Does addition of Remplissage procedure cause external rotation deficit in the patient undergoing standard Bankart repair for recurrent shoulder dislocation with engaging Hill-Sach’s lesions ?

/0 Comments/in /by

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 7-10 |  Nilesh Kamat, Ashutosh Ajri, Vivek M Sodhai, Vikrant Kalamb, Ashok K Shyam, Parag K Sancheti

Authors:  Nilesh Kamat [1], Ashutosh Ajri [1], Vivek M Sodhai [1], Vikrant Kalamb [1], Ashok K Shyam [1,2], Parag K Sancheti [1]

[1] Department of Orthopaedics, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, India.
[2] Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence
Dr. Vivek Sodhai
Clinical Fellow, Department of Orthopaedics,
Sancheti Institute Of Orthopaedics and Rehabilitation, Pune, India.
E-mail: vivek.sodhai89@gmail.com

Abstract

Background: To determine the effect of Remplissage procedure with Bankart repair compared to standard Bankart repair alone on resultant external rotation of the shoulder in patients of anterior shoulder instability with engaging Hill-Sach’s lesion.
Methods: Out of 46 patients, 18 patients underwent arthroscopic Remplissage combined with Bankart repair (group I) and the other 28 patients underwent arthroscopic standard Bankart repair alone (group II). Clinical outcomes were retrospectively evaluated by assessing the range of motion, complications, recurrence rates, and functional results were assessed utilizing the UCLA and ROWE score.
Results: Average follow-up period of 23.88 ± 5.26 (range, 12-48) months. Average external rotation loss compared to normal side in group I was of 5.00° ± 0.44° (range, 70°-90°)( p=0.031) in external rotation in abduction and 1.67° ± 0.18° (range, 75°-90°)( p=0.36 ) in external rotation in neutral at the last follow up and in group II it was 0.86°±0.35° (range, 70°-90°)( p=0.559 ) in external rotation in abduction and 0.89° ± 0.38° (range, 70°-90°)( p=0.646 ) in external rotation in neutral at the last follow-up. The average UCLA score was 34.00 ± 1.46 (range, 32-35) in group I and 33.29 ± 1.86 (range, 30-35) in group II (p=0.154). Average Rowe score was 92.22 ± 6.24 (range, 95-100) in the group I and 96.55±5.99 (range, 90-100) in the group II (p=0.025).
Conclusion: The addition of Remplissage procedure with standard Bankart repair causes significant loss of external rotation in abduction in patients of engaging Hill-Sach’s lesion compared to standard Bankart repair alone.
Level of Evidence: Level III
Keywords: Anterior shoulder instability, Remplissage procedure, Bankart’s repair, External rotation, Hill-Sach’s lesion.

References

1. Bessière C, Trojani C, Carles M, Mehta SS, Boileau P. The open Latarjet procedure is more reliable in terms of shoulder stability than arthroscopic Bankart repair. Clin Orthop Relat Res 2014;472(8):2345–51. doi:10.1007/s11999-014-3550-9
2. Boileau P, O’Shea K, Vargas P, Pinedo M, Old J, Zumstein M. Anatomical and functional results after arthroscopic Hill-Sachs Remplissage. J Bone Joint Surg Am. 2012;94(7):618-26. Doi: 10.2106/JBJS.K.00101
3. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to a failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000;16(7):677-694. doi:10.1053/jars.2000.17715
4. Connolly RS. Humeral head defects associated with shoulder dislocations: Their diagnostic and surgical significance. Instr Course Lect 1972;21:42-54.
5. Deutsch AA, Kroll DG. Decreased range of motion following arthroscopic Remplissage. Orthopedics 2008;31(5):492. PMID: 19292311
6. Elkinson I, Giles JW, Faber KJ, Boons HW, Ferreira LM, Johnson JA, et al. The effect of the Remplissage procedure on shoulder stability and range of motion: an in vitro biomechanical assessment. J Bone Joint Surg Am 2012;94(11):1003–12. Doi: 10.2106/JBJS.J.01956
7. Franceschi F, Papalia R, Rizzello G, Franceschetti E, Del Buono A, Panascì M, et al. Remplissage repair: new frontiers in the prevention of recurrent shoulder instability: a 2-year follow-up comparative study. Am J Sports Med. 2012;40(11):2462-9. Doi: 10.1177/0363546512458572
8. Haviv B, Mayo L, Biggs D. Outcomes of arthroscopic “Remplissage”: capsulotenodesis of the engaging large Hill-Sachs lesion. J Orthop Surg Res 2011;6(1):29. doi:10.1186/1749-799x-6-29
9. Kazel MD, Sekiya JK, Greene JA, Bruker CT. Percutaneous correction (humeroplasty) of humeral head defects (Hill-Sachs) associated with anterior shoulder instability: a cadaveric study. Arthroscopy. 2005;21(12):1473-8. doi: 10.1016/j.arthro.2005.09.004
10. Koo SS, Burkhart SS, Ochoa E. Arthroscopic double-pulley Remplissage technique for engaging Hill-Sachs lesions in anterior shoulder instability repairs. Arthroscopy 2009;25(11):1343-1348. doi:10.1016/j.arthro.2009.06.0115.
11. Krackhardt T, Schewe B, Albrecht D, Weise K: Arthroscopic fixation of the subscapularis tendon in the reverse Hill-Sachs lesion for traumatic unidirectional posterior dislocation of the shoulder. Arthroscopy 2006,22(2):227.e1-227.e6. doi:10.1016/j.arthro.2005.10.004
12. Kronberg M, Brostrom LA. Proximal humeral osteotomy to correct the anatomy in patients with recurrent shoulder dislocations. J Orthop Trauma. 1991;5(2):129-33. Doi: 10.1097/00005131-199105020-00002
13. Miniaci A, Berlet G. Recurrent anterior instability following failed surgical repair: allograft reconstruction of large humeral head defects [Abstract]. J Bone Joint Surg Br. 2001;83(Suppl 1):19-20.
14. Moros C, Ahmad CS: Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability. Orthopedics 2009, 32(8). doi: 10.3928/01477447-20090624-21
15. Nourissat G, Kilinc AS, Werther JR, Doursounian L. A prospective, comparative, radiological, and clinical study of the influence of the “Remplissage” procedure on shoulder range of motion after stabilization by arthroscopic Bankart repair. Am J Sports Med. 2011;39(10):2147-52. Doi: 10.1177/0363546511416315
16. Park MJ, Garcia G, Malhotra A, Major N, Tjoumakaris FP, Kelly JD 4th. The evaluation of arthroscopic Remplissage by high-resolution magnetic resonance imaging. Am J Sports Med. 2012;40(10):2331-6. Doi: 10.1177/0363546512456974
17. Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sach’s “Remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy. 2008;24(6):723-6. Doi: 10.1016/j.arthro.2008.03.015
18. Weber BG, Simpson LA, Hardegger F. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am. 1984;66(9):1443-50. PMID: 6501339.

How to Cite this article: Kamat N, Ajri A, Sodhai VM, Kalamb V, Shyam AK, Sancheti PK | Does addition of Remplissage procedure cause external rotation deficit in the patient undergoing standard Bankart repair for recurrent shoulder dislocation with engaging Hill-Sach’s lesions ? | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1):7-10.

(Abstract    Full Text HTML)      (Download PDF)

Outcomes Following Open Reduction Internal Fixation of Extra Articular or Simple Articular Distal Humerus Fractures in Patients over 75 Years of Age

/0 Comments/in /by

Acta of Shoulder and Elbow Surgery | Volume 4 | Issue 1 | January-June 2020 | Page 2-6 |  Benjamin W. Sears, Mitchell J. Sungelo, Jacqueline E. Bader, Armodios M. Hatzidakis, Charles L. Getz

Authors:  Benjamin W. Sears [1], Mitchell J. Sungelo [2], Jacqueline E. Bader [1], Armodios M. Hatzidakis [1], Charles L. Getz [3]

[1] Western Orthopaedics, 1830 Franklin St Ste 450 Denver, CO 80218
[2] University of Colorado School of Medicine, 13001 E. 17th Place Aurora, CO 80045
[3] Rothman Institute, 925 Chestnut St Philadelphia, PA 19107

Address of Correspondence
Dr. Benjamin W. Sears,
Western Orthopaedics, 1830 Franklin St Ste 450 Denver, CO 80218
E-mail: bwsears@gmail.com

Abstract

Introduction: Treatment of distal humerus fractures in the aged population remains controversial due to concerns for bone quality, healing capacity, and integrity of the surrounding soft tissue envelope. We evaluated outcomes of open reduction internal fixation (ORIF) in patients aged ≥75 years with extra articular or simple articular distal humerus fractures (AO Type A or B).
Methods: Between 2011 to 2016, 13 patients 75 years of age or older identified in the last five years at two tertiary elbow centers as having undergone ORIF for AO Type A or B distal humerus fractures were retrospectively reviewed.
Results: The final average Mayo Elbow Performance Scores (MEPS) was 83.1 (range, 50-100). Average range of motion included lack of extension to 15° (range, 0-40°), and an average flexion to 128° (range, 115-140°). Average time to union was 12.2 weeks; however, two patients treated with percutaneous pinning resulted in nonunion. One required conversion to total elbow arthroplasty for pain with osseous collapse. There were no triceps or ulnar nerve issues, and no associated perioperative medical complications.
Conclusions: ORIF for AO Type A or B distal humerus fractures in the elderly population provides for immediate/early, functional use of the extremity, predictable union, limited perioperative complications and no long-term weight bearing restrictions. Conversion to total elbow arthroplasty can be utilized as a salvage procedure.
Level of evidence: Level IV.
Keywords: Distal humerus fracture, Elderly, ORIF, Arthroplasty, Fixation, Osteoporosis, Percutaneous pinning, Locked plates.

References

1. Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17(1):38-47. DOI: 10.1097/00005131-200301000-00006
2. Palvanen M, Kannus P, Niemi S, Parkkari J. Secular trends in the osteoporotic fractures of the distal humerus in elderly women. Eur J Epidemiol 1998;14(2):159-64. DOI: 10.1023/a:1007496318884
3. Amir S, Jannis S, Daniel R. Distal humerus fractures: a review of current therapy concepts. Curr Rev Musculoskelet Med 2016;9(2):199-206. DOI: 10.1007/s12178-016-9341-z
4. O’Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005;14(1 Suppl S):186s-94s. DOI: 10.1016/j.jse.2004.09.033
5. Sanchez-Sotelo J, Torchia ME, O’Driscoll SW. Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique. J Bone Joint Surg Am 2007;89(5): 961-9. DOI: 10.2106/JBJS.G.01502
6. Liu JJ, Ruan HJ, Wang JG, et al. Double-column fixation for type C fractures of the distal humerus in the elderly. J Shoulder Elbow Surg 2009;18(4):646-51. DOI: 10.1016/j.jse.2008.12.012
7. Lovy AJ, Keswani A, Koehler SM, et al. Short-Term Complications of Distal Humerus Fractures in Elderly Patients: Open Reduction Internal Fixation Versus Total Elbow Arthroplasty. Geriatr Orthop Surg Rehabil 2016;7(1): 39-44. DOI: 10.1177/2151458516630030
8. Strauss EJ, Alaia M, Egol KA. Management of distal humeral fractures in the elderly. Injury 2007;38 Suppl 3: S10-6. DOI: 10.1016/j.injury.2007.08.006
9. Varecka TF, Myeroff C. Distal humerus fractures in the elderly population. J Am Acad Orthop Surg. 2017;25:673-83. DOI: 10.5435/JAAOS-D-15-00683
10. Desloges W, Faber KJ, King GJ, Athwal GS. Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients. J Shoulder Elbow Surg 2015; 24(8):1187-96. DOI: 10.1016/j.jse.2015.05.032
11. Githens M, Yao J, Sox AH, Bishop J. Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty for the Treatment of Geriatric Distal Humerus Fractures: A Systematic Review and Meta-Analysis. J Orthop Trauma 2014;28(8): p. 481-8. DOI: 10.1097/BOT.0000000000000050
12. Mansat P, Nouaille Degorce H, Bonnevialle N, Demezon H, Fabre T. Total elbow arthroplasty for acute distal humeral fractures in patients over 65 years old – results of a multicenter study in 87 patients. Orthop Traumatol Surg Res 2013; 99(7):779-84. DOI: 10.1016/j.otsr.2013.08.003
13. McKee MD, Veillette CJ, Hall JA, Schemitsch EH, Wild LM, McCormack R, et al. A multicenter, prospective, randomized, controlled trial of open reduction–internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 2009;18(1): 3-12. DOI: 10.1016/j.jse.2008.06.005
14. Egol KA, Tsai P, Vazques O, Tejwani NC. Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows. Am J Orthop (Belle Mead NJ) 2011;40(2): 67-71.
15. Ellwein A, Lill H, Voigt C, Wirtz P, Jensen G, Katthagen JC. Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus. Int Orthop 2015; 39(4):747-54. DOI: 10.1007/s00264-014-2635-0
16. Frankle MA, Herscovici D Jr, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 2003;17(7):473-80. DOI: 10.1097/00005131-200308000-00001
17. Voloshin I, Schippert DW, Kakar S, Kaye EK, Morrey BF. Complications of total elbow replacement: a systematic review. J Shoulder Elbow Surg 2011;20(1): 158-68. DOI: 10.1016/j.jse.2010.08.026
18. Charissoux JL, Vergnenegre G, Pelissier M, Fabre T, Mansat P. Epidemiology of distal humerus fractures in the elderly. Orthop Traumatol Surg Res 2013;99(7):765-9. DOI: 10.1016/j.otsr.2013.08.002
19. Gschwend N, Simmen BR, Matejovsky Z. Late complications in elbow arthroplasty. J Shoulder Elbow Surg 1996;5(2 Pt 1):86-96. DOI: 10.1016/s1058-2746(96)80002-4
20. Szekeres M and King GJ. Total elbow arthroplasty. J Hand Ther 2006;19(2): 245-53. DOI: 10.1197/j.jht.2006.02.010.

How to Cite this article: Sears BW, Sungelo MJ, Bader JE, Hatzidakis AM, Getz CL | Outcomes Following Open Reduction Internal Fixation of Extra Articular or Simple Articular Distal Humerus Fractures in Patients over 75 Years of Age | Acta of Shoulder and Elbow Surgery | January-June 2020; 4(1):2-6.

(Abstract    Full Text HTML)      (Download PDF)

Derotational humerus osteotomy and teres major tenotomy for recurrent posterior shoulder instability: A case report

/0 Comments/in /by

Acta 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

1- Tannenbaum E, Sekiya JK. Evaluation and management of p o s t e r i o r s h o u l d e r i n s t a b i l i t y. S p o r t s He a l t h . 2011;3(3):253–263. doi:10.1177/194173811140056
2- Paul J, Buchmann S, Beitzel K, Solovyova O, Imhoff AB .Posterior Shoulder Dislocation: Systematic Review and Treatment Algorithm.The Journal of Arthroscopic and Related Surgery, Vol 27, No 11 (November), 2011: pp 1562- 1572.doi:10.1016/j.arthro.2011.06.015
3- Bäcker HC, Galle SE, Maniglio M, Rosenwasser MP. Biomechanics of posterior shoulder instability – current
knowledge and literature review. World J Orthop 2018 N o v e m b e r 1 8 ; 9 ( 1 1 ) : 2 4 5 – 2 5 4 , D O I : 10.5312/wjo.v9.i11.245
4- Moroder P, Scheibel M, ABC classification of posterior shoulder instability.Obere Extrem.2017;12(2):66- 74.doi:10.1007/s11678-017-0404-6
5- Neer CS, Foster GR (1980) inferior capsular shift in involuntary inferior and multi directional instability of the shoulder . A preliminary report. J Bone Joint Surg Am. 1980 Sep;62(6):897-908
6- Scott DJ (1967) Treatmcnt of recurrent posterior dislocations of the shoulder by glenoplasty.Report of three cases. J Bone Joint Surg Am. 1967 Apr;49(3):471-6.
7- Grammont P, Lemaire JP, Crezard L, Berard J (1983) Les luxations dites “volontaires” de l’epaule du jeune sportif. Leur traitement par tenotomie du grand rond (teres major). Acta Orthop Belg. 1983 Jan-Apr;49(1-2):257-66
8- BG Weber, LA Simpson, F Hardegger , S Gallen. Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am. 1984;66:1443-1450.
9- G. K. Chaudhuri, A. Sengupta & A. K. Saha (1974) Rotation Osteotomy of the Shaft of the Humerus for Recurrent
Dislocation of the Shoulder: Anterior and Posterior, Acta O r t h o p a e d i c a S c a n d i n av i c a , 4 5 : 1 – 4 , 1 9 3 – 1 9 8 , DOI:10.3109/17453677408989139
10- Surin V1, Blåder S, Markhede G, Sundholm K. Rotational osteotomy of the humerus for posterior instability of the shoulder. J Bone Joint Surg Am. 1990 Feb;72(2):181-6.
11- J.C. Meynet .Subluxation posterieure recidivante de l’epaule :que peut-on proposer ?Orthop Traumatol (1994) 4: 135. https://doi.org/10.1007/BF017884499

How to Cite this article: Jad Chbib Abi Raad J, Bouttens D, Lebbos S, Obry C. Derotational humerus
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.

(Abstract    Full Text HTML)      (Download PDF)

Randomized controlled trial comparing local autologous bloodinjection and polidocanol injection for treatment of lateral epicondylosis of elbow

/0 Comments/in /by

Acta 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

1. Nirschl RP, Alvarado GJ. In: Morrey BF, Sanchez-Sotelo J, editors. The Elbow and Its Disorders, 4th ed. Philadelphia: Saunders Elsevier; 2009.
2. Sayegh ET, Strauch R J. Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A metaanalysis. ClinOrthopRelat Res. 2015 Mar;473(3):1093-107.
3. Judson CH, Wolf JM. Lateral epicondylitis: review of injection therapies. OrthopClin North Am. 2013 Oct;44(4):615 23.
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.
6. Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis:an analysis of the literature. Med Sci Sports Exerc. 1998 Aug;30(8):1183-90.
7. Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am AcadOrthop Surg. 2008 Jan;16(1):19- 29.
8. Zeisig E, Fahlström M, Ohberg L, Alfredson H. Pain relief after intratendinousinjections in patients with tennis elbow: results of a randomised study. Br JSports Med. 2008 Apr;42(4):267-71.
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.

How to Cite this article: Didel R, Kumar S. Randomized controlled trial comparing local autologous
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.

(Abstract    Full Text HTML)      (Download PDF)

Case Report: A rare case of Giant Cell Tumor of Distal Ulna

/0 Comments/in /by

Acta 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.

How to Cite this article: Chachcha S R, Saini R, Yadav A. Case Report: A rare case of Giant Cell Tumor of Distal Ulna. Acta of Shoulder and Elbow Surgery Jan-June 2019;3(1):19-20.

(Abstract    Full Text HTML)      (Download PDF)

Suprascapular neuropathy in a young male handball player: case report

/0 Comments/in /by

Acta 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.

How to Cite this article: Barros L H, Rodrigues C, Claro R. Suprascapular neuropathy in a young male handball player: case report. Acta of Shoulder and Elbow Surgery Jan – June 2019;3(1):16-18.

(Abstract    Full Text HTML)      (Download PDF)