and 4.3mm (P2)). For activities of daily living and sports activities, only anterior translation during reach axilla for P1 and upward translation during ball throwing for P2 were larger than the translation measured during range-of-motion movements (108% and 114%, respectively). While previous electromyography-based studies recommended external rotation during arm elevation to minimize upward translation, measures of glenohumeral translations suggest that internal rotation may be better. Similar amplitude of translation during ROM movement and sports activities suggests that large excursions of the humeral head may be caused not only by fast movements, but also by large amplitude movements. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Multiple aneurysms of the inferior pancreaticoduodenal artery: a rare complication of acute pancreatitis.

    PubMed

    Klonaris, Chris; Psathas, Emmanouil; Katsargyris, Athanasios; Lioudaki, Stella; Chatziioannou, Achilleas; Karatzas, Theodore

    2013-01-01

    Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed.

  9. Multiple Aneurysms of the Inferior Pancreaticoduodenal Artery: A Rare Complication of Acute Pancreatitis

    PubMed Central

    Klonaris, Chris; Katsargyris, Athanasios; Lioudaki, Stella; Chatziioannou, Achilleas; Karatzas, Theodore

    2013-01-01

    Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed. PMID:23509663

  10. Pathomechanics of acquired shoulder instability: a basic science perspective.

    PubMed

    Wang, Vincent M; Flatow, Evan L

    2005-01-01

    Normal asymptomatic glenohumeral motion is dependent on the coordinated function of dynamic and static stabilizers. Data from both selective sectioning studies of the capsuloligamentous components and tensile testing of the inferior glenohumeral ligament have provided important insights into the in situ function of these structures. However, little is known regarding the mechanism of microdamage accumulation in acquired shoulder instability. Recent findings suggest that cyclic subfailure loading of the inferior glenohumeral ligament may induce gradual stretching of the anteroinferior capsule, compromising its capacity to restrain excessive humeral translations. Further studies elucidating the mechanism of load transmission in the capsule during physiologic arm motion, as well as data on the intrinsic healing response of the capsular ligaments, are required to more fully characterize the pathoetiology of acquired shoulder instability.

  11. Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft.

    PubMed

    Shin, Sang-Jin; Campbell, Sean; Scott, Jonathan; McGarry, Michelle H; Lee, Thay Q

    2014-09-01

    The purpose of this study was to introduce a novel surgical technique for simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft and to compare its biomechanical characteristics to those of a coracoid cerclage reconstruction of the coracoclavicular ligaments. Six matched pairs of human acromioclavicular joints with an average age of 54.8 ± 7.8 years were used. One shoulder from each pair received the single tendon acromioclavicular-coracoclavicular reconstruction; the contralateral shoulder received the coracoid cerclage reconstruction. Bovine extensor tendon was used for both techniques. The single tendon acromioclavicular-coracoclavicular reconstruction technique provided anatomic restoration of the two coracoclavicular ligaments and the superior and inferior acromioclavicular ligaments simultaneously using one coracoid hole, one acromion hole, and two clavicular holes with interference screws. Anterior-posterior and superior-inferior translations were quantified for all specimens before and after reconstruction, followed by load to failure testing. Following coracoid cerclage reconstruction, total anterior-posterior translation was significantly greater than intact (10.0 ± 5.7 mm; p = 0.008). Following single tendon acromioclavicular-coracoclavicular reconstruction, there was no significant difference in anterior-posterior translation compared to intact (-1.6 ± 2.2 mm; n.s.). The coracoid cerclage technique demonstrated significantly greater anterior-posterior translation than the single tendon acromioclavicular-coracoclavicular technique (p = 0.007). Both techniques restored superior-inferior translation to the intact condition (n.s.). Ultimate load, deformation at ultimate load, and energy absorbed at ultimate load were significantly greater after acromioclavicular-coracoclavicular reconstruction than after coracoid cerclage reconstruction (p < 0.05). This novel single tendon

  12. An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist.

    PubMed

    Telleria, Jessica J M; Lindsey, Derek P; Giori, Nicholas J; Safran, Marc R

    2011-05-01

    To examine and describe the normal anatomic intra-articular locations of the hip capsular ligaments in the central and peripheral compartments of the hip joint. Eight paired fresh-frozen human cadaveric hips (mean age, 73.3 years) were carefully dissected free of soft tissue to expose the hip capsule. Needles were placed through the capsule along the macroscopic borders of the hip capsular ligaments. Arthroscopy was performed on each hip, and the relations of the needles, and thus the ligaments, to the arthroscopic portals and other soft-tissue and osseous landmarks in the hip were recorded by use of a clock-face reference system. The iliofemoral ligament (ILFL) ran from 12:45 to 3 o'clock. The ILFL was pierced by the anterolateral and anterior portals just within its lateral and medial borders, respectively. The pubofemoral ligament was located from the 3:30 to the 5:30 clock position; the lateral border was at the psoas-U perimeter, and the medial border was at the junction of the anteroinferior acetabulum and the cotyloid fossa. The ischiofemoral ligament (ISFL) ran from the 7:45 to the 10:30 clock position. The posterolateral portal pierced the ISFL just inside its superior/lateral border, and the inferior/lateral border was located at the posteroinferior acetabulum. In the peripheral compartment the lateral ILFL and superior/lateral ISFL borders were in proximity to the lateral synovial fold. The medial ILFL and lateral pubofemoral ligament borders were closely approximated to the medial synovial fold. The hip capsular ligaments have distinct and consistent arthroscopic locations within the hip joint and are associated with clearly identifiable landmarks in the central and peripheral compartments. The standard hip arthroscopy portals are closely related to the borders of the hip capsular ligaments. These findings will help orthopaedic surgeons know which structures are being addressed during arthroscopic surgery and may help in the development of future hip

  13. Characteristics of the three ligaments of human spring ligament complex from a viewpoint of elements.

    PubMed

    Tohno, Yoshiyuki; Tohno, Setsuko; Taniguchi, Akira; Azuma, Cho; Minami, Takeshi; Mahakkanukrauh, Pasuk

    2012-06-01

    To elucidate characteristics of the three ligaments constituting the spring ligament complex from a viewpoint of elements, the authors investigated age-related changes of elements, relationships among their elements, relationships among ligaments in the elements, and gender differences in the three ligaments of the spring ligament complex, the superomedial calcaneonavicular (SMCN), inferoplantar longitudinal calcaneonavicular (ICN), and third or medioplantar oblique calcaneonavicular (TCN) ligaments. After ordinary dissection at Nara Medical University was finished, the SMCN, ICN, and TCN ligaments of the spring ligament complex were removed from the subjects. The subjects consisted of 10 men and 12 women, ranging in age from 62 to 99 years (average age = 80.5 ± 9.7 years). After incineration with nitric acid and perchloric acid, the element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that although the Ca and P content hardly changed in the SMCN ligament with aging, the Ca and P content in the ICN ligament increased to about three and five times higher in the 80s in comparison with the 60s, respectively, whereas in the TCN ligament, it increased about 40% and 90% higher in the 80s compared with the 60s, respectively. Regarding the relationships among elements, significant direct correlations were found among the contents of Ca, P, and Mg in all the three ligaments of the spring ligament complex. This finding was in agreement with the previous finding obtained with the three ligaments of the anterior cruciate ligament, posterior longitudinal ligament, and ligamentum capitis femoris. Whether there were significant correlations among the three ligaments of the spring ligament complex with regard to the Ca, P, S, Mg, Zn, and Fe contents was examined using Pearson's correlation. It was found that there were significant direct correlations between the SMCN and TCN ligaments in all the Ca, P, Mg, and Zn contents and

  14. Reliability of a New Clinical Instrument for Measuring Internal and External Glenohumeral Rotation

    PubMed Central

    Lindenfeld, Thomas N.; Fleckenstein, Cassie M.; Levy, Martin S.; Grood, Edward S.; Frush, Todd J.; Parameswaran, A. Dushi

    2015-01-01

    Background: The shoulder plays a critical role in many overhead athletic activities. Several studies have shown alterations in shoulder range of motion (ROM) in the dominant shoulder of overhead athletes and correlation with significantly increased risk of injury to the shoulder and elbow. The purpose of this study was to measure isolated glenohumeral joint internal/external rotation (IR/ER) to determine inter- and intraobserver reliability of a new clinical device. Hypothesis: (1) Inter- and intraobserver reliability would exceed 90% for measures of glenohumeral joint IR, ER, and total arc of motion; (2) the dominant arm would exhibit significantly increased ER, significantly decreased IR, and no difference in total arc of motion compared with the nondominant shoulder; and (3) a significant difference exists in total arc between male and female patients. Study Design: Case series. Level of Evidence: Level 4. Methods: Thirty-seven subjects (mean age, 23 years; range, 13-54 years) were tested by 2 orthopaedic surgeons. A single test consisted of 1 arc of motion from neutral to external rotation to internal rotation and back to neutral within preset torque limits. Each examiner performed 3 tests on the dominant and nondominant shoulders. Each examiner completed 2 installations. Results: Testing reliability demonstrated that neither trial, installation, nor observer were significant sources of variation. The maximum standard deviation was 1.3° for total arc of motion and less than 2° for most other measurements. Dominant arm ER was significantly greater than nondominant arm ER (P = 0.02), and dominant arm IR was significantly less than nondominant arm IR (P = 0.00). Mean total rotation was 162°, with no significant differences in total rotation between dominant and nondominant arms (P = 0.34). Mean total arc of motion was 45° greater in female subjects. Differences in total arc of motion between male and female subjects was statistically significant (P < 0

  15. Bioreactor Design for Tendon/Ligament Engineering

    PubMed Central

    Wang, Tao; Gardiner, Bruce S.; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B.; Wang, Allan; Xu, Jiake

    2013-01-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments. PMID:23072472

  16. Bioreactor design for tendon/ligament engineering.

    PubMed

    Wang, Tao; Gardiner, Bruce S; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B; Wang, Allan; Xu, Jiake; Smith, David W; Lloyd, David G; Zheng, Ming H

    2013-04-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments.

  17. Minimal effect of patella eversion on ligament balancing in cruciate-retaining total knee arthroplasty.

    PubMed

    Aunan, Eirik; Kibsgård, Thomas; Röhrl, Stephan M

    2017-03-01

    The effect of patellar eversion on ligament laxity measurements is still unclear. The purpose of this study was to investigate the influence of patellar eversion on medial and lateral ligament laxity measurements performed intra-operatively in total knee arthroplasty (TKA). A total of 49 knees (27 female) with mean age 70 years (42-83) and mean body mass index of 28.5 were operated consecutively with a cruciate-retaining prosthesis. Medial and lateral ligament laxity in extension and in 90° of flexion was measured with the spatula-method intra-operatively after implantation of the prosthetic components with the patella everted and thereafter with the patella repositioned. The corresponding changes in gap height and inclination were calculated. A statistically significant increase of 0.6 mm (p < 0.001) in ligament laxity (condylar lift-off) laterally in flexion was found with the patella repositioned compared to everted. No differences were found in extension or medially in flexion. Correspondingly, the flexion gap increased by 0.4 mm (p < 0.001) and the flexion gap inclination increased by 0.6° (p = 0.002) when the patella was repositioned. Earlier research has shown that ligament laxity must be at least 1-2 mm to cause inferior function after TKA. In the current study, we found that the effect of patellar eversion on ligament laxity measurements is too small to be considered clinically relevant. PROSPECTIVE STUDY EVALUATING THE EFFECT OF PATIENT CHARACTERISTICS: Level II.

  18. Lore's fascia and the platysma-auricular ligament are distinct structures.

    PubMed

    O'Brien, Justin X; Rozen, Warren M; Whitaker, Iain S; Ashton, Mark W

    2012-09-01

    Lore's fascia and the platysma-auricular ligament are discreet fascial structures anterior and inferior to the auricle respectively. The nomenclature and descriptions of these structures have been presented inconsistently in the literature. There is also concern that placement of platysma suspension sutures into these structures may risk damage to the underlying facial nerve trunk. The aim of this study was to clarify the anatomy of Lore's fascia and the platysma-auricular ligament, and their relationship to the facial nerve trunk. A cadaveric study utilising twelve fresh cadaveric hemi-faces was undertaken, investigating the anatomy of Lore's fascia and the platysma-auricular ligament. This comprised dissection of the periauricular fascial layers and identification of the relationship of these two structures to the facial nerve trunk. A histological study of Lore's fascia was performed. Lore's fascia and the platysma-auricular ligament were identified in all 12 hemi-faces. The structures were anatomically distinct in all cases. The relationship of the facial nerve was documented in each case, with the facial nerve trunk found to lie at least 2 cm deep to the most superficial parts of both structures. Lore's fascia was demonstrable with histology. Lore's fascia and the platysma-auricular ligament are separate and consistently demonstrable structures. Both are suitable for platysma suspension sutures in terms of facial nerve trunk safety, and Lore's ligament can be used as a guide to facial nerve preservation in parotidectomy. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  19. [Colposuspension of the sacrospinal ligament].

    PubMed

    Neri Ruz, E S; Ruiz Moreno, J A; Cárdenas Salinas, J

    1998-10-01

    During a period of 15 years, at the Hospital Central Militar, 36 operations were done to fix the vaginal cupule to sacrocyatic ligament, as therapeutic or preventive surgery; most of the fixations were together with vaginal hysterectomy by genital prolapse; and six of them were as surgical therapy of vaginal cupule prolapse. Complications were in 2.8% (one case), recidive of cupule prolapse and in 2.8% pudendal vein lesion. Long term result has been excellent, with minimal morbidity.

  20. Acceleration of Ligament Healing with Cellular Attractants

    DTIC Science & Technology

    2008-07-01

    14. ABSTRACT Rupture of the anterior cruciate ligament (ACL) with subsequent damage to the menisci and articular cartilage in the knee joint is a...warriors. 15. SUBJECT TERMS aggrecan; anterior cruciate ligament /physiology; antigens, CD44/isolation & purification; cartilage/physiology; collagen...McDevitt, Cahir A.   page Report to DOD 4 INTRODUCTION The anterior cruciate ligament (ACL) plays a pivotal role in the biomechanical

  1. Ligament length relationships in the moving knee.

    PubMed

    Sidles, J A; Larson, R V; Garbini, J L; Downey, D J; Matsen, F A

    1988-01-01

    This article presents an investigation of potential ligament attachment sites for surgical reconstruction of the anterior and posterior cruciate ligaments as well as for the lateral extraarticular iliotibial band tenodesis. Our methodology was based on quantitative measurements of knee anatomy and motion in fresh cadavers, not on biomechanical modeling. Using computer search techniques, we located all the ligament insertion sites that were nearly isometric for motion of the intact knee.

  2. Imaging of the anterior cruciate ligament

    PubMed Central

    Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

    2011-01-01

    The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

  3. INTERDEPENDENT SUPERIORITY AND INFERIORITY FEELINGS

    PubMed Central

    Ingham, Harrington V.

    1949-01-01

    It is postulated that in neurotic persons who have unrealistic feelings of superiority and inferiority the two are interdependent. This is a departure from the concept of previous observers that either one or the other is primary and its opposite is overcompensation. The author postulates considerable parallelism, with equal importance for each. He submits that the neurotic person forms two logic-resistant compartments for the two opposed self-estimates and that treatment which makes inroads of logic upon one compartment, simultaneously does so upon the other. Two examples are briefly reported. The neurotic benefits sought in exaggeration of capability are the same as those sought in insistence upon inferiority: Presumption of superiority at once bids for approbation and delivers the subject from the need to prove himself worthy of it in dreaded competition; exaggeration of incapability baits sympathy and makes competition unnecessary because failure is conceded. Some of the characteristics of abnormal self-estimates that distinguish them from normal are: Preoccupation with self, resistance to logical explanation of personality problems, inconsistency in reasons for beliefs in adequacy on the one hand and inadequacy on the other, unreality, rationalization of faults, and difficulty and vacillation in the selection of adequate goals. PMID:15390573

  4. Functional anatomy of the alar ligaments.

    PubMed

    Dvorak, J; Panjabi, M M

    1987-03-01

    Nineteen upper cervical spine specimens were dissected to examine the macroscopic and functional anatomy of alar ligaments. They are on both sides, symmetrically placed, approximately 10-13 mm long and elliptical in cross-section 3 X 6 mm in diameter. The fiber orientation is dependent on the height of dens axis, mostly in the cranial caudal direction. In 12 specimens there was a ligamentous connection between dens and lateral mass of the atlas as a part of the alar ligament. In 2 specimens anterior atlanto-dental ligament was identified. The computerized tomographic (CT) images can clearly show alar ligaments in axial, coronal, and sagittal planes. The ligaments limit the axial rotation in the occipito-atlanto-axial complex (to the right by left alar and vice versa) as well as in side bending. The ligament is most stretched, and consequently most vulnerable, when the head is rotated and in addition flexed. This mechanism, common in whiplash injuries, could lead to irreversible overstretching or rupture of the ligaments especially as the ligaments consist of mainly collagen fibers.

  5. High-Pressure Balloon-Assisted Stretching of the Coracohumeral Ligament to Determine the Optimal Stretching Positions: A Cadaveric Study.

    PubMed

    Baek, Sora; Lee, Kyu Jin; Kim, Keewon; Han, Seung-Ho; Lee, U-Young; Lee, Kun-Jai; Chung, Sun Gun

    2016-10-01

    The coracohumeral ligament (CHL) is a thick capsular structure and markedly thickened when affected by adhesive capsulitis. Therapeutic stretching is the most commonly applied treatment for adhesive capsulitis, but optimal stretching postures for maximal therapeutic effects on the CHL have not been fully investigated. To investigate the most effective stretching direction for the CHL by measuring the stretching intensity in 5 different directions and to determine whether the stretching intervention resulted in loosening of the ligament by comparing the changes of CHL tightness before and after stretching. Biomechanical cadaver study. Academic institution cadaver laboratory. Nine fresh frozen cadaveric shoulders. A high-pressure balloon catheter inserted under the CHL and intraballoon pressure was measured, to evaluate CHL tightness without ligament damage as well as to augment and monitor stretching intensity. To find the optimal stretching direction, the glenohumeral joint was stretched from the neutral position into 5 directions sequentially under pressure-monitoring: flexion, extension [EX], external rotation [ER], EX+ER, and EX+ER+adduction [AD] directions. CHL tightness was determined by a surrogate parameter, the additional pressure created by the overlying CHL. The pressure increase (ΔPstr) by a specific directional stretch was considered as the stretching intensity. ΔPstr by the 5 directions were mean (standard deviation) values of 0.03 ± 0.07 atm, 0.87 ± 1.31 atm, 1.13 ± 1.36 atm, 1.49 ± 1.32 atm, and 2.10 ± 1.70 atm, respectively, revealing the highest ΔPstr by the EX+ER+AD stretch (P < .05). The balloon pressure by the overlying CHL was decreased from 0.45 ± 0.35 atm to 0.18 ± 0.14 atm (P = .012) before and after the stretching manipulation. EX+ER+AD of the glenohumeral joint resulted in the greatest increase in balloon pressure, implying that it could be the most effective stretching direction. A series of stretching manipulations assisted

  6. Glenohumeral and Hip Range-of-Motion and Strength Measures in Youth Baseball Athletes.

    PubMed

    Picha, Kelsey J; Harding, Josie L; Bliven, Kellie C Huxel

    2016-06-02

    The repetitive demands of throwing affect glenohumeral (GH) range of motion (ROM) and strength. Less is known about hip alterations in skeletally immature athletes. To compare GH and hip ROM and strength between age, position, and side of youth baseball athletes. Cross-sectional study. Multicenter testing. Seventy-two healthy baseball athletes. Participants' self-reported characteristics were age group (7-11 years [n = 28] or 12-18 years [n = 44]), position (pitcher [n = 22], position player [n = 47], unreported [n = 3]), and side (throwing or nonthrowing arm, lead or stance leg). Bilateral GH and hip internal- and external-rotation ROM were measured passively and summed for total arc of motion (TAM). Glenohumeral and hip rotation and gluteus medius strength were measured. Analyses included linear mixed models. Glenohumeral internal rotation was less in throwing than in nonthrowing arms (P < .05) except in younger pitchers (P = .86). Compared with older athletes, younger athletes had more GH external rotation (103.3° ± 7.7° versus 97.5° ± 9.4°; P = .002), TAM (156.4° ± 8.7° versus 147.9° ± 10.9°; P = .04), and external rotation in throwing compared with nonthrowing arms (101.9° ± 1.2° versus 97.9° ± 1.1°; P < .001). Glenohumeral TAM was less in throwing than in nonthrowing arms (150.5° ± 2.1° versus 154.9° ± 1.3°; P = .01). Younger athletes had more hip internal rotation (38.9° ± 6.8° versus 31.2° ± 7.5°; P < .001) and TAM (68.4° ± 10.0° versus 60.7° ± 9.8°; P = .001) than older athletes. Lead-leg hip internal-rotation ROM was greater than in the stance leg (34.8° ± 8.9° versus 32.8° ± 7.7°; P = .01). Overall, older players were stronger than younger players (P < .05), and the throwing arm was stronger in internal rotation than the nonthrowing arm (10.12 ± 3.72 lb [4.59 ± 1.69 kg] versus 9.43 ± 3.18 lb [4.28 ± 1.44 kg]; P = .047). Youth baseball athletes had typical GH ROM adaptations of less internal rotation and more

  7. Management of humeral and glenoid bone loss in recurrent glenohumeral instability.

    PubMed

    Mascarenhas, Randy; Rusen, Jamie; Saltzman, Bryan M; Leiter, Jeff; Chahal, Jaskarndip; Romeo, Anthony A; MacDonald, Peter

    2014-01-01

    Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted.

  8. Management of Humeral and Glenoid Bone Loss in Recurrent Glenohumeral Instability

    PubMed Central

    Rusen, Jamie; Leiter, Jeff; Chahal, Jaskarndip; MacDonald, Peter

    2014-01-01

    Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted. PMID:25136461

  9. Glenohumeral and Hip Range-of-Motion and Strength Measures in Youth Baseball Athletes

    PubMed Central

    Harding, Josie L.; Bliven, Kellie C. Huxel

    2016-01-01

    Context:  The repetitive demands of throwing affect glenohumeral (GH) range of motion (ROM) and strength. Less is known about hip alterations in skeletally immature athletes. Objective:  To compare GH and hip ROM and strength between age, position, and side of youth baseball athletes. Design:  Cross-sectional study. Setting:  Multicenter testing. Patients or Other Participants:  Seventy-two healthy baseball athletes. Participants' self-reported characteristics were age group (7−11 years [n = 28] or 12−18 years [n = 44]), position (pitcher [n = 22], position player [n = 47], unreported [n = 3]), and side (throwing or nonthrowing arm, lead or stance leg). Main Outcome Measure(s):  Bilateral GH and hip internal- and external-rotation ROM were measured passively and summed for total arc of motion (TAM). Glenohumeral and hip rotation and gluteus medius strength were measured. Analyses included linear mixed models. Results:  Glenohumeral internal rotation was less in throwing than in nonthrowing arms (P < .05) except in younger pitchers (P = .86). Compared with older athletes, younger athletes had more GH external rotation (103.3° ± 7.7° versus 97.5° ± 9.4°; P = .002), TAM (156.4° ± 8.7° versus 147.9° ± 10.9°; P = .04), and external rotation in throwing compared with nonthrowing arms (101.9° ± 1.2° versus 97.9° ± 1.1°; P < .001). Glenohumeral TAM was less in throwing than in nonthrowing arms (150.5° ± 2.1° versus 154.9° ± 1.3°; P = .01). Younger athletes had more hip internal rotation (38.9° ± 6.8° versus 31.2° ± 7.5°; P < .001) and TAM (68.4° ± 10.0° versus 60.7° ± 9.8°; P = .001) than older athletes. Lead-leg hip internal-rotation ROM was greater than in the stance leg (34.8° ± 8.9° versus 32.8° ± 7.7°; P = .01). Overall, older players were stronger than younger players (P < .05), and the throwing arm was stronger in internal rotation than the nonthrowing arm (10.12 ± 3.72 lb [4.59 ± 1.69 kg] versus 9.43

  10. Treatment of the Open Glenohumeral Joint with the Anterior Deltoid Muscle Flap

    PubMed Central

    Xipoleas, George D.; Woods, Daniel; Batac, Joseph; Addona, Tommaso

    2016-01-01

    Summary: Upper extremity reconstruction is most often encountered in trauma patients. Although the rate of complications from elective orthopedic procedures remains relatively low, these complications are oftentimes in the form of open joints or joint infections that can be devastating. Classically, wounds of the shoulder girdle have been treated with large muscles such as the pectoralis major, pectoralis minor, and latissimus dorsi. Flaps more local to the area including the deltoid muscle flap have been overlooked due to their small size. Despite its size, the anterior deltoid can be used for shoulder girdle reconstruction with minimal functional deficit and allows for reconstruction of the glenohumeral joint without sacrifice of the larger muscles of the upper trunk. This study reports a case of a chronic shoulder girdle wound and successful management with the use of an anterior deltoid muscle flap. PMID:27826470

  11. Computed and conventional arthrotomography of the glenohumeral joint: normal anatomy and clinical experience

    SciTech Connect

    Deutsch, A.L.; Resnick, D.; Mink, J.H.; Berman, J.L.; Cone, R.O. III; Resnik, C.S.; Danzig, L.; Guerra, J. Jr.

    1984-12-01

    The glenohumeral joint was studied in 25 cadavers and 136 patients using computed arthrotomography (CAT) and conventional arthrotomography (AT) to assess shoulder instability. Cadaver shoulders were injected with air or latex, sectioned with a band saw, and normal articular anatomy outlined. CAT was performed in 81 patients and characterized the glenoid labrum as normal, abnormal, or detached. Hill-Sachs defects were seen in 20 out of 29 patients with anterior labral abnormalities, while bicipital tendon abnormalities were evident on CAT in 6. Of 55 patients who had AT, the status of the labrum was clarified in 13 of the 16 patients who had surgery or arthroscopy. Both methods can characterize the labrum; however, CAT is more comprehensive and appears ideal for both detection of Hill-Sachs defects and imaging the bicipital tendon. CAT requires less technical expertise and radiation than AT and is tolerated better by patients in pain.

  12. Adhesive Capsulitis of the Shoulder Joint: Value of Glenohumeral Distance on Magnetic Resonance Arthrography.

    PubMed

    Lee, Kyu Hong; Park, Hee Jin; Lee, So Yeon; Youn, In Young; Kim, Eugene; Park, Jai Hyung; Park, Se Jin

    2017-01-01

    To evaluate the usefulness of glenohumeral distance (GHD) on axial images of magnetic resonance (MR) arthrography for diagnosis of adhesive capsulitis and to compare this finding with previously reported classic MR arthrographic findings of adhesive capsulitis. Our study was approved by the institutional ethical review board of our institute. We evaluated 41 patients (M-F, 35:6; mean age, 46 years; adhesive capsulitis, 21; no adhesive capsulitis, 20) who underwent MR arthrography. Two radiologists measured GHD, width of the axillary recess, and capsular thickness in consensus. The GHD was measured from the subchondral bone of the glenoid fossa to the subchondral bone of the humeral head at the level of the midline of the humeral head. Glenohumeral distance (anterior, middle, posterior, and mean), width of the axillary recess, and capsular thickness (anterior, posterior, and mean) were compared in the adhesive capsulitis and no adhesive capsulitis groups using the Mann-Whitney U test. The mean GHD of the no adhesive capsulitis group was longer than that of the adhesive capsulitis group. The length differences were statistically significant (P < 0.05). The mean width of the axillary recess of the no adhesive capsulitis group was significantly wider than that of the adhesive capsulitis group (P < 0.001). The mean capsular thickness of the no adhesive capsulitis group was significantly thinner than that in the adhesive capsulitis group (P = 0.001). A decreased GHD on MR arthrography can be another useful feature to diagnose adhesive capsulitis in addition to previously presented radiologic features such as capsular thickening and reduced axillary recess capacity.

  13. Open glenohumeral dislocation: skeletonization of the proximal humerus without associated fracture.

    PubMed

    Maroney, Samuel S; Devinney, D Scott

    2011-11-09

    Shoulder dislocations are common injuries. In the realm of high-energy trauma, enough force can be dissipated to violate the entire soft tissue envelope surrounding the shoulder girdle, generating an open injury. This article presents a case of a young man involved in a motorcycle accident in which he sustained an open glenohumeral dislocation with complete skeletonization of the proximal humerus. There were no associated fractures with his injury. Our patient underwent staged irrigation and debridement of his shoulder with delayed tendoligamentous reconstruction of the skeletonized proximal humerus. After reconstruction, he was immobilized for 3 weeks and then began a progressive shoulder rehabilitation protocol. He healed with no evidence of infection, residual instability, or avascular necrosis at his 4-month follow-up examination. At that point, he had regained functional use of his shoulder for activities of daily living and had no pain. His range of active motion was limited to 90° of flexion and abduction, 0° of external rotation, and internal rotation to the L4. He had complete resolution of a sensory and motor axillary neuropraxia that resulted from his initial injury. It was felt that the patient had potential for continued gains in range of motion and strength.Our patient is only the second description of an open glenohumeral dislocation with no associated fractures of the proximal humerus. This skeletonization of the proximal humerus represents a complex soft tissue injury that severely compromises the functional capacity of the shoulder. Understanding the nature of the injury and the involved structures and maintaining a sound treatment algorithm allow orthopedic surgeons to maximize the patient's functional outcome.

  14. Reference Values for the Scalene Interval Width During Varying Degrees of Glenohumeral Abduction Using Ultrasonography.

    PubMed

    Mattox, Ross; Battaglia, Patrick J; Welk, Aaron B; Maeda, Yumi; Haun, Daniel W; Kettner, Norman W

    The aim of this study was to establish reference values for the width of the interval between the anterior and middle scalene muscles using ultrasonography during varying degrees of glenohumeral joint (GH) abduction. Reliability and body mass index (BMI) data were also assessed. Interscalene triangles of asymptomatic participants were scanned bilaterally in the transverse plane. Images were obtained at 0°, 90°, and 150° of GH abduction with the participant seated. Width measurements were taken between the anterior and middle scalene muscle borders by bisecting the C6 nerve root as it passed superficial to the posterior tubercle of the C7 transverse process. Intra- and interexaminer reliability and BMI correlation were studied. Statistical significance was defined as P ≤ .05. Images of 42 scalene intervals were included from 21 participants (11 female). Mean participant age was 25.3 ± 3.9 years; mean BMI was 25.4 ± 2.7 kg/m(2). Scalene interval measurements at 0°, 90°, and 150° of GH abduction were 4.5 ± 0.5 mm, 4.6 ± 0.5 mm, and 4.4 ± 0.7 mm, respectively, without a significant difference (P = .07). Intraexaminer reliability was excellent (0°: intraclass correlation coefficient [ICC] = 0.82; 90°: ICC = 0.89; 150°: ICC = 0.90). Interexaminer reliability was good to excellent (0°: ICC = 0.59; 90°: ICC = 0.85; 150°: ICC = 0.89). Body mass index was positively correlated only at 0° of GH abduction. This study establishes previously unreported reference ultrasonography values for the width of the scalene interval. Intraexaminer reliability was excellent at all glenohumeral positions, and interexaminer reliability was determined to be good to excellent. Body mass index was positively correlated only at 0° of GH abduction. Copyright © 2016. Published by Elsevier Inc.

  15. Muscular activation during plyometric exercises in 90° of glenohumeral joint abduction.

    PubMed

    Ellenbecker, Todd S; Sueyoshi, Tetsuro; Bailie, David S

    2015-01-01

    Plyometric exercises are frequently used to increase posterior rotator cuff and periscapular muscle strength and simulate demands and positional stresses in overhead athletes. The purpose of this study was to provide descriptive data on posterior rotator cuff and scapular muscle activation during upper extremity plyometric exercises in 90° of glenohumeral joint abduction. Levels of muscular activity in the posterior rotator cuff and scapular stabilizers will be high during plyometric shoulder exercises similar to previously reported electromyographic (EMG) levels of shoulder rehabilitation exercises. Descriptive laboratory study. Twenty healthy subjects were tested using surface EMG during the performance of 2 plyometric shoulder exercises: prone external rotation (PERP) and reverse catch external rotation (RCP) using a handheld medicine ball. Electrode application included the upper and lower trapezius (UT and LT, respectively), serratus anterior (SA), infraspinatus (IN), and the middle and posterior deltoid (MD and PD, respectively) muscles. A 10-second interval of repetitive plyometric exercise (PERP) and 3 repetitions of RCP were sampled. Peak and average normalized EMG data were generated. Normalized peak and average IN activity ranged between 73% and 102% and between 28% and 52% during the plyometric exercises, respectively, with peak and average LT activity measured between 79% and 131% and between 31% and 61%. SA activity ranged between 76% and 86% for peak and between 35% and 37% for average activity. Muscular activity levels in the MD and PD ranged between 49% and 72% and between 12% and 33% for peak and average, respectively. Moderate to high levels of muscular activity were measured in the rotator cuff and scapular stabilizers during these plyometric exercises with the glenohumeral joint abducted 90°.

  16. Altering ligament water content affects ligament pre-stress and creep behaviour.

    PubMed

    Thornton, G M; Shrive, N G; Frank, C B

    2001-09-01

    The water content of a ligament can be altered by injury and surgical intervention in vivo, and inadvertently or purposely during in vitro tests. We investigated how altering the water content of the rabbit medial collateral ligament (MCL) affected its resulting creep behaviour (defined as an increase in strain from sequential cyclic and static creep tests). The water content of normal MCLs 4) was compared to that of MCLs soaked for 1 h in a sucrose solution (n = 4) or phosphate buffered saline (PBS; n = 8). Sucrose exposure decreased hydration and PBS exposure increased hydration. In addition, soaking in PBS caused a shift in ligament zero (the position where there was 0.1 N of tension on the ligament). Following the same single solution treatment, additional MCLs were creep tested at 4.1 MPa using a load based on the ligament cross-sectional area measured before solution treatment: sucrose (n = 4), PBS new "ligament zero" (n = 5). and PBS old "ligament zero" (n = 6). Normal MCLs were also tested at 4.1 MPa (n = 7) in a humidity chamber that maintained normal ligament water content. Additional MCLs were treated with both solutions in series (n = 12) to examine the reversibility of the mechanical changes caused by single solution treatment. This was the first investigation to show that ligament creep behaviour was clearly affected by the initial state of hydration: creep decreased with decreased hydration and creep increased with increased hydration. Another unique finding was that ligaments with increased hydration had decreased ligament functional length and increased ligament pre-stress. The creep behaviour of these ligaments was decreased if they were loaded from the pre-stressed state compared to the unloaded state. These results suggest that maintenance of physiological water content is important for in vitro mechanical testing of ligaments and controlling the low-load stress state of ligaments in situ.

  17. Exercise therapy for treatment of supraspinatus tears does not alter glenohumeral kinematics during internal/external rotation with the arm at the side.

    PubMed

    Ferrer, Gerald A; Miller, R Matthew; Zlotnicki, Jason P; Tashman, Scott; Irrgang, James J; Musahl, Volker; Debski, Richard E

    2017-09-01

    Rotator cuff tears are a significant clinical problem, with exercise therapy being a common treatment option for patients. Failure rates of exercise therapy may be due to the failure to improve glenohumeral kinematics. Tears involving the supraspinatus may result in altered glenohumeral kinematics and joint instability for internal/external rotation with the arm at the side because not all muscles used to stabilize the glenohumeral joint are functioning normally. The objective of the study is to assess in vivo glenohumeral kinematic changes for internal/external rotation motions with the arm at the side of patients with a symptomatic full-thickness supraspinatus tear before and after a 12-week exercise therapy programme. Five patients underwent dynamic stereoradiography analysis before and after a 12-week exercise therapy protocol to measure changes in glenohumeral kinematics during transverse plane internal/external rotation with the arm at the side. Patient-reported outcomes and shoulder strength were also evaluated. No patient sought surgery immediately following exercise therapy. Significant improvements in isometric shoulder strength and patient-reported outcomes were observed (p < 0.05). No significant changes in glenohumeral kinematics following physical therapy were found. Isolated supraspinatus tears resulted in increased joint translations compared to healthy controls from the previous literature for internal/external rotation with the arm at the side. Despite satisfactory clinical outcomes following exercise therapy, glenohumeral kinematics did not change. The lack of changes may be due to the motion studied or the focus of current exercise therapy protocols being increasing shoulder strength and restoring range of motion. Current exercise therapy protocols should be adapted to also focus on restoring glenohumeral kinematics to improve joint stability since exercise therapy may have different effects depending on the motions of daily living. Prognostic

  18. Shape recognition and inferior temporal neurons.

    PubMed Central

    Schwartz, E L; Desimone, R; Albright, T D; Gross, C G

    1983-01-01

    Inferior temporal cortex plays an important role in shape recognition. To study the shape selectivity of single inferior temporal neurons, we recorded their responses to a set of shapes systematically varying in boundary curvature. Many inferior temporal neurons were selective for stimuli of specific boundary curvature and maintained this selectivity over changes in stimulus size or position. The method of describing boundary curvature was that of Fourier descriptors. PMID:6577453

  19. The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics.

    PubMed Central

    Fuss, F K

    1991-01-01

    The posterior portion of the ulnar collateral ligament, which arises from the posterior surface of the medial epicondyle, is taut in maximal flexion. The anterior portion, which takes its origin from the anterior and inferior surfaces of the epicondyle, contains three functional fibre bundles. One of these is taut in maximal extension, another in intermediate positions between middle position and full flexion while the third bundle is always taut and serves as a guiding bundle. Movements of the elbow joint are checked by the ligaments well before the bony processes forming the jaws of the trochlear notch lock into the corresponding fossae on the humerus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2050566

  20. Trends in Materials Science for Ligament Reconstruction.

    PubMed

    Sava, Oana Roxana; Sava, Daniel Florin; Radulescu, Marius; Albu, Madalina Georgiana; Ficai, Denisa; Veloz-Castillo, Maria Fernanda; Mendez-Rojas, Miguel Angel; Ficai, Anton

    2017-01-01

    The number of ligament injuries increases every year and concomitantly the need for materials or systems that can reconstruct the ligament. Limitations imposed by autografts and allografts in ligament reconstruction together with the advances in materials science and biology have attracted a lot of interest for developing systems and materials for ligament replacement or reconstruction. This review intends to synthesize the major steps taken in the development of polymer-based materials for anterior cruciate ligament, their advantages and drawbacks and the results of different in vitro and in vivo tests. Until present, there is no successful polymer system for ligament reconstruction implanted in humans. The developing field of synthetic polymers for ligament reconstruction still has a lot of potential. In addition, several nano-structured materials, made of nanofibers or in the form of ceramic/polymeric nanocomposites, are attracting the interest of several groups due to their potential use as engineered scaffolds that mimic the native environment of cells, increasing the chances for tissue regeneration. Here, we review the last 15 years of literature in order to obtain a better understanding on the state-of-the-art that includes the usage of nano- and poly-meric materials for ligament reconstruction, and to draw perspectives on the future development of the field.

  1. The inferior medial genicular artery and its vascularization of the pes anserinus superficialis: A cadaveric study.

    PubMed

    Hirtler, Lena; Ederer, Manuel; Faber, Mike; Weninger, Patrick

    2016-01-01

    A common method for reconstruction of the anterior cruciate ligament (ACL) is it's replacement by a free avascular graft, using the gracilis and/or semitendinosus tendons. These grafts pass a vulnerable phase in the ligamentization-process during the 1(st) year after reconstruction. The aims of this study were first to evaluate the vascularization of the pes anserinus superficialis (PAS) by the inferior medial genicular artery (IMGA) and second to develop a pedunculated surgical technique for ACL reconstruction, to preserve a maximal amount of natural vascularization of the tendons inserting at the PAS. First, the vascularization of the PAS was assessed in 12 fresh-frozen lower extremities. The IMGA was identified at its origin at the popliteal artery and perfused with a methylene blue solution. Second, a pedunculated ACL reconstruction was performed in 5 fresh-frozen lower extremities under maintenance of the distal tendon insertion at PAS. The PAS is a highly vascularized structure. Vessels originate from the IMGA, running along the three tendons of the PAS in the paratendinous tissue. Histologically intratendinous vessels exist; however, perfusion of the inserting tendons through intratendinous vessels was not proven macroscopically. The pedunculated grafts could be positioned and fixed successfully into the bone tunnels in all knees. Although intratendinous vascularization of the tendons of the PAS via the IMGA was not proven, this study indicates a new possibility of ACL reconstruction. The described operation technique can be conducive to shorten the vulnerable phase of the graft-ligamentization after ACL reconstruction.

  2. [Ligament injuries of fingers and thumbs].

    PubMed

    Schmitt, R

    2017-01-01

    Degenerative and traumatic ligament lesions of the carpometacarpal joints frequently occur at the thumb ray, whereas the carpometacarpal amphiarthrosis of other finger rays are rarely affected. The metacarpophalangeal and interphalangeal joints of the thumb and fingers are stabilized by bilaterally running collateral ligaments and palmar plates. At the base of the metacarpophalangeal joints, several ligaments of the extensor hoods guide the extensor tendons and coordinate the fine motoric skills of phalangeal flexing and extending. Several annular and cruciform ligaments hold the flexor tendons close to the finger skeleton. Other than at the wrist, differentiation between dynamic and static instability patterns is possible by physical examination. This review article presents the ligaments of the thumb and the fingers, the traumatic and degenerative lesions as well as the diagnostic capability of x‑rays, cinematography, magnetic resonance imaging (MRI) and MR arthrography.

  3. Lateral ligament reconstruction procedures for the ankle.

    PubMed

    Tourné, Y; Mabit, C

    2017-02-01

    Capsule/ligament lesions of the lateral compartment of the ankle lead to lateral laxity, which is a prime contributor to chronic ankle instability. Lateral ligament reconstruction stabilizes the joint. Exhaustive preoperative clinical and paraclinical work-up is essential. The present article classifies, presents and criticizes the main techniques in terms of long-term stabilization and reduction of osteoarthritis risk. Anatomic ligament repair with reinforcement (mainly extensor retinaculum) or anatomic ligament reconstruction are the two recommended options. Non-anatomic reconstructions using the peroneus brevis should be abandoned. Arthroscopy is increasingly being developed, but results need assessment on longer follow-up than presently available. Postoperative neuromuscular reprogramming is fundamental to optimal recovery. Finally, the concept of complex ankle instability is discussed from the diagnostic and therapeutic points of view. The various forms of ligament reconstruction failure and corresponding treatments are reported.

  4. [Lateral ligament injuries of the ankle joint].

    PubMed

    Walther, M; Kriegelstein, S; Altenberger, S; Volkering, C; Röser, A; Wölfel, R

    2013-09-01

    Lateral ligament injuries are the most common sports injury and have a high incidence even in non-sportive activities. Although lateral ligament injuries are very common there is still a controversial debate on the best management. The diagnosis is based on clinical examination and X-ray images help to rule out fractures. Further imaging, especially magnetic resonance imaging (MRI) is used to diagnose associated injuries. According to the recommendations of the various scientific societies the primary therapy of lateral ligament injuries is conservative. Chronic ankle instability develops in 10-20 % of patients and the instability can be a result of sensomotoric deficits or insufficient healing of the lateral ligament complex. If the patient does not respond to an intensive rehabilitation program an operative reconstruction of the lateral ligaments has to be considered. Most of the procedures currently performed are anatomical reconstructions due to better long-term results compared to tenodesis procedures.

  5. Anatomical variation in the anterolateral ligament of the knee and a new dissection technique for embalmed cadaveric specimens.

    PubMed

    Parker, Matthew; Smith, Heather F

    2016-12-18

    Claes et al. recently documented and described the anterolateral ligament (ALL) of the knee, demonstrating its existence in 97% of their samples. Here, we further examined the anatomy of this ligament, documented its morphological variation, and assessed the feasibility of its dissection in preserved cadaveric specimens. To achieve this, we dissected 53 preserved cadaveric knees and documented their morphological variation in the anterolateral ligament. The originally described dissection technique for identifying and following the ALL requires flexion of the knee, a state which is often not possible in stiff, preserved cadavers. Here, we describe and confirm the feasibility of an alternate dissection technique in which the quadriceps femoris tendon is incised, for use on specimens in which flexion of the undissected knee is not possible. We also identify a novel technique for assessing whether the anterolateral ligament is absent from a specimen or has simply been obliterated or overlooked, using the lateral inferior genicular vasculature. These dissection techniques have great potential for the dissection of preserved cadavers used in gross anatomy laboratories, and we discuss the applications of such an approach in student-led dissections. Our dissections also uncovered noticeable variation in the anterolateral ligament course and position. Most notably, it often inserts significantly more laterally than the classical presentation (30.2%), or originates more proximally with superficial fibers extending superiorly and laterally over the distal femur (7.5%).

  6. Isolated posterior cruciate ligament calcification

    PubMed Central

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  7. Inferior vena caval masses identified by echocardiography

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Asher, C. R.; Xu, Y.; Huang, V.; Griffin, B. P.; Stewart, W. J.; Novick, A. C.; Thomas, J. D.

    1999-01-01

    The most common cause of an inferior vena caval mass is renal cell carcinoma that extends through the lumen, occurring in 47 of 62 patients (85%). Detection of an inferior vena caval mass affects the surgical approach requiring cardiopulmonary bypass for resection when the mass extends to the heart.

  8. Inferior vena caval masses identified by echocardiography

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Asher, C. R.; Xu, Y.; Huang, V.; Griffin, B. P.; Stewart, W. J.; Novick, A. C.; Thomas, J. D.

    1999-01-01

    The most common cause of an inferior vena caval mass is renal cell carcinoma that extends through the lumen, occurring in 47 of 62 patients (85%). Detection of an inferior vena caval mass affects the surgical approach requiring cardiopulmonary bypass for resection when the mass extends to the heart.

  9. The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury

    PubMed Central

    Bahm, J.

    2016-01-01

    In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature. PMID:28077955

  10. The Surgical Strategy to Correct the Rotational Imbalance of the Glenohumeral Joint after Brachial Plexus Birth Injury.

    PubMed

    Bahm, J

    2016-01-01

    In upper brachial plexus birth injury, rotational balance of the glenohumeral joint is frequently affected and contracture in medial rotation of the arm develops, due to a severe palsy or insufficient recovery of the lateral rotators. Some of these children present with a severe glenohumeral joint contracture in the first months, although regular physiotherapy has been provided, a condition associated with a posteriorly subdislocated or dislocated humeral head. These conditions should be screened early by a pediatrician or specialized physiotherapist. Both aspects of muscular weakness affecting the lateral rotators and the initial or progressive glenohumeral deformity and/or subdislocation must be identified and treated accordingly, focusing on the reestablishment of joint congruence and strengthening of the lateral rotators to improve rotational balance, thus working against joint dysplasia and loss of motor function of the shoulder in a growing child. Our treatment strategy adapted over the last 20 years to results from retrospective studies, including biomechanical aspects on muscular imbalance and tendon transfers. With this review, we confront our actual concept to recent literature.

  11. Autologous conditioned plasma as therapy of tendon and ligament lesions in seven horses

    PubMed Central

    Georg, Rindermann; Maria, Cislakova; Gisela, Arndt

    2010-01-01

    This case report describes the intralesional application of autologous conditioned plasma (ACP) in seven horses as treatment of severe tendinitis of the superficial digital flexor tendon, deep digital flexor tendon, or desmitis of the inferior check ligament. Follow-up data of the horses revealed a positive outcome in 10 to 13 months post injury. All horses treated with ACP were either performing in their previous work-load or were back in full training. Further studies with long-term follow-up will have to be performed to support these clinical intermediate-term observations. PMID:20458161

  12. Bilateral inferior petrosal sinus sampling

    PubMed Central

    Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo

    2016-01-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  13. Bilateral inferior petrosal sinus sampling.

    PubMed

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

  14. HIP AND GLENOHUMERAL PASSIVE RANGE OF MOTION IN COLLEGIATE SOFTBALL PLAYERS

    PubMed Central

    Plummer, Hillary; Brambeck, Allison

    2016-01-01

    Background and Purpose Range of motion deficits at the hip and glenohumeral joint (GHJ) may contribute to the incidence of injury in softball players. With injury in softball players on the rise, softball related studies in the literature are important. The purpose of this study was to examine hip and GHJ passive range of motion (PROM) patterns in collegiate softball players. Hypothesis It was hypothesized that the position players would exhibit significantly different PROM patterns than pitchers. Additionally, position players would exhibit significantly different side-to-side differences in PROM for both the hip and GHJ compared to pitchers. Study Design Prospective cohort study. Methods Forty-nine collegiate softball players (19.63 ± 1.15 years; 170.88 ± 8.08 cm; 72.96 ± 19.41 kg) participated. Passive hip and GHJ internal (IR) and external rotation (ER) measures were assessed. Glenohumeral PROM was measured with the participants supine with the arm abducted to 90 °. The measurements were recorded when the scapula began to move or a firm capsular end-feel was achieved. The hip was positioned in 90 ° of flexion and passively rotated until a capsular end-feel was achieved. Total PROM was calculated by taking the sum of IR and ER for both the hip and GHJ. Results No significant side-to-side PROM differences were observed in pitchers, at the GHJ or hip joint. Position players throwing side hip IR was significantly greater than the non-throwing side hip (p = 0.002). The non-throwing side hip had significantly greater ER compared to the throwing side hip (p = 0.002). When examining side-to-side differences at the GHJ, IR was significantly greater in the non-throwing shoulder (p = 0.047). No significant differences in total range of motion of the hip and GHJ were observed. Conclusion In the current study, position players displayed side-to-side differences in hip and GHJ IR PROM while no statistically significant differences were

  15. Ulnar Collateral Ligament Injuries of the Thumb

    PubMed Central

    McKeon, Kathleen E.; Gelberman, Richard H.; Calfee, Ryan P.

    2013-01-01

    Background: The clinical diagnosis of thumb ulnar collateral ligament disruption has been based on joint angulation during valgus stress testing. This report describes a definitive method of distinguishing between complete and partial ulnar collateral ligament injuries by quantifying translation of the proximal phalanx on the metacarpal head during valgus stress testing. Methods: Sixty-two cadaveric thumbs underwent standardized valgus stress testing under fluoroscopy with the ulnar collateral ligament intact, following an isolated release of the proper ulnar collateral ligament, and following a combined release of both the proper and the accessory ulnar collateral ligament (complete ulnar collateral ligament release). Following complete ulnar collateral ligament release, the final thirty-seven thumbs were also analyzed after the application of a valgus force sufficient to cause 45° of valgus angulation at the metacarpophalangeal joint to model more severe soft-tissue injury. Two independent reviewers measured coronal plane joint angulation (in degrees), ulnar joint line gap formation (in millimeters), and radial translation of the proximal phalanx on the metacarpal head (in millimeters) on digital fluoroscopic images that had been randomized. Results: Coronal angulation across the stressed metacarpophalangeal joint progressively increased through the stages of the testing protocol: ulnar collateral ligament intact (average [and standard deviation], 20° ± 8.1°), release of the proper ulnar collateral ligament (average, 23° ± 8.3°), and complete ulnar collateral ligament release (average, 30° ± 8.9°) (p < 0.01 for each comparison). Similarly, gap formation increased from the measurement in the intact state (5.1 ± 1.3 mm), to that following proper ulnar collateral ligament release (5.7 ± 1.5 mm), to that following complete ulnar collateral ligament release (7.2 ± 1.5 mm) (p < 0.01 for each comparison). Radial translation of the proximal phalanx on the

  16. TREM-1, HMGB1 and RAGE in the Shoulder Tendon: Dual Mechanisms for Inflammation Based on the Coincidence of Glenohumeral Arthritis.

    PubMed

    Thankam, Finosh G; Dilisio, Matthew F; Dietz, Nicholas E; Agrawal, Devendra K

    2016-01-01

    Rotator cuff injury (RCI) is a major musculoskeletal disorder in the adult population where inflammation and pain are major contributing factors. Coincidence of other clinical conditions like glenohumeral arthritis aggravates inflammation and delays the healing response. The mechanism and signaling factors underlying the sustenance of inflammation in the rotator cuff joint are largely unknown. The present article aims to elucidate the involvement of inflammatory molecule, TREM-1 (Triggering Receptors Expressed on Myeloid cells-1), and danger-associated molecular patterns (DAMPs), including high mobility group protein 1 (HMGB-1) and RAGE (receptor for advanced glycation end products), in the setting of RCI with respect to the severity of glenohumeral arthritis. Biceps tendons (15 specimens) from the shoulder and blood (11 samples) from patients with glenohumeral arthritis (Group-1, n = 4) and without glenohumeral arthritis (Group-2, n = 11) after RCI surgery were obtained for the study. Molecular and morphological alterations between the groups were compared using histology, immunofluorescence, RT-PCR and flow cytometry. MRI and histomorphology assessment revealed severe inflammation in Group-1 patients while in Group-2 ECM disorganization was prominent without any hallmarks of inflammation. A significant increase in TREM-1 expression in circulating neutrophils and monocytes was observed. Elevated levels of TREM-1, HMGB-1 and RAGE in Group-1 patients along with CD68+ and CD16+ cells confirmed DAMP-mediated inflammation. Expression of TREM-1 in the tendon of Group-2 patients even in the absence of immune cells presented a new population of TREM-expressing cells that were confirmed by real-time PCR analysis and immunofluorescence. Expression of HMGB-1 and RAGE in the biceps tendon from the shoulder of patients without glenohumeral arthritis implied TREM-1-mediated inflammation without involving immune cells, whereas in patients with glenohumeral arthritis

  17. Deficits in Glenohumeral Passive Range of Motion Increase Risk of Shoulder Injury in Professional Baseball Pitchers: A Prospective Study.

    PubMed

    Wilk, Kevin E; Macrina, Leonard C; Fleisig, Glenn S; Aune, Kyle T; Porterfield, Ron A; Harker, Paul; Evans, Timothy J; Andrews, James R

    2015-10-01

    Shoulder injuries from repetitive baseball pitching continue to be a serious, common problem. To determine whether passive range of motion of the glenohumeral joint was predictive of shoulder injury or shoulder surgery in professional baseball pitchers. Cohort study; Level of evidence, 2. Passive range of motion of the glenohumeral joint was assessed with a bubble goniometer during spring training for all major and minor league pitchers of a single professional baseball organization over a period of 8 successive seasons (2005-2012). Investigators performed a total of 505 examinations on 296 professional pitchers. Glenohumeral external and internal rotation was assessed with the pitcher supine and the arm abducted to 90° in the scapular plane with the scapula stabilized anteriorly at the coracoid process. Total rotation was defined as the sum of internal and external glenohumeral rotation. Passive shoulder flexion was measured with the pitcher supine and the lateral border of the scapula manually stabilized. After examination, shoulder injuries and injury durations were recorded by each pitcher's respective baseball organization and reported to the league as an injury transaction as each player was placed on the disabled list. Highly significant side-to-side differences were noted within subjects for each range of motion measurement. There were 75 shoulder injuries and 20 surgeries recorded among 51 pitchers, resulting in 5570 total days on the disabled list. Glenohumeral internal rotation deficit, total rotation deficit, and flexion deficit were not significantly related to shoulder injury or surgery. Pitchers with insufficient external rotation (<5° greater external rotation in the throwing shoulder) were 2.2 times more likely to be placed on the disabled list for a shoulder injury (P = .014; 95% CI, 1.2-4.1) and were 4.0 times more likely to require shoulder surgery (P = .009; 95% CI, 1.5-12.6). Insufficient shoulder external rotation on the throwing side

  18. The Acute Effects of Hold-Relax Proprioceptive Neuromuscular Facilitation With Vibration Therapy on Glenohumeral Internal-Rotation Deficit.

    PubMed

    Tucker, W Steven; Slone, Stephen W

    2016-08-01

    Clinicians use various stretching techniques to prevent the onset of and treat glenohumeral internal-rotation deficit (GIRD). It is unknown which stretching technique is the most effective. To investigate the acute effects of hold-relax proprioceptive neuromuscular facilitation (PNF) with and without vibration therapy on internal rotation in individuals with GIRD. 2-within (stretch × time) comparison with repeated measures. Controlled laboratory. 11 male current and former overhead athletes (19.8 ± 1.4 y, 184.5 ± 4.5 cm, 91.8 ± 11.6 kg) who presented with GIRD. At 3 separate sessions, participants performed 1 of 3 randomly assigned stretches: hold-relax PNF (PNF), hold-relax PNF in combination with a whole-body-vibration unit set at 30 Hz (PNF-V), and static stretch (SS). Pretest and posttest maximum passive glenohumeral internal-rotation measurements were taken with a digital protractor. The dependent variables were the mean glenohumeral internal-rotation measurements taken at the pretest and posttest. The influence of stretch (PNF, PNF-V, and SS) and time (pretest and posttest) on mean glenohumeral internal rotation was compared using a 3 × 2 factorial ANOVA with repeated measures on both variables (P ≤ .05). There was a stretch-by-time interaction (F2,20 = 34.697, P < .001). Post hoc testing revealed that the PNF posttest (73.0° ± 10.4°) was greater than the PNF pretest (60.0° ± 11.8°), the PNF-V posttest (74.7° ± 10.0°) was greater than the PNF-V pretest (57.4° ± 10.4°), and the SS posttest (67.0° ± 10.7°) was greater than the SS pretest (60.1° ± 9.4°). When comparing the posttest values, the PNF-V posttest was greater than the SS posttest. All 3 stretches (PNF, PNF-V, and SS) resulted in acute increases in glenohumeral internal rotation in individuals presenting with GIRD. The PNF-V stretch resulted in the greatest increase and would be the most clinically beneficial for patients with GIRD.

  19. Validation of a new model-based tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics.

    PubMed

    Bey, Michael J; Zauel, Roger; Brock, Stephanie K; Tashman, Scott

    2006-08-01

    Shoulder motion is complex and significant research efforts have focused on measuring glenohumeral joint motion. Unfortunately, conventional motion measurement techniques are unable to measure glenohumeral joint kinematics during dynamic shoulder motion to clinically significant levels of accuracy. The purpose of this study was to validate the accuracy of a new model-based tracking technique for measuring three-dimensional, in vivo glenohumeral joint kinematics. We have developed a model-based tracking technique for accurately measuring in vivo joint motion from biplane radiographic images that tracks the position of bones based on their three-dimensional shape and texture. To validate this technique, we implanted tantalum beads into the humerus and scapula of both shoulders from three cadaver specimens and then recorded biplane radiographic images of the shoulder while manually moving each specimen's arm. The position of the humerus and scapula were measured using the model-based tracking system and with a previously validated dynamic radiostereometric analysis (RSA) technique. Accuracy was reported in terms of measurement bias, measurement precision, and overall dynamic accuracy by comparing the model-based tracking results to the dynamic RSA results. The model-based tracking technique produced results that were in excellent agreement with the RSA technique. Measurement bias ranged from -0.126 to 0.199 mm for the scapula and ranged from -0.022 to 0.079 mm for the humerus. Dynamic measurement precision was better than 0.130 mm for the scapula and 0.095 mm for the humerus. Overall dynamic accuracy indicated that rms errors in any one direction were less than 0.385 mm for the scapula and less than 0.374 mm for the humerus. These errors correspond to rotational inaccuracies of approximately 0.25 deg for the scapula and 0.47 deg for the humerus. This new model-based tracking approach represents a non-invasive technique for accurately measuring dynamic glenohumeral

  20. Ligament Tissue Engineering and Its Potential Role in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Yates, E. W.; Rupani, A.; Foley, G. T.; Khan, W. S.; Cartmell, S.; Anand, S. J.

    2012-01-01

    Tissue engineering is an emerging discipline that combines the principle of science and engineering. It offers an unlimited source of natural tissue substitutes and by using appropriate cells, biomimetic scaffolds, and advanced bioreactors, it is possible that tissue engineering could be implemented in the repair and regeneration of tissue such as bone, cartilage, tendon, and ligament. Whilst repair and regeneration of ligament tissue has been demonstrated in animal studies, further research is needed to improve the biomechanical properties of the engineered ligament if it is to play an important part in the future of human ligament reconstruction surgery. We evaluate the current literature on ligament tissue engineering and its role in anterior cruciate ligament reconstruction. PMID:22253633

  1. Inferior alveolar nerve block: Alternative technique

    PubMed Central

    Thangavelu, K.; Kannan, R.; Kumar, N. Senthil

    2012-01-01

    Background: Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. Aim and Objective: The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. Materials and Methods: This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. Conclusion: This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages. PMID:25885503

  2. Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.

    PubMed

    Dale, Kevin M; Bailey, James R; Moorman, Claude T

    2017-01-01

    The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing.

  3. Central serous chorioretinopathy resulting in altered vision and color perception after glenohumeral corticosteroid injection.

    PubMed

    Hurvitz, Andrew P; Hodapp, Kristin L; Jadgchew, Jason; Solomon, Daniel J; Stolldorf, Hunter S; Provencher, Matthew T

    2009-08-01

    Complications from shoulder corticosteroid injections are uncommon. This article presents a case of altered color perception and visual disturbances in a 29-year-old male active duty Navy SEAL following an intra-articular glenohumeral corticosteroid injection, previously unreported in the orthopedic literature. The corticosteroid injection was administered for the treatment of right-shoulder stiffness occurring approximately 3 months following an arthroscopic superior labrum anterior-posterior (SLAP) repair and subacromial decompression of the ipsilateral shoulder. The patient experienced immediate relief after the injection. Seven days later, however, he began to notice visual disturbances with color and image distortion of his right eye. He also developed a papular, nonpruritic rash on his upper trunk that eventually extended down his legs. He was diagnosed by an ophthalmologist as having central serous chorioretinopathy, a condition in which serous fluid accumulates in the subretinal space of the eye, causing detachment of the retina from the underlying retinal pigment epithelium. The reaction spontaneously resolved within approximately 10 to 12 weeks without treatment. Although intra-articular corticosteroid injections are frequently performed with a low rate of complication, clinicians should be familiar with this rare yet distressing condition. Furthermore, patients with increased production of endogenous corticosteroids (eg, those with Cushing's syndrome, type A personality, hypertension, or obstructive sleep apnea) should be warned of the potential of chorioretinopathy after an intra-articular corticosteroid injection.

  4. Preliminary evaluation of a robotic apparatus for the analysis of passive glenohumeral joint kinematics

    PubMed Central

    2013-01-01

    Background The shoulder has the greatest range of motion of any joint in the human body. This is due, in part, to the complex interplay between the glenohumeral (GH) joint and the scapulothoracic (ST) articulation. Currently, our ability to study shoulder kinematics is limited, because existing models isolate the GH joint and rely on manual manipulation to create motion, and have low reproducibility. Similarly, most established techniques track shoulder motion discontinuously with limited accuracy. Methods To overcome these problems, we have designed a novel system in which the shoulder girdle is studied intact, incorporating both GH and ST motions. In this system, highly reproducible trajectories are created using a robotic actuator to control the intact shoulder girdle. High-speed cameras are employed to track retroreflective bone markers continuously. Results We evaluated this automated system’s capacity to reproducibly capture GH translation in intact and pathologic shoulder conditions. A pair of shoulders (left and right) were tested during forward elevation at baseline, with a winged scapula, and after creation of a full thickness supraspinatus tear. Discussion The system detected differences in GH translations as small as 0.5 mm between different conditions. For each, three consecutive trials were performed and demonstrated high reproducibility and high precision. PMID:23883431

  5. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

    PubMed Central

    Ramhamadany, Eamon; Modi, Chetan S

    2016-01-01

    The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures. PMID:27335809

  6. The relationship between anterior glenohumeral laxity and proprioception in collegiate baseball players.

    PubMed

    Laudner, Kevin G; Meister, Keith; Kajiyama, Satoshi; Noel, Bria

    2012-11-01

    To determine if a relationship exists between anterior glenohumeral (GH) laxity and proprioception. Cross-sectional study. University biomechanics laboratory. Thirty asymptomatic collegiate baseball players. Anterior GH laxity. Proprioception (active joint position sense) at positions of 75 degrees of external rotation, 30 degrees of external rotation, and 30 degrees of internal rotation were measured using an isokinetic dynomometer. Anterior GH laxity was measured using an instrumented arthrometer. Linear regression analyses showed that there were no relationships between anterior GH laxity and active joint position sense at 30 degrees of GH internal rotation and 30 degrees of GH external rotation (r = 0.21, P = 0.13). However, there was a moderate positive relationship between anterior GH laxity and joint position sense at 75 degrees of shoulder external rotation (r = 0.56, P = 0.001). These results suggest that shoulder proprioception in 75 degrees of external rotation decreases as anterior GH laxity increases. These results may prove beneficial in the prevention, evaluation, and treatment of various shoulder injuries associated with GH laxity.

  7. Preliminary evaluation of a robotic apparatus for the analysis of passive glenohumeral joint kinematics.

    PubMed

    Rosso, Claudio; Müller, Andreas M; Entezari, Vahid; Dow, William A; McKenzie, Brett; Stanton, Stacey K; Li, Daniel; Cereatti, Andrea; Ramappa, Arun J; DeAngelis, Joseph P; Nazarian, Ara; Della Croce, Ugo

    2013-07-24

    The shoulder has the greatest range of motion of any joint in the human body. This is due, in part, to the complex interplay between the glenohumeral (GH) joint and the scapulothoracic (ST) articulation. Currently, our ability to study shoulder kinematics is limited, because existing models isolate the GH joint and rely on manual manipulation to create motion, and have low reproducibility. Similarly, most established techniques track shoulder motion discontinuously with limited accuracy. To overcome these problems, we have designed a novel system in which the shoulder girdle is studied intact, incorporating both GH and ST motions. In this system, highly reproducible trajectories are created using a robotic actuator to control the intact shoulder girdle. High-speed cameras are employed to track retroreflective bone markers continuously. We evaluated this automated system's capacity to reproducibly capture GH translation in intact and pathologic shoulder conditions. A pair of shoulders (left and right) were tested during forward elevation at baseline, with a winged scapula, and after creation of a full thickness supraspinatus tear. The system detected differences in GH translations as small as 0.5 mm between different conditions. For each, three consecutive trials were performed and demonstrated high reproducibility and high precision.

  8. Age specific isokinetic glenohumeral internal and external rotation strength in elite junior tennis players.

    PubMed

    Ellenbecker, T; Roetert, E P

    2003-03-01

    The high incidence of overuse shoulder injuries in elite junior tennis players is often attributed to both the high repetitive stresses inherent in the game, as well as muscular imbalances in the humeral rotators. The purpose of this study was to isokinetically measure concentric glenohumeral joint internal and external rotation strength, to develop a bilateral descriptive profile in elite junior tennis players across two age ranges. One hundred forty seven elite junior players between the ages of 12 and 21 were bilaterally tested on a Cybex isokinetic dynamometer with 90 degrees of abduction. Players were analysed in two groups (12-17 and 18-21 years of age), using isokinetic variables of peak torque and work relative to body weight. Data analysis consisted of ANOVAs, with dependent t-tests used for post-hoc testing where main effect differences were identified. Results indicated no significant main effect difference in the isokinetic relative parameters between the two age groups (p > .01). Significantly greater (p < .001) dominant arm internal rotation was measured in both groups for both males and females, with no significant difference in external rotation strength measured between extremities in either age group. These data show specific adaptations in shoulder strength and identify a relative muscular imbalance between the internal and external rotators on the dominant arm of elite junior tennis players. Normative data presented in this study can assist clinicians and researchers in interpreting isokinetic test results in elite junior tennis players.

  9. [Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications].

    PubMed

    López-Hualda, A; Marín-Aguado, M A; Valencia-García, H; López-González, D; Gavín-González, C

    2014-01-01

    Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. To compare injuries and complications after surgery between one group older than forty years of age and another younger group. A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group. There was no significant difference between the complications after surgery and the age according to the design (P>.05). Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  10. Profile of collagen gene expression in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder☆☆☆

    PubMed Central

    Belangero, Paulo Santoro; Leal, Mariana Ferreira; de Castro Pochini, Alberto; Andreoli, Carlos Vicente; Ejnisman, Benno; Cohen, Moises

    2014-01-01

    Objective To evaluate the expression of the genes COL1A1, COL1A2, COL3A1 and COL5A1 in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder. Methods Samples from the glenohumeral capsule of 18 patients with traumatic anterior instability of the shoulder were evaluated. Male patients with a positive grip test and a Bankart lesion seen on magnetic resonance imaging were included. All the patients had suffered more than one episode of shoulder dislocation. Samples were collected from the injured glenohumeral capsule (anteroinferior region) and from the macroscopically unaffected region (anterosuperior region) of each patient. The expression of collagen genes was evaluated using the polymerase chain reaction after reverse transcription with quantitative analysis (qRT-PCR). Results The expression of COL1A1, COL1A2 and COL3A1 did not differ between the two regions of the shoulder capsule. However, it was observed that the expression of COL5A1 was significantly lower in the anteroinferior region than in the anterosuperior region (median ± interquartile range: 0.057 ± 0.052 vs. 0.155 ± 0.398; p = 0.028) of the glenohumeral capsule. Conclusion The affected region of the glenohumeral capsule in patients with shoulder instability presented reduced expression of COL5A1. PMID:26229875

  11. Anterior cruciate ligament (ACL) injury -- aftercare

    MedlinePlus

    ... ACL injury - aftercare References Amy E, Micheo W. Anterior cruciate ligament tear. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation . 2nd ed. St. Louis, MO: ...

  12. Arthrofibrosis of the knee following ligament surgery.

    PubMed

    DeHaven, Kenneth E; Cosgarea, Andrew J; Sebastianelli, Wayne J

    2003-01-01

    Arthrofibrosis of the knee is one of the most serious complications that can result from ligament surgery. Reported incidence of arthrofibrosis following anterior cruciate ligament reconstruction ranges from 4% to 35%. The loss of motion caused by arthrofibrosis can be even more disabling than the instability for which the reconstruction was performed, often requiring extensive physical therapy and/or surgical lysis of adhesions. With aggressive rehabilitation and modifications in the bracing of knees undergoing ligament reconstruction, the incidence of this complication has decreased significantly. Additionally, delaying anterior cruciate ligament reconstruction until the acute inflammatory period has resolved has also been shown to be a significant factor in the reduction of postoperative knee stiffness.

  13. Posterior cruciate ligament (PCL) injury - aftercare

    MedlinePlus

    Adib F, Curtis C, Bienkowski P Micheli LJ. Posterior cruciate ligament sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, ...

  14. Prosthetic Anterior Cruciate Ligament Repairs: Current Status.

    DTIC Science & Technology

    1985-01-01

    patellar tendon was (dev eloped to augment or reconstruct the repaired anteriormenu cruciate ligamnent.’ The purpose of this app~roach was to provide an...intercondvlar niotch in the manner of Eriksson. ’ Thus the transfe~rred patellar tendon lay adjacent to the repairedI anterior cruciate ligament and supportedl...splint.’ B y using a hiode- hinli(tionl).ly gradable ligament. autogenous tissue grafts. such ats at portion of the, patella tendon . at asfied with would

  15. Osseous Injury Associated With Ligamentous Tear of the Knee.

    PubMed

    Lee, Chee Hwee; Tan, Chih Feng; Kim, Okwha; Suh, Kyung Jin; Yao, Min-Szu; Chan, Wing P; Wu, Jim S

    2016-11-01

    One of the most common knee injuries is ligament tear, which may initially manifest as an osseous injury in radiographs. Radiologists should therefore be able to recognize ligament tears of the knee as osseous abnormalities in images. This review focuses on the imaging features of knee ligament injuries and their related osseous injuries: anterior cruciate ligament (ACL) tear with Segond fracture; associated marrow contusion; ACL avulsion fracture; posterior cruciate ligament (PCL) tear with osseous avulsion of the ligament including arcuate sign; reverse Segond fracture; PCL avulsion fracture; medial collateral ligament tear with Pellegrini-Stieda disease; lateral collateral ligament tear with avulsion fracture of the fibular head; and patellar ligament injuries with Osgood-Schlatter and Sinding-Larsen-Johansson.

  16. Impact biomechanics of lateral knee bracing. The anterior cruciate ligament.

    PubMed

    Paulos, L E; Cawley, P W; France, E P

    1991-01-01

    We evaluated the effects of six different prophylactic braces on ACL ligament strain under dynamic valgus loads using a mechanical surrogate limb validated against human cadaveric specimens. Medical collateral ligament and anterior cruciate ligament peak forces, medial collateral ligament and anterior cruciate ligament tension initiation times, and impact safety factors were calculated for both braced and unbraced conditions. These tests were conducted to determine whether or not application of a prophylactic brace might provide protection to the anterior cruciate ligament under valgus loading conditions. The results of this study indicate that those braces that increased impact duration appear to differentially protect the anterior cruciate ligament more than the medial collateral ligament, and that most of the braces tested appear to provide some degree of protection to the anterior cruciate ligament under direct lateral impacts. These findings should be confirmed clinically.

  17. [Inferior vestibular neuritis: diagnosis using VEMP].

    PubMed

    Walther, L E; Repik, I

    2012-02-01

    Vestibular evoked myogenic potentials (VEMP) are a new method to establish the functional status of the otolith organs. The sacculocollic reflex of the cervical VEMP to air conduction (AC) reflects predominantly saccular function due to saccular afferents to the inferior vestibular nerve. We describe a case of inferior vestibular neuritis as a rare differential diagnosis of vestibular neuritis. Clinical signs were a normal caloric response, unilaterally absent AC cVEMPs and bilaterally preserved ocular VEMPs (AC oVEMPs).

  18. The Cruciate Ligaments in Total Knee Arthroplasty.

    PubMed

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction.

  19. Anterior cruciate ligament replacement: a review.

    PubMed

    Silver, F H; Tria, A J; Zawadsky, J P; Dunn, M G

    1991-01-01

    The anterior cruciate ligament (ACL) is the major intra-articular mechanical element that limits motion of the tibia with respect to the femur. It is a multi-fasciculated structure composed of crimped aligned collagen fibers. The purpose of this paper is to review the literature on ACL structure and mechanical properties in an effort to stimulate the development of a new generation of more effective replacement devices. Replacement of the ACL is achieved using biologic and synthetic grafts. Biologic grafts include illiotibial band, semitendinosus and gracilis tendons, patellar tendon, and meniscus. Bone-patellar-bone complexes used to replace the ACL are revascularized and ultimately replaced by neo-ligament. Synthetic implants including the Integraft, Leads-Keio ligament, Gore-Tex¿ ligament and Kennedy Ligament Augmentation Device (LAD) have either not been approved or approved by the FDA for limited use as a replacement for the ACL. The Kennedy LAD has been found to increase the strength of autogenous tissue during revascularization. Based on the success of autografts and the Kennedy LAD, we conclude that the next generation of ACL replacement devices will consist of a scaffold and a biodegradable augmentation device. The scaffold will have a structure that mimics the normal ACL as well as stimulates revascularization and healing. A biodegradable augmentation device will be employed to mechanically reinforce the scaffold without stress shielding the neo-ligament. By combining the advantages of autografts and a biodegradable augmentation device, a new generation of ACL replacements will be achieved.

  20. Ligament repair: a molecular and immunohistological characterization.

    PubMed

    Roseti, L; Buda, R; Cavallo, C; Desando, G; Facchini, A; Grigolo, B

    2008-01-01

    The anterior cruciate ligament (ACL) is the most commonly injured tissue of the human knee. Its poor ability to regenerate after injury represents a challenge to ligament tissue engineering. An understanding of the molecular composition of the structures used for its repair is essential for clinical assessments and for the implementation of tissue engineering strategies. The objective of this study was to evaluate, both at gene and protein levels, the expression of characteristic molecules in human ACL, patellar, semitendinosus and gracilis tendons and in the ligament reconstructed with patellar or semitendinosus and gracilis tendons. We demonstrated that primary ACL and tendon tissues all express collagen I, II, Sox-9, tenascin-C and aggrecan. Collagen X expression was detected at very low levels or undetectable. Cathepsin B, MMP-1 and MMP-13 were expressed at higher levels in the ACL reconstructed by the two tendons, showing that a remodeling process occurs during "ligamentization". Both our molecular and immunohistochemical evaluations did not reveal significative differences between the tendons and ligaments analyzed. However, ACL reconstructed with semitendinosus and gracilis tendon seems to present a higher expression of collagen type II when compared to that reconstructed with patellar tendon. This study could give a reasonable identification of genetic and protein markers specific to tendon/ligament tissues and be helpful in testing tissue engineering approaches for ACL reconstruction.

  1. A mechanistic damage model for ligaments.

    PubMed

    Barrett, Jeff M; Callaghan, Jack P

    2017-08-16

    The accuracy of biomechanical models is predicated on the realism by which they represent their biomechanical tissues. Unfortunately, most models use phenomenological ligament models that neglect the behaviour in the failure region. Therefore, the purpose of this investigation was to test whether a mechanistic model of ligamentous tissue portrays behaviour representative of actual ligament failure tests. The model tracks the time-evolution of a population of collagen fibres in a theoretical ligament. Each collagen fibre is treated as an independent linear cables with constant stiffness. Model equations were derived by assuming these fibres act as a continuum and applying a conservation law akin to Huxley's muscle model. A breaking function models the rate of collagen fibre breakage at a given displacement, and was chosen to be a linear function for this preliminary analysis. The model was fitted to experimental average curves for the cervical anterior longitudinal ligament. In addition, the model was cyclically loaded to test whether the tissue model behaves similarly. The model agreed very well with experiment with an RMS error of 14.23 N and an R(2) of 0.995. Cyclic loading exhibited a reduction in force similar to experimental data. The proposed model showcases behaviour reminiscent of actual ligaments being strained to failure and undergoing cyclic load. Future work could incorporate viscous effects, or validate the model further by testing it in various loading conditions. Characterizing the breaking function more accurately would also lead to better results. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Imaging appearances of lateral ankle ligament reconstruction.

    PubMed

    Chien, Alexander J; Jacobson, Jon A; Jamadar, David A; Brigido, Monica Kalume; Femino, John E; Hayes, Curtis W

    2004-01-01

    Six patients were retrospectively identified as having undergone lateral ligament reconstruction surgery. The surgical procedures were categorized into four groups: direct lateral ligament repair, peroneus brevis tendon rerouting, peroneus brevis tendon loop, and peroneus brevis tendon split and rerouting. At radiography and magnetic resonance (MR) imaging, the presence of one or more suture anchors in the region of the anterior talofibular ligament indicates direct ligament repair, whereas a fibular tunnel indicates peroneus brevis tendon rerouting or loop. Both ultrasonography (US) and MR imaging demonstrate rerouted tendons as part of lateral ankle reconstruction; however, MR imaging can also depict the rerouted tendon within an osseous tunnel if present, especially if T1-weighted sequences are used. Artifact from suture material may obscure the tendon at MR imaging but not at US. With both modalities, the integrity of the rerouted peroneus brevis tendon is best evaluated by following the tendon proximally from its distal attachment site, which typically remains unchanged. The rerouted tendon or portion of the tendon can then be traced proximally to its reattachment site. Familiarity with the surgical procedures most commonly used for lateral ankle ligament reconstruction, and with the imaging features of these procedures, is essential for avoiding diagnostic pitfalls and ensuring accurate assessment of the ligament reconstruction.

  3. Tissue Engineering Strategies in Ligament Regeneration

    PubMed Central

    Yilgor, Caglar; Yilgor Huri, Pinar; Huri, Gazi

    2012-01-01

    Ligaments are dense fibrous connective tissues that connect bones to other bones and their injuries are frequently encountered in the clinic. The current clinical approaches in ligament repair and regeneration are limited to autografts, as the gold standard, and allografts. Both of these techniques have their own drawbacks that limit the success in clinical setting; therefore, new strategies are being developed in order to be able to solve the current problems of ligament grafting. Tissue engineering is a novel promising technique that aims to solve these problems, by producing viable artificial ligament substitutes in the laboratory conditions with the potential of transplantation to the patients with a high success rate. Direct cell and/or growth factor injection to the defect site is another current approach aiming to enhance the repair process of the native tissue. This review summarizes the current approaches in ligament tissue engineering strategies including the use of scaffolds, their modification techniques, as well as the use of bioreactors to achieve enhanced regeneration rates, while also discussing the advances in growth factor and cell therapy applications towards obtaining enhanced ligament regeneration. PMID:22242032

  4. Robotic inferior vena cava surgery.

    PubMed

    Davila, Victor J; Velazco, Cristine S; Stone, William M; Fowl, Richard J; Abdul-Muhsin, Haidar M; Castle, Erik P; Money, Samuel R

    2017-03-01

    Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy. All patients undergoing robotic surgery that included cavotomy and repair from 2011 to 2014 were retrospectively reviewed. Data were obtained detailing preoperative demographics, operative details, and postoperative morbidity and mortality. Ten patients (6 men) underwent robotic vena caval procedures at our institution. Seven patients underwent robotic nephrectomy with removal of IVC tumor thrombus and retroperitoneal lymph node dissection. Three patients underwent robotic explantation of an IVCF after multiple endovascular attempts at removal had failed. The patients with renal cell carcinoma were a mean age of was 65.4 years (range, 55-74 years). Six patients had right-sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5 cm (range, 1-8 cm). All patients underwent robotic radical nephrectomy, with caval tumor thrombus removal and retroperitoneal lymph node dissection. The average operative time for patients undergoing surgery for renal cell carcinoma was 273 minutes (range, 137-382 minutes). Average intraoperative blood loss was 428 mL (range, 150-1200 mL). The patients with IVCF removal were a mean age of 33 years (range, 24-41 years). Average time from IVCF placement until robotic removal was 35.5 months (range, 4.3-57.3 months). Before robotic IVCF removal, a minimum of two endovascular retrievals were attempted. Average operative time

  5. [Suture of the anterior cruciate ligament--what is the real value of this method?].

    PubMed

    Seiler, H; Frank, H R

    1993-09-01

    After suture of the anterior cruciate ligament without anatomical augmentation, used as a routine method, 88 patients were followed up after a minimum of 2 years using the Lysholm score and the activity scale. Residual laxity was checked clinically and with the KT-1000. For comparison, 20 patients with chronic symptomatic anterolateral instability were followed up who had been operated on using the Eriksson technique during the same time period. Postoperative treatment was a limited functional approach. The peripheral ligament structures were treated following the Hughston and Müller principles. In two-thirds of the knees lateral tenodesis was added. The results of the suture method were disappointing and inferior to the results obtained by the Eriksson technique (trend). The Lysholm score was 77 and 82, respectively. The activity scale was 4.4 (recreational sports) for both groups. The Lachmann sign (KT-1000) in side-to-side comparison (89 N) showed a residual laxity of 1.9 mm and 0.8 mm (average), respectively. In no series was tractopexy of demonstrable advantage. The final conclusion must be that the suture method (with iliotibial tract tenodesis) is not superior to guided conservative treatment. Despite an unfavorable situation preoperatively, the (abandoned) technique of ligament substitution is superior to the suture method (trend). In isokinetic testing dominant knees fare better. In good results, a high hamstrings-quadriceps ratio is typical. The reasons for this are not well-trained hamstrings, but the relative insufficiency of the quadriceps mechanism.

  6. One-step venous reconstruction using the donor's round ligament in right-lobe living-donor liver transplantation.

    PubMed

    Toshima, Takeo; Ikegami, Toru; Matsumoto, Yoshihiro; Yoshiya, Shohei; Harimoto, Norifumi; Yamashita, Yo-ichi; Yoshizumi, Tomoharu; Ikeda, Tetsuo; Shirabe, Ken; Maehara, Yoshihiko

    2015-04-01

    We herein report the use of an opened round ligament as a venous patch graft for inferior right hepatic vein (IRHV) reconstruction and anastomosis to the inferior vena cava (IVC) in living-donor liver transplantation (LDLT) using a right-lobe (RL) graft. After laparotomy, the donor's round ligament was harvested and opened, and the semi-transparent umbilical vein, which was 7.0 cm in length and 3.0 cm in width, was carefully trimmed on the back table for use as a patch graft. The right hepatic vein of the graft was anastomosed to the harvested patch, and the IRHV was anastomosed to an independent hole made in the wall on the other side of the patch, to form a bridged vascular patch for anastomosis to the IVC. The interposition graft filled promptly and provided a good outflow from the posterior segment. This is the first report of venous reconstruction using a donor's round ligament graft in RL-LDLT.

  7. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament.

    PubMed

    Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Leão, Renata Vidal; Demange, Marco Kawamura; Bordalo-Rodrigues, Marcelo

    2017-04-01

    Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions. Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated. Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation

  8. Arthrosis of glenohumeral joint after arthroscopic Bankart repair: a long-term follow-up of 13 years.

    PubMed

    Kavaja, Lauri; Pajarinen, Jarkko; Sinisaari, Ilkka; Savolainen, Vesa; Björkenheim, Jan-Magnus; Haapamäki, Ville; Paavola, Mika

    2012-03-01

    The purpose of the study was to establish radiologic and clinical occurrence of glenohumeral arthrosis after arthroscopic Bankart repair. Between January 1994 and December 1998, an arthroscopic Bankart repair was performed in 187 patients at our institution. We were able to assess clinical and radiologic glenohumeral arthrosis in 72 of the 101 patients who met the inclusion criteria (74 shoulders) (71%) after a 13-year follow-up. An additional 9 patients were interviewed by telephone. Radiologic arthrosis was evaluated with the Samilson-Prieto classification and clinical arthrosis with an arthrosis-specific quality-of-life questionnaire (Western Ontario Osteoarthritis of the Shoulder test). In addition, functional impairment was assessed with the Constant score and subjective satisfaction with a questionnaire. Radiologic arthrosis was diagnosed in 50 of 74 shoulders (68%), with 40 (80%) of them classified as mild. The mean score on the Western Ontario Osteoarthritis of the Shoulder questionnaire was 280 points (85% of the best possible score), which is considered relatively good. The mean Constant score was 78 points, and 75% of the patients were extremely satisfied or satisfied with the final results of operative treatment. The radiologic evaluation and self-assessment of the patients imply that the incidence of glenohumeral arthrosis after arthroscopic Bankart repair is quite common but the symptoms are generally mild and comparable to nonoperative treatment. Arthrosis rarely causes more than minor subjective symptoms or a minor objectively perceived disadvantage during 13 years' follow-up. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  9. The Effects of Latarjet Reconstruction on Glenohumeral Instability in the Presence of Combined Bony Defects

    PubMed Central

    Patel, Ronak M.; Walia, Piyush; Gottschalk, Lionel; Jones, Morgan H.; Fening, Stephen D.; Miniaci, Anthony

    2015-01-01

    Objectives: Recurrent glenohumeral instability is often a result of underlying bony defects in the glenoid and/or humeral head. Anterior glenoid augmentation with a bone block (i.e. Latarjet) has been recommended for glenoid bone loss in the face of recurrent instability. However, no study has investigated the effect of Latarjet augmentation in the setting of both glenoid and humeral head defects (Hill-Sachs Defects (HSD)). The purpose of this study was to evaluate the stability achieved through a Latarjet procedure in the presence of combined bony defects. Our hypothesis was that Latarjet augmentation would increase shoulder stability for glenoid defects with small HSD, but have limited success in cases with large concomitant HSD. Methods: Eighteen fresh-frozen cadaveric specimens were tested at combinations of glenohumeral abduction (ABD) angles of 20°, 40°, and 60° and external rotation (ER) angles of 0°, 40°, and 80°. Each experiment applied a 50N medial load on the humerus to replicate the static load of soft tissues, and then simulated anterior dislocation by translating the glenoid in an anterior direction. Translational distance and medial-lateral displacement of the humeral head, along with horizontal reaction forces, were recorded for every trial. Specimens were tested in an intact condition (no defect), different combinations of defects, and with Latarjet augmentation. The Latarjet was performed for 20% and 30% glenoid defects by transferring the specimen’s coracoid process anterior to the glenoid flush with the articulating surface. Results: Results are summarized in Fig. 1. The vertical axis represents the normalized distance to dislocation with respect to the values of the intact joint. The horizontal axis represents the varying sizes and combinations of bony defects. Latarjet augmentation improved stability for every combination of bony defects. At 20° ABD, 0°ER, and 20% glenoid defect size, the percentage of intact translation did not

  10. The Effects of Latarjet Reconstruction on Glenohumeral Instability in the Presence of Combined Bony Defects

    PubMed Central

    Patel, Ronak Maneklal; Walia, Piyush; Gottschalk, Lionel; Jones, Morgan H.; Fening, Stephen D.; Miniaci, Anthony

    2015-01-01

    Objectives: Recurrent glenohumeral instability is often as a result of underlying bony defects in the glenoid and/or humeral head. Anterior glenoid augmentation with a bone block (i.e. Latarjet) has been recommended for glenoid bone loss in the face of recurrent instability. However, no study has investigated the effect of Latarjet augmentation in the setting of both glenoid and humeral head defects (Hill-Sachs Defects (HSD)). The purpose of this study was to evaluate the stability achieved through a Latarjet procedure in the presence of combined bony defects. Methods: Eighteen fresh-frozen cadaveric specimens were tested at all combinations of glenohumeral abduction (ABD) angles of 20°, 40°, and 60° and three external rotation (ER) levels (0°, 40°, and 80°). Each experiment comprised of anterior dislocation by translating the glenoid under a 50N medial load applied on the humerus, simulating the static load of soft tissues. Translational distance and medial-lateral displacement of the humeral head, along with horizontal reaction forces were recorded for every trial. Specimens were tested in an intact condition (no defect), different combinations of defects, and with Latarjet augmentation. The Latarjet was performed for 20% and 30% glenoid defects by transferring the specimen's coracoid process anterior to the glenoid flush with the articulating surface. Four different humeral head defects were created of sizes 6%, 19%, 31%, and 44% of humeral diameter. Repeated measures analysis of variance (ANOVA) was performed with statistical significance set at p <0.05. Results: Results are summarized in Fig. 1. The vertical axis represents the normalized distance to dislocation with respect to the values of the intact joint. The horizontal axis represents the varying sizes and combinations of bony defects. At 20° ABD and 0°ER, increasing HSD size did not affect percentage of intact translation with a constant glenoid defect of 20% before and after Latarjet

  11. In vivo glenohumeral translation under anterior loading in an open-MRI set-up.

    PubMed

    Cereatti, Andrea; Calderone, Manuela; Buckland, Dan M; Buettner, Anne; Della Croce, Ugo; Rosso, Claudio

    2014-11-28

    The evaluation of the glenohumeral joint laxity requires the estimate of displacements of the humeral head centre (HHC) with respect to the glenoid. To the authors׳ knowledge, several studies have been conducted to estimate HHC translations in vivo but data under anterior loading conditions has not been collected yet. Aim of this study was to develop a non-invasive experimental methodology based on magnetic resonance (MR) imaging for the in vivo evaluation of the HHC translations due to an anteriorly directed force. Fourteen asymptomatic shoulders were acquired using a horizontal open MR scanner with the subjects in the supine position both at 15° and 90° of arm abduction with and without an anterior force of 20N applied at the HHC level. When no load was applied, from 15° to 90° of arm abduction, the HHC moved, anteriorly (1.5±1.3mm) and superiorly (1.8±1.3mm) while smaller displacements were observed medio-laterally (0.4±0.7mm). Under the application of the anterior force the 3D displacement of the HHC with respect to the glenoid was 1.6±1.2mm and 1.3 ±0.7mm, respectively at 15° and 90° of arm abduction. The level of precision associated to the GHJ translation was less than 0.33mm along all directions i.e. one order of magnitude smaller than the relevant translations. In conclusion, the MRI-based methodology allowed for the analysis of HHC displacements under conditions of anterior loads within an acceptable level of reliability. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Anterior Glenohumeral Laxity and Stiffness After a Shoulder-Strengthening Program in Collegiate Cheerleaders

    PubMed Central

    Laudner, Kevin G; Metz, Betsy; Thomas, David Q

    2013-01-01

    Context Approximately 62% of all cheerleaders sustain some type of orthopaedic injury during their cheerleading careers. Furthermore, the occurrence of such injuries has led to inquiry regarding optimal prevention techniques. One possible cause of these injuries may be related to inadequate conditioning in cheerleaders. Objective To determine whether a strength and conditioning program produces quantifiable improvements in anterior glenohumeral (GH) laxity and stiffness. Design Descriptive laboratory study. Setting University laboratory. Patients or Other Participants A sample of 41 collegiate cheerleaders (24 experimental and 17 control participants) volunteered. No participants had a recent history (in the past 6 months) of upper extremity injury or any history of upper extremity surgery. Intervention(s) The experimental group completed a 6-week strength and conditioning program between the pretest and posttest measurements; the control group did not perform any strength training between tests. Main Outcome Measure(s) We measured anterior GH laxity and stiffness with an instrumented arthrometer. We conducted a group × time analysis of variance with repeated measures on time (P < .05) to determine differences between groups. Results A significant interaction was demonstrated, with the control group having more anterior GH laxity at the posttest session than the strengthening group (P = .03, partial η2 = 0.11). However, no main effect for time (P = .92) or group (P = .97) was observed. In another significant interaction, the control group had less anterior GH stiffness at the posttest session than the strengthening group (P = .03, partial η2 = 0.12). Main effects for time (P = .02) and group (P = .004) were also significant. Conclusions Cheerleaders who participate in a shoulder-strengthening program developed less anterior GH laxity and more stiffness than cheerleaders in the control group. PMID:23672322

  13. Anterior glenohumeral laxity and stiffness after a shoulder-strengthening program in collegiate cheerleaders.

    PubMed

    Laudner, Kevin G; Metz, Betsy; Thomas, David Q

    2013-01-01

    Approximately 62% of all cheerleaders sustain some type of orthopaedic injury during their cheerleading careers. Furthermore, the occurrence of such injuries has led to inquiry regarding optimal prevention techniques. One possible cause of these injuries may be related to inadequate conditioning in cheerleaders. To determine whether a strength and conditioning program produces quantifiable improvements in anterior glenohumeral (GH) laxity and stiffness. Descriptive laboratory study. University laboratory. A sample of 41 collegiate cheerleaders (24 experimental and 17 control participants) volunteered. No participants had a recent history (in the past 6 months) of upper extremity injury or any history of upper extremity surgery. The experimental group completed a 6-week strength and conditioning program between the pretest and posttest measurements; the control group did not perform any strength training between tests. We measured anterior GH laxity and stiffness with an instrumented arthrometer. We conducted a group × time analysis of variance with repeated measures on time (P < .05) to determine differences between groups. A significant interaction was demonstrated, with the control group having more anterior GH laxity at the posttest session than the strengthening group (P = .03, partial η2 = 0.11). However, no main effect for time (P = .92) or group (P = .97) was observed. In another significant interaction, the control group had less anterior GH stiffness at the posttest session than the strengthening group (P = .03, partial η2 = 0.12). Main effects for time (P = .02) and group (P = .004) were also significant. Cheerleaders who participate in a shoulder-strengthening program developed less anterior GH laxity and more stiffness than cheerleaders in the control group.

  14. The accuracy of measuring glenohumeral motion with a surface humeral cuff.

    PubMed

    Hamming, David; Braman, Jonathan P; Phadke, Vandana; LaPrade, Robert F; Ludewig, Paula M

    2012-04-30

    Conclusions about normal and pathologic shoulder motion are frequently made from studies using skin surface markers, yet accuracy of such sensors representing humeral motion is not well known. Nineteen subjects were investigated with flock of birds electromagnetic sensors attached to transcortical pins placed into the scapula and humerus, and a thermoplastic cuff secured on the arm. Subjects completed two repetitions of raising and lowering the arm in the sagittal, scapular and coronal planes, as well as shoulder internal and external rotation with the elbow at the side and abducted to 90°. Humeral motion was recorded simultaneously from surface and bone fixed sensors. The average magnitude of error was calculated for the surface and bone fixed measurements throughout the range of motion. ANOVA tested for differences across angles of elevation, raising and lowering, and differences in body mass index. For all five motions tested, the plane of elevation rotation average absolute error ranged from 0-2°, while the humeral elevation rotation average error ranged from 0-4°. The axial rotation average absolute error was much greater, ranging from 5° during elevation motions to approaching 30° at maximum excursion of internal/external rotation motions. Average absolute error was greater in subjects with body mass index greater than 25. Surface sensors are an accurate way of measuring humeral elevation rotations and plane of elevation rotations. Conversely, there is a large amount of average error for axial rotations when using a humeral cuff to measure glenohumeral internal/external rotation as the primary motion.

  15. Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder.

    PubMed

    Fayad, Fouad; Roby-Brami, Agnès; Yazbeck, Chadi; Hanneton, Sylvain; Lefevre-Colau, Marie-Martine; Gautheron, Vincent; Poiraudeau, Serge; Revel, Michel

    2008-01-01

    We aimed to describe 3D scapular kinematics and scapulohumeral rhythm (SHR) in glenohumeral (GH) osteoarthritis shoulders compared to unaffected shoulders and to compare the abnormal scapular kinematic schema for GH osteoarthritis with that for frozen shoulder. Thirty-two patients with stiff shoulder (16 with GH osteoarthritis and 16 with frozen shoulder) performed maximal arm elevation in two planes, sagittal and frontal. Scapular rotations and humeral elevation of the affected and unaffected shoulders were measured by the Polhemus Fastrak electromagnetic system. Patients with GH osteoarthritis were older, had longer disease duration (p<0.001) and less restricted humeral elevation in the frontal plane (p=0.01). Protraction was significantly lower for the affected shoulders except for arm elevation in the frontal plane in the GH osteoarthritis group. Furthermore, protraction was lower with frozen shoulder than GH osteoarthritis during arm elevation in the frontal plane. Scapular lateral rotation and SHR were significantly higher for the affected shoulders in both groups whatever the plane of elevation. SHR showed a fair to moderate negative correlation with maximal humeral elevation in both groups and appears to be higher with frozen shoulder than GH osteoarthritis. In addition, SHR of the affected shoulder showed a fair to moderate correlation with disease duration only with GH osteoarthritis. Scapular tilt did not differ between affected and unaffected sides and was not influenced by type of disease. In conclusion, the increased scapular lateral rotation described in frozen shoulder is also observed in GH osteoarthritis. SHR of the affected shoulder is inversely related to severity of limitation of shoulder range of motion, which suggests a compensatory pattern.

  16. Rotator cuff-sparing approaches for glenohumeral joint access: an anatomic feasibility study.

    PubMed

    Amirthanayagam, Tressa D; Amis, Andrew A; Reilly, Peter; Emery, Roger J H

    2017-03-01

    The deltopectoral approach for total shoulder arthroplasty can result in subscapularis dysfunction. In addition, glenoid wear is more prevalent posteriorly, a region difficult to access with this approach. We propose a posterior approach for access in total shoulder arthroplasty that uses the internervous interval between the infraspinatus and teres minor. This study compares this internervous posterior approach with other rotator cuff-sparing techniques, namely, the subscapularis-splitting and rotator interval approaches. The 3 approaches were performed on 12 fresh frozen cadavers. The degree of circumferential access to the glenohumeral joint, the force exerted on the rotator cuff, the proximity of neurovascular structures, and the depth of the incisions were measured, and digital photographs of the approaches in different arm positions were analyzed. The posterior approach permits direct linear access to 60% of the humeral and 59% of the glenoid joint circumference compared with 39% and 42% for the subscapularis-splitting approach and 37% and 28% for the rotator interval approach. The mean force of retraction on the rotator cuff was 2.76 (standard deviation [SD], 1.10) N with the posterior approach, 2.72 (SD, 1.22) N with the rotator interval, and 4.75 (SD, 2.56) N with the subscapularis-splitting approach. From the digital photographs and depth measurements, the estimated volumetric access available for instrumentation during surgery was comparable for the 3 approaches. The internervous posterior approach provides greater access to the shoulder joint while minimizing damage to the rotator cuff. Copyright © 2017. Published by Elsevier Inc.

  17. The effect of the rotator interval on glenohumeral kinematics during abduction.

    PubMed

    Haghpanah, Babak; Walley, Kempland C; Hingsammer, Andreas; Harlow, Ethan R; Oftadeh, Ramin; Vaziri, Ashkan; Ramappa, Arun J; DeAngelis, Joseph P; Nazarian, Ara

    2016-01-28

    The rotator interval (RI) has been exploited as a potentially benign point of entry into the glenohumeral (GH) joint. Bounded by the supraspinatus, subscapularis and coracoid process of the scapula, the RI is believed to be important in the shoulder's soft tissue balancing and function. However, the role of the RI in shoulder kinematics is not fully understood. The purpose of this study is to describe the effect of the RI on GH motion during abduction of the arm. Six shoulders from three cadaveric torsos were studied to assess the impact of changes in the RI during abduction under four conditions: Intact (Baseline), Opened, Repaired (repaired with side-to-side tissue approximation, no overlap) and Tightened (repaired with 1 cm overlap). For each group, the GH translation and area under the Curve (AUC) were measured during abduction using an intact cadaveric shoulder (intact torso). GH kinematics varied in response to each intervention and throughout the entire abduction arc. Opening the RI caused a significant change in GH translation. The Repair and Tightened groups behaved similarly along all axes of GH motion. The RI is central to normal GH kinematics. Any insult to the tissue's integrity alters the shoulder's motion throughout abduction. In this model, closing the RI side-to-side has the same effect as tightening the RI. Since suture closure may offer the same benefit as tightening the RI, clinicians should consider this effect when treating patients with shoulder laxity. This investigation provides an improved perspective on the role of the RI on GH kinematics during abduction. When managing shoulder pathology, surgeons should consider how these different methods of RI closure affect the joint's motion. In different circumstances, the surgical approach to the RI can be tailored to address each patient's specific needs.

  18. MicroRNAs Associated with Shoulder Tendon Matrisome Disorganization in Glenohumeral Arthritis

    PubMed Central

    Thankam, Finosh G.; Boosani, Chandra S.; Dilisio, Matthew F.; Dietz, Nicholas E.

    2016-01-01

    The extracellular matrix (ECM) provides core support which is essential for the cell and tissue architectural development. The role of ECM in many pathological conditions has been well established and ECM-related abnormalities leading to serious consequences have been identified. Though much has been explored in regards to the role of ECM in soft tissue associated pathologies, very little is known about its role in inflammatory disorders in tendon. In this study, we performed microRNA (miRNA) expression analysis in the long head of the human shoulder biceps tendon to identify key genes whose expression was altered during inflammation in patients with glenohumeral arthritis. We identified differential regulation of matrix metalloproteinases (MMPs) that could be critical in collagen type replacement during tendinopathy. The miRNA profiling showed consistent results between the groups and revealed significant changes in the expression of seven different miRNAs in the inflamed tendons. Interestingly, all of these seven miRNAs were previously reported to have either a direct or indirect role in regulating the ECM organization in other pathological disorders. In addition, these miRNAs were also found to alter the expression levels of MMPs, which are the key matrix degrading enzymes associated with ECM-related abnormalities and pathologies. To our knowledge, this is the first report which identifies specific miRNAs associated with inflammation and the matrix reorganization in the tendons. Furthermore, the findings also support the potential role of these miRNAs in altering the collagen type ratio in the tendons during inflammation which is accompanied with differential expression of MMPs. PMID:27992561

  19. Intra-articular infiltration therapy for patients with glenohumeral osteoarthritis: A systematic review of the literature

    PubMed Central

    Colen, Sascha; Geervliet, Pieter; Haverkamp, Daniël; Van Den Bekerom, Michel P. J.

    2014-01-01

    Background: Conservative treatments are especially in patients with glenohumeral osteoarthritis (GH-OA) important, since shoulder arthroplasty has its limitations. In this systematic review, we will evaluate the current evidence regarding the efficacy of intra-articular (IA) infiltration treatment options in patients with GH-OA. Materials and Methods: The following databases are searched: Pubmed/Medline, Cochrane Clinical Trial Register, Embase and the WHO clinical trial register. All IA injection products used for the treatment of shoulder OA in humans are included. Results: A total of 8 studies could be included in this review. Hyaluronic acid (HA) showed effect sizes of 2.07, 2.02 and 2.11 at 6, 12 and 26 weeks follow-up, respectively. Placebo (1.60, 1.82 and 1.68) also showed stable effect sizes at the same time points. The efficacy of corticosteroids (CS) decreased rapidly at follow-up (1.08, 0.43 and 0.19). Although statistical significant, the maximum difference in effect sizes between HA and placebo was only 0.43 with absolute values between 2.0 and 6.4 on a 100-point visual analogue score for pain. Conclusion: IA treatment with HA has a good efficacy at follow-up compared to baseline. However, the difference in efficacy between HA and placebo never reaches the minimal clinically important difference at any of the follow-up points. We are not able to give clear recommendations for the use of IA CS injections in patients with GH-OA. In future research, we recommend focusing on sufficiently powered randomized trials to compare the efficacies of HA, CS, placebo and other IA treatment options in patients with GH-OA. PMID:25538430

  20. COMPARATIVE STUDY on the MANAGEMENT of GLENOHUMERAL JOINT DISLOCATION. Closed Reduction vs. Arthroscopic Remplissage with Bankart Lesion Repair.

    PubMed

    Fakih, Riad; Hamie, Muhieddine Rada; Yassine, Mahmoud Sami

    2016-01-01

    Conservative treatment of posttraumatic anteroinferior shoulder instability leads to a high failure rate and consequently high recurrence in young and active population. Each recurrence can increase the structural damage of both bony structures and soft tissues (Hill-Sachs lesion, Bankart lesion). Remplissage technique combined with Bankart repair have been proposed as a treatment option. Early arthroscopic treatment for shoulder dislocation will result in better outcome and lower recurrence rate than nonoperative management. We retrospectively reviewed 60 cases from 2010 to 2015 treated by remplissage technique with Bankart repair or closed reduction for anterior shoulder dislocation. All surgeries and closed reductions were done by the same surgeon. Mean age of patients was 30 years, most of them males having experienced one or more recurrent dislocations; mean follow-up was 2 years. Patients with Hill-Sachs lesions < 40% on the articular surface and < 20% of bone defect in the glenoid cavity were included. Exclusion criteria were: glenohumeral arthritis or other inflammation, fracture around the shoulder joint, elderly patients with osteoporosis. All patients included in the study were followed up after 6, 12 and 24 months. Rowe score was used to assess the stability of the shoulders and goniometry to assess the range of motion of the glenohumeral joints. The results confirm that the remplissage technique with Bankart repair takes the upper hand over the conservative management and does not produce any severe adverse effect on postoperative shoulder range of motion. A slight restriction (≈10º) observed in external rotation did not prevent 69% of patients from resuming their preinjury sports activities. At the last follow-up, 90% of patients had a stable shoulder. Conservative management was associated with high rate of recurrence limiting the daily activity of our patients and interfering with their return to sports activities. Except from the recurrence of

  1. Ligamentous contributions to pelvic stability in a rotationally unstable open-book injury: a cadaver study.

    PubMed

    Abdelfattah, Adham; Moed, Berton R

    2014-10-01

    Due to the orientation of the sacroiliac joint (SIJ), as the symphysis widens in an open-book pelvic ring disruption, it should displace inferiorly. The purposes of this study were to reconfirm this inferior displacement and to evaluate the relative contributions of the pubic symphysis (PS), the sacrotuberous/sacrospinous ligament complex (STL/SSL) and the anterior sacroiliac ligament (ASIL) to pelvic ring stability in a rotationally unstable open-book injury. For each of 6 cadaver pelves, the right hemipelvis was fixed to a table and the PS was sectioned. Under fluoroscopy, a manual external rotational force was then applied through the unfixed, left ilium. At the point of maximal displacement, a permanent AP image was obtained. With magnification corrected, horizontal (H) and vertical (V) displacements were measured. The pelves were then divided into two groups of three each. In Group 1, the PS release was followed by sectioning of the STL/SSL, and then the ASIL. In Group 2, the PS release was followed by sectioning of the ASIL and then the STL/SSL. The above described technique of manual manipulation and radiographic measurement was repeated after each stage of ligament release. The displacement after initial PS sectioning was not significantly different when comparing Group 1 to Group 2. In both groups, a significant and progressive increase in displacement was noted when the PS (H and V; p<0.05) and ASIL (H and V; p<0.05) were sectioned. However, there was no significant change with SSL/STL sectioning in either group. Vertical displacements were all directed inferiorly. The PS and ASIL are important in maintaining pelvic ring external rotational stability. However, the SSL/STL has little, if any, effect in this regard. Due to the orientation of the SIJ, external rotation of the hemipelvis, as in open-book injury, will show inferior vertical, as well as horizontal, displacement on the AP radiograph, despite the PSIL being intact. Copyright © 2014 Elsevier Ltd

  2. Isolated glenohumeral range of motion, excluding side-to-side difference in humeral retroversion, in asymptomatic high-school baseball players.

    PubMed

    Mihata, Teruhisa; Takeda, Atsushi; Kawakami, Takeshi; Itami, Yasuo; Watanabe, Chisato; Doi, Munekazu; Neo, Masashi

    2016-06-01

    Glenohumeral range of motion is correlated with shoulder capsular condition and is thus considered to be predictive of shoulder pathology. However, in throwing athletes, a side-to-side difference in humeral retroversion makes it difficult to evaluate capsular condition on the basis of glenohumeral range of motion measured by using the conventional technique. The purpose of this study was to measure isolated glenohumeral rotation, excluding side-to-side differences in humeral retroversion, in asymptomatic high-school baseball players. A total of 195 high-school baseball players (52 pitchers and 143 position players; median age, 16 years) and 20 high-school non-throwing athletes (median age, 16 years) without any shoulder symptoms were enroled in this study. Glenohumeral external and internal rotations were measured by using both a conventional technique and our ultrasound-assisted technique. This technique, neutral rotation, was standardized on the basis of the ultrasonographically visualized location of the bicipital groove to exclude side-to-side differences in humeral retroversion from the calculated rotation angle. Intra- and inter-observer agreements of rotational measurements were evaluated by using intra-class correlation coefficients (ICCs). Isolated glenohumeral rotation measurements, excluding side-to-side differences in humeral retroversion, demonstrated excellent intra-observer (ICC > 0.89) and inter-observer (ICC > 0.78) agreements. Isolated glenohumeral internal rotation was significantly less in the dominant shoulder than in the non-dominant shoulder in asymptomatic baseball players (P < 0.001). Isolated glenohumeral external rotation in baseball players was significantly greater than in non-throwing athletes (P < 0.05). In the baseball players, humeral torsion in the dominant shoulder was significantly greater than that in the non-dominant shoulder (P < 0.001), indicating that the retroversion angle was greater in dominant shoulders than

  3. The transverse occipital ligament: anatomy and potential functional significance.

    PubMed

    Tubbs, R Shane; Griessenauer, Christoph J; McDaniel, Jenny Gober; Burns, Amanda M; Kumbla, Anjali; Cohen-Gadol, Aaron A

    2010-03-01

    Knowledge of the anatomy of ligaments that bind the craniocervical junction is important for treating patients with lesions of this region. Although the anatomy and function of these ligaments have been well described, those of the transverse occipital ligament (TOL) have remained enigmatic. To describe the anatomy and functions of the transverse occipital ligament. Via a posterior approach, 9 cadaveric specimens underwent dissection of the craniocervical junction with special attention to the presence and anatomy of the TOL. The TOL was identified in 77.8% of the specimens. The ligament was found to be rectangular with fibers running horizontally between the lateral aspects of the foramen magnum. The attachment of each ligament near the occipital condyle was consistent, and each ligament was found superior to the transverse portion of the cruciform ligament and inserted just posterior to the lateral attachment sites of the alar ligaments. The average width, length, and thickness of the TOL was 0.34, 1.94, and 0.13 cm, respectively. The TOL in some specimens also had connections to the alar and transverse ligaments. The TOL was found in the majority of our specimens. The possible functions of this ligament when attached to the alar ligaments include providing additional support to these structures in stabilizing lateral bending, flexion, and axial rotation of the head. Knowledge of this ligament may aid in further understanding craniocervical stability and help in differentiating normal from pathology via imaging modalities.

  4. Anterior Cruciate Ligament Graft Choices

    PubMed Central

    Macaulay, Alec A.; Perfetti, Dean C.; Levine, William N.

    2012-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts. Evidence Acquisition: The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts. Results: Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost. Conclusions: Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft. PMID:23016071

  5. The posterior talofibular ligament: an anatomical study with clinical implication in clubfoot surgery.

    PubMed

    Courvoisier, Aurélien; Vialle, Raphaël; Thévenin-Lemoine, Camille; Mary, Pierre; Damsin, Jean-Paul

    2008-11-01

    The role of the posterior talofibular ligament (PTFL) in the clubfoot deformity remains unclear. We conducted an anatomical study to precise its topography and role in maintaining tibiotalar equinus in patients with clubfoot deformity. Ten ankles were dissected using a wide posterior exposure. The PTFL was identified at the posterior aspect of the ankle and its relations with other anatomical structures were noted. After opening of the tibiotalar and subtalar joints, the superior aspect of the PTFL was clearly seen, running horizontally from the fibula to a prominent tubercle on the posterior surface of the talus. The tibiotalar and subatalar joint capsules joined together laterally on the posterior edge of the PTFL and medially on the posterior part of the talus. A fibrous structure identified as being the "tibial slip" was noted in four cases between the posterior medial aspect of the lateral malleolus and the tibiotalar posterior capsule. Two different groups of fibers were identified inside the PTFL. Correcting the equinus and inversion of the talus needed an extensive release of soft tissues of the posterior part of the ankle. Our description of both short anterior and long posterior fibers of the PTFL improved our comprehension of functional anatomy of this ligament. We have found that PTFL is part of a posterior joint complex between the tibiotalar and subtalar joint. The posterior joint complex is a heritage of ankle evolution from a prehensile to a weight-bearing joint pattern. The inferior tibiofibular transverse ligament, the tibial slip and the calcaneofibular ligament are interpreted as derivatives of this ancestral meniscus and stabilize the weight-bearing ankle. Because the posterior fibers of the PTFL and the tibial slip are part of the complex, they should be excised like the posterior capsules during clubfoot surgery.

  6. Advanced imaging of the scapholunate ligamentous complex.

    PubMed

    Shahabpour, Maryam; Staelens, Barbara; Van Overstraeten, Luc; De Maeseneer, Michel; Boulet, Cedric; De Mey, Johan; Scheerlinck, Thierry

    2015-12-01

    The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.

  7. Lateralization Technique and Inferior Alveolar Nerve Transposition

    PubMed Central

    Sanches, Marco Antonio; Ramalho, Gabriel Cardoso; Manzi, Marcello Roberto

    2016-01-01

    Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. PMID:27433360

  8. An evidence-based review on the validity of the Kaltenborn rule as applied to the glenohumeral joint.

    PubMed

    Brandt, Corlia; Sole, Gisela; Krause, Maria W; Nel, Mariette

    2007-02-01

    Kaltenborn's convex-concave rule is a familiar concept in joint treatment techniques and arthrokinematics. Recent investigations on the glenohumeral joint appear to question this rule and thus accepted practice guidelines. An evidence-based systematic review was conducted to summarize and interpret the evidence on the direction of the accessory gliding movement of the head of the humerus (HOH) on the glenoid during physiological shoulder movement. Five hundred and eighty-one citations were screened. Data from 30 studies were summarized in five evidence tables with good inter-extracter agreement. The quality of the clinical trials rated a mean score of 51.27% according to the Physiotherapy Evidence Database scale (inter-rater agreement: kappa=-0.6111). Heterogeneity among studies precluded a quantitative meta-analysis. Weighting of the evidence according to Elwood;s classification and the Agency for Health Care Policy and Research classification guidelines indicated that evidence was weak and limited. Poor methodological quality, weak evidence, heterogeneity and inconsistent findings among the reviewed studies regarding the direction of translation of the HOH on the glenoid, precluded the drawing of any firm conclusions from this review. Evidence, however, indicated that not only the passive, but also the active and control subsystems of the shoulder may need to be considered when determining the direction of the translational gliding of the HOH. The indirect method, using Kaltenborn's convex-concave rule as applied to the glenohumeral joint, may therefore need to be reconsidered.

  9. Inferior Vena Cava Filters for Recurrent Thrombosis

    PubMed Central

    Patel, Salil H.; Patel, Rima

    2007-01-01

    Inferior vena cava filters are often used as alternatives to anticoagulant therapy for the prevention of pulmonary embolism. Many of the clinical data that support the use of these devices stem from relatively limited retrospective studies. The dual purpose of this review is to examine the incidence of thrombotic complications associated with inferior vena cava filters and to discuss the role of anticoagulant therapy concurrent with filter placement. Device-associated morbidity and overall efficacy can be considered only in the context of rates of vena cava thrombosis, insertion-site thrombosis, recurrent deep venous thrombosis, and recurrent pulmonary embolism. PMID:17622366

  10. Anatomic Anterolateral Ligament Reconstruction Improves Postoperative Clinical Outcomes Combined with Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Qiu, Man; Zhou, Aiguo; Zhang, Jian; Jiang, Dianming

    2016-01-01

    A significant cohort of patients is plagued by postoperative rotational instability after the anatomic anterior cruciate ligament (ACL) reconstruction surgery. Anatomic anterolateral ligament (ALL) reconstruction was performed in this study with the aim to assess the clinical role of ALL in knee’s stability and joint functions. Sixty patients were recruited and divided into three groups to perform the operations of anatomic single-bundle ACL reconstruction, anatomic double-bundle ACL reconstruction, and anatomic single-bundle ACL reconstruction + anterolateral ligament reconstruction, respectively. And then postoperative knee’s stability and joint functions were evaluated to compare the clinical outcomes among the three different kind of operations. The postoperative knee’s stability and joint functions of the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group were better than the anatomic single-bundle ACL reconstruction group. No significant difference was observed between the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group. The anatomic anterolateral ligament reconstruction could improve the clinical outcomes after patients performed the anatomic single-bundle anterior cruciate ligament reconstruction. This indicates that the anterolateral ligament plays a crucial role in knee’s stability and joint function, especially the rotational stability. Key points Anatomic anterolateral ligament reconstruction combined with anatomic anterior cruciate ligament reconstruction was performed to treat the patients with ACL rupture. Compared to the anatomic single-bundle ACL reconstruction group, the anatomic single-bundle ACL reconstruction + ALL reconstruction group achieve a better clinical outcomes. The results suggest that the anterolateral ligament plays a crucial role in knee’s stability and joint function

  11. Nonuniform distribution of collagen density in human knee ligaments.

    PubMed

    Mommersteeg, T J; Blankevoort, L; Kooloos, J G; Hendriks, J C; Kauer, J M; Huiskes, R

    1994-03-01

    It is generally recognized that the mechanical properties of soft connective tissues are affected by their structural components. We documented collagen density distributions in human knee ligaments to quantify differences in density within and between these ligaments. In order to explain the variations in mechanical properties within and between different knee ligaments as described in the literature, the distributions of collagen density were correlated with these biomechanical findings. Human knee ligaments were shown to be nonhomogeneous structures with regard to collagen density. The anterior bundles of all ligaments contained significantly more collagen mass per unit of volume than the posterior bundles did. The percentage differences between the anterior and posterior bundles, in relation to the posterior bundles, were about 25% for the anterior cruciate ligament (ACL) and the collateral ligaments and about 10% for the posterior cruciate ligament (PCL). Along the cruciate ligaments, the central segments had higher collagen densities than did segments adjacent to the ligament insertions (ACL 9%, PCL 24%). The collagen density in the ACL was significantly lower than that in the other ligaments. These variations within and between the ligaments correlate well with the variations in mechanical properties described in the literature; however, other structural differences have to be taken into account to fully explain the variations in mechanical properties from the structural components.

  12. The inferior medial genicular artery and its vascularization of the pes anserinus superficialis: A cadaveric study

    PubMed Central

    Hirtler, Lena; Ederer, Manuel; Faber, Mike; Weninger, Patrick

    2016-01-01

    Background: A common method for reconstruction of the anterior cruciate ligament (ACL) is it's replacement by a free avascular graft, using the gracilis and/or semitendinosus tendons. These grafts pass a vulnerable phase in the ligamentization-process during the 1st year after reconstruction. The aims of this study were first to evaluate the vascularization of the pes anserinus superficialis (PAS) by the inferior medial genicular artery (IMGA) and second to develop a pedunculated surgical technique for ACL reconstruction, to preserve a maximal amount of natural vascularization of the tendons inserting at the PAS. Materials and Methods: First, the vascularization of the PAS was assessed in 12 fresh-frozen lower extremities. The IMGA was identified at its origin at the popliteal artery and perfused with a methylene blue solution. Second, a pedunculated ACL reconstruction was performed in 5 fresh-frozen lower extremities under maintenance of the distal tendon insertion at PAS. Results: The PAS is a highly vascularized structure. Vessels originate from the IMGA, running along the three tendons of the PAS in the paratendinous tissue. Histologically intratendinous vessels exist; however, perfusion of the inserting tendons through intratendinous vessels was not proven macroscopically. The pedunculated grafts could be positioned and fixed successfully into the bone tunnels in all knees. Conclusion: Although intratendinous vascularization of the tendons of the PAS via the IMGA was not proven, this study indicates a new possibility of ACL reconstruction. The described operation technique can be conducive to shorten the vulnerable phase of the graft-ligamentization after ACL reconstruction. PMID:27904225

  13. Bioactive scaffolds for bone and ligament tissue.

    PubMed

    Guarino, Vincenzo; Causa, Filippo; Ambrosio, Luigi

    2007-05-01

    Bone and ligament injuries present the greatest challenges in connective tissue regeneration. The design of materials for these applications lies at the forefront of material science and is the epitome of its current ambition. Indeed, its goal is to design and fabricate reproducible, bioactive and bioresorbable 3D scaffolds with tailored properties that are able to maintain their structure and integrity for predictable times, even under load-bearing conditions. Unfortunately, the mechanical properties of today's available porous scaffolds fall short of those exhibited by complex human tissues, such as bone and ligament. The manipulation of structural parameters in the design of scaffolds and their bioactivation, through the incorporation of soluble and insoluble signals capable of promoting cell activities, are discussed as possible strategies to improve the formation of new tissues both in vitro and in vivo. This review focuses on the different approaches adopted to develop bioactive composite systems for use as temporary scaffolds for bone and anterior ligament regeneration.

  14. Tissue engineering of ligaments for reconstructive surgery.

    PubMed

    Hogan, MaCalus V; Kawakami, Yohei; Murawski, Christopher D; Fu, Freddie H

    2015-05-01

    The use of musculoskeletal bioengineering and regenerative medicine applications in orthopaedic surgery has continued to evolve. The aim of this systematic review was to address tissue-engineering strategies for knee ligament reconstruction. A systematic review of PubMed/Medline using the terms "knee AND ligament" AND "tissue engineering" OR "regenerative medicine" was performed. Two authors performed the search, independently assessed the studies for inclusion, and extracted the data for inclusion in the review. Both preclinical and clinical studies were reviewed, and the articles deemed most relevant were included in this article to provide relevant basic science and recent clinical translational knowledge concerning "tissue-engineering" strategies currently used in knee ligament reconstruction. A total of 224 articles were reviewed in our initial PubMed search. Non-English-language studies were excluded. Clinical and preclinical studies were identified, and those with a focus on knee ligament tissue-engineering strategies including stem cell-based therapies, growth factor administration, hybrid biomaterial, and scaffold development, as well as mechanical stimulation modalities, were reviewed. The body of knowledge surrounding tissue-engineering strategies for ligament reconstruction continues to expand. Presently, various tissue-engineering techniques have some potential advantages, including faster recovery, better ligamentization, and possibly, a reduction of recurrence. Preclinical research of these novel therapies continues to provide promising results. There remains a need for well-designed, high-powered comparative clinical studies to serve as a foundation for successful translation into the clinical setting going forward. Level IV, systematic review of Level IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  15. Assessing Posterior Shoulder Contracture: The Reliability and Validity of Measuring Glenohumeral Joint Horizontal Adduction

    PubMed Central

    Laudner, Kevin G; Stanek, Justin M; Meister, Keith

    2006-01-01

    Context: Increased contracture of the dominant posterior shoulder in throwing athletes has been associated with the development of altered shoulder rotational motion as well as several shoulder conditions. Clinicians must be able to accurately and reliably measure posterior shoulder contractures during the evaluation of such athletes in order to provide appropriate treatment. Objective: To evaluate the reliability and validity of assessing posterior shoulder contracture by measuring supine glenohumeral (GH) horizontal adduction. Design: Descriptive with repeated measures. Setting: The biomechanics laboratory at Illinois State University (Normal, IL) and the athletic training room in Surprise, AZ. Patients or Other Participants: Twenty-four shoulders were tested in 12 subjects (age = 21.9 ± 4.3 years, height = 175.0 ± 10.0 cm, mass = 82.4 ± 19.1 kg) for determination of reliability, and 46 shoulders were tested in 23 professional baseball pitchers (age = 21.25 ± 1.66 years, height = 190.0 ± 5.0 cm, mass = 88.45 ± 6.99 kg) for determination of validity. Main Outcome Measure(s): We examined intratester and intertester reliability over 3 testing sessions by having 2 examiners measure GH horizontal adduction with the subject in a supine position with the scapula stabilized. To determine the validity and clinical usefulness of this measurement, we examined the relationship between GH horizontal adduction motion and internal shoulder rotational motion among a group of baseball pitchers. Results: Intraclass correlation coefficients were high for intratester (0.93, SEM = 1.64°) and intertester (0.91, SEM = 1.71°) measurements. This measurement was also shown to have a moderate to good relationship with lost internal shoulder rotational motion ( r = .72, P = .001) of the dominant arm among the baseball pitchers. Conclusions: Based on the results of this study, we found that measuring GH horizontal adduction with the subject supine and the scapula stabilized is a

  16. Ankle instability and arthroscopic lateral ligament repair.

    PubMed

    Acevedo, Jorge I; Mangone, Peter

    2015-03-01

    Over the last 50 years, the surgical management of chronic lateral ankle ligament insufficiency has focused on 2 main categories: local soft-tissue reconstruction and tendon grafts/transfer procedures. There is an increasing interest in the arthroscopic solutions for chronic instability of the ankle. Recent biomechanical studies suggest the at least one of the arthroscopic techniques can provide equivalent results to current open local soft-tissue reconstruction (such as the modified Brostrom technique). Arthroscopic lateral ankle ligament reconstruction is becoming an increasingly acceptable method for the surgical management of chronic lateral ankle instability. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. The Biology of Bone and Ligament Healing.

    PubMed

    Cottrell, Jessica A; Turner, Jessica Cardenas; Arinzeh, Treena Livingston; O'Connor, J Patrick

    2016-12-01

    This review describes the normal healing process for bone, ligaments, and tendons, including primary and secondary healing as well as bone-to-bone fusion. It depicts the important mediators and cell types involved in the inflammatory, reparative, and remodeling stages of each healing process. It also describes the main challenges for clinicians when trying to repair bone, ligaments, and tendons with a specific emphasis on Charcot neuropathy, fifth metatarsal fractures, arthrodesis, and tendon sheath and adhesions. Current treatment options and research areas are also reviewed.

  18. Injuries of the scapholunate ligament in children.

    PubMed

    Alt, Volker; Gasnier, Jacky; Sicre, Gérard

    2004-09-01

    Wrist arthroscopy was performed in three children (9, 11 and 12 years old) after persisting pain over the dorsal scapholunate region and revealed intraligamentous tear of the scapholunate ligament in two cases and its avulsion from the scaphoid border in one case. Open surgical repair of all lesions was performed after arthroscopy during the same session. After an average follow-up of 2.4 years all patients were pain free and resumed all sports activities. This study shows that different kind of injuries can occur to the scapholunate ligament in the skeletally immature carpus. Surgical repair leads to good results.

  19. Cementless surface replacement hemiarthroplasty for primary glenohumeral osteoarthritis: results of over 5-year follow-up in patients with or without rotator cuff deficiency

    PubMed Central

    Al-Hadithy, Nawfal; Furness, Nicholas; Patel, Ronak; Jonas, Sam; Jobbagy, Attila; Lowdon, Ian

    2015-01-01

    Background Cementless surface replacement hemiarthroplasty (CSRHA) is an established treatment for glenohumeral osteoarthritis; however, studies evaluating its role in arthritis with rotator cuff deficiency are limited. This study reviews the outcomes of CSRHA for glenohumeral osteoarthritis with and without rotator cuff tears. Methods 41 CSRHA (Mark III Copeland prosthesis) were performed for glenohumeral osteoarthritis with intact rotator cuffs (n = 21) and cuff-deficient shoulders (n = 20). Patients were assessed using Oxford and Constant questionnaires, patient satisfaction, range of motion measurements and by radiography. Results Mean age and follow-up were 75 years and 5.1 years, respectively. Functional gains were significantly higher in patients with intact rotator cuffs compared to cuff-deficient shoulders, with Oxford Shoulder Score improving from 18 to 37.5 and 15 to 27 and forward flexion improved from 60° to 126° and 44° to 77° in each group, respectively. Two patients with deficient cuffs had deficient subscapularis tendons; one of which was dislocated anteriorly. Conclusions CSRHA provides significant improvements in pain and function in patients with glenohumeral osteoarthritis. In patients with deficient cuffs, functional gains are limited, and should be considered in low-demand patients where pain is the primary problem. Caution should be taken in patients with a deficient subscapularis as a result of the risk of dislocation. PMID:27582984

  20. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament.

    PubMed

    E Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor

    2015-01-01

    Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up.

  1. Efferent pathways modulate hyperactivity in inferior colliculus.

    PubMed

    Mulders, Wilhelmina Henrica A M; Seluakumaran, Kumar; Robertson, Donald

    2010-07-14

    Animal models have demonstrated that mild hearing loss caused by acoustic trauma results in spontaneous hyperactivity in the central auditory pathways. This hyperactivity has been hypothesized to be involved in the generation of tinnitus, a phantom auditory sensation. We have recently shown that such hyperactivity, recorded in the inferior colliculus, is still dependent on cochlear neural output for some time after recovery (up to 6 weeks). We have now studied the capacity of an intrinsic efferent system, i.e., the olivocochlear system, to alter hyperactivity. This system is known to modulate cochlear neural output. Anesthetized guinea pigs were exposed to a loud sound and after 2 or 3 weeks of recovery, single-neuron recordings in inferior colliculus were made to confirm hyperactivity. Olivocochlear axons were electrically stimulated and effects on cochlear neural output and on highly spontaneous neurons in inferior colliculus were assessed. Olivocochlear stimulation suppressed spontaneous hyperactivity in the inferior colliculus. This result is in agreement with our earlier finding that hyperactivity can be modulated by altering cochlear neural output. Interestingly, the central suppression was generally much larger and longer lasting than reported previously for primary afferents. Blockade of the intracochlear effects of olivocochlear system activation eliminated some but not all of the effects observed on spontaneous activity, suggesting also a central component to the effects of stimulation. More research is needed to investigate whether these central effects of olivocochlear efferent stimulation are due to central intrinsic circuitry or to coactivation of central efferent collaterals to the cochlear nucleus.

  2. TREM-1, HMGB1 and RAGE in the Shoulder Tendon: Dual Mechanisms for Inflammation Based on the Coincidence of Glenohumeral Arthritis

    PubMed Central

    Thankam, Finosh G.; Dilisio, Matthew F.; Dietz, Nicholas E.

    2016-01-01

    Rotator cuff injury (RCI) is a major musculoskeletal disorder in the adult population where inflammation and pain are major contributing factors. Coincidence of other clinical conditions like glenohumeral arthritis aggravates inflammation and delays the healing response. The mechanism and signaling factors underlying the sustenance of inflammation in the rotator cuff joint are largely unknown. The present article aims to elucidate the involvement of inflammatory molecule, TREM-1 (Triggering Receptors Expressed on Myeloid cells-1), and danger-associated molecular patterns (DAMPs), including high mobility group protein 1 (HMGB-1) and RAGE (receptor for advanced glycation end products), in the setting of RCI with respect to the severity of glenohumeral arthritis. Biceps tendons (15 specimens) from the shoulder and blood (11 samples) from patients with glenohumeral arthritis (Group-1, n = 4) and without glenohumeral arthritis (Group-2, n = 11) after RCI surgery were obtained for the study. Molecular and morphological alterations between the groups were compared using histology, immunofluorescence, RT-PCR and flow cytometry. MRI and histomorphology assessment revealed severe inflammation in Group-1 patients while in Group-2 ECM disorganization was prominent without any hallmarks of inflammation. A significant increase in TREM-1 expression in circulating neutrophils and monocytes was observed. Elevated levels of TREM-1, HMGB-1 and RAGE in Group-1 patients along with CD68+ and CD16+ cells confirmed DAMP-mediated inflammation. Expression of TREM-1 in the tendon of Group-2 patients even in the absence of immune cells presented a new population of TREM-expressing cells that were confirmed by real-time PCR analysis and immunofluorescence. Expression of HMGB-1 and RAGE in the biceps tendon from the shoulder of patients without glenohumeral arthritis implied TREM-1-mediated inflammation without involving immune cells, whereas in patients with glenohumeral arthritis

  3. Macroscopic and Microscopic Analysis of the Thumb Carpometacarpal Ligaments

    PubMed Central

    Ladd, Amy L.; Lee, Julia; Hagert, Elisabet

    2012-01-01

    Background: Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability. Methods: Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments. Results: Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p < 0.001) than the volar ligaments, with a significantly greater cellularity and greater sensory innervation compared with the anterior oblique ligament (p < 0.001). The anterior oblique ligament was consistently a thin structure with a histologic appearance of capsular tissue with low cellularity. Conclusions: The dorsal deltoid ligament

  4. Arthroscopic Repair of Superomedial Spring Ligament by Talonavicular Arthroscopy.

    PubMed

    Lui, Tun Hing

    2017-02-01

    A spring ligament tear can occur because of failure of the tibialis posterior tendon in adult-acquired flatfoot deformity or as an isolated injury with a normal tibialis posterior tendon. The superomedial spring ligament is the most common site of rupture. Compromise of this ligament is a primary causative factor of peritalar subluxation, and a functioning tibialis posterior tendon cannot prevent or correct a planovalgus foot deformity. Therefore, the spring ligament should be repaired in addition to treatment of tibialis posterior tendon abnormalities. The purpose of this technical note is to describe a minimally invasive approach for repair of the superomedial spring ligament by talonavicular arthroscopy.

  5. The role of the scapulo-thoracic and gleno-humeral joints in upper-limb motion in children with hemiplegic cerebral palsy.

    PubMed

    Brochard, Sylvain; Lempereur, Mathieu; Mao, Linda; Rémy-Néris, Olivier

    2012-08-01

    The pathophysiology of abnormal shoulder motion in children with hemiplegic cerebral palsy is not yet well understood. The aim of this study was to compare the motion of the two principle shoulder joints in children with hemiplegic cerebral palsy and typically developing children. 10 children in each group carried out 6 tasks recorded by an optoelectronic system. The analysis protocol was based on an acromion marker cluster, a functional method to determine the gleno-humeral rotation center and different Euler sequences thus providing three dimensional thoraco-humeral, scapulo-thoracic and gleno-humeral kinematics during upper-limb motion. In the children with hemiplegic cerebral palsy, the scapulo-thoracic joint was more protracted (P<0.05) and tended to be more laterally rotated depending on the tasks and the degree of humeral elevation. The gleno-humeral joint was limited in elevation (P<0.09), internal rotation (P<0.05) and plane of elevation (P<0.05) depending on the task. At rest, the orientation of the arm was more related to the scapular posture than to the gleno-humeral orientation, the latter which appeared to compensate the initial internal arm rotation at the beginning of the motion. The scapulo-thoracic joint plays a key role in arm posture at rest and during motion but does not seem to limit arm motion. The gleno-humeral joint compensates the scapula orientation at small degrees of humeral elevation but has a reduced total range of motion. Clinical management should focus on both joints taking into account their respective roles in upper-limb motion in this population. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Revisiting the clinical anatomy of the alar ligaments.

    PubMed

    Osmotherly, Peter G; Rivett, Darren A; Mercer, Susan R

    2013-01-01

    The morphology of the alar ligaments has been inconsistently described, particularly with regard to the existence of an atlantal portion. Despite these inconsistencies, these descriptions have been used to develop physical tests for the integrity of these ligaments in patients with cervical spine problems. The purpose of this study was to describe the detailed macrostructure of the alar ligaments. The alar ligaments of 11 cervical spine specimens from embalmed adult cadavers were examined by fine dissection. A detailed description of the macrostructure of these ligaments and their attachment sites was recorded. Measurements were performed with respect to ligament dimensions and relations with selected bony landmarks. No atlantal portion of the alar ligament was viewed in any specimen. The attachment of the ligaments on the odontoid process occurred on its lateral and posterolateral aspects, frequently below the level of the apex. The occipital attachment was on the medial surface of the occipital condyles in close proximity to the atlanto-occipital joints. The orientation of the ligaments was primarily horizontal. The presence of transverse bands extending occiput to occiput with minimal or no attachment to the odontoid process was a common variant. The absence of findings with respect to the atlantal portion of the alar ligament suggests that it may be considered an anatomical variant, not an essential component for stability of the craniocervical complex. These findings may inform the use and interpretation of clinical tests for alar ligament integrity.

  7. Ligament tissue engineering using synthetic biodegradable fiber scaffolds.

    PubMed

    Lin, V S; Lee, M C; O'Neal, S; McKean, J; Sung, K L

    1999-10-01

    Tissue engineering offers the possibility of replacing damaged human ligaments with engineered ligament tissues. Hence, we attempted to culture in vitro ligament tissues by seeding human anterior cruciate ligament (ACL) and medial collateral ligament (MCL) cells onto synthetic biodegradable polymer fiber scaffolds. The ACL and MCL cells readily attached to the scaffold fibers. These cells and their secreted matrix soon surrounded the scaffold fibers and bridged the gaps in between. Beginning at 2 weeks, portions of the scaffolds were completely filled with tissue matrix. By 5 weeks, the scaffolds became single bundles of tissue. Thus the cell/fiber system appears to be a viable system for culturing ligament tissues. Additionally, cell proliferation under mechanical and biochemical stimuli was studied for up to 4 days. Whereas mechanical stimulus and transforming growth factor enhanced proliferation, inflammatory agents (lipopolysaccharide and complement C5a) had a negative effect. This work can thus contribute to a sound strategy for culturing replacement ligament tissues in vitro.

  8. Ankle Arthroscopic Reconstruction of Lateral Ligaments (Ankle Anti-ROLL)

    PubMed Central

    Takao, Masato; Glazebrook, Mark; Stone, James; Guillo, Stéphane

    2015-01-01

    Ankle instability is a condition that often requires surgery to stabilize the ankle joint that will improve pain and function if nonoperative treatments fail. Ankle stabilization surgery may be performed as a repair in which the native existing anterior talofibular ligament or calcaneofibular ligament (or both) is imbricated or reattached. Alternatively, when native ankle ligaments are insufficient for repair, a reconstruction of the ligaments may be performed in which an autologous or allograft tendon is used to reconstruct the anterior talofibular ligament or calcaneofibular ligament (or both). Currently, ankle stabilization surgery is most commonly performed through an open incision, but arthroscopic ankle stabilization using repair techniques has been described and is being used more often. We present our technique for anatomic ankle arthroscopic reconstruction of the lateral ligaments (anti-ROLL) performed in an all–inside-out manner that is likely safe for patients and minimally invasive. PMID:26900560

  9. Ankle Arthroscopic Reconstruction of Lateral Ligaments (Ankle Anti-ROLL).

    PubMed

    Takao, Masato; Glazebrook, Mark; Stone, James; Guillo, Stéphane

    2015-10-01

    Ankle instability is a condition that often requires surgery to stabilize the ankle joint that will improve pain and function if nonoperative treatments fail. Ankle stabilization surgery may be performed as a repair in which the native existing anterior talofibular ligament or calcaneofibular ligament (or both) is imbricated or reattached. Alternatively, when native ankle ligaments are insufficient for repair, a reconstruction of the ligaments may be performed in which an autologous or allograft tendon is used to reconstruct the anterior talofibular ligament or calcaneofibular ligament (or both). Currently, ankle stabilization surgery is most commonly performed through an open incision, but arthroscopic ankle stabilization using repair techniques has been described and is being used more often. We present our technique for anatomic ankle arthroscopic reconstruction of the lateral ligaments (anti-ROLL) performed in an all-inside-out manner that is likely safe for patients and minimally invasive.

  10. Smart instrumentation for determination of ligament stiffness and ligament balance in total knee arthroplasty.

    PubMed

    Hasenkamp, W; Villard, J; Delaloye, J R; Arami, A; Bertsch, A; Jolles, B M; Aminian, K; Renaud, P

    2014-06-01

    Ligament balance is an important and subjective task performed during total knee arthroplasty (TKA) procedure. For this reason, it is desirable to develop instruments to quantitatively assess the soft-tissue balance since excessive imbalance can accelerate prosthesis wear and lead to early surgical revision. The instrumented distractor proposed in this study can assist surgeons on performing ligament balance by measuring the distraction gap and applied load. Also the device allows the determination of the ligament stiffness which can contribute a better understanding of the intrinsic mechanical behavior of the knee joint. Instrumentation of the device involved the use of hall-sensors for measuring the distractor displacement and strain gauges to transduce the force. The sensors were calibrated and tested to demonstrate their suitability for surgical use. Results show the distraction gap can be measured reliably with 0.1mm accuracy and the distractive loads could be assessed with an accuracy in the range of 4N. These characteristics are consistent with those have been proposed, in this work, for a device that could assist on performing ligament balance while permitting surgeons evaluation based on his experience. Preliminary results from in vitro tests were in accordance with expected stiffness values for medial collateral ligament (MCL) and lateral collateral ligament (LCL).

  11. Isolated unilateral rupture of the alar ligament.

    PubMed

    Wong, Sui-To; Ernest, Kimberly; Fan, Grace; Zovickian, John; Pang, Dachling

    2014-05-01

    Only 6 cases of isolated unilateral rupture of the alar ligament have been previously reported. The authors report a new case and review the literature, morbid anatomy, and pathogenesis of this rare injury. The patient in their case, a 9-year-old girl, fell head first from a height of 5 feet off the ground. She presented with neck pain, a leftward head tilt, and severe limitation of right rotation, extension, and right lateral flexion of the neck. Plain radiographs and CT revealed no fracture but a shift of the dens toward the right lateral mass of C-1. Magnetic resonance imaging of the cervical spine showed signal hyperintensity within the left dens-atlas space on both T1- and T2-weighted sequences and interruption of the expected dark signal representing the left alar ligament, suggestive of its rupture. After 12 weeks of immobilization in a Guilford brace, MRI showed lessened dens deviation, and the patient attained full and painless neck motion. Including the patient in this case, the 7 patients with this injury were between 5 and 21 years old, sustained the injury in traffic accidents or falls, presented with marked neck pain, and were treated with external immobilization. All patients had good clinical outcome. The mechanism of injury is hyperflexion with rotation. Isolated unilateral alar ligament rupture is a diagnosis made by excluding associated fracture, dislocation, or disruption of other major ligamentous structures in the craniovertebral junction. CT and MRI are essential in establishing the diagnosis. External immobilization is adequate treatment.

  12. Mouse models in tendon and ligament research.

    PubMed

    Mienaltowski, Michael J; Birk, David E

    2014-01-01

    Mutant mouse models are valuable resources for the study of tendon and ligament biology. Many mutant mouse models are used because their manifested phenotypes mimic clinical pathobiology for several heritable disorders, such as Ehlers-Danlos Syndrome and Osteogenesis Imperfecta. Moreover, these models are helpful for discerning roles of specific genes in the development, maturation, and repair of musculoskeletal tissues. There are several categories of genes with essential roles in the synthesis and maintenance of tendon and ligament structures. The form and function of these tissues depend highly upon fibril-forming collagens, the primary extracellular macromolecules of tendons and ligaments. Models for these fibril-forming collagens, as well as for regulatory molecules like FACITs and SLRPs, are important for studying fibril assembly, growth, and maturation. Additionally, mouse models for growth factors and transcription factors are useful for defining regulation of cell proliferation, cell differentiation, and cues that stimulate matrix synthesis. Models for membrane-bound proteins assess the roles of cell-cell communication and cell-matrix interaction. In some cases, special considerations need to be given to spatio-temporal control of a gene in a model. Thus, conditional and inducible mouse models allow for specific regulation of genes of interest. Advances in mouse models have provided valuable tools for gaining insight into the form and function of tendons and ligaments.

  13. Orientation feedback during simulated simple translation tests has little clinical significance on the magnitude and precision of glenohumeral joint translations.

    PubMed

    Musahl, Volker; Moore, Susan M; McMahon, Patrick J; Debski, Richard E

    2006-11-01

    The repeatability of shoulder instability clinical examinations has been reported to be poor, producing a large range of translations. The objective of this study was to determine the effect of providing the clinician with joint orientation feedback on the magnitude and precision of glenohumeral joint kinematics. A 6-degree of freedom magnetic tracking system was used to determine the kinematics of the humerus with respect to the scapula (n=8 cadaveric shoulders). The joints were preconditioned with simple loading tests five times. At 60 degrees of glenohumeral abduction and 0 degrees of flexion/extension, a clinician then applied an anterior and posterior load to the humerus until a manual maximum simulating a simple translation test (STT) was achieved at 0, 30, and 60 degrees of external rotation with and without angular orientation feedback of the humerus with respect to the scapula. The precision for the external rotation was within 4.3 degrees for the feedback group and 17.5 degrees for the no feedback group over all external rotations. For achieving the target external rotation of 30 degrees , there was a significant difference in precision between the feedback and no feedback groups (p<0.05). The magnitudes of the anterior translations were 18.2+/-5.3, 15.5+/-5.1, and 9.9+/-5.5 mm for the feedback group and 19.3+/-6.6, 17.5+/-4.9, and 11.5+/-5.3 mm for the no feedback group, at 0, 30, and 60 degrees of external rotation, respectively. There was a significant difference in the precision of anterior translation at 30 and 60 degrees of external rotation for 4 of 8 specimens (p<0.05). Significant differences in the precision of the posterior translation was only detected at 0 degrees of external rotation for 3 of 8 specimens (p<0.05). Based on the data obtained, providing orientation feedback to a clinician performing a simulated STT results in increased precision for not only the target external rotations but also the resulting glenohumeral translations. While

  14. Spray-painted human fibronectin coating as an effective strategy to enhance graft ligamentization of a polyethylene terephthalate artificial ligament.

    PubMed

    Li, Hong; Chen, Chen; Ge, Yunsheng; Chen, Shiyi

    2014-05-01

    To enhance graft ligamentization after anterior cruciate ligament (ACL) reconstruction, human fibronectin (FN) was coated on polyethylene terephthalate (PET) ligaments by spray painting. The FN-coated PET ligaments were investigated in vitro using rat mesenchymal stromal cells (MSCs). MSCs cultured on FN-coated grafts resulted in similar cell densities and amounts of proliferating cells with control grafts without coating. The FN-coated group not only gave rise to MSC-derived collagen-like tissues but also enhanced the expression of collagen-I gene. Furthermore, rat ACL reconstruction models were used to evaluate the effect of the FN coating in vivo. The FN coating significantly promoted new ligament tissue regeneration into the graft fibers. In conclusion, sprayed FN coating had a positive effect to enhance graft ligamentization of PET artificial ligament.

  15. Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology.

    PubMed

    Ladd, Amy L; Lee, Julia; Hagert, Elisabet

    2012-08-15

    Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability. Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments. Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p < 0.001) than the volar ligaments, with a significantly greater cellularity and greater sensory innervation compared with the anterior oblique ligament (p < 0.001). The anterior oblique ligament was consistently a thin structure with a histologic appearance of capsular tissue with low cellularity. The dorsal deltoid ligament complex is uniformly stout and robust; this

  16. Leiomyosarcoma arising from the inferior mesenteric vein

    PubMed Central

    Clemente, Gennaro; Sarno, Gerardo; Barbaro, Brunella; Nuzzo, Gennaro

    2009-01-01

    Leyomiosarcomas arising from the portal/mesenteric venous system are very rare tumours, and only a few cases have been reported in the global literature. As the other leyomiosarcomas of vascular origin, they are associated with a poor prognosis. The present report describes the case of a 66-year-old woman with a leyomiosarcoma of the inferior mesenteric vein, unexpectedly found during a CT scan performed for another indication. A brief review of the literature is also given. The patient underwent radical surgical excision and enjoys a good health, without radiological signs of recurrence, 24 months after surgery. In this case, an early incidental diagnosis determined an early treatment and, probably, a favourable prognosis. This is the second case of leyomiosarcoma of the inferior mesenteric vein reported in the literature. PMID:21686492

  17. Professional Pitchers With Glenohumeral Internal Rotation Deficit (GIRD) Display Greater Humeral Retrotorsion Than Pitchers Without GIRD.

    PubMed

    Noonan, Thomas J; Shanley, Ellen; Bailey, Lane B; Wyland, Douglas J; Kissenberth, Michael J; Hawkins, Richard J; Thigpen, Charles A

    2015-06-01

    Dominant shoulder glenohumeral internal rotation deficit (GIRD) has been associated with pitching arm injuries. The relationship of humeral torsion on development of GIRD is not clear. Pitchers displaying GIRD will display greater humeral retrotorsion when compared with those without GIRD. Cross-sectional study; Level of evidence, 3. Humeral torsion and shoulder range of motion (ROM) were measured in 222 professional pitchers before spring training from 2009 to 2012. Shoulder external rotation (ER) and internal rotation (IR) ROM were assessed in 90° of abduction with the scapula stabilized. Humeral torsion was measured via ultrasound using previously described and validated methods. Side-to-side differences in total arc of motion (ER + IR), ER, and IR ROM and humeral torsion were calculated as nondominant minus dominant arm measures for analysis. Pitchers were classified as having GIRD if their dominant arm displayed an IR deficit ≥15° concomitant with a total arc of motion deficit ≥10° compared with their nondominant arm. A mixed-model analysis of variance (side × GIRD) was used to compare dominant and nondominant humeral torsion between pitchers with GIRD (n = 60) and those without GIRD (n = 162). Independent t tests were used to compare the side-to-side difference in humeral torsion between pitchers with GIRD and those without GIRD (α = 0.05). Pitchers with GIRD displayed significantly less humeral torsion (ie, greater retrotorsion) in their dominant arm as compared with those without GIRD (GIRD = 4.5° ± 11.8°, no GIRD = 10.4° ± 11.7°; P = .002). Pitchers with GIRD also displayed a greater side-to-side difference in humeral torsion (GIRD = 19.5° ± 11.9°, no GIRD = 12.3° ± 12.4°; P = .001). However, pitchers with GIRD did not display an increase in dominant ER ROM (dominant ER = 131.8° ± 14.3°, nondominant ER 126.6° ± 13.1°) when compared with those without GIRD (dominant ER = 132.0° ± 14.2°, nondominant ER 122.6° ± 13.1°; P = .03

  18. A combination of Latarjet and Remplissage for treatment of severe glenohumeral instability and bone loss. A case report

    PubMed Central

    Ranne, Juha O.; Sarimo, Janne J.; Heinonen, Olli J.; Orava, Sakari Y.

    2013-01-01

    Recurrent glenohumeral instability is challenging to treat when large bony defects are present in the anterior glenoid and there is a large Hill–Sachs lesion. We present a case with extensive glenoid and humeral bone loss treated with open Latarjet procedure combined with posterior arthroscopic Remplissage. 3.5 years after surgery, there have been no dislocations or any subjective signs of instability. After half a year, the patient was able to return to work as an airline pilot. Constant score has improved from 33 to 74 and the Oxford instability score from 8 to 46. We find that in young patients with difficult instability combining the Latarjet and Remplissage is a good and replicable method. PMID:24403748

  19. Leiomyosarcoma of the Inferior Vena Cava

    PubMed Central

    Sadri, Ben Abid; Amine, Attaoui Mohamed; Zeineb, Mzoughi; Nizar, Miloudi; Lassad, Gharbi; Khalfallah, Mohamed Tahar

    2013-01-01

    Vascular leiomyosarcoma (LMS) are unique. The inferior vena cava (IVC) is the most affected organ (about 38% cases). We report the observation of a 50-year old woman who consulted for right upper quadrant pain. Imaging studies revealed a retroperitoneal mass that mimic a LMS of the IVC. The patient was operated. A resection of the IVC along with the tumor was performed without reconstruction. The management of LMS is surgical and depends upon the location and tumor characteristics. PMID:24765501

  20. Neck ligament strength is decreased following whiplash trauma

    PubMed Central

    Tominaga, Yasuhiro; Ndu, Anthony B; Coe, Marcus P; Valenson, Arnold J; Ivancic, Paul C; Ito, Shigeki; Rubin, Wolfgang; Panjabi, Manohar M

    2006-01-01

    Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95) mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the

  1. Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers.

    PubMed

    Wilk, Kevin E; Macrina, Leonard C; Fleisig, Glenn S; Porterfield, Ronald; Simpson, Charles D; Harker, Paul; Paparesta, Nick; Andrews, James R

    2011-02-01

    Glenohumeral internal rotation deficit (GIRD) indicates a 20° or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder. To determine whether GIRD and a deficit in total rotational motion (external rotation + internal rotation) compared with the nonthrowing shoulder correlate with shoulder injuries in professional baseball pitchers. Case series; Level of evidence, 4. Over 3 competitive seasons (2005 to 2007), passive range of motion measurements were evaluated on the dominant and nondominant shoulders for 170 pitcher-seasons. This included 122 professional pitchers during the 3 seasons of data collection, in which some pitchers were measured during multiple seasons. Ranges of motion were measured with a bubble goniometer during the preseason, by the same examiner each year. External and internal rotation of the glenohumeral joint was assessed with the participant supine and the arm abducted 90° in the plane of the scapula, with the scapula stabilized anteriorly at the coracoid process. The reproducibility of the test methods had an intraclass correlation coefficient of .81. Days in which the player was unable to participate because of injury or surgery were recorded during the season by the medical staff of the team and defined as an injury. Pitchers with GIRD (n = 40) were nearly twice as likely to be injured as those without but without statistical significance (P = .17). Pitchers with total rotational motion deficit greater than 5° had a higher rate of injury. Minor league pitchers were more likely than major league pitchers to be injured. However, when players were injured, major league pitchers missed a significantly greater number of games than minor league pitchers. Compared with pitchers without GIRD, pitchers with GIRD appear to be at a higher risk for injury and shoulder surgery.

  2. Cyclical loading of coracoclavicular ligament reconstructions: a comparative biomechanical study.

    PubMed

    Lee, Steven J; Keefer, Eric P; McHugh, Malachy P; Kremenic, Ian J; Orishimo, Karl F; Ben-Avi, Simon; Nicholas, Stephen J

    2008-10-01

    Reconstruction for injuries to the acromioclavicular joint remains controversial. A coracoclavicular ligament reconstruction with a semitendinosus tendon would have superior performance to the classic coracoacromial ligament transfer with or without augmentation. Controlled laboratory study. Five cadaveric shoulders were used to reconstruct the coracoclavicular ligaments with 3 methods: coracoacromial ligament transfer without augmentation, coracoacromial ligament transfer augmented with No. 5 Ethibond suture, and a semitendinosus tendon. Each reconstruction was cyclically loaded at 40 N to 80 N for 2500 cycles, then from 40 N to 210 N for 2500 cycles, followed by loading to failure. The number of cycles to 50% and 100% loss of acromioclavicular joint reduction were recorded. During the 40 N to 80 N-loading cycle, the coracoacromial transfer without augmentation failed (15 +/- 16 cycles). The augmented coracoacromial ligament transfer and the semitendinosus reconstruction did not fail (P = .008). During the 40 N to 210 N-loading cycle, the augmented coracoacromial ligament transfer failed (207 +/- 399 cycles). The semitendinosus reconstruction survived through both loading cycles (P < .01). Coracoclavicular ligament reconstruction with a semitendinosus graft is a biomechanically superior construct in a cyclically loaded setting to a coracoacromial ligament transfer augmented with a No. 5 Ethibond suture. The semitendinosus graft is a strong, biologic option for reconstruction of the coracoclavicular ligaments.

  3. Non-inferiority trials: are they inferior? A systematic review of reporting in major medical journals

    PubMed Central

    Morris, Tim P; Fielding, Katherine; Carpenter, James R; Phillips, Patrick P J

    2016-01-01

    Objective To assess the adequacy of reporting of non-inferiority trials alongside the consistency and utility of current recommended analyses and guidelines. Design Review of randomised clinical trials that used a non-inferiority design published between January 2010 and May 2015 in medical journals that had an impact factor >10 (JAMA Internal Medicine, Archives Internal Medicine, PLOS Medicine, Annals of Internal Medicine, BMJ, JAMA, Lancet and New England Journal of Medicine). Data sources Ovid (MEDLINE). Methods We searched for non-inferiority trials and assessed the following: choice of non-inferiority margin and justification of margin; power and significance level for sample size; patient population used and how this was defined; any missing data methods used and assumptions declared and any sensitivity analyses used. Results A total of 168 trial publications were included. Most trials concluded non-inferiority (132; 79%). The non-inferiority margin was reported for 98% (164), but less than half reported any justification for the margin (77; 46%). While most chose two different analyses (91; 54%) the most common being intention-to-treat (ITT) or modified ITT and per-protocol, a large number of articles only chose to conduct and report one analysis (65; 39%), most commonly the ITT analysis. There was lack of clarity or inconsistency between the type I error rate and corresponding CIs for 73 (43%) articles. Missing data were rarely considered with (99; 59%) not declaring whether imputation techniques were used. Conclusions Reporting and conduct of non-inferiority trials is inconsistent and does not follow the recommendations in available statistical guidelines, which are not wholly consistent themselves. Authors should clearly describe the methods used and provide clear descriptions of and justifications for their design and primary analysis. Failure to do this risks misleading conclusions being drawn, with consequent effects on clinical practice. PMID:27855102

  4. Anteroposterior translation of the glenohumeral joint in various pathologies: differences between shoulder MRI in the adducted neutral rotation and abducted externally rotated positions.

    PubMed

    Kim, Kyung Cheon; Rhee, Yong Girl; Park, Jin Young; Shin, Hyun Dae; Cha, Soo Min; Park, Jun Yeong; Han, Sun Cheol; Yang, Jae Hoon

    2015-09-01

    The present study was performed to determine the translation of the glenohumeral joint in patients with and without shoulder lesions by comparing the magnetic resonance images obtained in the conventional adducted neutral rotation position with those obtained in the abducted externally rotated position. Two hundred and eighty-five consecutive shoulders without rotator cuff tears that had been subjected to magnetic resonance imaging (MRI) without arthrography in the abducted externally rotated position were reviewed retrospectively. Among them, 50 shoulders without pathology were selected at random to be compared with three shoulder pathology groups, comprising shoulders with superior labrum, anterior-to-posterior (SLAP) lesions without range of motion (ROM) limitation (group I, 47 shoulders), with massive rotator cuff tears without ROM limitation (group II, 20 shoulders), and with full-thickness subscapularis tendon tears without ROM limitation (group III, 20 shoulders). Glenohumeral translation in the anterior-to-posterior direction relative to the glenoid face was evaluated using a method based on the glenohumeral contact point (CP) and humeral head centre (HHC) in the adducted neutral rotation and abducted externally rotated views, which were measured by three orthopaedic surgeons. For each shoulder, the differences in translation for the glenohumeral CP and HHC between the adducted neutral rotation and abducted externally rotated views were calculated as relative posterior translation in millimetres. The differences in ΔCP and ΔHHC between group I and the normal control group were not statistically significant. The differences in ΔCP (P = 0.001) and ΔHHC (P = 0.001) between group II and the normal control group were statistically significant. Additionally, the differences in ΔCP and ΔHHC between group III and the normal control group were not statistically significant. The MRI in abducted externally rotated view in patients with SLAP lesions or full

  5. Filtering through the data on retrievable inferior vena cava filters.

    PubMed

    Weinberg, Ido; Drachman, Douglas E

    2015-10-01

    Technical success rates with implantation and retrieval of retrievable inferior vena cava filters are high Inferior vena cava filters are being used for a wide range of indications Systems should be put in place to ensure prompt and effective retrieval of inferior vena cava filters once these are no longer needed. © 2015 Wiley Periodicals, Inc.

  6. Tarsal autografts for reconstruction of the scapholunate interosseous ligament: a biomechanical study.

    PubMed

    Hofstede, D J; Ritt, M J; Bos, K E

    1999-09-01

    A biomechanical cadaver study was performed to identify a potential bone-ligament-bone autograft from the foot for reconstruction of the scapholunate interosseous ligament (SLIL). In this study the biomechanical properties of 9 dorsal tarsal ligaments and the anterior tibiofibular ligament were investigated and compared with those of the dorsal part of the SLIL. Fifteen fresh-frozen human cadaver feet and 14 fresh-frozen human cadaver wrists were used. In a Monsanto Tensometer testing apparatus (Monsanto Limited Instruments, Dorean Swindon, England) the complexes were uniaxially elongated at a constant velocity of 6.35 mm/min until rupture occurred. The stiffness and strength values for each tarsal ligament were calculated and compared with those of the dorsal part of the SL ligament. Analysis indicated that the third dorsal tarsometatarsal ligament (143 +/- 42 N) and the dorsal calcaneocuboid ligament (149 +/- 41 N) were comparable to the dorsal part of the SL ligament (141 +/- 20 N) while all other ligaments were stronger. The stiffness values of the third dorsal tarsometatarsal ligament (67 +/- 17 N/mm) and the dorsal calcaneocuboid ligament (55 +/- 14 N/mm) were comparable to the dorsal part of the SL ligament (61 +/- 6 N/mm). All the other ligaments had values that were higher than the dorsal part of the SL ligament. The strongest ligament appeared to be the medial dorsal cuneonavicular ligament (479 +/- 65 N), which had a stiffness value of 127 +/- 19 N/mm. Although the third dorsal tarsometatarsal ligament and the dorsal calcaneocuboid ligament are biomechanically most similar to the dorsal part of the SLIL, at present it is unclear how strength and stiffness values of ligaments are sustained following transplantation. From this selection of tarsal ligaments, the medial dorsal cuneonavicular ligament is the strongest ligament and it is therefore concluded that this ligament is the most suitable ligament to be used as an autograft for reconstruction of the

  7. Knee mechanics after repair of the anterior cruciate ligament. A cadaver study of ligament augmentation.

    PubMed

    Engebretsen, L; Lew, W D; Lewis, J L; Hunter, R E

    1989-12-01

    An experimental knee-testing system was used to investigate the immediate postoperative mechanical state in knees with nonaugmented and augmented repairs of the anterior cruciate ligament. Ligament, repair tissue, and augmentation forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage during the application of 90 N anteriorly-directed tibial loads to seven fresh knee specimens at 0-90 degrees of flexion. Force and motion data were collected from each knee with an intact and excised anterior cruciate ligament, and after performing (1) a nonaugmented repair and an augmented repair using the Ligament Augmentation Device (3M Company) placed either (2) anatomically through the lateral femoral condyle or (3) in the over-the-top position. The forces in the nonaugmented repair and the repair with the augmentation in the two positions were greater than the forces in the intact anterior cruciate ligament with the knee under the same anterior loads; this difference from normal was not significant with the over-the-top augmentation. With the augmentation anatomically placed, the load sharing did not reduce the force in the repair tissue as compared with the nonaugmented case. The over-the-top augmentation, on the other hand, lowered the repair tissue forces at extension while avoiding high repair tissue forces in flexion. The tibia was consistently in an externally rotated configuration compared with normal in both the unloaded and anterior load states with all three repair procedures.

  8. Sonographic anatomy of the gastrohepatic ligament.

    PubMed

    Desai, Gaurav; Filly, Roy A

    2010-01-01

    The purpose of this presentation is to illustrate anatomic and pathologic features of the gastrohepatic ligament (GHL) and to show its usefulness for precise localization of abnormalities, particularly in relation to the lesser peritoneal cavity and diseases occurring within the confines of the ligament itself. Cases were selected that illustrate the objectives above. Illustrations show various anatomic and pathologic features meant to enhance interpretation of left upper quadrant sonograms. Illustrations seen in the sonographic literature vaguely interpret the relationships of the GHL. Misunderstanding has led not only to improper nomenclature but also to the use of inappropriate indicators of lesser omental diseases. With a clear understanding of the anatomy of the GHL and its use as a pivotal marker for structures around and within it, one can avoid these pitfalls and better evaluate adult and pediatric lesser omental anatomy.

  9. Essentials of anterior cruciate ligament rupture management.

    PubMed

    Klinge, Stephen A; Sawyer, Gregory A; Hulstyn, Michael J

    2013-05-01

    Anterior cruciate ligament (ACL) rupture is a common knee injury and an understanding of current medical knowledge regarding its management is essential. Accurate and prompt diagnosis requires an awareness of injury mechanisms and risk factors, common symptoms and physical/radiologic findings. Early mobilization and physical therapy improves outcomes regardless of treatment modality. Many older patients regain sufficient stability and function after non-operative rehabilitation. Early ACL reconstruction is appropriate for younger patients and those who engage in activities requiring frequent pivoting and rapid direction changes. ACL surgery involves reconstruction of the torn ligament tissue with various replacement graft options, each with advantages and disadvantages. The guidance of a knowledgeable and experienced therapist is required throughout an intensive and prolonged rehabilitation course. Generally excellent outcomes and low complication rates are expected, but treatment does not prevent late osteoarthritis.

  10. [Anterior cruciate ligament injuries in children].

    PubMed

    Tercier, S; Zambelli, P-Y

    2013-07-17

    An increasing number of anterior cruciate ligament injuries are now seen in children and girls seem to be equally affected. Such neglected or untreated lesions could be the cause of early degenerative changes. Recently, many authors support the trend toward early surgical management in skeletally immature patients with complex meniscal tear or recurrent knee instability after proper rehabilitation. Improvement in pediatric knowledge and surgical techniques tend to support a tendency for more surgical treatment in children. The type of management is choosing according to history and physical examination. Magnetic resonance imaging is a useful tool not only for diagnosis but also for surgical treatment planning. We usually recommend anterior cruciate ligament reconstruction in children with knee instability or with further damages to the joint.

  11. Anterior cruciate ligament reconstruction and knee osteoarthritis

    PubMed Central

    Paschos, Nikolaos K

    2017-01-01

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not. PMID:28361013

  12. Knee ligament injury during lateral impact.

    PubMed

    Hearon, B F; Brinkley, J W; Raddin, J H; Fleming, B W

    1985-01-01

    A volunteer woman subject incurred injury to her right knee consisting of a torn anterior cruciate ligament and stretched medial collateral ligament during a lateral (+Gy) impact test. Similar injury has not been reported in the English-language literature an accidental sideward automotive crashes or lateral impact experimentation involving humans. The primary mechanism which produced this injury was external tibial rotation on the femur with the knee flexed. The factors contributing to the injury included extraordinarily forceful leg bracing by the subject, her knee joint laxity or hypermobility, and the absence of side supports to limit lower extremity flailing during the impact response. In future lateral impact tests, women subjects should be used with caution and any subject with abnormal joint mobility should be excluded from participation.

  13. Normal vibration frequencies of the vocal ligament

    PubMed Central

    Titze, Ingo R.; Hunter, Eric J.

    2006-01-01

    The vocal ligament is the tension-bearing element in the vocal folds at high pitches. It has traditionally been treated as a vibrating string, with only length and longitudinal stress governing its normal mode frequencies. Results of this investigation show that, when bending stiffness and variable cross section are included, the lowest normal mode frequency can more than double, depending on the strain of the ligament. This suggests that much higher phonation frequencies may be achievable than heretofore thought for a given vocal fold length (e.g., nearly 1000 Hz at 50% elongation over cadaveric resting length). It also brings back into the discussion the concept of “damping,” an old misnomer for a reduction of the effective length of vibration of the vocal folds by relatively stiff boundary segments known as macula flavae. A formula is given for correcting the ideal string equation for the lowest mode frequency to include bending stiffness and macula flavae effects. PMID:15139637

  14. Normal vibration frequencies of the vocal ligament

    NASA Astrophysics Data System (ADS)

    Titze, Ingo R.; Hunter, Eric J.

    2004-05-01

    The vocal ligament is the tension-bearing element in the vocal folds at high pitches. It has traditionally been treated as a vibrating string, with only length and longitudinal stress governing its normal mode frequencies. Results of this investigation show that, when bending stiffness and variable cross section are included, the lowest normal mode frequency can more than double, depending on the strain of the ligament. This suggests that much higher phonation frequencies may be achievable than heretofore thought for a given vocal fold length (e.g., nearly 1000 Hz at 50% elongation over cadaveric resting length). It also brings back into the discussion the concept of ``damping,'' an old misnomer for a reduction of the effective length of vibration of the vocal folds by relatively stiff boundary segments known as macula flavae. A formula is given for correcting the ideal string equation for the lowest mode frequency to include bending stiffness and macula flavae effects.

  15. Mechanisms of Noncontact Anterior Cruciate Ligament Injury

    PubMed Central

    Shimokochi, Yohei; Shultz, Sandra J

    2008-01-01

    Objective: To examine and summarize previous retrospective and observational studies assessing noncontact anterior cruciate ligament (ACL) injury mechanisms and to examine such reported ACL injury mechanisms based on ACL loading patterns due to knee loadings reported in in vivo, in vitro, and computer simulation studies. Data Sources: We searched MEDLINE from 1950 through 2007 using the key words anterior cruciate ligament + injury + mechanisms; anterior cruciate ligament + injury + mechanisms + retrospective; and anterior cruciate ligament + injury + mechanisms + video analysis. Study Selection: We selected retrospective studies and observational studies that specifically examined the noncontact ACL injury mechanisms (n  =  7) and assessed ACL loading patterns in vivo, in vitro, and using computer simulations (n  =  33). Data Extraction: The motion patterns reported as noncontact ACL injury mechanisms in retrospective and observational studies were assessed and critically compared with ACL loading patterns measured during applied external or internal (or both) forces or moments to the knee. Data Synthesis: Noncontact ACL injuries are likely to happen during deceleration and acceleration motions with excessive quadriceps contraction and reduced hamstrings co-contraction at or near full knee extension. Higher ACL loading during the application of a quadriceps force when combined with a knee internal rotation moment compared with an external rotation moment was noted. The ACL loading was also higher when a valgus load was combined with internal rotation as compared with external rotation. However, because the combination of knee valgus and external rotation motions may lead to ACL impingement, these combined motions cannot be excluded from the noncontact ACL injury mechanisms. Further, excessive valgus knee loads applied during weight-bearing, decelerating activities also increased ACL loading. Conclusions: The findings from this review lend support to ACL

  16. Quantifying the Nonlinear, Anisotropic Material Response of Spinal Ligaments

    NASA Astrophysics Data System (ADS)

    Robertson, Daniel J.

    Spinal ligaments may be a significant source of chronic back pain, yet they are often disregarded by the clinical community due to a lack of information with regards to their material response, and innervation characteristics. The purpose of this dissertation was to characterize the material response of spinal ligaments and to review their innervation characteristics. Review of relevant literature revealed that all of the major spinal ligaments are innervated. They cause painful sensations when irritated and provide reflexive control of the deep spinal musculature. As such, including the neurologic implications of iatrogenic ligament damage in the evaluation of surgical procedures aimed at relieving back pain will likely result in more effective long-term solutions. The material response of spinal ligaments has not previously been fully quantified due to limitations associated with standard soft tissue testing techniques. The present work presents and validates a novel testing methodology capable of overcoming these limitations. In particular, the anisotropic, inhomogeneous material constitutive properties of the human supraspinous ligament are quantified and methods for determining the response of the other spinal ligaments are presented. In addition, a method for determining the anisotropic, inhomogeneous pre-strain distribution of the spinal ligaments is presented. The multi-axial pre-strain distributions of the human anterior longitudinal ligament, ligamentum flavum and supraspinous ligament were determined using this methodology. Results from this work clearly demonstrate that spinal ligaments are not uniaxial structures, and that finite element models which account for pre-strain and incorporate ligament's complex material properties may provide increased fidelity to the in vivo condition.

  17. Validation of Cooper's ligament thickness in software breast phantoms

    NASA Astrophysics Data System (ADS)

    Kuperavage, Adam J.; Imran, Abdullah-Al-Zubaer; Bakic, Predrag R.; Maidment, Andrew; Pokrajac, David D.

    2017-03-01

    Anthropomorphic breast phantoms are important tools for a wide range of tasks including pre-clinical validation of novel imaging techniques. In order to improve the realism in the phantoms, assessment of simulated anatomical structures is crucial. Thickness of simulated Cooper's ligaments influences the percentage of dense tissue, as well as qualitative and quantitative properties of simulated images. We introduce three methods (2-dimensional watershed, 3-dimensional watershed, and facet counting) to assess the thickness of the simulated Cooper's ligaments in the breast phantoms. For the validation of simulated phantoms, the thickness of ligaments has been measured and compared with the input thickness values. These included a total of 64 phantoms with nominal ligament thicknesses of 200, 400, 600, and 800 μm. The 2-dimensional and 3-dimensional watershed transformations were performed to obtain the median skeleton of the ligaments. In the 2-dimensional watershed, the median skeleton was found cross-section by cross-section, while the skeleton was found for the entire 3-dimensional space in the 3-dimensional watershed. The thickness was calculated by taking the ratio of the total volume of ligaments and the volume of median skeleton. In the facet counting method, the ligament thickness was estimated as a ratio between estimated ligaments' volume and average ligaments' surface area. We demonstrated that the 2-dimensional watershed technique overestimates the ligament thickness. Good agreement was found between the facet counting technique and the 3-dimensional watershed for assessing thickness. The proposed techniques are applicable for ligaments' thickness estimation on clinical breast images, provided segmentation of Cooper's ligaments has been performed.

  18. The spatiotemporal development of innervation in spinal ligaments of chickens.

    PubMed Central

    Jiang, H; Moreau, M; Greidanus, N; Bilo, J; Russell, G; Raso, J; Bagnall, K

    1996-01-01

    The development of the innervation of both central and lateral (intertransverse) spinal ligaments was investigated in chickens between the time of hatching and 13 wk of age. A total of 36 White Leghorn chickens in 4 groups of 9 at ages 0, 2, 7, and 13 wk were used. The spinal ligaments were dissected, serially sectioned and labelled with a monoclonal antibody against neurofilament protein and observed using either conventional fluorescence or confocal microscopy. Only a few nerve elements were found in the ligaments at hatching and these consisted simply of single nerve fibres and small nerve bundles. The number of nerve elements increased rapidly up to 7 wk of age when large nerve bundles and Ruffini corpuscles were also found. The number of nerve elements decreased between 7 and 13 wk birds when the ligaments had begun to ossify and the amount of collagenous ligamentous tissue was significantly reduced. The fluctuation in numbers of neural elements was due to changes in numbers of single nerve fibres and small nerve bundles rather than large nerve bundles and Ruffini corpuscles which remained constant. In contrast to this significant increase in numbers of nerve elements, the innervation density of the ligaments decreased because of the overwhelming increase of the ligament volume due to growth. There were no differences between ligaments on the left and right sides of the body, but there was an unequal distribution of the neural elements within the ligaments; most were found in the cranial third of the intertransverse ligaments. These results show that significant changes in innervation of spinal ligaments occur during development and reflect the possibility that damage to the ligaments during this time could produce significant and permanent damage, especially in relation to the maintenance of an erect spine. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:8771396

  19. The spatiotemporal development of innervation in spinal ligaments of chickens.

    PubMed

    Jiang, H; Moreau, M; Greidanus, N; Bilo, J; Russell, G; Raso, J; Bagnall, K

    1996-08-01

    The development of the innervation of both central and lateral (intertransverse) spinal ligaments was investigated in chickens between the time of hatching and 13 wk of age. A total of 36 White Leghorn chickens in 4 groups of 9 at ages 0, 2, 7, and 13 wk were used. The spinal ligaments were dissected, serially sectioned and labelled with a monoclonal antibody against neurofilament protein and observed using either conventional fluorescence or confocal microscopy. Only a few nerve elements were found in the ligaments at hatching and these consisted simply of single nerve fibres and small nerve bundles. The number of nerve elements increased rapidly up to 7 wk of age when large nerve bundles and Ruffini corpuscles were also found. The number of nerve elements decreased between 7 and 13 wk birds when the ligaments had begun to ossify and the amount of collagenous ligamentous tissue was significantly reduced. The fluctuation in numbers of neural elements was due to changes in numbers of single nerve fibres and small nerve bundles rather than large nerve bundles and Ruffini corpuscles which remained constant. In contrast to this significant increase in numbers of nerve elements, the innervation density of the ligaments decreased because of the overwhelming increase of the ligament volume due to growth. There were no differences between ligaments on the left and right sides of the body, but there was an unequal distribution of the neural elements within the ligaments; most were found in the cranial third of the intertransverse ligaments. These results show that significant changes in innervation of spinal ligaments occur during development and reflect the possibility that damage to the ligaments during this time could produce significant and permanent damage, especially in relation to the maintenance of an erect spine.

  20. Mechanical Properties of Lower Limb Tendons and Ligaments in Primates.

    DTIC Science & Technology

    1982-07-01

    AD-Ri28 797 MECHANICAL PROPERTIES OF LOWER LIMB TENDONS AND i/i LIGAMENTS IN PRIMATES(U) MICHIGAN STATE UNIV EAST LANSING DEPT OF BIOMECHAlNICS D J...filottifj by &task ember) Lower Limb Tendons and Ligaments Hysteresis Chimpanzee 316io"chanical. Response Relaxation 1bratory Loads Miechanical Stress...tweoey an Idwoth, by Week Member) Ibis report covers a study of the material property characteristics of four ligaments and tendons from the lover limbs

  1. Median arcuate ligament syndrome in athletes.

    PubMed

    Harr, Jeffrey N; Haskins, Ivy N; Brody, Fred

    2017-01-01

    Exercise-related transient abdominal pain (ETAP) is a common entity in young athletes. Most occurrences are due to a "cramp" or "stitch," but an uncommon, and often overlooked, etiology of ETAP is median arcuate ligament syndrome (MALS). The initial presentation of MALS typically includes postprandial nausea, bloating, abdominal pain, and diarrhea, but in athletes, the initial presentation may be ETAP. We present a case series of three athletes who presented with exercise-related transient abdominal pain and were ultimately diagnosed and treated for MALS. Unlike other patients with median arcuate ligament syndrome, these athletes presented with exercise-induced pain, rather than the common postprandial symptoms. These symptoms persisted despite conservative measures. Work-up of patients with suspected MALS include a computed tomography or magnetic resonance angiography showing compression of the celiac artery with post-stenotic dilation, or a celiac artery ultrasound demonstrating increased velocities (>200 cm/s(2)) with deep exhalation. All patients underwent a laparoscopic median arcuate ligament release. Postoperatively, there were no complications, and all were discharged home on postoperative day #2. All patients have subsequently returned to athletics with resolution of their symptoms. ETAP is common in athletes and often resolves with preventative or conservative strategies. When ETAP persists despite these methods, alternative causes, including MALS, should be considered. A combination of a thorough history and physical exam, as well as radiographic data, is essential to make the appropriate diagnosis and treatment strategy.

  2. [Responses of ligamentous fibroblasts to mechanical stimulation].

    PubMed

    Desrosiers, E A; Méthot, S; Yahia, L; Rivard, C H

    1995-01-01

    Mechanical stimulation, as provided by physiotherapy or controlled motion is essentially the only factor able to improve anterior cruciate ligament (ACL) healing. We investigate the cellular effects of such stimulus. Two types of stimulations are applied on canine ACL fibroblasts: repetitive stretch of an elastomeric adhesion substrate and a laminar flow of culture media over the culture surface. Cell orientation, proliferation rate, synthesis and type of collagen as well as proteoglycans (PG) synthesis and hydrodynamic characteristics have been studied. According to our results, the fibroblasts tend to align perpendicularly to the deformation axis of their substrate, and along a laminar flow. The shear stress induced by the laminar flow does not modify significantly proliferation rate nor extracellular matrix synthesis. Substrate stretching however, increases proliferation rate, collagen synthesis, mostly type III, and PG synthesis, principally of small sizes. The characteristics of fibroblasts submitted to repeated deformation match those of fibroblasts from ligament scar tissues. Their orientation perpendicular to substratum deformation differs from the one usually encountered in the undamaged tissue: aligned on the ligament axis.

  3. Ganglion cysts of the posterior cruciate ligament.

    PubMed

    Shetty, Gautam M; Nha, Kyung Wook; Patil, Sachin P; Chae, Dong Ju; Kang, Ki Hoon; Yoon, Jung Ro; Choo, Suk Kyu; Yi, Jeong Woo; Kim, Ji Hoon; Baek, Jong Ryoon

    2008-08-01

    Ganglion cysts of the posterior cruciate ligament (PCL) are uncommon lesions found incidentally on MRI and arthroscopy. Twenty patients (11 males and nine females) with the mean age of 35 years presenting with a variety of knee signs and symptoms were found to have PCL cysts on MRI. Out of these, thirteen patients (65%) had isolated symptomatic PCL cysts and seven patients had associated chondral and meniscal lesions. Eight out of the 20 patients (40%) gave a history of antecedent trauma. On arthroscopy, the majority of the cysts were situated at the midsubstance of the ligament with inter-cruciate distension and no involvement of the substance of the ligament. The content of the cysts varied with the majority having yellowish viscous fluid and three containing serous and bloody fluid. All cysts were successfully treated arthroscopically through standard anterior, posteromedial and posterolateral portals with no signs of recurrence on MRI at a mean followup of 24 months. PCL cysts may clinically mimic meniscal or chondral lesions and preoperatively, MRI is essential for the diagnosis of ganglion cysts arising from the PCL. Ganglion cysts of the PCL can be successfully treated arthroscopically using standard portals.

  4. Ligament Mediated Fragmentation of Viscoelastic Liquids

    NASA Astrophysics Data System (ADS)

    Keshavarz, Bavand; Houze, Eric C.; Moore, John R.; Koerner, Michael R.; McKinley, Gareth H.

    2016-10-01

    The breakup and atomization of complex fluids can be markedly different than the analogous processes in a simple Newtonian fluid. Atomization of paint, combustion of fuels containing antimisting agents, as well as physiological processes such as sneezing are common examples in which the atomized liquid contains synthetic or biological macromolecules that result in viscoelastic fluid characteristics. Here, we investigate the ligament-mediated fragmentation dynamics of viscoelastic fluids in three different canonical flows. The size distributions measured in each viscoelastic fragmentation process show a systematic broadening from the Newtonian solvent. In each case, the droplet sizes are well described by Gamma distributions which correspond to a fragmentation-coalescence scenario. We use a prototypical axial step strain experiment together with high-speed video imaging to show that this broadening results from the pronounced change in the corrugated shape of viscoelastic ligaments as they separate from the liquid core. These corrugations saturate in amplitude and the measured distributions for viscoelastic liquids in each process are given by a universal probability density function, corresponding to a Gamma distribution with nmin=4 . The breadth of this size distribution for viscoelastic filaments is shown to be constrained by a geometrical limit which can not be exceeded in ligament-mediated fragmentation phenomena.

  5. [Experimental subendocardial postero-inferior infarctions].

    PubMed

    Medrano, G A; de Micheli, A

    1990-01-01

    In 30 mongrel dog hearts, epicardial and thoracic unipolar records were obtained after myocardial damage was produced by infiltration of 96% alcohol in the postero-inferior free left ventricular wall. Necrosis was transmural in 5 cases, subendocardial in 11 and intramural in 10. In 4 dogs, intramural unipolar and bipolar leads were recorded in order to determine the electrical subendocardium and its relation to potentials of Purkinje's fibres. At the end of each experiment, left posterior subdivision block (LPSB) was provoked. In 90% of the cases, direct epicardial records were QS in transmural infarction, qrS or less frequently QRS in subendocardial ones, and rS or qRS in the presence of intramural necrosis. In several cases myocardial necrosis was located in the middle third instead of the inferior third, but the direct registries were similar. Nevertheless the surface leads (II, III and aVF) did not show abnormal Q waves or greater voltage of Q and S, but there were RS complexes in V1 and V2. In 80% of the cases, transmural necrosis of inferior third was manifested by QS complexes and subendocardial necrosis by rS or qRS complexes with increased Q and S waves and reduced R waves. LPSB masked the signs of necrosis. There is no justification for speaking of myocardial infarction with or without abnormal Q waves, because it does not add more precision. Moreover these expressions can create confusion in cases of middle or high posterior myocardial necrosis, revealed by RS complexes in V1 and V2.

  6. Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Bonasia, Davide Edoardo; D’Amelio, Andrea; Pellegrino, Pietro; Rosso, Federica; Rossi, Roberto

    2015-01-01

    Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes. PMID:26330991

  7. Design of Phase II Non-inferiority Trials.

    PubMed

    Jung, Sin-Ho

    2017-09-01

    With the development of inexpensive treatment regimens and less invasive surgical procedures, we are confronted with non-inferiority study objectives. A non-inferiority phase III trial requires a roughly four times larger sample size than that of a similar standard superiority trial. Because of the large required sample size, we often face feasibility issues to open a non-inferiority trial. Furthermore, due to lack of phase II non-inferiority trial design methods, we do not have an opportunity to investigate the efficacy of the experimental therapy through a phase II trial. As a result, we often fail to open a non-inferiority phase III trial and a large number of non-inferiority clinical questions still remain unanswered. In this paper, we want to develop some designs for non-inferiority randomized phase II trials with feasible sample sizes. At first, we review a design method for non-inferiority phase III trials. Subsequently, we propose three different designs for non-inferiority phase II trials that can be used under different settings. Each method is demonstrated with examples. Each of the proposed design methods is shown to require a reasonable sample size for non-inferiority phase II trials. The three different non-inferiority phase II trial designs are used under different settings, but require similar sample sizes that are typical for phase II trials.

  8. Optimal management of ulnar collateral ligament injury in baseball pitchers

    PubMed Central

    Hibberd, Elizabeth E; Brown, J Rodney; Hoffer, Joseph T

    2015-01-01

    The ulnar collateral ligament stabilizes the elbow joint from valgus stress associated with the throwing motion. During baseball pitching, this ligament is subjected to tremendous stress and injury if the force on the ulnar collateral ligament during pitching exceeds the physiological limits of the ligament. Injuries to the throwing elbow in baseball pitchers result in significant time loss and typically surgical intervention. The purpose of this paper is to provide a review of current information to sports medicine clinicians on injury epidemiology, injury mechanics, injury risk factors, injury prevention, surgical interventions, nonsurgical interventions, rehabilitation, and return to play outcomes in baseball pitchers of all levels. PMID:26635490

  9. Decompression of inferior alveolar nerve: case report.

    PubMed

    Marques, Tiago Miguel Santos; Gomes, Joana Marques

    2011-01-01

    Paresthesia as a result of mechanical trauma is one of the most frequent sensory disturbances of the inferior alveolar nerve. This case report describes surgical treatment for paresthesia caused by a compressive phenomenon within the mandibular canal. The cause of the compression, a broken instrument left in the patient's mouth during previous endodontic therapy, was identified during routine radiography and computed tomography. Once the foreign object was removed by surgery, the paresthesia resolved quickly. This case highlights the potential for an iatrogenic mechanical cause of paresthesia.

  10. Shear ligament phenomena in Fe3Al intermetallics and micromechanics of shear ligament toughening

    NASA Astrophysics Data System (ADS)

    Chiu, H.; Mao, X.

    1996-12-01

    The environment-assisted cracking behavior of a Fe3Al intermetallic in an air moisture environment was studied. At room temperature, tensile ductility was found to be increased with strain rate, from 10.1 pct at 1×10-6 s-1 to 14.3 pct at 2 × 10-3 s-1. When tensile tests were done in heat-treated mineral oil on specimens that have been heated in the oil for 4 hours at 200°C, ductility was found to be recovered. These results suggest the existence of hydrogen embrittlement. Shear ligaments, which are ligament-like structures connected between microcracks, were observed on the tensile specimens. They undergo ductile fracture by shearing and enhance fracture toughness. This toughness enhancement (represented by J l ) was estimated by a micromechanical model. The values of the unknown parameters, which are the average ligament lengthbar l, the area fraction V l , and the work-to-fracture τ 1 γ 1, were obtained from scanning electron microscopy (SEM) observation. The total fracture toughness K c and J l were reduced toward a slower strain rate. The experimental fracture toughness, K Q , was found to be increased with strain rate, from 35 MPasqrt m at 2.54×10-5 mm·s-1 to 47 MPasqrt m at 2.54×10-2 mm·s-1. The fact that strain rate has a similar effect on K Q and K c verifies the importance of shear ligament in determining fracture toughness of the alloy. With the presence of hydrogen, length and work-to-fracture of the shear ligament were reduced. The toughening effect caused by shear ligament was reduced, and the alloy would behave in a brittle manner.

  11. A new snowboard injury caused by "FLOW" bindings: a complete deltoid ligament and anterior talofibular ankle ligament rupture.

    PubMed

    Haverkamp, Daniel; Hoornenborg, Daniel; Maas, Mario; Kerkhoffs, Gino

    2014-05-01

    We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and existence of medial and lateral ankle ligament rupture without osseous and syndesmotic involvement and to create awareness of these types of injuries.

  12. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings - technical note.

    PubMed

    Ferreira, Marcio de Castro; Zidan, Flavio Ferreira; Miduati, Francini Belluci; Fortuna, Caio Cesar; Mizutani, Bruno Moreira; Abdalla, Rene Jorge

    2016-01-01

    Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation.

  13. Clinical follow-up of horses treated with allogeneic equine mesenchymal stem cells derived from umbilical cord blood for different tendon and ligament disorders.

    PubMed

    Van Loon, Vic J F; Scheffer, Carmen J W; Genn, Herman J; Hoogendoorn, Arie C; Greve, Jan W

    2014-01-01

    Mesenchymal stem cells (MSCs) offer promise as therapeutic aids in the repair of tendon and ligament disorders in sport horses. Equine allogeneic MSCs derived from umbilical cord blood (eUCB-MSCs) can be obtained in a minimally invasive fashion with successful propagation of MSCs. The objective of this study was to determine the applicability and therapeutic effect of eUCB-MSCs on tendinitis of the superficial digital flexor tendon, desmitis of the suspensory ligament, tendinitis of the deep digital flexor tendon, and desmitis of the inferior check ligament in clinical cases. A retrospective clinical study was performed. At two equine clinics, 52 warmblood horses were treated with cultured eUCB-MSCs between 2009 and 2012. About 2-10 × 10(6) cells per lesion were administered. When a lesion was treated twice, the total amount could run up to 20 × 10(6) cells. Pearson's chi-squared test was used to compare the effect of the injured structure on the success rate, as well as the effect of the age of the horse. Based on repeated examinations, 40 horses (77%) returned to work on the same or a higher level based on information provided by the owner. Neither the injured structure nor the age of the horse had a statistically significant influence on the result. Overall, the results of treatment of some tendon and ligament injuries with eUCB-MSCs in clinical cases are promising.

  14. Biomechanical Comparison of the Latarjet Procedure with and without Capsular Repair

    PubMed Central

    Kleiner, Matthew T.; Payne, William B.; McGarry, Michelle H.; Tibone, James E.

    2016-01-01

    Background The purpose of this study was to determine if capsular repair used in conjunction with the Latarjet procedure results in significant alterations in glenohumeral rotational range of motion and translation. Methods Glenohumeral rotational range of motion and translation were measured in eight cadaveric shoulders in 90° of abduction in both the scapular and coronal planes under the following four conditions: intact glenoid, 20% bony Bankart lesion, modified Latarjet without capsular repair, and modified Latarjet with capsular repair. Results Creation of a 20% bony Bankart lesion led to significant increases in anterior and inferior glenohumeral translation and rotational range of motion (p < 0.005). The Latarjet procedure restored anterior and inferior stability compared to the bony Bankart condition. It also led to significant increases in glenohumeral internal and external rotational range of motion relative to both the intact and bony Bankart conditions (p < 0.05). The capsular repair from the coracoacromial ligament stump to the native capsule did not significantly affect translations relative to the Latarjet condition; however it did cause a significant decrease in external rotation in both the scapular and coronal planes (p < 0.005). Conclusions The Latarjet procedure is effective in restoring anteroinferior glenohumeral stability. The addition of a capsular repair does not result in significant added stability; however, it does appear to have the effect of restricting glenohumeral external rotational range of motion relative to the Latarjet procedure performed without capsular repair. PMID:26929804

  15. Biomechanical Comparison of the Latarjet Procedure with and without Capsular Repair.

    PubMed

    Kleiner, Matthew T; Payne, William B; McGarry, Michelle H; Tibone, James E; Lee, Thay Q

    2016-03-01

    The purpose of this study was to determine if capsular repair used in conjunction with the Latarjet procedure results in significant alterations in glenohumeral rotational range of motion and translation. Glenohumeral rotational range of motion and translation were measured in eight cadaveric shoulders in 90° of abduction in both the scapular and coronal planes under the following four conditions: intact glenoid, 20% bony Bankart lesion, modified Latarjet without capsular repair, and modified Latarjet with capsular repair. Creation of a 20% bony Bankart lesion led to significant increases in anterior and inferior glenohumeral translation and rotational range of motion (p < 0.005). The Latarjet procedure restored anterior and inferior stability compared to the bony Bankart condition. It also led to significant increases in glenohumeral internal and external rotational range of motion relative to both the intact and bony Bankart conditions (p < 0.05). The capsular repair from the coracoacromial ligament stump to the native capsule did not significantly affect translations relative to the Latarjet condition; however it did cause a significant decrease in external rotation in both the scapular and coronal planes (p < 0.005). The Latarjet procedure is effective in restoring anteroinferior glenohumeral stability. The addition of a capsular repair does not result in significant added stability; however, it does appear to have the effect of restricting glenohumeral external rotational range of motion relative to the Latarjet procedure performed without capsular repair.

  16. The Effects of Latarjet Reconstruction on Glenohumeral Kinematics in the Presence of Combined Bony Defects: A Cadaveric Model.

    PubMed

    Patel, Ronak M; Walia, Piyush; Gottschalk, Lionel; Kuklis, Matthew; Jones, Morgan H; Fening, Steve D; Miniaci, Anthony

    2016-07-01

    Recurrent glenohumeral instability is often a result of underlying bony defects in the glenoid and/or humeral head. Anterior glenoid augmentation with a coracoid bone block (ie, Latarjet procedure) has been recommended for glenoid bone loss in the face of recurrent instability. However, no study has investigated the effect of Latarjet augmentation in the setting of both glenoid and humeral head defects (Hill-Sachs defects). To evaluate the glenohumeral kinematics of the Latarjet procedure in the presence of combined bony defects. Controlled laboratory study. Eighteen fresh-frozen cadaveric specimens void of all surrounding soft tissue were tested at all combinations of glenohumeral abduction (ABD) angles of 20°, 40°, and 60° and 3 external rotation (ER) levels of 0°, 40°, and 80°. Each experiment comprised anterior dislocation by translating the glenoid under a 50-N medial load applied on the humerus, simulating the static load of soft tissue. The primary outcome measurement was defined as the percentage of intact translation (normalized distance to dislocation). Specimens were tested in an intact condition (no defect), with different combinations of defects, and with Latarjet augmentation. The Latarjet procedure was performed for 20% and 30% glenoid defects by transferring the specimen's coracoid process anterior to the glenoid so that it was flush with the articulating surface. Results depended on the position of the arm. At 20° of ABD and 0° of ER, a 20% glenoid defect decreased the percentage of intact translation regardless of the humeral head defect size (P ≤ .0001). In this same setting, Latarjet reconstruction restored translation to dislocation greater than the native intact joint for all sizes of humeral head defects. At 60° of ABD and 80° of ER, a 20% glenoid defect led to an overall decrease in translation to dislocation with increasing humeral head defects. While Latarjet augmentation resulted in increased translation to dislocation for all

  17. Can the ream and run procedure improve glenohumeral relationships and function for shoulders with the arthritic triad?

    PubMed

    Matsen, Frederick A; Warme, Winston J; Jackins, Sarah E

    2015-06-01

    The arthritic triad of glenoid biconcavity, glenoid retroversion, and posterior displacement of the humeral head on the glenoid is associated with an increased risk of failure of total shoulder joint replacement. Although a number of glenohumeral arthroplasty techniques are being used to manage this complex pathology, problems with glenoid component failure remain. In that the ream and run procedure manages arthritic pathoanatomy without a glenoid component, we sought evidence that this procedure can be effective in improving the centering of the humeral head contact on the glenoid and in improving the comfort and function of shoulders with the arthritic triad without the risk of glenoid component failure. We asked, for shoulders with the arthritic triad, whether the ream and run procedure could improve glenohumeral relationships as measured on standardized axillary radiographs and patient-reported shoulder comfort and function as recorded by the Simple Shoulder Test. Between January 1, 2006 and December 14, 2011, we performed 531 primary anatomic glenohumeral arthroplasties for arthritis, of which 221 (42%) were ream and run procedures. Of these, 30 shoulders in 30 patients had the ream and run procedure for the arthritic triad and had two years of clinical and radiographic follow-up. These 30 shoulders formed the basis for this case series. The average age of the patients was 56 ± 8 years; all but one were male. Two of the 30 patients requested revision to total shoulder arthroplasty within the first year after their ream and run procedure because of their dissatisfaction with their rehabilitation progress. For the 28 shoulders not having had a revision, we determined on the standardized axillary views before and after surgery the glenoid type, glenoid version (90° minus the angle between the plane of the glenoid face and the plane of the body of the scapula), and location of the humeral contact point with respect to the anteroposterio dimension of the

  18. Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability.

    PubMed

    Moros, Chris; Ahmad, Christopher S

    2009-08-01

    Bone deficiencies of either the humeral head or glenoid fossa may cause recurrent shoulder instability following soft tissue stabilization procedures. The engaging Hill-Sachs lesion, a major risk factor for instability, has been identified in a majority of patients with recurrent anterior instability. Guidance for surgical management of large humeral head deficiency presents few available options, with even fewer clinical data to support any one technique. Anteroinferior glenoid deficiency has also been a well-documented source of recurrent instability. The Latarjet coracoid transfer procedure corrects the glenoid defect by restoring the architecture of the inferior rim. Although coracoid transfer addresses containment on the glenoid, a concomitant large humeral head defect is at risk for engagement on the corrected glenoid. This article describes a case of a 50-year-old man presenting with recurrent right shoulder dislocations status post-open stabilization procedure 10 years prior. Radiologic evaluation demonstrated a large Hill-Sachs lesion with adjacent chondral derangement and a nonunion bony Bankart lesion. The Arthrosurface HemiCap humeral head resurfacing prosthesis (Arthrosurface Inc, Franklin, Massachusetts) was used to address the Hill-Sachs lesion with a Latarjet coracoid transfer procedure. We were unable to identify examples in the literature of the HemiCap used in the correction of a Hill-Sachs lesion for recurrent anterior instability. The HemiCap prosthesis has the benefit of correcting the Hill-Sachs lesion and adjacent chondral defect while preserving uninvolved articular surface. The combination of surgical interventions produced a successful result.

  19. Regulatory Scientific Advice on Non-Inferiority Drug Trials

    PubMed Central

    Knol, Mirjam J.; Klungel, Olaf H.; Gispen-De Wied, Christine C.; de Boer, Antonius; Hoes, Arno W.; Leufkens, Hubert G.; Mantel-Teeuwisse, Aukje K.

    2013-01-01

    The active-controlled trial with a non-inferiority design has gained popularity in recent years. However, non-inferiority trials present some methodological challenges, especially in determining the non-inferiority margin. Regulatory guidelines provide some general statements on how a non-inferiority trial should be conducted. Moreover, in a scientific advice procedure, regulators give companies the opportunity to discuss critical trial issues prior to the start of the trial. The aim of this study was to identify potential issues that may benefit from more explicit guidance by regulators. To achieve this, we collected and analyzed questions about non-inferiority trials posed by applicants for scientific advice in Europe in 2008 and 2009, as well as the responses given by the European Medicines Agency (EMA). In our analysis we included 156 final letters of advice from 2008 and 2009, addressed to 94 different applicants (manufacturers). Our analysis yielded two major findings: (1) applicants frequently asked questions ‘whether’ and ‘how’ to conduct a non-inferiority trial, 26% and 74%, respectively, and (2) the EMA regulators seem mainly concerned about the choice of the non-inferiority margin in non-inferiority trials (36% of total regulatory answers). In 40% of the answers, the EMA recommended using a stricter margin, and in 10% of the answers regarding non-inferiority margins, the EMA questioned the justification of the proposed non-inferiority margin. We conclude that there are still difficulties in selecting the appropriate methodology for non-inferiority trials. Straightforward and harmonized guidance regarding non-inferiority trials is required, for example on whether it is necessary to conduct such a trial and how the non-inferiority margin is determined. It is unlikely that regulatory guidelines can cover all therapeutic areas; therefore, in some cases regulatory scientific advice may be used as an opportunity for tailored advice. PMID:24040346

  20. Surgical treatment of lateral clavicle fractures associated with complete coracoclavicular ligament disruption: Clinico-radiological outcomes of acromioclavicular joint sparing and spanning implants

    PubMed Central

    Bhatia, Deepak N.; Page, Richard S.

    2012-01-01

    Purpose: Distal clavicle fracture associated with complete coracoclavicular ligament disruption represents an unstable injury, and osteosynthesis is recommended. This study was performed (1) to retrospectively analyse the clinico-radiological outcomes of two internal fixation techniques, and (2) to identify and analyse radiographic fracture patterns of fracture that are associated with this injury. Materials and Methods: A total of 15 patients underwent osteosynthesis with either (1) acromioclavicular joint-spanning implants (Group 1, Hook plate device, n = 10) or (2) joint-sparing implants (Group 2, distal radius plate, n = 5); these were reviewed at a mean period of 26.1 months (12 to 40 months). Clinical outcomes were measured using Constant Score (CS), Simple Shoulder Test (SST), and Walch ACJ score (WS). Radiographs and ultrasonography were used to assess the glenohumeral and acromioclavicular joints, and the subacromial space. Preoperative radiographs were analyzed for assessment of fracture lines to identify radiographic patterns. Statistical analysis of the data was performed to determine any significant differences between the two groups. Results: The overall clinical outcome was satisfactory (CS 80.8, SST 11.3, WS 17.6) and a high union rate (93.3%) was observed. Radiographic complications (acromioclavicular degeneration and subluxation, hook migration, abnormal ossification) did not negatively influence the final clinical outcomes. Four distinct radiographic fracture patterns were observed. A statistically significant difference ( P < 0.05) was observed in the reoperation rates between the two groups. Conclusions: Internal fixation of this fracture pattern is associated with a high union rate and favorable clinical outcomes with both techniques. A combination of distal radius plate and ligament reconstruction device resulted in stable fixation and significantly lower reoperation rates, and should be used when fracture geometry permits (Types 1 and 2

  1. A Profile of Glenohumeral Internal and External Rotation Motion in the Uninjured High School Baseball Pitcher, Part I: Motion

    PubMed Central

    Hurd, Wendy J.; Kaplan, Kevin M.; ElAttrache, Neal S.; Jobe, Frank W.; Morrey, Bernard F.; Kaufman, Kenton R.

    2011-01-01

    Context: The magnitude of motion that is normal for the throwing shoulder in uninjured baseball pitchers has not been established. Chronologic factors contributing to adaptations in motion present in the thrower's shoulder also have not been established. Objectives: To develop a normative profile of glenohumeral rotation motion in uninjured high school baseball pitchers and to evaluate the effect of chronologic characteristics on the development of adaptations in shoulder rotation motion. Design: Cohort study. Setting: Baseball playing field. Patients or Other Participants: A total of 210 uninjured male high school baseball pitchers (age = 16±1.1 years, height = 1.8 + 0.1 m, mass = 77.5±11.2 kg, pitching experience = 6±2.3 years). Intervention(s): Using standard goniometric techniques, we measured passive rotational glenohumeral range of motion bilaterally with participants in the supine position. Main Outcome Measure(s): Paired t tests were performed to identify differences in motion between limbs for the group. Analysis of variance and post hoc Tukey tests were conducted to identify differences in motion by age. Linear regressions were performed to determine the influence of chronologic factors on limb motion. Results: Rotation motion characteristics for the population were established. We found no difference between sides for external rotation (ER) at 0° of abduction (t209 = 0.658, P = .51), but we found side-to-side differences in ER (t209 = −13.012, P<.001) and internal rotation (t209 = 15.304, P<.001) at 90° of abduction. Age at the time of testing was a significant negative predictor of ER motion for the dominant shoulder (R2 = 0.019, P = .049) because less ER motion occurred at the dominant shoulder with advancing age. We found no differences in rotation motion in the dominant shoulder across ages (F4,205 range, 0.451–1.730, P>.05). Conclusions: This range-of-motion profile might be used to assist with the interpretation of normal and atypical

  2. Deficits in glenohumeral passive range of motion increase risk of elbow injury in professional baseball pitchers: a prospective study.

    PubMed

    Wilk, Kevin E; Macrina, Leonard C; Fleisig, Glenn S; Aune, Kyle T; Porterfield, Ron A; Harker, Paul; Evans, Timothy J; Andrews, James R

    2014-09-01

    Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Cohort study; Level of evidence, 2. For 8 consecutive years (2005-2012), passive range of motion of both the throwing and nonthrowing shoulders of all major and minor league pitchers within a single professional baseball organization were measured by using a bubble goniometer during spring training. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral external rotation and internal rotation were assessed in the supine position with the arm at 90° of abduction and in the plane of the scapula. The scapula was stabilized per methods previously established. Total rotation was defined as the sum of external rotation and internal rotation. Passive shoulder flexion was assessed with the subject supine and the scapula stabilized per methods previously established. Elbow injuries and days missed because of elbow injuries were assessed and recorded by the medical staff of the team. Throwing and nonthrowing shoulder measurements were compared by using Student t tests; 1-tailed Fisher exact tests were performed to identify significant associations between shoulder motion and elbow injury. Nominal logistic regression was performed to determine the odds of elbow injury. Significant differences were noted during side-to-side comparisons within subjects. There were 49 elbow injuries and 8 surgeries in 38 players, accounting for a total of 2551 days missed. Neither glenohumeral internal rotation deficit nor external rotation insufficiency was correlated with elbow injuries. Pitchers with deficits of >5° in total rotation in their throwing shoulders had a 2.6 times greater risk for injury. Pitchers with deficit of ≥5° in flexion of the throwing shoulder had

  3. Posterior Capsular Plication Constrains the Glenohumeral Joint by Drawing the Humeral Head Closer to the Glenoid and Resisting Abduction.

    PubMed

    DeAngelis, Joseph P; Hertz, Benjamin; Wexler, Michael T; Patel, Nehal; Walley, Kempland C; Harlow, Ethan R; Manoukian, Ohan S; Masoudi, Aidin; Vaziri, Ashkan; Ramappa, Arun J; Nazarian, Ara

    2015-08-01

    Shoulder pain is a common problem, with 30% to 50% of the American population affected annually. While the majority of these shoulder problems improve, there is a high rate of recurrence, as 54% of patients experience persistent symptoms 3 years after onset. Posterior shoulder tightness has been shown to alter glenohumeral (GH) kinematics. Clinically, posterior shoulder contractures result in a significant loss of internal rotation and abduction (ABD). In this study, the effect of a posterior capsular contracture on GH kinematics was investigated using an intact cadaveric shoulder without violating the joint capsule or the rotator cuff. Controlled laboratory study. Glenohumeral motion, humeral load, and subacromial contact pressure were measured in 6 fresh-frozen left shoulders during passive ABD from 60° to 100° using an automated robotic upper extremity testing system. Baseline values were compared with the experimental condition in which the full thickness of posterior tissues was plicated without decompressing the joint capsule. Posterior soft tissue plication resulted in increased compression between the humeral head and the glenoid (axial load) at 90° of ABD. Throughout ABD, the posterior contracture increased the anterior and superior moment on the humeral head, but it did not change the GH kinematics in this intact model. As a result, there was no increase in the subacromial contact pressure during ABD with posterior plication. In an intact cadaveric shoulder, posterior contracture does not alter GH motion or subacromial contact pressure during passive ABD. By tightening the soft tissue envelope posteriorly, there is an increase in compressive load on the articular cartilage and anterior/superior force on the humeral head. These findings suggest that subacromial impingement in the setting of a posterior soft tissue contracture may result from alterations in scapulothoracic motion, not changes in GH kinematics. This investigation demonstrates that

  4. Posterior Capsular Plication Constrains the Glenohumeral Joint by Drawing the Humeral Head Closer to the Glenoid and Resisting Abduction

    PubMed Central

    DeAngelis, Joseph P.; Hertz, Benjamin; Wexler, Michael T.; Patel, Nehal; Walley, Kempland C.; Harlow, Ethan R.; Manoukian, Ohan S.; Masoudi, Aidin; Vaziri, Ashkan; Ramappa, Arun J.; Nazarian, Ara

    2015-01-01

    Background: Shoulder pain is a common problem, with 30% to 50% of the American population affected annually. While the majority of these shoulder problems improve, there is a high rate of recurrence, as 54% of patients experience persistent symptoms 3 years after onset. Purpose: Posterior shoulder tightness has been shown to alter glenohumeral (GH) kinematics. Clinically, posterior shoulder contractures result in a significant loss of internal rotation and abduction (ABD). In this study, the effect of a posterior capsular contracture on GH kinematics was investigated using an intact cadaveric shoulder without violating the joint capsule or the rotator cuff. Study Design: Controlled laboratory study. Methods: Glenohumeral motion, humeral load, and subacromial contact pressure were measured in 6 fresh-frozen left shoulders during passive ABD from 60° to 100° using an automated robotic upper extremity testing system. Baseline values were compared with the experimental condition in which the full thickness of posterior tissues was plicated without decompressing the joint capsule. Results: Posterior soft tissue plication resulted in increased compression between the humeral head and the glenoid (axial load) at 90° of ABD. Throughout ABD, the posterior contracture increased the anterior and superior moment on the humeral head, but it did not change the GH kinematics in this intact model. As a result, there was no increase in the subacromial contact pressure during ABD with posterior plication. Conclusion: In an intact cadaveric shoulder, posterior contracture does not alter GH motion or subacromial contact pressure during passive ABD. By tightening the soft tissue envelope posteriorly, there is an increase in compressive load on the articular cartilage and anterior/superior force on the humeral head. These findings suggest that subacromial impingement in the setting of a posterior soft tissue contracture may result from alterations in scapulothoracic motion, not

  5. Acromioclavicular joint reconstruction with the LARS ligament in professional versus non-professional athletes.

    PubMed

    Marcheggiani Muccioli, Giulio Maria; Manning, Christopher; Wright, Philip; Grassi, Alberto; Zaffagnini, Stefano; Funk, Lennard

    2016-06-01

    To compare outcomes of acromioclavicular (AC) joint reconstruction with ligament augmentation and reconstruction system (LARS) ligament in professional and non-professional athletes at 2-year minimum follow-up. Forty-three patients (men; mean age 30, range 19-54 years) with Rockwood type III to V chronic AC joint dislocations underwent AC joint reconstruction with LARS ligament and standardized rehabilitation. Patients were divided into two groups: professionals (22) and non-professionals (21). Clinical and radiological evaluations were performed preoperatively, at 3- and 24-month follow-up. All clinical (Oxford and Constant) scores and patient satisfaction improved significantly from preoperative to follow-up intervals (p < 0.00001). However, professionals showed nonsignificant improvements from 3- to 24-month follow-up in Constant. Although groups differed preoperatively in Constant (p = 0.037), they were not different in preoperative-to-postoperative differences in clinical scores, postoperative final satisfaction and median time to return to unrestricted activity [4 (interquartiler range 3-5) months to return to full sport in professionals]. Follow-up radiographs revealed an AC joint ratio (clavicle inferior-to-superior translation as ratio of AC joint height) of 0.09 and 0.16 in 8/22 professionals, 0.19 and 0.31 in 9/21 non-professionals, 0.14 and 0.24 in 17/43 overall patients at 3- and 24-month follow-up, respectively. Slight loss of reduction (0.25 < AC joint ratio < 0.50): 21 %. There were no significant clinical-radiographic correlations. Complication: one coracoid fracture at follow-up and one wound infection. AC joint reconstruction with LARS ligament did not reveal differences in clinical outcomes between groups, with 2 % of failures (re-dislocations) at 2-year minimum follow-up. Superior radiological outcomes in professionals were not correlated to clinical results. Therapeutic study-prospective comparative study, Level II.

  6. Spring Ligament Complex and Posterior Tibial Tendon: MR Anatomy and Findings in Acquired Adult Flatfoot Deformity.

    PubMed

    Mengiardi, Bernard; Pinto, Clinton; Zanetti, Marco

    2016-02-01

    The spring ligament complex is an important stabilizer of the medial ankle, together with the posterior tibial tendon (PTT) and the deltoid ligament complex. Lesions in these stabilizers result in acquired adult flatfoot deformity. The spring ligament complex includes three ligaments: the superomedial calcaneonavicular ligament, the medioplantar oblique calcaneonavicular ligament, and the inferoplantar longitudinal calcaneonavicular ligament. Normal MR imaging anatomy of the spring ligament complex and the PTT are described and illustrated in detail. Isolated lesions of the spring ligament complex are rare. In most cases, spring ligament complex lesions are secondary to PTT dysfunction. The best criteria for an injury of the clinically relevant superomedial calcaneonavicular ligament are increased signal on proton-density or T2-weighted sequences with thickening (> 5 mm), thinning (< 2 mm), or partial or complete discontinuity. A thickened ligament can be simulated by the gliding layer between the PTT and the superomedial calcaneonavicular ligament (thickness: 1-3 mm). The most common location of injury is the superior and distal portion of the superomedial calcaneonavicular ligament. A lesion seen by the orthopedic foot surgeon at the junction between the tibiospring ligament and the superomedial portion of the calcaneonavicular ligament is commonly classified as a spring ligament injury. In addition, an overview of MR imaging findings in different stages of the acquired adult flatfoot deformity is provided.

  7. Comparative histology of mouse, rat, and human pelvic ligaments.

    PubMed

    Iwanaga, Ritsuko; Orlicky, David J; Arnett, Jameson; Guess, Marsha K; Hurt, K Joseph; Connell, Kathleen A

    2016-11-01

    The uterosacral (USL) and cardinal ligaments (CL) provide support to the uterus and pelvic organs, and the round ligaments (RL) maintain their position in the pelvis. In women with pelvic organ prolapse (POP), the connective tissue, smooth muscle, vasculature, and innervation of the pelvic support structures are altered. Rodents are commonly used animal models for POP research. However, the pelvic ligaments have not been defined in these animals. In this study, we hypothesized that the gross anatomy and histological composition of pelvic ligaments in rodents and humans are similar. We performed an extensive literature search for anatomical and histological descriptions of the pelvic support ligaments in rodents. We also performed anatomical dissections of the pelvis to define anatomical landmarks in relation to the ligaments. In addition, we identified the histological components of the pelvic ligaments and performed quantitative analysis of the smooth muscle bundles and connective tissue of the USL and RL. The anatomy of the USL, CL, and RL and their anatomical landmarks are similar in mice, rats, and humans. All species contain the same cellular components and have similar histological architecture. However, the cervical portion of the mouse USL and RL contain more smooth muscle and less connective tissue compared with rat and human ligaments. The pelvic support structures of rats and mice are anatomically and histologically similar to those of humans. We propose that both mice and rats are appropriate, cost-effective models for directed studies in POP research.

  8. Features extraction in anterior and posterior cruciate ligaments analysis.

    PubMed

    Zarychta, P

    2015-12-01

    The main aim of this research is finding the feature vectors of the anterior and posterior cruciate ligaments (ACL and PCL). These feature vectors have to clearly define the ligaments structure and make it easier to diagnose them. Extraction of feature vectors is obtained by analysis of both anterior and posterior cruciate ligaments. This procedure is performed after the extraction process of both ligaments. In the first stage in order to reduce the area of analysis a region of interest including cruciate ligaments (CL) is outlined in order to reduce the area of analysis. In this case, the fuzzy C-means algorithm with median modification helping to reduce blurred edges has been implemented. After finding the region of interest (ROI), the fuzzy connectedness procedure is performed. This procedure permits to extract the anterior and posterior cruciate ligament structures. In the last stage, on the basis of the extracted anterior and posterior cruciate ligament structures, 3-dimensional models of the anterior and posterior cruciate ligament are built and the feature vectors created. This methodology has been implemented in MATLAB and tested on clinical T1-weighted magnetic resonance imaging (MRI) slices of the knee joint. The 3D display is based on the Visualization Toolkit (VTK). Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. What Does the Transverse Carpal Ligament Contribute to Carpal Stability?

    PubMed Central

    Vanhees, Matthias; Verstreken, Frederik; van Riet, Roger

    2015-01-01

    Background The transverse carpal ligament is well known for its involvement in carpal tunnel syndrome, and sectioning of this ligament remains the definite treatment for this pathology. Some authors believe that the transverse carpal ligament is an important stabilizer of the carpal arch, whereas others do not consider it to be significant. Several studies have been performed, both in vivo and in in vitro. Sectioning of the transverse carpal ligament does not seem to have any effect on the width of the carpal arch in the unloaded condition. However, patients will load the arch during their activities of daily living. Materials and Methods A cadaveric study was done with distraction of the carpal bones before and after sectioning the transverse carpal ligament. Results With the transverse carpal ligament intact, the carpal arch is mobile, with distraction leading up to 50% widening of the arch. Sectioning of the transverse carpal ligament resulted in a significant widening of the carpal arch by a further 30%. Conclusions Loading of the carpal arch after sectioning of the transeverse carapal ligament leads to a significant increase in intracarpal mobility. This will inevitably influence carpal kinematics in the patient and might be responsible for some complications after simple carpal tunnel releases, such as pillar pain, palmar tenderness, and loss of grip strength. PMID:25709876

  10. What does the transverse carpal ligament contribute to carpal stability?

    PubMed

    Vanhees, Matthias; Verstreken, Frederik; van Riet, Roger

    2015-02-01

    Background The transverse carpal ligament is well known for its involvement in carpal tunnel syndrome, and sectioning of this ligament remains the definite treatment for this pathology. Some authors believe that the transverse carpal ligament is an important stabilizer of the carpal arch, whereas others do not consider it to be significant. Several studies have been performed, both in vivo and in in vitro. Sectioning of the transverse carpal ligament does not seem to have any effect on the width of the carpal arch in the unloaded condition. However, patients will load the arch during their activities of daily living. Materials and Methods A cadaveric study was done with distraction of the carpal bones before and after sectioning the transverse carpal ligament. Results With the transverse carpal ligament intact, the carpal arch is mobile, with distraction leading up to 50% widening of the arch. Sectioning of the transverse carpal ligament resulted in a significant widening of the carpal arch by a further 30%. Conclusions Loading of the carpal arch after sectioning of the transeverse carapal ligament leads to a significant increase in intracarpal mobility. This will inevitably influence carpal kinematics in the patient and might be responsible for some complications after simple carpal tunnel releases, such as pillar pain, palmar tenderness, and loss of grip strength.

  11. Bilateral ganglion cysts of the cruciate ligaments: a case report.

    PubMed

    Willis-Owen, Charles A; Konyves, Arpad; Martin, David K

    2010-08-01

    Symptomatic ganglion cysts of the cruciate ligaments are rare, and bilateral cases are extremely rare, with only one reported case in the literature. We report a case of bilateral cruciate ligament ganglion cysts successfully treated with arthroscopic resection, and review the literature regarding aetiology, diagnosis and management.

  12. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation.

    PubMed

    Bedoya, Maria A; McGraw, Michael H; Wells, Lawrence; Jaramillo, Diego

    2014-09-01

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed.

  13. Iatrogenic Spinal Cord Injury during Removal of the Inferior Articular Process in the Presence of Ossification of the Ligamentum Flavum

    PubMed Central

    Burke, Shane M.; Hwang, Steven W.; Safain, Mina G.; Riesenburger, Ron I.

    2016-01-01

    Ossified ligamentum flavum (OLF) is a condition of heterotopic lamellar bone formation within the yellow ligament. Some patients with OLF can be asymptomatic. However, asymptomatic OLF may not be obvious on preoperative MRI and could increase the risk of iatrogenic injury during treatments for unrelated spinal conditions. This report describes a case of spinal cord injury caused by the indirect transmission of force from an osteotome to an asymptomatic OLF during the resection of a thoracic inferior articular process (IAP). To prevent this outcome, we urge careful review of CT imaging in the preoperative setting and advocate the use of a high-speed drill instead of an osteotome during bone removal in the setting of an adjacent area of OLF. PMID:26885431

  14. Dynamic Mechanical Properties of Intact Human Cervical Spine Ligaments

    PubMed Central

    Ivancic, Paul C.; Coe, Marcus P.; Ndu, Anthony B.; Tominaga, Yasuhiro; Carlson, Erik J.; Rubin, Wolfgang; (FH), Dipl-Ing; Panjabi, Manohar M.

    2009-01-01

    BACKGROUND CONTEXT Most previous studies have investigated ligaments mechanical properties at slow elongation rates of less than 25 mm/s. PURPOSE To determine the tensile mechanical properties, at a fast elongation rate, of intact human cervical anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. STUDY DESIGN/SETTING In vitro biomechanical study. METHODS A total of 97 intact bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines (average age: 80.6 years, range, 71 to 92 years) and were elongated to complete rupture at an average (SD) peak rate of 723 (106) mm/s using a custom-built apparatus. Non-linear force vs. elongation curves were plotted and peak force, peak elongation, peak energy, and stiffness were statistically compared (P<0.05) among ligament. A mathematical model was developed to determine the quasi-static physiological ligament elongation. RESULTS Highest average peak force, up to 244.4 and 220.0 N in the ligamentum flavum and capsular ligament, respectively, were significantly greater than in the anterior longitudinal ligament and middle-third disc. Highest peak elongation reached 5.9 mm in the intraspinous and supraspinous ligaments, significantly greater than in the middle-third disc. Highest peak energy of 0.57 J was attained in the capsular ligament, significantly greater than in the anterior longitudinal ligament and middle-third disc. Average stiffness was generally greatest in the ligamentum flavum and least in the intraspinous and supraspinous ligaments. For all ligaments, peak elongation was greater than average physiological elongation computed using the mathematical model. CONCLUSIONS Comparison of the present results with previously reported data indicated that high speed elongation may cause cervical ligaments to fail at a higher peak force and smaller peak elongation and may be stiffer and absorb less energy, as compared to a

  15. Characterization and role of the immune response during ligament healing

    NASA Astrophysics Data System (ADS)

    Chamberlain, Connie S.

    Scar formation of ligaments after rupture remains a great challenge. Ligament healing involves a complex, coordinated series of events that form a neo-ligament, which is more disorganized and fibrotic in character than the native tissue. The repair process may extend from months to years, and the injured ligament never fully recovers its original mechanical properties. With little intrinsic healing potential, ruptures of the anterior cruciate ligament (ACL) are usually reconstructed. The "healed" tissues, however, do not regenerate native tissues or recapitulate their mechanical function. ACL grafts often lengthen (incidents range from 40-100%) and their strength can drop by ˜50% after remodeling. Reconstructed knees are often less stable and fail to restore normal joint kinematics. Our overall goal is to improve healing, making ligaments more regenerative. The first 2 studies characterized ligament healing in a spatial and temporal manner over 28 days. The experiments demonstrated creeping substitution and the potential role of the immune system to control the repair and/or regenerative process. From these studies, macrophages were identified as significant players during healing. Macrophages paralleled creeping substitution, were abundant within the healing ligament, and potentially played a destructive role via matrix phagocytosis. The role of macrophages during early ligament healing was then evaluated using liposome-encapsulated clodronate to inhibit phagocytosing macrophages. Clodronate attenuated the early infiltration of macrophages, resulting in delayed structural and functional healing. Macrophage re-infiltration into the wound resulted in continued ligament healing. These results suggested that early inhibition of phagocytosing macrophages is detrimental to ligament healing. The final experiment evaluated the effects of interleukin-4 on ligament healing. Interleukin-4 (IL-4) is reported to stimulate the Th2 lymphocyte/M2 macrophage pathway, reducing

  16. Bilateral inferior petrosal sinus sampling using vasopressin

    PubMed Central

    Kotwal, Narendra; Kumar, Yogesh; Upreti, Vimal; Singh, Amandeep; Garg, M. K.

    2016-01-01

    Context: Anatomical localization of pituitary adenoma can be challenging in adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome, and bilateral inferior petrosal sinus sampling (BIPSS) is considered gold standard in this regard. Stimulation using corticotrophin-releasing hormone (CRH) improves the sensitivity of BIPSS, however, same is not easily available in India. Therefore, we undertook this study of BIPPS using vasopressin as agent for stimulation owing to its ability to stimulate V3 receptors present on corticotrophs. Aims: To study the tumor localization and lateralization in difficult to localize cases of ACTH-dependent Cushing's syndrome by bilateral inferior petrosal sinus sampling using vasopressin for corticotroph stimulation. Settings and Design: Prospective observational study. Subjects and Methods: Six patients (5 females) meeting inclusion criteria underwent BIPSS using vasopressin for stimulation. Results: All six patients had nonsuppressible overnight and low dose dexamethasone suppression test with elevated plasma ACTH levels suggestive of ACTH-dependent Cushing's syndrome. High dose dexamethasone suppression test showed suppressible cortisol in two cases, and microadenoma was seen in two patients on magnetic resonance imaging pituitary. Contrast enhanced computed tomography of the abdomen showed left adrenal hyperplasia in one case and anterior mediastinal mass with bilateral adrenal hyperplasia another. Using BIPSS four patients were classified as having Cushing's disease that was confirmed histopathologically following surgery. Of the remaining two, one had primary pigmented nodular adrenocortical disease, and another had thymic carcinoid with ectopic ACTH production as the cause of Cushing's syndrome. No serious adverse events were noted. Conclusions: Vasopressin may be used instead of CRH and desmopressin for stimulation in BIPSS. PMID:27186561

  17. [Injuries of the alar ligaments in children and adolescents].

    PubMed

    Briem, D; Linhart, W; Dickmann, C; Rueger, J M

    2002-06-01

    Cervical spine trauma most commonly involves the lower parts in adults. In children lesions of the cervical spine can predominantly be found in the region of C1/C2 including ligament injuries at this level. However such injuries are difficult to detect and only few data are available concerning therapy and prognosis of atlantoxial ligament lesions. We report on two children suffering from isolated rupture of the alar ligaments. Both injuries were proven by magnetic resonance imaging which is recommended as the resource of choice for the evaluation of the cervical spine soft tissues in children. Although the biomechanic properties of the alar ligaments remain unclear non-operative treatment for the rupture of these ligaments seems to be adequate. In order to avoid neurologic symptoms or long term complications an immediate diagnosis is indispensable.

  18. Specialisation of extracellular matrix for function in tendons and ligaments.

    PubMed

    Birch, Helen L; Thorpe, Chavaunne T; Rumian, Adam P

    2013-01-01

    Tendons and ligaments are similar structures in terms of their composition, organisation and mechanical properties. The distinction between them stems from their anatomical location; tendons form a link between muscle and bone while ligaments link bones to bones. A range of overlapping functions can be assigned to tendon and ligaments and each structure has specific mechanical properties which appear to be suited for particular in vivo function. The extracellular matrix in tendon and ligament varies in accordance with function, providing appropriate mechanical properties. The most useful framework in which to consider extracellular matrix differences therefore is that of function rather than anatomical location. In this review we discuss what is known about the relationship between functional requirements, structural properties from molecular to gross level, cellular gene expression and matrix turnover. The relevance of this information is considered by reviewing clinical aspects of tendon and ligament repair and reconstructive procedures.

  19. Surgical Correction of Posttraumatic Scapulothoracic Bursitis, Rhomboid Major Muscle Injury, Ipsilateral Glenohumeral Instability, and Headaches Resulting from Circus Acrobatic Maneuvers

    PubMed Central

    Skedros, John G.; Langston, Tanner D.; Phippen, Colton M.

    2015-01-01

    We report the case of a 28-year-old transgender (male-to-female) patient that had a partial tear of the rhomboid major tendon, scapulothoracic bursitis, and glenohumeral instability on the same side. These conditions resulted from traumatic events during circus acrobatic maneuvers. Additional aspects of this case that make it unique include (1) the main traumatic event occurred during a flagpole exercise, where the patient's trunk was suspended horizontally while a vertical pole was grasped with both hands, (2) headaches were associated with the periscapular injury and they improved after scapulothoracic bursectomy and rhomboid tendon repair, (3) surgical correction was done during the same operation with an open anterior capsular-labral reconstruction, open scapulothoracic bursectomy without bone resection, and rhomboid tendon repair, (4) a postoperative complication of tearing of the serratus anterior and rhomboid muscle attachments with recurrent scapulothoracic pain occurred from patient noncompliance, and (5) the postoperative complication was surgically corrected and ultimately resulted in an excellent outcome at the one-year final follow-up. PMID:26273484

  20. Effects of joint position on the distraction distance during grade III glenohumeral joint distraction in healthy individuals.

    PubMed

    Park, Sam-Sik; Kim, Bo-Kyung; Moon, Ok-Kon; Choi, Wan-Suk

    2015-10-01

    [Purpose] The study investigated the effects of joint position on the distraction distance during Grade III glenohumeral joint distraction in healthy individuals. [Subjects and Methods] Twenty adults in their forties without shoulder disease were randomly divided into neutral position group (NPG; n = 7), resting position group (RPG; n = 7), and end range position group (ERPG; n = 6). After Kaltenborn Grade III distraction for 40s, the distance between glenoid fossa and humeral head was measured by ultrasound. [Results] The average distances between the humeral head and glenoid fossa before distraction were 2.86 ± 0.81, 3.21 ± 0.47, and 3.55 ± 0.59 mm for the NP, RP, and ERP groups. The distances after applying distraction were 3.12 ± 0.51, 3.86 ± 0.55, and 4.35 ± 0.32 mm. Between-group comparison after applying distraction revealed no significant differences between the NP and RP groups, while there was a statistically significant difference between the NP and RP groups, as well as between the NP and ERP groups. [Conclusion] Joint space was largest in ERP individuals when performing manual distraction.

  1. Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss.

    PubMed

    Katthagen, J Christoph; Anavian, Jack; Tahal, Dimitri S; Millett, Peter J

    2016-10-01

    Bipolar bone loss in patients with anterior glenohumeral instability is challenging to treat. The goal of the treatment is to restore stability by ensuring that the humeral head remains within the glenoid vault. This can be achieved either with the combination of an arthroscopic Bankart procedure and remplissage (glenoid bone loss <25%), or with a Latarjet procedure (glenoid bone loss >25%). In cases with more severe bipolar bone loss of both the glenoid and the humeral head, the conventional approach has been to lengthen the articular arc of the glenoid and to ignore the Hill-Sachs lesion. However, it has recently been shown that this can still lead to an "off-track" situation with persistent shoulder instability from engagement of the Hill-Sachs on the anterior glenoid. In these cases, the combination of a Hill-Sachs remplissage and the Latarjet procedure can be effective in preventing persistent instability. In this technical note, the surgical technique of an arthroscopic Hill-Sachs remplissage in combination with an open Latarjet procedure is presented.

  2. Glenohumeral joint kinematics measured by intracortical pins, reflective markers, and computed tomography: A novel technique to assess acromiohumeral distance.

    PubMed

    Dal Maso, Fabien; Blache, Yoann; Raison, Maxime; Lundberg, Arne; Begon, Mickaël

    2016-08-01

    Combination of biplane fluoroscopy and CT-scan provides accurate 3D measurement of the acromiohumeral distance (AHD) during dynamic tasks. However, participants performed only two and six trials in previous experiments to respect the recommended radiation exposure per year. Our objective was to propose a technique to assess the AHD in 3D during dynamic tasks without this limitation. The AHD was computed from glenohumeral kinematics obtained using markers fitted to pins drilled into the scapula and the humerus combined with 3D bone geometry obtained using CT-scan. Four participants performed range-of-motion, daily-living, and sports activities. Sixty-six out of 158trials performed by each participant were analyzed. Two participants were not considered due to experimental issues. AHD decreased with arm elevation. Overall, the smallest AHD occurred in abduction (1.1mm (P1) and 1.2mm (P2)). The smallest AHD were 2.4mm (P1) and 3.1mm (P2) during ADL. It was 2.8mm (P1) and 1.1mm (P2) during sports activities. The humeral head greater and lesser tuberosities came the nearest to the acromion. The proposed technique increases the number of trials acquired during one experiment compared to previous. The identification of movements maximizing AHD is possible, which may provide benefits for shoulder rehabilitation.

  3. Physical therapy intervention for a former power lifter after arthroscopic microfracture procedure for grade iv glenohumeral chondral defects.

    PubMed

    Hensley, Craig P; Sum, Jonathan

    2011-03-01

    Power lifting places the shoulder complex at risk for injury. Microfracture is a relatively new procedure for chondral defects of the glenohumeral joint and is not well described in the literature. The purpose of this case report is to describe the post-operative rehabilitation used with a power lifter who underwent a microfracture procedure to address glenoid and humeral chondral defects, debridement of type I superior labral anterior-posterior lesion, and a subacromial decompression. The patient was a 46 year-old male who was evaluated nine weeks status-post arthroscopic microfracture procedure for glenoid and humeral chondral defects, debridement of superior labral anterior-posterior (SLAP) lesion, and subacromial decompression. Rehabilitation consisted of postural education, manual therapy, rotator cuff and scapular strengthening, dynamic stabilization, weightbearing exercises, and weight training over nine weeks (24 sessions). Lifting modifications were addressed. Results of the QuickDASH indicate that activities of daily living (ADLs), work, and sports modules all improved significantly, and the patient was able to return to recreational power lifting with limited discomfort or restrictions. A structured post-operative physical therapy treatment program allowed this patient to return to recreational power lifting while restoring independent function for work-related activities and ADLs.

  4. PHYSICAL THERAPY INTERVENTION FOR A FORMER POWER LIFTER AFTER ARTHROSCOPIC MICROFRACTURE PROCEDURE FOR GRADE IV GLENOHUMERAL CHONDRAL DEFECTS

    PubMed Central

    Sum, Jonathan

    2011-01-01

    Background: Power lifting places the shoulder complex at risk for injury. Microfracture is a relatively new procedure for chondral defects of the glenohumeral joint and is not well described in the literature. Objectives: The purpose of this case report is to describe the post-operative rehabilitation used with a power lifter who underwent a microfracture procedure to address glenoid and humeral chondral defects, debridement of type I superior labral anterior-posterior lesion, and a subacromial decompression. Case Description: The patient was a 46 year-old male who was evaluated nine weeks status-post arthroscopic microfracture procedure for glenoid and humeral chondral defects, debridement of superior labral anterior-posterior (SLAP) lesion, and subacromial decompression. Rehabilitation consisted of postural education, manual therapy, rotator cuff and scapular strengthening, dynamic stabilization, weightbearing exercises, and weight training over nine weeks (24 sessions). Lifting modifications were addressed. Outcomes: Results of the QuickDASH indicate that activities of daily living (ADLs), work, and sports modules all improved significantly, and the patient was able to return to recreational power lifting with limited discomfort or restrictions. Discussion: A structured post-operative physical therapy treatment program allowed this patient to return to recreational power lifting while restoring independent function for work-related activities and ADLs. PMID:21655454

  5. Effects of joint position on the distraction distance during grade III glenohumeral joint distraction in healthy individuals

    PubMed Central

    Park, Sam-Sik; Kim, Bo-Kyung; Moon, Ok-Kon; Choi, Wan-Suk

    2015-01-01

    [Purpose] The study investigated the effects of joint position on the distraction distance during Grade III glenohumeral joint distraction in healthy individuals. [Subjects and Methods] Twenty adults in their forties without shoulder disease were randomly divided into neutral position group (NPG; n = 7), resting position group (RPG; n = 7), and end range position group (ERPG; n = 6). After Kaltenborn Grade III distraction for 40s, the distance between glenoid fossa and humeral head was measured by ultrasound. [Results] The average distances between the humeral head and glenoid fossa before distraction were 2.86 ± 0.81, 3.21 ± 0.47, and 3.55 ± 0.59 mm for the NP, RP, and ERP groups. The distances after applying distraction were 3.12 ± 0.51, 3.86 ± 0.55, and 4.35 ± 0.32 mm. Between-group comparison after applying distraction revealed no significant differences between the NP and RP groups, while there was a statistically significant difference between the NP and RP groups, as well as between the NP and ERP groups. [Conclusion] Joint space was largest in ERP individuals when performing manual distraction. PMID:26644692

  6. Glenohumeral articular cartilage lesions: prospective comparison of non-contrast magnetic resonance imaging and findings at arthroscopy.

    PubMed

    Spencer, Brian A; Dolinskas, Carol A; Seymour, Peter A; Thomas, Stephen J; Abboud, Joseph A

    2013-09-01

    The purpose of this study was to assess the diagnostic sensitivity, specificity, accuracy, negative predictive value (NPV), positive predictive value (PPV), and test-retest reliability of magnetic resonance imaging (MRI) for detecting cartilage abnormalities of the glenohumeral joint in comparison with the gold standard of diagnostic arthroscopy. Forty-four patients with a preoperative non-contrast MRI study of their affected shoulder underwent arthroscopy by one surgeon for rotator cuff tendinopathy from 2009 to 2010. Articular cartilage defects were prospectively recorded and graded according to the International Cartilage Repair Society classification system at the time of arthroscopy. One year after surgery, the preoperative MRI were reviewed by a board-certified radiologist and the treating surgeon for articular cartilage defects of both the humeral head and the glenoid. Sensitivity, specificity, accuracy, and test-retest reliability were calculated. At arthroscopy, 43% of the shoulders were found to have articular cartilage defects. When the readers' findings were combined, the sensitivity of detecting humeral lesions on MRI was 32%; specificity, 80%; accuracy, 63%; PPV, 57%; and NPV, 66%. The sensitivity of detecting glenoid lesions was 31%; specificity, 86%; accuracy, 76%; PPV, 33%; and NPV, 85%. This study finds that the overall accuracy of MRI in detecting articular cartilage damage in patients with the clinical diagnosis of subacromial pathology is moderate. Level II, development of diagnostic criteria based on consecutive patients with universally applied reference "gold" standard. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  7. Anatomical glenohumeral internal rotation deficit and symmetric rotational strength in male and female young beach volleyball players.

    PubMed

    Saccol, Michele Forgiarini; Almeida, Gabriel Peixoto Leão; de Souza, Vivian Lima

    2016-08-01

    Beach volleyball is a sport with a high demand of shoulder structures that may lead to adaptations in range of motion (ROM) and strength like in other overhead sports. Despite of these possible alterations, no study evaluated the shoulder adaptations in young beach volleyball athletes. The aim of this study was to compare the bilateral ROM and rotation strength in the shoulders of young beach volleyball players. Goniometric passive shoulder ROM of motion and isometric rotational strength were evaluated in 19 male and 14 female asymptomatic athletes. External and internal ROM, total rotation motion, glenohumeral internal rotation deficit (GIRD), external rotation and internal rotation strength, bilateral deficits and external rotation to internal rotation ratio were measured. The statistical analysis included paired Student's t-test and analysis of variance with repeated measures. Significantly lower dominant GIRD was found in both groups (p<0.05), but only 6 athletes presented pathological GIRD. For strength variables, no significant differences for external or internal rotation were evident. Young beach volleyball athletes present symmetric rotational strength and shoulder ROM rotational adaptations that can be considered as anatomical. These results indicate that young practitioners of beach volleyball are subject to moderate adaptations compared to those reported for other overhead sports.

  8. The effect of CT dose on glenohumeral joint congruency measurements using 3D reconstructed patient-specific bone models

    NASA Astrophysics Data System (ADS)

    Lalone, Emily A.; Fox, Anne-Marie V.; Kedgley, Angela E.; Jenkyn, Thomas R.; King, Graham J. W.; Athwal, George S.; Johnson, James A.; Peters, Terry M.

    2011-10-01

    The study of joint congruency at the glenohumeral joint of the shoulder using computed tomography (CT) and three-dimensional (3D) reconstructions of joint surfaces is an area of significant clinical interest. However, ionizing radiation delivered to patients during CT examinations is much higher than other types of radiological imaging. The shoulder represents a significant challenge for this modality as it is adjacent to the thyroid gland and breast tissue. The objective of this study was to determine the optimal CT scanning techniques that would minimize radiation dose while accurately quantifying joint congruency of the shoulder. The results suggest that only one-tenth of the standard applied total current (mA) and a pitch ratio of 1.375:1 was necessary to produce joint congruency values consistent with that of the higher dose scans. Using the CT scanning techniques examined in this study, the effective dose applied to the shoulder to quantify joint congruency was reduced by 88.9% compared to standard clinical CT imaging techniques.

  9. Skeletal ligament healing using the recombinant human amelogenin protein.

    PubMed

    Hanhan, Salem; Ejzenberg, Ayala; Goren, Koby; Saba, Faris; Suki, Yarden; Sharon, Shay; Shilo, Dekel; Waxman, Jacob; Spitzer, Elad; Shahar, Ron; Atkins, Ayelet; Liebergall, Meir; Blumenfeld, Anat; Deutsch, Dan; Haze, Amir

    2016-05-01

    Injuries to ligaments are common, painful and debilitating, causing joint instability and impaired protective proprioception sensation around the joint. Healing of torn ligaments usually fails to take place, and surgical replacement or reconstruction is required. Previously, we showed that in vivo application of the recombinant human amelogenin protein (rHAM(+)) resulted in enhanced healing of the tooth-supporting tissues. The aim of this study was to evaluate whether amelogenin might also enhance repair of skeletal ligaments. The rat knee medial collateral ligament (MCL) was chosen to prove the concept. Full thickness tear was created and various concentrations of rHAM(+), dissolved in propylene glycol alginate (PGA) carrier, were applied to the transected MCL. 12 weeks after transection, the mechanical properties, structure and composition of transected ligaments treated with 0.5 μg/μl rHAM(+) were similar to the normal un-transected ligaments, and were much stronger, stiffer and organized than control ligaments, treated with PGA only. Furthermore, the proprioceptive free nerve endings, in the 0.5 μg/μl rHAM(+) treated group, were parallel to the collagen fibres similar to their arrangement in normal ligament, while in the control ligaments the free nerve endings were entrapped in the scar tissue at different directions, not parallel to the axis of the force. Four days after transection, treatment with 0.5 μg/μl rHAM(+) increased the amount of cells expressing mesenchymal stem cell markers at the injured site. In conclusion application of rHAM(+) dose dependently induced mechanical, structural and sensory healing of torn skeletal ligament. Initially the process involved recruitment and proliferation of cells expressing mesenchymal stem cell markers.

  10. Shoulder range of motion deficits in baseball players with an ulnar collateral ligament tear.

    PubMed

    Garrison, J Craig; Cole, Mollie A; Conway, John E; Macko, Michael J; Thigpen, Charles; Shanley, Ellen

    2012-11-01

    Shoulder range of motion (ROM) deficits are associated with elbow injury in baseball players. To compare the ROM characteristics of baseball players with a diagnosed ulnar collateral ligament (UCL) tear with those of a group of age-, activity-, and position-matched healthy controls. Cross-sectional study; Level of evidence, 3. Sixty male competitive high school and collegiate baseball players participated. Thirty athletes (age [mean ± standard deviation], 18.20 ± 1.56 years) with a diagnosed UCL tear were compared with 30 (age, 18.57 ± 0.86 years) age-, activity-, and position-matched players without a UCL injury. Of the 60 participants, there were 44 pitchers, 4 catchers, 5 infielders, and 7 outfielders. Participants were measured for shoulder internal rotation (IR), external rotation (ER), and horizontal adduction (HA) at 90° of shoulder elevation. Participants were also measured for elbow extension in a seated position. Group comparisons were made between participants with and without a UCL injury using independent t tests with an α level set at P < .05. All measurements were taken bilaterally, and the differences (involved to uninvolved) were used to calculate means for all variables, including glenohumeral internal rotation deficit (GIRD), total rotational motion (TRM), HA, and elbow extension. Baseball players with a UCL tear (UCLInj) exhibited significantly greater deficits in TRM compared with the control group of healthy baseball players (NUCLInj) (UCLInj = -6.67° ± 11.82°, NUCLInj = 0.93° ± 9.91°; P = .009). No group differences were present for GIRD (UCLInj = -12.53° ± 5.98°, NUCLInj = -13.63° ± 5.90°; P = .476), HA (UCLInj = -3.00° ± 5.01°, NUCLInj = -3.23° ± 5.15°; P = .860), or elbow extension (UCLInj = -2.63° ± 7.86°, NUCLInj = -1.17° ± 2.76°; P = .339). Pitchers with a UCL tear had significantly greater deficits in TRM (UCLInjPitch = -6.96° ± 11.20°, NUCLInjPitch = 1.29° ± 8.33°; P = .0087) and dominant shoulder ER

  11. Finite element analysis of nonanatomic tenodesis reconstruction methods of combined anterior talofibular ligament and calcaneofibular ligament deficiency.

    PubMed

    Zhang, Ming-Yan; Xu, Can; Li, Kang-Hua

    2011-10-01

    Nonanatomic tenodesis reconstruction procedures have been used for lateral ankle ligament reconstruction. However, there has been no comparison of Watson-Jones, Evans, and Chrisman-Snook procedures with respect to biomechanical characteristics such as kinematics, ligaments and grafts stresses using finite element analysis. A three-dimensional finite element model of the ankle including seven bony structures, cartilage and nine principal ligaments surrounding the ankle joint complex was developed and validated. In addition to the intact model, combined anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) deficient, Watson-Jones reconstruction, Evans reconstruction and Chrisman-Snook reconstruction models were simulated. Then, the forces in the ligaments and grafts and the kinematics of the talus and calcaneus were predicted for an inversion or internal torque of 1.7 Nom and an anterior drawer stress of 150 N through the range of ankle motion. All three operations were able to improve the stability of the ankle, but the effectiveness of each procedure was dependent on the direction of the stress applied and the position of the ankle in dorsiflexion-plantarflexion. This study showed that the Watson-Jones procedure has advantages with regard to anterior and rotational stabilities as well as ligaments and grafts stresses in comparison with other nonanatomic tenodesis reconstruction methods. The knowledge of stress inside the ligaments and reconstructed grafts could help to better understand the biomechanical behavior of the reconstructed joint.

  12. A new approach to determine ligament strain using polydimethylsiloxane strain gauges: exemplary measurements of the anterolateral ligament.

    PubMed

    Zens, Martin; Ruhhammer, Johannes; Goldschmidtboeing, Frank; Woias, Peter; Feucht, Matthias J; Mayr, Herrmann O; Niemeyer, Philipp

    2014-12-01

    A thorough understanding of ligament strains and behavior is necessary to create biomechanical models, comprehend trauma mechanisms, and surgically reconstruct those ligaments in a manner that restores a physiological performance. Measurement techniques and sensors are needed to conduct this data with high accuracy in an in vitro environment. In this work, we present a novel sensor device that is capable of continuously recording ligament strains with high resolution. The sensor principle of this biocompatible strain gauge may be used for in vitro measurements and can easily be applied to any ligament in the human body. The recently rediscovered anterolateral ligament (ALL) of the knee joint was chosen to display the capability of this novel sensor system. Three cadaver knees were tested to successfully demonstrate the concept of the sensor device and display first results regarding the elongation of the ALL during flexion/extension of the knee.

  13. Partial breast reconstruction with mini superficial inferior epigastric artery and mini deep inferior epigastric perforator flaps.

    PubMed

    Spiegel, Aldona J; Eldor, Liron

    2010-08-01

    In this study, partial breast reconstruction was undertaken after breast conservation therapy using mini abdominal free flaps on both an immediate and delayed basis.Patient demographics, oncologic status, reconstructive data, and complications were collected from medical records.Twelve patients (age range 39-60) were included in this study with a mean fo