1
|
Brandariz R, Charbonnier C, Culebras Almeida A, Lädermann A, Cunningham G. The role of bone morphology of the greater tuberosity and lateral acromion on subacromial space during scaption: a three-dimensional dynamic simulation analysis. BMC Musculoskelet Disord 2023; 24:888. [PMID: 37968608 PMCID: PMC10647087 DOI: 10.1186/s12891-023-06957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
| | - Caecilia Charbonnier
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alejandro Culebras Almeida
- Shoulder and Elbow Center La Colline, Geneva, Switzerland
- Department of Orthopaedics and Traumatology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Alexandre Lädermann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Gregory Cunningham
- Shoulder and Elbow Center La Colline, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
| |
Collapse
|
2
|
Flaherty F. Simultaneous isolated avulsion fractures of the lesser tuberosities of the humeri: A rare occurrence secondary to alcohol withdrawal seizures. Radiol Case Rep 2022; 17:4435-4438. [PMID: 36188088 PMCID: PMC9520500 DOI: 10.1016/j.radcr.2022.08.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022] Open
Abstract
Fractures of the lesser tuberosity of the humerus are typically traumatic in nature, most commonly occurring in association with multi-part fractures of the humeral head, often in the setting of a posterior shoulder dislocation. Isolated fractures of the lesser tuberosity are considerably more rare and are difficult to diagnose on standard shoulder radiographs without an axillary view. These fractures have been associated with 3 main types of injury: acute abduction/external rotation injury, acute injury or repetitive stress injury in adolescent overhead or throwing athletes, and rarely as a seizure associated injury. The mechanism of injury in these cases has been posited to relate to the subscapularis tendon, either resisting forced abduction/external rotation in the setting of trauma, exerting chronic or acute avulsive traction in the setting of adolescent overhead or throwing athletes, or violently contracting and avulsing the lesser tuberosity in the setting of seizures. We present an unusual case of a 27-year-old male with a history of alcohol use disorder with bilateral shoulder pain after minor trauma and observed seizure-like activity. Clinical work-up revealed bilateral isolated avulsion fractures of the lesser tuberosities, which was thought to be on the basis of seizure-related violent contraction of the subscapularis muscles. The clinical relevance of this case is that a high clinical index of suspicion is needed in order to detect lesser tuberosity avulsion fractures and avoid the consequences of untreated injury such as instability or impingement.
Collapse
|
3
|
Garbis NG, Walsh DJ. Delayed Repair of a Lesser Tuberosity Avulsion Fracture in an Adolescent 3 Years After Initial Injury. Orthopedics 2022; 46:e189-e192. [PMID: 36067048 DOI: 10.3928/01477447-20220831-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This case study examines an adolescent athlete who had an avulsion fracture of the lesser tuberosity of the humerus. This is a relatively rare injury, although a collection of case studies have identified an increase in this type of injury in the past 15 years. Uniquely, the patient experienced a delay in appropriate diagnosis for approximately 3 years from the time of his initial injury. This is one of the most significant delays in diagnosis and treatment in the current body of literature regarding lesser tuberosity fractures. The authors include a detailed series of imaging studies, including preoperative plain radiographs, preoperative computed tomography, intraoperative arthroscopic images, and postoperative plain radiographs. In addition, a thorough description of the patient's surgery is presented. The degree of scarring to the axillary nerve present in this patient required conversion to a full open reduction. The authors' aim is that this case can be used as a reference for future surgical decision making, particularly in pediatric patients whose injuries are highly chronic or who are actively involved in athletic physical training programs. [Orthopedics. 20XX;XX(X):xx-xx.].
Collapse
|
4
|
Spek RW, Schoolmeesters BJ, den Haan C, Jaarsma RL, Doornberg JN, van den Bekerom MP. What are the patient-reported outcomes, functional limitations, and complications after lesser tuberosity fractures? a systematic review of 172 patients. JSES Int 2021; 5:754-764. [PMID: 34223426 PMCID: PMC8245972 DOI: 10.1016/j.jseint.2021.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lesser tuberosity fractures are relatively rare, with an incidence of 0.46 per 100,000 persons per year. This systematic review was performed to address patient-reported outcomes (PROMs), shoulder function, and complications after lesser tuberosity fractures in pediatric and adult patients, as well as patients with an associated posterior shoulder dislocation. Within these groups, identical outcomes were evaluated for nonoperative, surgical, acute and delayed treatment. METHOD A comprehensive search was carried out in multiple databases. Articles were included if patients sustained a lesser tuberosity fracture without a concomitant proximal humerus fracture. There were no restrictions on age, type of treatment, fragment displacement, time to presentation, or associated injuries. RESULTS One thousand six hundred forty-four records were screened for eligibility of which 71 studies were included (n = 172). Surgical treatment was provided to 50 of 62 (81%) pediatric patients, 49 of 66 (74%) adults, and 34 of 44 (77%) patients with an associated posterior shoulder dislocation. In the pediatric group, the mean of PROMs was 94 (range 70-100) and among adults 89 (range 85-100). In the posterior shoulder dislocation group, 89% did not regain full range of motion and the complication rate was 17%. In pediatric patients, surgery was associated with fewer complications (P = .021) compared to nonoperative treatment. CONCLUSION Pediatric patients have excellent outcomes after lesser tuberosity fractures and respond well to surgical treatment. Adults have acceptable outcomes but patients with an associated posterior shoulder dislocation have impaired range of shoulder movement and are more likely to develop complications.
Collapse
Affiliation(s)
- Reinier W.A. Spek
- Medical Doctor, Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | | | | | - Ruurd L. Jaarsma
- Orthopaedic Trauma Surgeon, Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Job N. Doornberg
- Orthopaedic Trauma Surgeon, Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Michel P.J. van den Bekerom
- Orthopaedic Surgeon, Shoulder and Elbow Expertise Centre, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| |
Collapse
|
5
|
de Casas R, Novoa B, Cobelo E, Cidoncha M. Reconstruction of a massive avulsion fracture of the lesser tuberosity using the arthroscopic tension band technique: a case report and brief review of the literature. JSES Int 2020; 4:730-733. [PMID: 33345207 PMCID: PMC7738591 DOI: 10.1016/j.jseint.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ricardo de Casas
- Department of Orthopedic Surgery, Clinica Traumacor, A Coruna, Spain
| | - Benedicto Novoa
- Department of Orthopedic Surgery, Clinica Traumacor, A Coruna, Spain
| | - Elisa Cobelo
- Department of Orthopedic Surgery, Clinica Traumacor, A Coruna, Spain
| | - Myriam Cidoncha
- Department of Physical Medicine, Clinica Traumacor, A Coruna, Spain
| |
Collapse
|
6
|
Zhang H, Zhang Q, Li ZL. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. INTERNATIONAL ORTHOPAEDICS 2018; 43:1909-1916. [DOI: 10.1007/s00264-018-4078-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/21/2018] [Accepted: 07/30/2018] [Indexed: 11/29/2022]
|
7
|
Cregar WM, MacLean IS, Verma NN, Trenhaile SW. Lesser Tuberosity Avulsion Fracture Repair Using Knotless Arthroscopic Fixation. Arthrosc Tech 2018; 7:e899-e905. [PMID: 30258770 PMCID: PMC6153270 DOI: 10.1016/j.eats.2018.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/25/2018] [Indexed: 02/03/2023] Open
Abstract
Although some literature may suggest that acute nondisplaced lesser tuberosity fractures should undergo nonoperative management, there is a body of evidence that supports surgical stabilization of these injuries due to concern for fracture displacement, nonunion and malunion, anteromedial impingement, and possible biceps tendon subluxation or dislocation. In this Technical Note, we introduce a novel technique for arthroscopic fixation of lesser tuberosity avulsion fractures using a knotless repair. In the lateral decubitus position using standard arthroscopic portals, with the addition of the biceps accessory portal, 2 ULTRATAPE sutures are fixed to the avulsed fragment in luggage-tag fashion to create a secure, knotless fixation. These are used to mobilize and anatomically approximate the lesser tuberosity to the avulsion bed and are held in place with suture anchors placed immediately adjacent to the fracture bed. This technique provides good anatomic reduction with maximal surface area for bone-to-bone healing.
Collapse
Affiliation(s)
- William M. Cregar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.,Address correspondence to William M. Cregar, M.D., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Ste 201, Chicago, IL 60612, U.S.A.
| | - Ian S. MacLean
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N. Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | |
Collapse
|
8
|
Cunningham G, Nicodème-Paulin E, Smith MM, Holzer N, Cass B, Young AA. The greater tuberosity angle: a new predictor for rotator cuff tear. J Shoulder Elbow Surg 2018; 27:1415-1421. [PMID: 29703680 DOI: 10.1016/j.jse.2018.02.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The implication of scapular morphology in rotator cuff tears has been extensively studied. However, the role of the greater tuberosity (GT) should be of equal importance. The aim of this study was to propose a new radiographic marker, the GT angle (GTA), which measures the position of the GT in relation to the center of rotation of the humeral head. The hypothesis was that a higher angle value would be associated with a higher likelihood in detecting a rotator cuff tear. METHODS During 1 year, patients were prospectively recruited from a single institution specialized shoulder clinic in 2 different groups. The patient group consisted of individuals with a degenerative rotator cuff tear involving at least the supraspinatus. The control group consisted of individuals with no rotator cuff pathology. Individuals in both groups with congenital, post-traumatic, or degenerative alterations of the proximal humerus were excluded. The GTA was measured on an anteroposterior shoulder x-ray image with the arm in neutral rotation by 3 observers at 2 different times. RESULTS The study recruited 71 patients (33 patients, 38 controls). Mean GTA value was 72.5° (range, 67.6°-79.2°) in patients and 65.2° (range, 55.8°-70.5°) for controls (P <.001). A value above 70° resulted in 93-fold higher odds of detecting a rotator cuff tear (P <.001). Interobserver and intraobserver reliability were high. CONCLUSIONS GT morphology is implicated in rotator cuff tears. The GTA is a reliable radiographic marker, with more than 70° being highly predictive in detecting such lesions.
Collapse
Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland.
| | | | - Margaret M Smith
- Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicolas Holzer
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Benjamin Cass
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Allan A Young
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| |
Collapse
|
9
|
Abdrabou AM, Shalaby MH. Narrowed coraco-humeral distance on MRI: Association with subscapularis tendon tear. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
10
|
Redefining anterior shoulder impingement: a literature review. INTERNATIONAL ORTHOPAEDICS 2017; 42:359-366. [PMID: 28585076 DOI: 10.1007/s00264-017-3515-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
Many different types of impingements have been described in the shoulder. Inasmuch as the term 'shoulder impingement' usually refers to subacromial impingement, anterior impingement usually refers to subcoracoid impingement. However, there are many different subtypes of anterior impingements in the shoulder, and awareness of their existence is critical as they vary in their nature and treatment. Recent advances in biomechanical research and arthroscopic exploration of the anterior structures of the shoulder have brought new insights on the various potential impingements, warranting a revision and update of the current definitions of anterior shoulder impingement. The purpose of this article is to propose a comprehensive review and classification of all different subtypes of anterior impingement in the shoulder, including newly described entities.
Collapse
|
11
|
Sonographic Findings in Subcoracoid Impingement Syndrome: A Case Report and Literature Review. PM R 2016; 9:204-209. [PMID: 27317912 DOI: 10.1016/j.pmrj.2016.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/04/2016] [Accepted: 06/10/2016] [Indexed: 11/23/2022]
Abstract
Subcoracoid impingement syndrome is a rare and underrecognized cause of anterior shoulder pain. Currently, subcoracoid impingement syndrome is understood to involve impingement of anatomic structures such as the subcoracoid bursa and subscapularis tendon within the coracohumeral space, and there are no reports of sonographic findings in subcoracoid impingement syndrome other than the impingement of thickened subscapularis bursa. Here we report a case of subcoracoid impingement syndrome, including a novel sonographic finding, arthroscopic findings, and a proposed pathophysiology. LEVEL OF EVIDENCE V.
Collapse
|
12
|
Pauly S, Scheibel M. Knöcherne Ausrisse der Rotatorenmanschette. DER ORTHOPADE 2016; 45:159-66. [DOI: 10.1007/s00132-015-3214-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
13
|
Abstract
Proximal humerus fractures remain one of the most common orthopaedic injuries, particularly in the elderly. Displaced fractures often require surgery, and management can be challenging because of comminution and poor bone quality. Despite advances in surgical technique and implant design, reoperation for malunion or nonunion of the tuberosity (arthroplasty) or screw penetration (open reduction and internal fixation) remains problematic. Recent studies have demonstrated acceptable results following nonsurgical management of displaced proximal humerus fractures in elderly, low-demand patients. In younger, more active patients, reduced function and pain that accompany select proximal humeral malunions are generally poorly tolerated. Surgical options for symptomatic, malunited tuberosities include osteotomy, tuberoplasty with rotator cuff repair and subacromial decompression, or decompression alone. Surgical neck malunion can be managed with corrective osteotomy and preservation of the native joint. Arthroplasty is reserved for complex malunions with joint incongruity. Surgical management of symptomatic proximal humeral malunion remains challenging, but good outcomes can be achieved with proper patient selection.
Collapse
|
14
|
Osti L, Soldati F, Del Buono A, Massari L. Subcoracoid impingement and subscapularis tendon: is there any truth? Muscles Ligaments Tendons J 2013; 3:101-5. [PMID: 23888292 DOI: 10.11138/mltj/2013.3.2.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Subcoracoid impingement and stenosis have been described related to anterior shoulder pain and subscapularis tendon tears, but the pathogenesis and related treatment of this condition has still not been explained properly. Variability of coracoid morphology has been described and both traumatic and iatrogenic factors can modify it. Some authors referred this to a primary narrow coracohumeral distance with different threshold values defined as increased risk factor for subscapularis and antero-superior RC tear; opposite theories stated that the stenosis is secondary to an anterosuperior translation of the humeral head toward the coracoid due to degenerative changes of the rotator cuff tendons. Limited coracoplasty can be performed when related risk factors are identified; however no clear consensus arises from specific literature review and extensive clinical and instrumental examination of the patient should be performed in order to identify specific risk factors for subscapularis tendon pathology and, subsequently, tailor the proper approach.
Collapse
Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopic and Sports Medicine, Hesperia Hospital, Modena, Italy
| | | | | | | |
Collapse
|
15
|
Abstract
BACKGROUND Lesser tuberosity avulsion fractures in adolescents occur infrequently. Perhaps because of their rarity, many cases are missed on initial physical exam, imaging studies, and even diagnostic arthroscopy, leading to delay in diagnosis. Without operative intervention, these injuries may cause significant morbidity, whereas operative fixation has predictably good results. We review 6 cases and compare them to a review of the previous published cases. METHODS All cases of isolated lesser tuberosity avulsions in skeletally immature patients treated by the senior author (MTB) at a pediatric referral center were included. The mean follow-up was over 4 years (range, 2 to 7 y). Operative treatment consisted of a diagnostic arthroscopy to evaluate for concomitant pathology, followed by an open reattachment of the tuberosity through an incision in line with the anterior axillary fold. A lasso technique using suture anchors and sutures to loop over and hold down the fragment is our preferred method as it decreases the risk of fracture seen with fixation using screws or sutures through drill holes in the tuberosity. RESULTS Even with a frequent delay in diagnosis, all patients had a predictably good outcome with an average American Shoulder and Elbow Surgeons score of 97 (range, 88 to 100) and a Western Ontario Shoulder Instability Index of 94 (range, 84 to 100). The patient history, symptoms, and physical exam findings were consistent across the published cases. The prototypical patient is a male, age 13, who sustains an abduction and extension injury during sports. Anterior shoulder pain, positive belly press, and lift-off signs are frequent findings. CONCLUSIONS A high index of suspicion is needed to recognize this uncommon injury. History, physical exam for subscapularis function, and magnetic resonance imaging should be diagnostic. Operative treatment with a suture anchor lasso technique leads to predictably good results. LEVEL OF EVIDENCE Level IV therapeutic study.
Collapse
|
16
|
Busilacchi A, Bottegoni C, Gigante A. Arthroscopic management of heterotopic ossification of the subscapularis tendon in a patient with tuberculosis: a case report. J Shoulder Elbow Surg 2012; 21:e1-5. [PMID: 21831669 DOI: 10.1016/j.jse.2011.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 04/22/2011] [Accepted: 05/07/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Alberto Busilacchi
- Orthopaedic Clinic and Department of Molecular Pathology and Innovative Therapies, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | | |
Collapse
|
17
|
Abstract
Bony avulsions of the rotator cuff and isolated greater or lesser tuberosity fractures are rare injuries and a clear consensus regarding classification and therapy does not yet exist. Conservative therapy is limited, especially in injuries with displaced fragments and in these cases surgical treatment is frequently indicated. The ongoing development of arthroscopic techniques has led to quite a number of reports about arthroscopically assisted or total arthroscopic techniques in the treatment of these injuries. The advantages and disadvantages of arthroscopic concepts for the treatment of bony avulsions of the rotator cuff are presented with reference to the current literature.
Collapse
|
18
|
Arthroscopic tuberoplasty for subacromial impingement secondary to proximal humeral malunion. Knee Surg Sports Traumatol Arthrosc 2010; 18:988-91. [PMID: 19826787 DOI: 10.1007/s00167-009-0939-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 09/14/2009] [Indexed: 10/20/2022]
Abstract
Subacromial impingement secondary to malunion of proximally displaced greater tuberosity fractures may be treated with arthroscopic acromioplasty in patients with slight displacements, but open anatomical repositioning of the malunited fragment is recommended when more severe deformities exist. This deformity may also be addressed by abrading the protruding proximal portion of the greater tuberosity (tuberoplasty). However, this procedure would require full elevation of the rotator cuff insertion if performed with open surgery. This article reports a technique of arthroscopic tuberoplasty based on combined intra- and extra-articular transtendinous abrasion of the proximal end of the greater tuberosity for malunions with severe upward displacement of the greater tuberosity. This procedure allows for major preservation of the rotator cuff insertion.
Collapse
|
19
|
Mulyadi E, Harish S, O'Neill J, Rebello R. MRI of impingement syndromes of the shoulder. Clin Radiol 2008; 64:307-18. [PMID: 19185661 DOI: 10.1016/j.crad.2008.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 07/31/2008] [Accepted: 08/07/2008] [Indexed: 01/23/2023]
Abstract
The diagnosis of shoulder impingement is primarily a clinical one. Imaging has a role in assisting clinicians in developing a treatment strategy by identifying and characterizing the cause of shoulder impingement. In this review, the relevant anatomy, cause/pathomechanics, clinical features, and magnetic resonance imaging (MRI) findings of the different types of impingement syndromes are presented.
Collapse
Affiliation(s)
- E Mulyadi
- Department of Diagnostic Imaging, St Joseph's Healthcare, 50, Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada
| | | | | | | |
Collapse
|