Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand最新文献

{"title":"Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.","authors":"Philipp Moroder,&nbsp;Marvin Minkus,&nbsp;Elisabeth Böhm,&nbsp;Victor Danzinger,&nbsp;Christian Gerhardt,&nbsp;Markus Scheibel","doi":"10.1007/s11678-017-0399-z","DOIUrl":"https://doi.org/10.1007/s11678-017-0399-z","url":null,"abstract":"<p><strong>Background: </strong>Functional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffective as well.</p><p><strong>Objectives: </strong>The aim was to investigate the effectiveness of a \"shoulder pacemaker\" device that stimulates underactive muscles in patients with functional instability during shoulder movement in order to re-establish glenohumeral stability.</p><p><strong>Patients and methods: </strong>Three patients with unsuccessfully treated functional shoulder instability causing pain, emotional stress, as well as limitations during daily activities and sports participation were enrolled in this pilot project. The device was used to stimulate the external rotators of the shoulder and retractors of the scapula. Pain level, subjective shoulder instability, range of motion, visible aberrant muscle activation, and signs of dislocation were compared when the device was switched on and off.</p><p><strong>Results: </strong>No changes were observed when the device was attached but switched off. When the device was switched on, all patients were able to move their arms freely without pain, discomfort, or subjective or objective signs of instability. All patients rated this as an excellent experience and volunteered to train further with the device. No complications were observed.</p><p><strong>Conclusion: </strong>The electric stimulation of hypoactive rotator cuff and periscapular muscles by means of the shoulder pacemaker successfully re-establishes stability in patients with functional shoulder instability during the time of application.</p><p><strong>Video online: </strong>The online version of this article (doi: 10.1007/s11678-017-0399-z) contains the video: \"The Shoulder-Pacemaker: treatment of functional shoulder instability with pathological muscle activation pattern\". Video by courtesy of P. Moroder, M. Minkus, E. Böhm, V. Danzinger, C. Gerhardt and M. Scheibel, Charité Universitätsmedizin Berlin 2017, all rights reserved.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"12 2","pages":"103-108"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-017-0399-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Humeral bone grafting in stemless shoulder arthroplasty.","authors":"Fabian Plachel,&nbsp;Markus Scheibel","doi":"10.1007/s11678-017-0424-2","DOIUrl":"https://doi.org/10.1007/s11678-017-0424-2","url":null,"abstract":"","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"12 3","pages":"183-185"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-017-0424-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ABC classification of posterior shoulder instability.","authors":"Philipp Moroder,&nbsp;Markus Scheibel","doi":"10.1007/s11678-017-0404-6","DOIUrl":"https://doi.org/10.1007/s11678-017-0404-6","url":null,"abstract":"<p><p>Posterior glenohumeral instability (PGHI) is a commonly under- and misdiagnosed pathology owing to its variety of clinical presentations. In order to facilitate diagnosis and treatment, the simple yet comprehensive ABC classification for PGHI is based on the underlying pathomechanical principles and current standard of treatment. Three main groups of PGHI are distinguished based on the type of instability: A (first time), B (dynamic), C (static). Two subtypes further differentiate these groups in terms of their specific pathomechanism and provide a guideline in the choice of appropriate treatment: A (1, subluxation; 2, dislocation), B (1, functional; 2, structural), C (1, constitutional; 2, acquired). While conservative treatment is warranted in most patients with type 1 PGHI (A1, B1, C1), surgical treatment should be considered on an individual basis in patients with type 2 PGHI (A2, B2, C2), while keeping in mind that the different groups and subtypes can overlap, co-exist, or even progress from one to another over time. Of course the necessity for surgical treatment depends on the extent of the structural defects, on the severity of symptoms, on the chronicity, as well as on patient-specific functional demand, age, and health status. Nonetheless, the ABC classification helps to correctly diagnose the type of PGHI and provides a guideline for the generally recommended type of treatment.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"12 2","pages":"66-74"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-017-0404-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35364700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chondral defects of the glenohumeral joint: Long-term outcome after microfracturing of the shoulder.","authors":"Sophia M Hünnebeck,&nbsp;Petra Magosch,&nbsp;Peter Habermeyer,&nbsp;Markus Loew,&nbsp;Sven Lichtenberg","doi":"10.1007/s11678-017-0415-3","DOIUrl":"https://doi.org/10.1007/s11678-017-0415-3","url":null,"abstract":"<p><strong>Introduction: </strong>An increasing number of young patients are diagnosed with chondral lesions. Minimally invasive surgical techniques are important in order to delay progression of the early stages of osteoarthritis and the need for total joint replacement.</p><p><strong>Materials and methods: </strong>Patients (<i>n</i> = 32) who had received microfracturing of the shoulder were retrospectively enrolled, of whom 5 had received shoulder replacements after a mean time of 47 months. Of these patients, 23 completed the Disabilities of the Arm, Shoulder and Hand (DASH) and Constant-Murley Scores in addition to an additional subjective questionnaire. Patients were then clinically examined and received x‑ray analysis of the operated shoulder. Data from an additional 4 patients were acquired by telephone interview.</p><p><strong>Results: </strong>Mean follow-up was 105 months. Of the included patients, 13/27 patients reported no pain, 12/27 patients moderate pain. Of these 12, 6/27 reported pain only at night and 3/27 only during rest. Concerning the outcome of surgery, 19/27 patients were \"satisfied\" or \"very satisfied\". There was a statistically significant increase in internal rotation, but no further differences in the range of motion pre- and postoperatively. Patients without any signs of osteoarthritis before surgery showed statistically significantly better outcomes. There was a statistically significant increase in radiological signs of osteoarthrosis in pre- versus postoperative patients. Patients with bipolar lesions showed statistically significantly poorer Subjective Shoulder Value (SSV) results.</p><p><strong>Conclusion: </strong>Even though microfracturing does not prevent radiographic progression, microfracture of the glenohumeral joint might be worth considering as part of a treatment regimen for younger patients who may not yet be treated with arthroplasty.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"12 3","pages":"165-170"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-017-0415-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subacromial spacer implantation for massive rotator cuff tears: Clinical outcome of arthroscopically treated patients.","authors":"Malte Holschen,&nbsp;Florian Brand,&nbsp;Jens D Agneskirchner","doi":"10.1007/s11678-016-0386-9","DOIUrl":"https://doi.org/10.1007/s11678-016-0386-9","url":null,"abstract":"<p><strong>Background: </strong>Massive rotator cuff tears (MRCT) can be treated arthroscopically by partial reconstruction, tenotomy/tenodesis of the long head of the biceps, and debridement. A new treatment option is the additional implantation of a biodegradable spacer (InSpace Balloon®; ISB) into the subacromial space, which reduces subacromial shear forces to keep the humeral head centered in the glenoid. The aim of this study is to investigate the clinical outcome of patients with MRCT who were treated arthroscopically with or without an additional ISB.</p><p><strong>Methods: </strong>The clinical outcome of patients treated with conventional arthroscopic techniques (<i>n</i> = 11, group A, partial repair, biceps tenotomy, and debridement) and that of patients treated with a supplementary ISB (<i>n</i> = 12, group B) was retrospectively analyzed. Preoperatively and postoperatively, shoulder function was assessed with the Constant and American Shoulder and Elbow Surgeons (ASES) scores. At follow-up after a mean of 22 months, patients filled out a questionnaire about their subjective satisfaction.</p><p><strong>Results: </strong>Preoperative shoulder function was lower in patients treated with an ISB (ASES score: group A, 59.1; group B, 31.5; Constant score: group A, 60.7; group B, 36.8). At follow-up, both groups had improved shoulder function (Constant score: group A, 60.7-77.6; <i>p</i> < 0.001; group B, 36.8-69.5; <i>p</i> < 0.001; ASES score: group A, 59.1-88.6; <i>p</i> < 0.001; group B, 31.5-85.7; <i>p</i> < 0.001). Patients in both groups were subjectively satisfied with their outcome.</p><p><strong>Conclusion: </strong>The ISB is a feasible treatment option for MRCT, providing subjective pain relief and improved shoulder function. Further studies with larger patient collectives and longer follow-up are needed to confirm whether it is a safe and cost-effective treatment.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"12 1","pages":"38-45"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-016-0386-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision of reversed shoulder arthroplasty: Is a reoperation possible?","authors":"Stijn Casier,&nbsp;Bart Middernacht,&nbsp;Alexander Van Tongel,&nbsp;Lieven De Wilde","doi":"10.1007/s11678-017-0400-x","DOIUrl":"https://doi.org/10.1007/s11678-017-0400-x","url":null,"abstract":"<p><strong>Introduction: </strong>As the number of reversed shoulder arthroplasty (RSA) procedures increases, the revision rate will also increase. In case of severe bone insufficiency, instability or infection of the primary RSA, revision to another RSA is preferable but not always possible. Hemiarthroplasty (HA), spacers and resection arthroplasty (RA) have been described in this indication.</p><p><strong>Materials and methods: </strong>Between 2004 and 2016, 20 shoulders in 19 patients were treated at Ghent University Hospital for failed revision of RSA. Nine received a megahead prosthesis, a spacer was implanted in 6, and 5 underwent RA.</p><p><strong>Results: </strong>Indications for implantation of a megahead prosthesis were loosening RSA (<i>n</i> = 5), infection (<i>n</i> = 4), dislocation (<i>n</i> = 1) and nerve irritation (<i>n</i> = 1). Improvement of range of motion was observed. Anterosuperior migration of the prosthesis was noted in 2 patients. Another 2 patients were ultimately revised to RSA. Seven permanent spacers were implanted for infection, of which 2 remain in place till today. The other 5 were revised to RSA. Of the 5 patients treated with RA, 3 were revised further on to RSA, resulting in pain relief and regain of function.</p><p><strong>Discussion: </strong>Our study shows that a megahead prosthesis has better functional results than RA, but is inferior to RSA. Due to increasing surgical experience and improving technique, 9 patients could ultimately be reconverted to another RSA. A review of current literature is presented. In HA and RA, the functional results are poor, and pain relief is uncertain. Results of spacers are variable and can be satisfactory. Arthrodesis is a last resort.</p><p><strong>Conclusion: </strong>In our case series study, a hemiarthroplasty can be performed in case of failure of RSA. However, the results are inferior to another RSA.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"12 1","pages":"16-24"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-017-0400-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft tissue-based surgical techniques for treatment of posterior shoulder instability.","authors":"Alessandro Castagna,&nbsp;Marco Conti,&nbsp;Raffaele Garofalo","doi":"10.1007/s11678-017-0413-5","DOIUrl":"https://doi.org/10.1007/s11678-017-0413-5","url":null,"abstract":"<p><p>Posterior shoulder instability is a rare clinical condition that encompasses different degrees of severity including various possible pathologies involving the labrum, capsule, bony lesions, and even locked posterior dislocation. When focusing on soft tissue involvement, the diagnosis of posterior instability may be difficult to make because frequently patients report vague symptoms not associated with a clear history of traumatic shoulder dislocation. Pathological soft tissue conditions associated with posterior instability in most cases are related to posterior labral tear and/or posterior capsular detensioning/tear. The diagnosis can be facilitated by physical examination using specific clinical tests (i. e., jerk test, Kim test, and reinterpreted O'Brien test) together with appropriate imaging studies (i. e., magnetic resonance arthrography). Arthroscopy may help in a complete evaluation of the joint and allows for the treatment of soft tissue lesions in posterior instability. Caution is warranted in the case of concomitant posterior glenoid chondral defect as a potential cause of poor outcome after soft tissue repair in posterior instability.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"12 2","pages":"82-89"},"PeriodicalIF":0.4,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-017-0413-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35364701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical and histological analysis of tumors of the upper extremity.","authors":"Andrzej Zyluk,&nbsp;Agnieszka Mazur","doi":"10.1007/s11678-015-0314-4","DOIUrl":"https://doi.org/10.1007/s11678-015-0314-4","url":null,"abstract":"<p><strong>Background: </strong>Tumors of the upper extremity are common and usually benign. The most commonly diagnosed are ganglion cysts: specific, non-neoplastic swellings localized mostly around the wrist.</p><p><strong>Objective: </strong>The objective of this retrospective study was to determine the proportion of various types of nonganglionic hand tumors operated on at the authors' institution in 2014.</p><p><strong>Methods: </strong>A total of 246 patients, 141 women (57 %) and 105 men (43 %), with a mean age of 53 years and with tumorsof the upper extremity, were identified and treated in the authors' institution in 2014.</p><p><strong>Results: </strong>Almost half of the lesions were localized in the fingers (<i>n</i> = 119, 48 %), followed by the wrist (<i>n</i>=49, 20 %), metacarpus (<i>n</i> = 40, 16 %), and more proximal parts (<i>n</i> = 38, 16 %). The time between the patients noticing the lesion and surgery was a mean of 4 years (range, 1 month to 30 years). The most common lesion was giant cell tumor of the tendon sheath (<i>n</i> = 58, 23 %), followed by lipoma (<i>n</i> = 40, 16 %), epidermal cyst (<i>n</i> = 23, 9 %), enchondroma (<i>n</i>=16, 6 %), hemangioma (<i>n</i> = 14, 6 %), fibroma (<i>n</i> = 11, (4 %), glomus tumor (<i>n</i> = 10, (4 %), and rheumatoid nodule (<i>n</i> = 10, (4 %). Two cases of malignant fibrosarcoma were identified incidentally.</p><p><strong>Conclusion: </strong>A brief review of the literature is made referring to the data presented here.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"10 4","pages":"252-257"},"PeriodicalIF":0.4,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-015-0314-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex forearm deformities: operative strategy in posttraumatic pathology.","authors":"Konrad Mader,&nbsp;Marianne Koolen,&nbsp;Mark Flipsen,&nbsp;Arnard van der Zwan,&nbsp;Dietmar Pennig,&nbsp;John Ham","doi":"10.1007/s11678-015-0341-1","DOIUrl":"https://doi.org/10.1007/s11678-015-0341-1","url":null,"abstract":"<p><p>Complex posttraumatic forearm deformities have a significant impact on the integrity of the upper extremity leading to pain, instability in both the proximal and/or distal radioulnar articulation, and reduced range of forearm motion. Corrective osteotomy or more advanced procedures for malunited fractures or other posttraumatic deformities of the upper extremity, especially in the forearm are challenging procedures. In this review we will discuss the essential aspects of anatomy and pathomechanics, clinical and radiological assessment and the pathway from preoperative planning to the actual deformity correction surgery, either with one-stage correction or using gradual lengthening with external fixation (\"callotasis techniques\") and finally the functional outcome we can expect for our patients. In addition we will analyze the modern computer-assisted techniques available to date.</p>","PeriodicalId":43682,"journal":{"name":"Obere Extremitaet-Schulter-Ellenbogen-Hand-Upper Extremity-Shoulder Elbow Hand","volume":"10 4","pages":"229-239"},"PeriodicalIF":0.4,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s11678-015-0341-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35322827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}