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Acta of Shoulder and Elbow Surgery by http://asesjournal.com/ is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
ISSN 2457-0338
Derotational humerus osteotomy and teres major tenotomy for recurrent posterior shoulder instability: A case report
/0 Comments/in Vol 3 | Issue 2| July-Dec 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 2 | July-December 2019 | Page 6-10 | Jad Chbib Abi Raad, Denis Bouttens, Simon Lebbos, Christophe Obry
Authors: Jad Chbib Abi Raad [1], Denis Bouttens [1], Simon Lebbos [1], Christophe Obry [1].
[1] Department of Orthopaedics, Fondation Hopale – Institut Calot (France)
Address of Correspondence
Dr. Jad Chbib Abi Raad ,
Fondation Hopale – Institut Calot (France)
E-mail: jadabiraad@gmail.com
jad.chbib-abi-raad@hopale.com
Abstract
Posterior instability represents about 10 percent of shoulder instabilities. It enclose dislocation or more frequently posterior sub luxation. Posterior instability can be also associated with constitutional laxity and multidirectional instability. The factors related to this instability depends of the etiology (traumatic, atraumatic), bony factors (glenoid and humeral head, defects, ante and retroversions) and the soft tissues. We describe a case of 28 year old lady, with recurrent posterior shoulder instability despite 3 previous interventions (2 posterior bone blocks and a glenoid osteotomy). For the treatment we combined two techniques: Derotational humerus osteotomy and Teres major tenotomy. We found that Derotational humerus osteotomy can be used as an alternative for glenoid osteotomy, or after failed glenoid osteotomy, to treat the instability. It can be associated with teres major tenotomy which was previously described mainly for voluntary posterior dislocation.
Keywords: Posterior instability, Posterior subluxation , Laxity, Derotational osteotomy, Teres major tenotomy, voluntary, involuntary.
References
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osteotomy and teres major tenotomy for recurrent posterior shoulder instability: A Case report. Acta of Shoulder and Elbow Surgery July – Dec 2019; 3(2): 6-10.
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Randomized controlled trial comparing local autologous bloodinjection and polidocanol injection for treatment of lateral epicondylosis of elbow
/0 Comments/in Vol 3 | Issue 2| July-Dec 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 2 | July – Dec 2019 | Page 2-5 | Rajendra Didel, Saurabh Kumar
Authors: Rajendra Didel [1], Saurabh Kumar [2].
[1] Department of Orthopaedics, Govt Medical College, Pali, Rajasthan, India.
[2] Department of Orthopaedics, U.C.M.S & G.T.B Hospital, Delhi, India.
Address of Correspondence
Dr. Saurabh Kumar,
U.C.M.S & G.T.B Hospital, Delhi, India.
E-mail: srbrai@gmail.com
Abstract
Background: Lateral epicondylosis has been found to occur in approximately 2% of general population. It’s etiology and management still remains controversial. Various studies have shown benefits with local injection of autologous blood and polidocanol individually. However, there is paucity of studies comparing the results between these both, hence we envisage to compare the clinical and functional outcomes of local autologous blood versus polidocanol injection for the treatment of lateral epicondylosis of elbow.
Materials and methods: 60 patients (age group- 18 to 60 years)with clinically diagnosed lateral epicondylosis of elbow were enrolled for the study. They were randomized into 2 groups. Group I (n = 30) was treated with autologous blood injection and Group II (n = 30) with polidocanol injection after Nirschl staging. Patients were evaluated clinically at 6& 12 weeks after the injection and were again staged by Nirschl staging on both the visits.
Results: 34 patients successfully completed 12 weeks follow-up and were included in the analysis. It was observed that clinical outcomes in terms of Nirschl score at 6 and 12 weeks was better in Group I as compared to Group II. Statistical comparison between the two groups revealed that mean values of Nirschl score were lower in group I (4.41+1.004 and 3.71+1.532 at 6 weeks and 12 weeks of follow-up respectively) as compared to group II (4.76+1.300 and 4.47+1.281at 6 weeks and 12 weeks follow-up respectively). Down staging of disease symptom was clinically better in group I (16/17) as compared to group II (11/17). However the difference in the mean values of Nirschl score between the groups was not statistically significant (p=0.342).
Conclusion: Although autologous blood injection showed a better clinical improvement as compared to polidocanol injection, the difference was not statistically significant between these both.
Keywords: Lateral epicondylosis, Autologous blood injection, Polidocanol injection
References
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4. Chop WM Jr. Tennis elbow. Postgrad Med. 1989 Oct;86(5):301-4, 307-8.
5. Hong QN, Durand MJ, Loisel P. Treatment of lateral epicondylitis: where is the evidence? Joint Bone Spine. 2004 Sep;71(5):369-73.
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9. Jindal N, Gaury Y, Banshiwal RC, Lamoria R, Bachhal V. Comparison of shortterm results of single injection of autologous blood and steroid injection in tennis elbow: a prospective study. J OrthopSurg Res. 2013 Apr 27;8:10.
10. Wolf JM, Ozer K, Scott F, Gordon MJ, Williams AE. Comparison of autologousblood, corticosteroid, and saline injection in the treatment of lateralepicondylitis: a prospective, randomized, controlled multicenter
study. J HandSurg Am. 2011 Aug;36(8):1269-72.
11. Edwards SG, Calandruccio JH. Autologous blood injections for refractorylateral epicondylitis. J Hand Surg Am. 2003 Mar;28(2):272-8.
12. Ozturan KE, Yucel I, Cakici H, Guven M, Sungur I. Autologous blood and corticosteroid injection and extracoporeal shock wave therapy in the treatment oflateral epicondylitis. Orthopedics. 2010 Feb;33(2):84-91.
13. Kazemi M, Azma K, Tavana B, RezaieeMoghaddam F, Panahi A. Autologous bloodversus corticosteroid local injection in the short-term treatment of lateralelbow tendinopathy: a randomized clinical trial of efficacy. Am J Phys
MedRehabil. 2010 Aug;89(8):660-7.
14. Zeisig E, Ohberg L, Alfredson H. Sclerosingpolidocanol injections in chronic painful tennis elbow-promising results in a pilot study. Knee Surg Sports TraumatolArthrosc. 2006 Nov;14(11):1218-24.
15. Connell DA, Ali KE, Ahmad M, Lambert S, Corbett S, Curtis M. Ultrasoundguidedautologous blood injection for tennis elbow. Skeletal Radiol. 2006Jun;35(6):371-7.
16. Gani NU, Butt MF, Dhar SA, et al. Autologous blood injection in the treatment of Refractory Tennis Elbow. The Internet Journal of Orthopaedic Surgery 2007.
17. Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011Sep;45(12):966-71.
18. Raeissadat SA, Sedighipour L, Rayegani SM, Bahrami MH, Bayat M, Rahimi R.Effect of Platelet-Rich Plasma (PRP) versus Autologous Whole Blood on Pain andFunction Improvement in Tennis Elbow: A Randomized Clinical Trial. Pain ResTreat. 2014;2014:191525.
blood injection and polidocanol injection for treatment of lateral epicondylosis
of elbow. Acta of Shoulder and Elbow Surgery July – Dec 2019; 3(2): 2-5.
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Case Report: A rare case of Giant Cell Tumor of Distal Ulna
/0 Comments/in Vol 3 | Issue 1| Jan-June 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 19-20 | Soham R Chachcha, Ramavtar Saini, Anand Yadav
Authors: Soham R Chachcha [1], Ramavtar Saini [1], Anand Yadav [1].
[1] Dept. Of Orthopaedics, Geetanjali Medical College and Hospital Udaipur.
Address of Correspondence
Dr. Soham R Chachcha,
Dept. Of Orthopaedics, Geetanjali Medical College and Hospital Udaipur.
E-mail: chacha_soham@yahoo.co.in , chachasoham@gmail.com
Abstract
Background: Giant Cell tumor has a reported incidence of 30% in Indian population out of which only 10% cases occur in adults more than 65 years of age. Distal Femur and proximal Tibia are the most common sites followed by distal Radius . Distal Ulna Giant cell tumor is a rare presentation.
Methods: There are no clear-cut guidelines for treatment of Giant Cell Tumor. The treatment of choice in case of Giant Cell Tumor usually is wide block resection of tumor, and to prevent recurrence adjuvant procedures can be used such as cryotheryapy, phenol, cementing and bone grafting and burring. We used the en bloc resection method.
Result: After the en bloc resection of the tumor, the patient had relief in pain and the range of motion at wrist joint was restored.
Conclusion: Giant Cell tumor of distal Ulna is a rare entity and it is even rarer in Geriatric population. It can be treated with en bloc resection.
Keywords: Distal, Ulna, Giant Cell, Tumor, Geriatric.
References
1. Dr Ajay Puri, Dr. M. G. Agarwal and Dr. DinshawPardiwala in ‘Current concepts in bone and soft tissue tumors’ Chapter 6 Giant Cell Tumor Of Bone Page: 53-63.
2. Goldenberg RR, Campbell CJ, Bonfiglio M. Giant-Cell tumor of bone. An analysis of two hundred and eighteen cases. J Bone Joint Surg Am 1970;52:619-64.
3. D. J. McDonald, F. H. Sim, R. A. McLeod, and D. C. Dahlin, “Giant-cell tumor of bone,” Journal of Bone and Joint Surgery. Series A, vol. 68, no. 2, pp. 235–242, 1986.
4. Cooney WP, Damron TA, Sim FH, Linscheid RL. En bloc resection of tumors of the distal end of the ulna. J Bone Joint Surg Am [Internet]. 1997 Mar [cited 2015 Aug 8];79(3):406–12. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9070531.
5. B. J. Gainor and J. Schaberg, “The rheumatoid wrist after resection of the distal ulna,” Journal of Hand Surgery, vol. 10, no. 6 I, pp. 837–844, 1985.
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Suprascapular neuropathy in a young male handball player: case report
/0 Comments/in Vol 3 | Issue 1| Jan-June 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 16-18 | Luís Henrique Barros, Claudia Rodrigues, Rui Claro
Authors: Luís Henrique Barros [1], Claudia Rodrigues [1], Rui Claro [1].
[1] Centro Hospitalar do Porto
Address of Correspondence
Dr. Luís Henrique Barros,
Avenida da República, 855, 1º direito, Vila Nova de Gaia, 4430-201, Portugal
Centro Hospitalar do Porto
E-mail: luisbarros8@gmail.com
Abstract
Background: Suprascapular neuropathy is an uncommon but a very disabling condition. If not diagnosed early, it can lead to irreversible changes. Their prevalence is higher among males and active population, mainly in overhead athletes.
Methods: A 22-year-old male, who is a handball player, reported right shoulder pain, fatigue, and discomfort after one month holding a backpack during hiking in his vacations. He did not remember any trauma to the right shoulder. Clinically, he had a normal active and passive range of motion but the moderate weakness of the right shoulder external rotator muscles. At inspection, he had marked atrophy of supraspinatus and infraspinatus muscles. MRI demonstrated a superior labrum from anterior to the posterior lesion with large multiloculated Paralabral cyst and electromyography was consistent with compression of the suprascapular nerve.
Results: The patient was submitted to arthroscopic labral repair and decompression of the suprascapular nerve. Six months after surgery he has no pain and limitation and is recovering strength
Conclusions: Paralabral cysts are described in the literature as causing compression on spinoglenoid notch and thus coursing with infraspinatus atrophy. This case demonstrates an unusual presentation with both supra and infraspinatus muscles atrophy. Early recognition of these injuries is crucial because complication and morbidity rates are high with delayed diagnosis, mainly in the athlete population.
Keywords: suprascapular neuropathy, SLAP lesion, paralabral cyst, overhead athletes lesions, supraspinatus muscle atrophy, infraspinatus muscle atrophy.
References
1. Schroeder AJ, Bedeir YH, Schumaier AP, Desai VS, Grawe BM. Arthroscopic Management of SLAP Lesions With Concomitant Spinoglenoid Notch Ganglion Cysts: A Systematic Review Comparing Repair Alone to Repair With Decompression. Arthroscopy. 2018. Epub 2018/03/05. doi: 10.1016/j.arthro.2018.01.031. PubMed PMID: 29501216.
2. Zehetgruber H, Noske H, Lang T, Wurnig C. Suprascapular nerve entrapment. A meta-analysis. International orthopaedics. 2002;26(6):339-43. Epub 2002/12/06. doi: 10.1007/s00264-002-0392-y. PubMed PMID: 12466865; PubMed Central PMCID: PMCPMC3620977.
3. Schroder CP, Lundgreen K, Kvakestad R. Paralabral cysts of the shoulder treated with isolated labral repair: effect on pain and radiologic findings. J Shoulder Elbow Surg. 2018;27(7):1283-9. Epub 2018/02/17. doi: 10.1016/j.jse.2017.12.022. PubMed PMID: 29449084.
4. Romeo AA, Rotenberg DD, Bach BR, Jr. Suprascapular neuropathy. J Am Acad Orthop Surg. 1999;7(6):358-67. Epub 2001/08/11. PubMed PMID: 11497489.
5. Pillai G, Baynes JR, Gladstone J, Flatow EL. Greater strength increase with cyst decompression and SLAP repair than SLAP repair alone. Clinical orthopaedics and related research. 2011;469(4):1056-60. Epub 2010/11/26. doi: 10.1007/s11999-010-1661-5. PubMed PMID: 21104358; PubMed Central PMCID: PMCPMC3048282.
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Surgical treatment of shoulder instability using transsubscapularis transfer of the long biceps tendon
/0 Comments/in Vol 3 | Issue 1| Jan-June 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 13-15 | Yonder Archanjo Ching San Junior, Max RogÃcrio Freitas Ramos, Settings Luiz, Diogo Fagundes Henrique Pereira Alves, Paulo RogÃcrio Moritz Postigo
Authors: Yonder Archanjo Ching San Junior[1], Max RogÃcrio Freitas Ramos[1], Settings Luiz[1], Diogo Fagundes Henrique Pereira Alves[1], Paulo RogÃcrio Moritz Postigo [1].
[1] Consultório: Av. Paisagista José Silva de Azevedo Neto, 200 – Bloco 7
(Ecology) Sala 330 – Barra da Tijuca
Clínica Le Sage: Rua da Assembléia, 10 – Sala 1215 – Centro – Rio de
Janeiro
Address of Correspondence
Dr. Yonder Archanjo Ching San Junior,
Ortopedia e Traumatologia – Cirurgia do Ombro e Cotovelo
Email: yondersanjr@gmail.com
Abstract
Objectives: To describe the long bicepstendon transfer technique for the treatment of anterior shoulder instability.
Method: The long tendon of the biceps brachiiwas detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity using subscapularis tenotomy, reproducing the slingeffect and increasing the anterior bone block.
Results: The technique is easy to perform and minimises the risks of coracoid process transfer.
Conclusion: Transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.
Keywords: Joint instability/pathology, Joint instability/surgery, Shoulder joint/pathology, Shoulder joint/surgery, Cadaver
References
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3. Burkhart SS, DeBeer JF. Traumatic Glenoumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repairs: Significance of the Inverted-Pear Glenoid and the Humeral Engaging Hill-Sachs Lesion. Arthroscopy 2000;16(7):677-94
4. Lo IKY, Parten PM, Burkhart SS. The Inverted Pear Glenoid: an Indicator of Significant Glenoid Bone Loss. Arthroscopy 2004;20(2):169-174
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9. Huysmans PE, Haen PS, Kidd M, Dhert WJ, Willems JW. The shape of the inferior part of the glenoid: a cadaveric study. J Shoulder Elbow Surg 2006;15(6):759-763
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11. Burkhart SS, DeBeer JF, Barth JRH, Criswell T, Roberts C, Richards DP. Results of Modified Latarjet Reconstruction in Patients With Anterior Instability and Significant Bone Loss. Arthroscopy 2007;23(10):1033-1041
12. Sturzenegger, M., Béguin, D., Grünig, B. et al. Muscular strength after rupture of the long head of the biceps. Arch. Orth. Traum. Surg. 1986; 105(18): 225-29
13. Kelly, AM., Drakos, MC., Fealy, S., Taylor, SA., O’Brien, SJ. Arthroscopic Release of the Long Head of the Biceps Tendon. Am Jour Sport Med. 2005;33(2): 208-13
14. Elser, F., Braun, S. Dewing, CB. Giphart, JE., Millett PJ. Anatomy, Function, Injuries, and Treatment of the Long Head of the Biceps Brachii Tendon. Arthroscopy 2011; 27(4): 581-92
15. Karlsson J. In reparable rotator cuff tears with lesions of the long head of the biceps brachii tendon, tenotomy did not differ from tenodesis in terms of function or pain. JBJS. 2017; 99(4):351.
16. JC Garcia Jr, Nunes CV, Raffaelli MDP, Sasaki AD, Salem SH, Rowinski S, Pina M. Long Head of Biceps- a Vestigial Structure? Acta of Shoulder and Elbow Surgery Jan – June 2017;2(1):22-27
17. Taylor SA, Ramkumar PN, Fabricant PD, Dines JS, Gausden E, White A, Conway JE, O’Brien SJ. The clinical impact of bicipital tunnel decompression during long head of the biceps tendon surgery: a systematic review and meta-analysis. Arthroscopy. 2016; 32(6):1155-64.
18. Winston BA, Robinson K, Crawford D. “Monocept”: A Brief Report of Congenital Absence of the Long Head of the Biceps Tendon and Literature Review. Case reports in orthopedics. 2017;2017.
19. JC Garcia Jr, AM Cardoso Jr, MB D. Mello. Arthroscopic Long Head Biceps Tenodesis in Coracoid associated with its Transfer to the Conjoined Tendon. Acta of Shoulder and Elbow Surgery Jan – June 2017;2(1):7-10
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Evaluation of Complications of Shoulder Arthroscopy in the Treatment of Sub acromial Pathologies
/0 Comments/in Vol 3 | Issue 1| Jan-June 2019 /by ASESADMIN2016Acta of Shoulder and Elbow Surgery | Volume 3 | Issue 1 | Jan- June 2019 | Page 7-12 | Alexandre de Almeida, Nayvaldo Couto de Almeida, Rafael Filipini Carraro, Samuel Pante, Ana Paula Agostini, Daniel C Agostini
Authors: Alexandre de Almeida [1], Nayvaldo Couto de Almeida [1], Rafael Filipini Carraro [2], Samuel Pante [1], Ana Paula Agostini [3], Daniel C Agostini [4].
[1] Department of Orthopaedic, Pompeia Hospital, Caxias do Sul, RS, Brazil
[2] Second Year Fellowship Resident at Pompeia Hospital, Caxias do Sul, RS, Brazil
[3] Department of Pediatrics, Caxias do Sul University, Caxias do Sul, RS, Brazil
[4] Department of Radiology, General Hospital, Caxias do Sul, RS, Brazil
Address of Correspondence
Dr. Alexandre de Almeida,
Rua Vitório Buzelatto, 222/601. Caxias do Sul, RS, Brazil.
Zip: 95020290.
E-mail: alealmeida19613@gmail.com
Abstract
Objectives: to analyze the prevalence of complications of arthroscopic shoulder surgery for the treatment of sub acromial pathologies and verify if it is affected by sex, age, obesity, smoking habit or by the surgeon’s learning curve.
Methods: from Aug 2001 to Oct 2017, 1322 shoulders were treated for sub acromial pathologies by arthroscopic technique. One surgeon operated all the cases of subacromial pathologies. Exclusion criteria were revision surgeries and insufficient medical records, resulting in a total of 1246 patients.
Results: The analysis of the sample showed a significant predominance (p<0.0001) of the female patients (60.5%). The group of female patients had the highest age (p<0.001). There were complications in 197 patients. The prevalence of complications was 15.8%. Analyzing the female patients separately, a prevalence of complications of 16.5% was verified, while the male patients had 14.8% (p=0.432). Statistical analysis showed a higher prevalence of complications in younger patients (p=0.036). Obese patients (25.8% of the sample) had 13.4% of complications, while non-obese patients had 16.7% (p=0.161). The analysis of complications according to smoking habits did not show a higher prevalence of complications when comparing smokers and nonsmokers (p=0.492). The most frequent complication found in the study was stiffness, with 63 cases (32.5% of the complications). We found 36 cases of stiffness (6.3%) in the immobilized group with a common sling, while the immobilized group with a neutral rotation cushion of the MS presented 27 cases of stiffness (4%). The reduction of 2.3% with the use of sling in neutral rotation was not considered significant (p = 0.066). We analyzed the first 400 arthroscopic cases with the last 400 cases operated. 20.8% of complications were found in the first 400 cases operated and 10.5% in the last 400 cases (p<0.001).
Conclusion: The prevalence of complications of arthroscopic shoulder surgery for the treatment of sub acromial disorders was 15.8%. It was not possible to demonstrate sex, obesity and smoking as risk factors for shoulder arthroscopy complications. It was possible to demonstrate that the age under 65 years and the surgeon’s learning curve significantly affect the prevalence of complications after shoulder arthroscopy.
Keywords: shoulder, arthroscopy, complications.
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3. Dal Molin FF, Mothes FC, Feder MG. Eficácia do aprendizado da videoartroscopia em modelos sintéticos / Effectiveness of the videoarthroscopy learning process in synthetic shoulder modelss. Rev. bras. ortop; 47(1): 83-91, jan.-fev. 2012.
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6. Andersen C, Winding TN, Vesterby MS. Development of simulated arthroscopic skills. A randomized trial of virtual-reality training of 21 orthopedic surgeons. Acta Orthop. 2011 Feb; 82(1): 90–95.
7. Frank RM, Erickson B, Frank JM, Bush-Joseph CA, Bach Jr. BR, Cole BJ, Romeo AA, Provencher MT, Verma NN. Utility of Modern Arthroscopic Simulator Training Models. Published online: December 02, 2013
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