The inferior capsular shift operation for instability of the shoulder. Long-term results in 34 shoulders.
(9/1247)
We reviewed 26 patients with 34 shoulders treated by the inferior capsular shift operation for inferior and multidirectional instability. The mean follow-up was 8.3 years. In total, 12 shoulders showed voluntary subluxation. Eight operations used an anterior and posterior approach, 11 were by the posterior route, and 15 shoulders had an anterior approach. In 30 shoulders (85%) the outcome was satisfactory and 20 (59%) scored good or excellent results on the Rowe system. Instability had recurred in nine shoulders (26%) from three months to three years after the operation. Six of the 12 shoulders with voluntary subluxation (50%) had recurrence, as against three of the other 22 (14%), a statistically significant difference. The operation is therefore not indicated for voluntary subluxation. The 19 shoulders which had been assessed in 1987 at a mean of 3.5 years after surgery, were also reviewed in 1995 and found to have no significant changes in instability or Rowe score. This shows that the capsular shift appeared to have maintained its tension over an eight-year period. After the use of a posterior approach, 64% of the shoulders showed a posterolateral defect on radiographs of the humerus. (+info)
Ultrasound screening for hips at risk in developmental dysplasia. Is it worth it?
(10/1247)
Between May 1992 and April 1997, there were 20,452 births in the Blackburn District. In the same period 1107 infants with hip 'at-risk' factors were screened prospectively by ultrasound. We recorded the presence of dislocation and dysplasia detected under the age of six months using Graf's alpha angle. Early dislocation was present in 36 hips (34 dislocatable and 2 irreducible). Of the 36 unstable hips, 30 (83%) were referred as being Ortolani-positive or unstable; 25 (69%) of these had at least one of the risk factors. Only 11 (31%) were identified from the 'at-risk' screening programme alone (0.54 per 1000 live births). Eight cases of 'late' dislocation presented after the age of six months (0.39 per 1000 live births). The overall rate of dislocation was 2.2 per 1000 live births. Only 31% of the dislocated hips belonged to a major 'at-risk' group. Statistical analysis confirmed that the risk factors had a relatively poor predictive value if used as a screening test for dislocation. In infants referred for doubtful clinical instability, one dislocation was detected for every 11 infants screened (95% confidence interval (CI) 8 to 17) whereas in infants referred because of the presence of any of the major 'at-risk' factors the rate was one in 75 (95% CI 42 to 149). Routine ultrasound screening of the 'at-risk' groups on their own is of little value in significantly reducing the rate of 'late' dislocation in DDH, but screening clinically unstable hips alone or associated with 'at-risk' factors has a high rate of detection. (+info)
Laxity in healthy and osteoarthritic knees.
(11/1247)
OBJECTIVE: Although it is a cause of osteoarthritis (OA) in animal models, laxity in human knee OA has been minimally evaluated. Ligaments become more compliant with age; whether this results in clinical laxity is not clear. In theory, laxity may predispose to OA and/or result from OA. Our goals were to examine the correlation of age and sex with knee laxity in control subjects without OA, compare laxity in uninvolved knees of OA patients with that in older control knees, and examine the relationship between specific features of OA and knee laxity. METHODS: We assessed varus-valgus and anteroposterior laxity in 25 young control subjects, 24 older control subjects without clinical OA, radiographic OA, or a history of knee injury, and 164 patients with knee OA as determined by the presence of definite osteophytes. A device was designed to assess varus-valgus laxity under a constant varus or valgus load while maintaining a fixed knee flexion angle and thigh and ankle immobilization. Radiographic evaluations utilized protocols addressing position, beam alignment, magnification, and landmark definition; the semiflexed position was used, with fluoroscopic confirmation. RESULTS: In the controls, women had greater varus-valgus laxity than did men (3.6 degrees versus 2.7 degrees; 95% confidence interval [95% CI] of difference 0.38, 1.56; P = 0.004), and laxity correlated modestly with age (r = 0.29, P = 0.04). Varus-valgus laxity was greater in the uninvolved knees of OA patients than in older control knees (4.9 degrees versus 3.4 degrees; 95% CI of difference 0.60, 2.24; P = 0.0006). In OA patients, varus-valgus laxity increased as joint space decreased (slope -0.34; 95% CI -0.48, -0.19; P < 0.0001) and was greater in knees with than in knees without bony attrition (5.3 degrees versus 4.5 degrees; 95% CI of difference 0.32, 1.27; P = 0.001). CONCLUSION: Greater varus-valgus laxity in the uninvolved knees of OA patients versus older control knees and an age-related increase in varus-valgus laxity support the concept that some portion of the increased laxity of OA may predate disease. Loss of cartilage/bone height is associated with greater varus-valgus laxity. These results raise the possibility that varus-valgus laxity may increase the risk of knee OA and cyclically contribute to progression. (+info)
Joint hypermobility and genetic collagen disorders: are they related?
(12/1247)
The HDCTs constitute a heterogeneous group of rare genetically determined diseases, the best known of which are Ehlers-Danlos and Marfan syndromes and osteogenesis imperfecta. Hypermobility is a feature common to them all, but it is also a feature that is highly prevalent in the population at large. Symptomatic hypermobile subjects (whose symptoms are attributable to their hypermobility) are said to be suffering from the benign joint hypermobility syndrome, which has many features that overlap with the HDCTs. It is not yet known whether there is a variety of hypermobility (symptomatic or otherwise) that is not part of a connective tissue disorder. (+info)
Shoulder instability in young athletes.
(13/1247)
The term "shoulder instability" constitutes a spectrum of disorders that includes dislocation, subluxation and laxity. Anterior instability is the most common form of glenohumeral instability and may be associated with nerve injury. The diagnosis of anterior, posterior or multidirectional instability is based on a thorough history and physical examination that includes specific provocative maneuvers. The load-and-shift test, the relocation test, the drawer test, the sulcus test and the anterior apprehension test are useful for assessment of the shoulder. Radiographic studies should include special views to delineate specific lesions, such as a Bankart lesion and a Hill-Sachs defect. Early surgical intervention may be a consideration, especially in younger patients. Recent studies suggest that surgical intervention after the first dislocation may reduce the rate of recurrence. Rehabilitation is accomplished in four phases, beginning with rest and pain control and proceeding to isometric and isotonic exercises. The goal is for the patient to reach 90 percent strength in the injured shoulder compared with the uninjured shoulder. (+info)
Dynamic stability of glenohumeral joint during scapular plane elevation.
(14/1247)
OBJECTIVE: To investigate the muscle-controlled dynamic stability of the glenohumeral joint through X-ray fluoroscopy in active and passive shoulder elevation in scapular plane. METHODS: Sixty healthy volunteers were collected in this study, including 23 men and 37 women, with an average age of 28.4 years. Passive and active shoulder elevation in scapular plane were observed under X-ray imaging. In 18 subjects, X-ray films were taken when the shoulder elevated in scapular plane from 0 degree to 150 degrees with a 30 degrees interval at each stage in both active and passive movements. The angles between the pivot of the humerus and the glenoid surface (GHA) during the active and passive motion were calculated and analyzed. Manual examination was also applied in the same manner. RESULTS: The pivot of the humerus had a tendency to be vertically closer to the glenoid surface in the active elevation than in the passive elevation. The differences of GHA between the active and passive motion at 0 degree, 30 degrees, 60 degrees, 90 degrees, 120 degrees and 150 degrees elevation were 4.55 degrees +/- 0.37 degree, 5.44 degrees +/- 1.16 degrees, 6.50 degrees +/- 1.50 degrees, 4.94 degrees +/- 0.82 degree, 4.50 degrees +/- 0.40 degree and 1.44 degrees +/- 0.68 degree, respectively. Manual examination found the angle between the scapula and the humerus tended to be larger in the active motion than in the passive motion. CONCLUSION: The active coordination of the muscles around the shoulder is beneficial to the dynamic stability of the glenohumeral joint. (+info)
Spinal instrumentation for unstable C1-2 injury.
(15/1247)
Seventeen patients with unstable C1-2 injuries were treated between 1990 and 1997. Various methods of instrumentation surgery were performed in 16 patients, excluding a case of atlantoaxial rotatory fixation. Posterior stabilization was carried out in 14 cases using Halifax interlaminar clamp, Sof'wire or Danek cable, or more recently, transarticular screws. Transodontoid anterior screw fixation was performed in four cases of odontoid process fractures, with posterior instrumentation in two cases because of malunion. Rigid internal fixation by instrumentation surgery for the unstable C1-2 injury avoids long-term application of a Halo brace and facilitates early rehabilitation. However, the procedure is technically demanding with the risk of neural and vascular injuries, particularly with posterior screw fixation. Sagittal reconstruction of thin-sliced computed tomography scans at the C1-2 region, neuronavigator, and intraoperative fluoroscopy are essential to allow preoperative surgical planning and intraoperative guidance. (+info)
Femoral intercondylar notch measurements in osteoarthritic knees.
(16/1247)
METHODS: We measured the dimensions of the intercondylar notch of the femur in 32 patients with primary severe osteoarthrosis (OA) of the knee and 54 embalmed cadaveric knees. RESULTS: There were 56 knees with morphologically normal anterior cruciate ligament (ACL), 11 knees with lax or partially ruptured ACL and 19 knees with missing ACL. The average width of the intercondylar notch in knees with lax and missing ACL was significantly narrower than that of knees with normal ACL. In addition, knees with missing ACL had a significantly smaller notch depth than knees with normal ACL. In medial compartment OA (56 knees), the notch width and depth in knees with severe OA (37 knees) were significantly smaller than those in normal (19 knees) and mild to moderate OA groups (19 knees). CONCLUSION: Our results indicate that osteophyte growth in the femoral intercondylar notch seems to correlate with the progression of medial compartment OA of the knee. (+info)