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- Hovelius, Lennart, et al.
(author)
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Documentation of disclocation arthropathy of the shoulder "area index" : a better method to objectify the humeral osteophyte?
- 2008
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In: Journal of shoulder and elbow surgery. - St. Louis, MO : Mosby Yearbook, Inc.. - 1058-2746 .- 1532-6500. ; 17:2, s. 197-201
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Journal article (peer-reviewed)abstract
- We suggest a method to validate the Samilson-Prieto classification system of dislocation arthropathy of the shoulder. Based on a mean standard sagital measure of the humeral head, we calculate an area index for the humeral osteophyte. The application of this method is done on a previous published series of 56 shoulders with a follow-up time of 15 years minimum after surgery with the Bankart or Bristow repairs. This technique of evaluation showed that the Bristow shoulders had a higher mean area index value on all radiological projections compared to the Bankart shoulders. The highest index was found on AP radiogrammes angulated 45° from above with the arm in neutral rotation (subcoracoid view) followed by the AP view in inward rotation. Our observations indicate that the humeral osteophyte mostly has its largest size at 4 to 5 o'clock position, as visualized with its greatest index on the subcoracoid view. Mild arthropathy, according to Samilson-Prieto, had a mean osteophyte area index of 3.7 (standard deviation, 3.4) on the AP inward rotation view. The corresponding figures for moderate arthropathy were 10.6 (standard deviation, 13.3) and 30.3 for severe (standard deviation, 24.1), respectively. The use of this index, based on the AP view in inward and outward rotation, will make future comparisons between different series of patients more reliable than using just the Samilson-Prieto classification. The radiological change over time should also be more appropriately described. Furthermore, this paper emphasizes the importance of using the same radiological views when dislocation arthropathy of the shoulder is documented.
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- Hovelius, Lennart, et al.
(author)
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One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years : Study II - the evolution of dislocation arthropathy
- 2006
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In: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 15:3, s. 279-289
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Journal article (peer-reviewed)abstract
- Dislocation arthropathy after surgical treatment of recurrent anterior dislocation of the shoulder has been a subject of discussion over the years. The objective of this prospective study was to evaluate the Bristow-Latarjet repair at 2 and 15 years after surgery with respect to arthropathy and to evaluate factors responsible for this development. At 2 and 15 years after a Bristow-Latarjet repair for recurrent anterior dislocation, we prospectively analyzed the radiographs of 115 of 118 shoulders. The majority of the patients also had radiography of the nonindex shoulder (111/118). Dislocation arthropathy was found on ordinary anteroposterior views in 46 of 115 shoulders (mild in 39, moderate in 5, and severe in 2). The anteroposterior view angulated 45 degrees from above gave the best visualization of the humeral osteophyte and, together with the axial view, doubled the incidence of moderate and severe arthropathy at follow-up (mild in 40, moderate in 11, and severe in 5). Of 38 shoulders with a postoperative position of the transferred coracoid process 2 to 4 mm medial to the glenoid rim and the screw and transplant parallel to the glenoid, 3 had moderate arthropathy (8%) compared with 8 shoulders with moderate arthropathy and 5 with severe arthropathy out of 77 shoulders with a nonoptimal position of the coracoid (17%) (P = not significant). The degree of restriction of outward rotation at 2 years did not influence the degree of arthropathy after 15 years. Global assessment of the operative result was not related to arthropathy at follow-up. When the first dislocation occurred before age 23 years, the incidence of arthropathy was significantly lower than when it occurred in age 23 years or older (P = .006). When all views were included, moderate or severe dislocation arthropathy was found in 14% of the shoulders, and a further 35% had mild arthropathy. When follow-up studies of operated series of shoulder dislocations with the Bristow-Latarjet method are done, it is important to have the same radiologic views to compare the incidence of dislocation arthropathy correctly.
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- Norlin, Rolf, et al.
(author)
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Small full-thickness tears do well ten to thirteen years after arthroscopic subacromial decompression
- 2008
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In: Journal of shoulder and elbow surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 17:1 Suppl., s. 12S-16S
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Journal article (peer-reviewed)abstract
- A consecutive series of 181 patients with clinical signs of subacromial impingement underwent arthroscopic subacromial decompression (ASD). All patients had the same surgical procedure, and all pathological findings at the arthroscopy were recorded. Ten to 13 years (mean, 11.2) after the procedure, 162 patients (91%) were available for follow-up consisting of clinical examination and the Constant-Murley and DASH scores. The overall mean value of the age correlated Constant score was 77 points. Men had significantly better Constant score than women. The state of the rotator cuff at the index procedure was found to affect the outcome significantly. Patients with isolated full-thickness supraspinatus tears had the best results, followed by those with partial tears, intact cuffs, or large tears involving more than 1 tendon. ASD in the treatment of subacromial impingement yields good long-term results. Small full-thickness supraspinatus tears had the best results, indicating that the ASD might prevent further cuff deterioration and that repair of these lesions may be unnecessary.
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- Herbertsson, Pär, et al.
(author)
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Displaced Mason type I fractures of the radial head and neck in adults: A fifteen- to thirty-three-year follow-up study
- 2005
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In: Journal of Shoulder and Elbow Surgery. - : Elsevier BV. - 1058-2746. ; 14:1, s. 73-77
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Journal article (peer-reviewed)abstract
- Undisplaced radial head and neck fractures are consistently described with no long-term deficits. The aim of this study was to evaluate specifically the long-term outcome of displaced Mason type I fractures, which have not previously described. Twenty women and twelve men, with a mean age of 46 years (range, 22-69 years) when they sustained a displaced Mason type I fracture, were reexamined at a mean of 21 years (range, 15-33 years) after injury. All were treated nonoperatively. Twenty-nine individuals had no subjective complaints, whereas three had occasional elbow pain. There was no objective impairment, and none had elbow osteoarthritis, defined as reduced joint space, whereas there was more radiographic degeneration in the formerly fractured elbow than in the uninjured elbow (85% vs 4%, P < .001). We conclude that the long-term results of nonoperatively treated displaced Mason type I fractures of the radial head and neck are predominantly favorable.
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- Johansson, Kajsa, et al.
(author)
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Intraobserver and interobserver reliability for the strength test in the Constant-Murley shoulder assessment
- 2005
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In: Journal of Shoulder and Elbow Surgery. - : Elsevier BV. - 1058-2746. ; 14:3, s. 273-278
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Journal article (peer-reviewed)abstract
- This study evaluates the standardized strength test in the Constant-Murley shoulder assessment of adults with healthy shoulders in a randomized, single-blind design. The following questions were to be answered: (1) Can the spring balance and a digital dynamometer both yield the same result? (2) What is the intraobserver and interobserver reliability of the strength test? (3) Is the strength test sensitive to change in technique or affected by calculation with mean or maximum values? Ten subjects were included in a comparison of the Handyscale (digital dynamometer) and the mechanical spring balance for concurrent validity, resulting in intraclass correlation coefficient values ranging from 0.96 to 0.99. For intraobserver and interobserver reliability, 2 observers tested 20 subjects with the Handyscale and retested them after 2 weeks. Regardless of technique during testing, this resulted in almost perfect agreement (intraclass correlation coefficient range, 0.89–0.98). The digital dynamometer can replace the conventional spring balance. The standardized strength test in the Constant-Murley shoulder assessment is reliable in young subjects with healthy shoulders, independent of technique or whether calculated with mean or maximum values.
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